Comparison of different local analgesia protocols in postoperative pain management after total knee arthroplasty.

OBJECTIVES: This study was to compare the effects of different local analgesia protocols on osteoarthritis patients undergoing total knee arthroplasty (TKA). METHODS: Medical records of 148 osteoarthritis patients who underwent unilateral TKA between October 2016 and October 2017 in our hospital were retrospectively analyzed. All these patients were divided into three groups according to the pain management protocol (morphine, morphine + cocktail [100 mg ropivacaine, 10 mg morphine, and 30 mL 0.9% sodium chloride solution containing 2 mL betamethasone (4 mg)], or cocktail). The postoperative visual analog scale (VAS) score, muscle strength, and complications were compared between the groups. RESULTS: At 6 and 12 hours post-operation, the VAS score in group C was significantly higher than that in group A or group B. In addition, the muscle (quadriceps femoris) strength score of group C (3.7 ± 2.8) was significantly higher than that in groups A and B at 6 and 12 hours post-operation. The VAS score and muscle strength score showed no significant differences among the three groups at 24 and 36 hours post-operation. The time of postoperative first void of group C was significantly shorter than that of groups A and B. Groups A or B had a significantly higher incidence of nausea and emesis compared with group C. The incidence of pruritus was higher in groups A or B than that in group C. CONCLUSION: Epidural anesthesia combined with local analgesic cocktail injection is a preferable effective multimodal analgesia for TKA.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression.

OBJECTIVE: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). METHODS: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. RESULTS: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6±0.48g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. CONCLUSION: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Breaking the silence of the lambs: integrating medical staff in prevention of human trafficking / Rompiendo el silencio de los corderos: integrar el personal médico en la prevención de tráfico humano / Quebrando o silêncio dos cordeiros: integrando o pessoal médico na prevenção do tráfico de seres humanos

Introduction: Human trafficking, including forced prostitution, is a form of human rights violation regarding right to life and respect for human dignity. The Physician-patient relationship may serve as a process for victim identification on the basis of physicians’ responsibilities to detect human trafficking. Method: This empirical study was based on a survey among physicians who may have been in contact with foreign sex workers. Almost eighty physicians in three health facilities were selected according to their high potentiality for coming into contact with foreign sex workers as patients. 228 physicians selected to that aim. 82 of them responded to the questionnaire which was performed in order to evaluate their perception and knowledge human trafficking and their attitudes towards sex work. Results: All physicians think that some women among the sex workers are exploited, exposed to violence and coerced to work against their will (100%). Almost all of them know that it is compulsory for the healthcare professionals to inform the security forces of the women who are exploited (80.0%). Nearly half of them have given medical care to a sex worker (46.9%) and 39.0 percent have thought that it may be related to human trafficking. The ones who have informed the police of a human trafficking case are only 10 per cent. Conclusions: We think that the professional should be equipped with ethical values encompassing both a patient’s dignity and general welfare. This may include the professional’s responsibility to make an assessment as to whether the patient is a victim or a sex worker. Furthermore human trafficking in sex work and sexual health are public health issues therefore it should be covered under standards of practice and ethical codes of conduct.

Introducción: El tráfico humano, incluyendo prostitución forzada, es una forma de violación de derechos humanos relacionada con el derecho a la vida y el respeto a la dignidad humana. La relación médico-paciente puede servir como un proceso para identificar víctimas, con base en la responsabilidad del médico de detectar tráfico humano. Método: Este estudio empírico se basó en un cuestionario aplicado a médicos que podían haber estado en contacto con trabajadores sexuales extranjeros. Se seleccionaron unos 80 médicos de tres centros de salud, de acuerdo con su alta probabilidad de entrar en contacto con trabajadores sexuales extranjeros como pacientes. Se seleccionaron 228 médicos para ese objetivo. De estos, 82 respondieron al cuestionario desarrollado para evaluar su percepción y conocimiento del tráfico humano y sus actitudes hacia el trabajo sexual. Resultados: Todos los médicos piensan que algunas mujeres trabajadoras sexuales son explotadas, expuestas a violencia y forzadas a trabajar en contra de su voluntad (100%). Casi todos saben que es obligatorio para el profesional de la salud el informar a las fuerzas de seguridad sobre las mujeres que son explotadas (80,0%). Casi la mitad han proporcionado cuidado médico a un trabajador sexual (46,9%) y 39,0% ha pensado que puede estar relacionado con el tráfico humano. Solo un 10% ha informado a la policía sobre un caso de tráfico humano. Conclusiones: Pensamos que los profesionales deberían formarse en valores éticos incluyendo tanto la dignidad del paciente como su bienestar general. Esto puede incluir la responsabilidad profesional de evaluar si el paciente es una víctima o un trabajador sexual. Además, el tráfico humano en el trabajo sexual y la salud sexual son temas de salud pública, por lo tanto debieran cubrirse de acuerdo con los estándares de la práctica y códigos éticos de conducta.

Introdução: O tráfico de pessoas, incluindo a prostituição forçada, é uma forma de violação dos direitos humanos sobre o direito à vida e o respeito pela dignidade humana. A relação médico-paciente pode servir como um processo para a identificação das vítimas, com base em responsabilidades dos médicos para detectar o tráfico de seres humanos. Método: Este estudo empírico foi baseado numa pesquisa entre os médicos que possam ter estado em contacto com os trabalhadores do sexo estrangeiros. Quase oitenta médicos em três unidades de saúde foram selecionados de acordo com sua alta potencialidade para entrar em contato com profissionais do sexo estrangeiros como pacientes. 228 médicos foram selecionados para esse objetivo. 82 deles responderam ao questionário que foi realizado com a finalidade de avaliar a sua percepção e o seu conhecimento sobre o tráfico de seres humanos e as suas atitudes em relação ao trabalho sexual. Resultados: Todos os médicos pensam que algumas mulheres entre os trabalhadores do sexo são exploradas, expostas à violência e coagidas a trabalhar contra a sua vontade (100%). A maioria deles sabe da obrigação dos profissionais de saúde de informar às forças de segurança sobre mulheres que são exploradas (80,0%). Quase metade deles tem dado assistência médica a trabalhadora do sexo (46,9%) e 39,0 por cento pensaram que isto pode estar relacionado ao tráfico de seres humanos. Os que informaram à polícia de um caso de tráfico de seres humanos são apenas 10 por cento. Conclusões: Nós pensamos que o profissional deve estar incorporado de valores éticos que abrangem tanto a dignidade do paciente como o bem-estar geral. Isso deve incluir a responsabilidade do profissional em avaliar se o paciente é uma vítima ou um profissional do sexo. Além disso o tráfico humano no trabalho do sexo e saúde sexual são questões de saúde pública, por isso, devem ser cobertos pelos padrões de prática e códigos éticos de conduta.