The efficacy and safety of subcutaneous continuous local infiltration analgesia with ropivacaine in patients undergoing total knee arthroplasty: a comparative study.

BACKGROUND: Continuous local infiltration analgesia (CLIA) can be administered via intraarticular or periarticular techniques in patients undergoing total knee arthroplasty (TKA). The purpose of this investigation was to retrospectively report a single-center experience of epidural analgesia with subcutaneous CLIA versus epidural analgesia without CLIA among patients undergoing TKA. METHODS: This single-center retrospective study was conducted in Saudi Arabia. From January 01, 2014, to December 30, 2020, medical records of all patients who underwent TKA were reviewed. Patients who received subcutaneous CLIA with epidural analgesia were assigned to the intervention group, whereas those who received epidural analgesia without subcutaneous CLIA were assigned to the control group. The efficacy endpoints included: (i) postoperative pain scores at 24 h, 48 h, 72 h, and 3 months; (ii) postoperative opioid consumption at 24 h, 48 h, 72 h, and 24-72 h (cumulative); (iii) length of hospital stay; and (iv) postoperative functional recovery of the knee 3 months post-operation, according to the Knee Injury and Osteoarthritis Outcome Score. RESULTS: At rest and during mobilization, the CLIA group (n = 28) achieved significantly lower postoperative pain scores 24 h, 48 h, 72 h, and 3 months post-operation than the non-CLIA group (n = 35). Subgroup analysis revealed that the CLIA group achieved significantly less opioid consumption 24 h and 48 h post-operation than the non-CLIA group. There was no difference between the groups regarding the length of hospital stay or functional scores 3 months post-operation. There was no significant difference between the groups regarding the rate of wound infection, other infections, and readmission within 30 days. CONCLUSION: Subcutaneous CLIA is a technically feasible and safe procedure without major adverse events but with reduced postoperative pain scores (at rest and during mobilization) and opioid consumption. Additional larger studies are warranted to confirm our results. Moreover, a head-to-head comparison between subcutaneous CLIA and periarticular or intraarticular CLIA is an interesting prospective investigation.

A proportional odds model of risk behaviors associated with recurrent road traffic crashes among young adults in Kuwait.

BACKGROUND: The aims of this cross-sectional study were to i) assess one-year period prevalence of one, two, three or more road traffic crashes (RTCs) as an ordinal outcome and ii) identify the drivers' characteristics associated with this ordinal outcome among young adult drivers with propensity to recurrent RTCs in Kuwait. METHODS: During December 2016, 1465 students, 17 years old or older from 15 colleges of Kuwait University participated in this cross-sectional study. A self-administered questionnaire was used for data collection. One-year period prevalence (95% confidence interval (CI)) of one, two, three or more RTCs was computed. Multivariable proportional odds model was used to identify the drivers' attributes associated with the ordinal outcome. RESULTS: One-year period prevalence (%) of one, two and three or more RTCs respectively was 23.1 (95% CI: 21.2, 25.6), 10.9 (95% CI: 9.4, 12.6), and 4.6 (95% CI: 3.6, 5.9). Participants were significantly (p < 0.05) more likely to be in higher RTCs count category than their current or lower RCTs count, if they habitually violated speed limit (adjusted proportional odds ratio (pORadjusted) = 1.40; 95% Cl: 1.13, 1.75), ran through red lights (pORadjusted = 1.64; 95%CI: 1.30, 2.06), frequently (≥ 3) received multiple (> 3) speeding tickets (pORadjusted = 1.63; 95% CI: 1.12, 2.38), frequently (> 10 times) violated no-parking zone during the past year (pORadjusted = 1.64; 95% CI: 1.06, 2.54) or being a patient with epilepsy (pORadjusted = 4.37; 95% CI: 1.63, 11.70). CONCLUSION: High one-year period prevalence of one, two and three or more RTCs was recorded. Targeted education based on identified drivers' attributes and stern enforcement of traffic laws may reduce the recurrent RTCs incidence in this and other similar populations in the region.

COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study.

OBJECTIVE: To study the effectiveness of COVID-19 convalescent plasma (CCP) therapy for patients with moderate and severe COVID-19 disease. METHODS: This non-randomized prospective cohort study was conducted from May 21 to June 30, 2020, at four major tertiary hospitals in Kuwait. CCP was administered to 135 patients. The control group comprised 233 patients who received standard treatment. All patients (N = 368, median age 54 [range 15-82]) had laboratory-confirmed SARS-CoV-2 infection and either moderate or severe COVID-19 disease. RESULTS: CCP treatment was associated with a higher rate of clinical improvement in patients with moderate or severe disease. Among those with moderate COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 8 days in the control group (p = 0·006). For severe COVID-19 disease, time to clinical improvement was 7 days in the CCP group, versus 15.5 days in the control group (p = 0·003). In the adjusted analysis, patients with moderate disease treated with CCP had a significantly lower 30-day mortality rate. Compared to the control group, oxygen saturation improved within 3 days of CCP transfusion, and lymphocyte counts improved from day 7 in patients with moderate COVID-19 disease and day 11 in patients with severe disease. C-reactive protein levels declined throughout the first 14 days after CCP transfusion. None of the CCP patients developed a serious transfusion reaction. CONCLUSIONS: The data show that administration of CCP is a safe treatment option for patients with COVID-19 disease with a favorable outcome in the rate of, and time to, clinical improvement.

Period prevalence and factors associated with road traffic crashes among young adults in Kuwait.

OBJECTIVES: This cross-sectional study assessed one-year period prevalence of road traffic crashes (RTCs) and examined the factors associated with RTCs among young adults in Kuwait. DESIGN AND SETTINGS: During December 2016, 1500 students enrolled in 15 colleges of Kuwait University were invited to participate in the study. Students 18 years old or older and who drive by themselves were eligible. Data were collected using a structured self-administered questionnaire. One-year period prevalence of RTCs (≥1 vs. none) was computed. Multivariable log-binomial regression model was used to identify the risk factors associated with one-year period prevalence of RTCs. RESULTS: Of 1500 invited individuals, 1465 (97.7%) participated, of which 71.4% (1046/1465) were female, 56.4% (804/1426) were aged between 21 and 25 years, and 67.1% (980/1460) were Kuwaitis. One-year period prevalence of RTC was 38.9%. The final multivariable log-binomial regression model showed that after adjusting for the influences of other variables in the model, participants were more likely to have had at least one RTC during the past year, if they habitually sped over limit (adjusted PR = 1.19; 95% confidence interval (CI): 1.04-1.36), crossed a red light (adjusted PR = 1.33; 95% CI: 1.16-1.52), or if they have had three or more speeding tickets (adjusted PR = 1.40; 95% CI: 1.13-1.73) compared to those who reportedly had no RTC during the same period. CONCLUSION: One-year period prevalence of RTCs among university students in Kuwait, though relatively lower than the reported figures in similar populations elsewhere in the region, is yet high enough to warrant diligent attention. Habitual speeding, having had three or more speeding tickets, and the practice of crossing a red light were significantly and independently associated with at least one RTC during the past year. Targeted education and enforcement of existing traffic laws may reduce the RTCs frequency in this relatively young population. Future studies may look at impact of such interventions.