Analogue Scale Research Articles

Gastrointestinal function and pain outcomes following segmental resection or discoid resection for low rectal endometriosis.

This study aims to examine the effect of full thickness discoid resection (FTDR) and modified, limited nerve-vessel sparing segmental bowel resection (NVSSR) in symptomatic patients with low rectal deep endometriosis (DE) within 7 cm from the anal verge. Presurgical and postsurgical evaluation of gastrointestinal (GI) function reflected by low anterior resection syndrome (LARS) and gastrointestinal function-related quality of life index (GIQLI) scores, complication rates, pain scores/visual analog scale (VAS) and endometriosis health profile (EHP-30) was performed. In this prospective multicenter cohort study, 63premenopausal patients with symptomatic low (within 7 cm from the anal verge) colorectal endometriosis, undergoing low modified limited nerve vessel sparing rectal segmental bowel resection (NVSSR) and full thickness discoid resection (FTDR) were evaluated. Presurgery and postsurgery lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters compared between two groups. Out of 63women, 49(77.8%) underwent NVSSR while 14(22.2%) underwent FTDR. LARS-like symptoms were observed presurgically in 24/63 (38.1%) patients. Postsurgical LARS was observed in 14/63 (22.2%) of the patients (10/49, 20.4% in NVSSR vs.4/14, 28.5% in the FTDR group). The LARS-like symptoms significantly decreased following surgery in the FTDR group (p = 0.049) and showed atrend for decrease in the NVSSR group (p = 0.077). Postsurgical de novo LARS was only observed in 5/63 (8%) of the patients (NVSSR 4/49, 8.1%, FTDR 1/14, 7.1%). Postsurgical GIQLI scores improved in both groups (p < 0.001) with comparable changes in the NVSSR and FTDR cohorts (p = 0.490). Postoperative gradeIII complication rates between NVSSR and FTDR did not vary significantly (6/49, 12.2% vs.3/14, 21.4% p = 0.26). Pain/VAS scores and EHP-30 scores significantly decreased after amean follow-up of 29.6 ± 11 months and 30.6 ± 11months in the NVSSR and FTDR groups, respectively (EHP-30; p < 0.001; dysmenorrhea, dyspareunia, dyschezia all p < 0.05 for both cohorts). When comparing low colorectal surgery by either NVSSR or FTDR in ahigh-risk group for surgical complications, both techniques confer improvement of GI function reflected by LARS and GIQLI with non-significant differences in major complication rates, reduced pain and EHP-30 scores.

Immunological Tumor Microenvironment of Solitary Fibrous Tumors-Associating Immune Infiltrate with Variables of Prognostic Significance.

Solitary fibrous tumors (SFTs) are morphologically heterogeneous tumors characterized by the NAB2::STAT6 gene fusion. Clinical outcomes may vary widely, and while most cases have favorable outcomes, some can progress to aggressive disease, manifesting as recurrence and metastasis, and ultimately resulting in patient death. Herein, we analyze the immunological tumor microenvironment (ITME) of SFTs, aiming to determine its prognostic value and correlation with established risk stratification systems (RSSs). A retrospective observational multicenter study of 52 fusion-confirmed SFTs with clinical follow-up data. Immunohistochemical analysis including CD163, CD68, CD3, CD8, CD20, PDL-1, PD-1, and LAG1 were evaluated in tissue microarrays, using an analog scale with scores ranging from 0 to 3 (0 = ≤9, 1 = 10-49, 2 = 50-99, and 3 = >100 positive cells per 10 high-power fields). The expression of these markers was correlated with clinical outcomes, morphological characteristics previously evaluated in whole slide tissue sections (hypercellularity/hypocellularity, round-oval or spindle dominant constituent cell (DCC) morphology, and necrosis), Ki67, overall survival, and RSS. Only one of the fifty-two cases studied showed progression. In the multivariate analysis, neither the presence nor absence of immune cells (B-lymphocytes, T-lymphocytes, and macrophages) showed any association with the assessed RSSs (Demicco, Sugita, G-score, and Huang). Interestingly, the case that showed progression had high immune infiltrate with expression of CD68, CD163, CD8, and CD20 markers (score of 3). Round-oval cell morphology was associated with the presence of higher levels of CD163 macrophages. Lastly, the scant presence of CD20+ lymphocytes correlated with less necrosis, and cases with higher PDL-1 expression correlated with increased Ki67 values. All cases were negative for LAG-1 and PD-1. SFT ITME components correlated with independent variables with prognostic significance. Nevertheless, ITME did not correlate with RSS scores.

Use of pressor algometry in a patient with cervical dorsopathy

Dorsopathies are large and disparate group of diseases of the musculoskeletal and articular-ligamentous apparatus of the spine, which are united by the presence of pain syndrome in the trunk and extremities. Pain as a clinical phenomenon is one of the most diffi cult to interpret complaints encountered in medical practice. Despite the signifi cance of the problem, there are still diffi culties in objectivising and assessing the severity of the pain syndrome. Currently, methods of pain status assessment can be divided into objective, based on the analysis of the level of induced pain and instrumental registration of results; and subjective, such as the use of visual analogue pain scale. At the same time, the assessment of pain and painfulness from the position of osteopathic methodology is an important link in the course of distinguishing the prevalent component of DM, as well as in the framework of differential diagnosis. However, in practice, there may be some diffi culties in objectifying the degree of pain severity and assessing its change on the background of treatment. If for pain it is possible to use the analogue scales already mentioned, there is no such possibility to assess painfulness. We have described a clinical case to study the possibility of using pressor algometry in a patient with cervical dorsopathy to assess pain sensitivity (painfulness) and select correction techniques.

Sistem Penghitung Berat Gabah Berbasis Desktop

One of the interesting things to examine is the way farmers measure their grain harvest using scales. The reality in the field is that weighing is sometimes not accurate regarding the weight of certain types of grain. Actors in the field sometimes cheat by tampering with analog scales. Based on this problem, researchers conducted research to create a digital grain weight calculation application. The research was carried out by creating a digital weighing application that uses Arduino Uno as a microcontroller, load cell and HX711 module. The system is equipped with a desktop-based application to manage grain sales calculations based on weight. Testing is carried out by comparing measurement results between digital scales and the designed system. The test results show that the designed system can carry out measurements with an accuracy level of up to 90%

112 What’s your emergency? Overview of mental health and sleep disorders among emergency medical dispatchers in a French 112 call center

BackgroundEmergency medical dispatchers (EMD) experience significant occupational stress. Medical dispatching includes call-taking, triage, dispatch, and providing callers gesture guidance to the victims. Every decision has a major impact on the patient’s outcome. Chronic exposure to stress and potentially traumatic situations, combined with night shifts can impact the stress response and physical health of staff.ObjectivesTo evaluate the prevalence of mental health and sleep disorders among EMD personnel working in a 112-call center, prior to an evidence-based prevention intervention (primary outcome); and to assess the relationship between health outcomes and DM (secondary outcome).MethodsWe conducted a descriptive, monocentric study with 109 EMD. HAD Anxiety (HAD-A) and Depression (HAD-D) scores, and the PTSD checklist for DSM-5 (PCL-5) were used to explore mental health disorders. The Epworth Sleepiness Scale, and other analog scales were used to explore sleep disorders. DM resources were assessed using the Freiburg Mindfulness Inventory (FMI), and its Presence and Acceptance subscales.ResultsA total of 72% of the EMD working in the call center were included. Of these, 16.6% had moderate anxiety disorder, and 6.4% had an anxiety disorder (Mean HAD-A: 6.05 ± 2.88). Furthermore, 16.6% had a moderate depression disorder, and 6.4% had a depression disorder (Mean HAD-D: 4.28 ± 3.28), and 16% had symptoms of PTSD (Mean PCL-5: 17.57 ± 13.67). Turning to sleep, 39% may suffer from excessive daytime sleepiness (EDS), and 10% had confirmed EDS (Mean Epworth score 10.47 ± 4.41). Finally, 39% had moderate insomnia, and 59% had severe insomnia (Mean insomnia: 13.84 ± 5.77.). Medium-strength negative correlations were found between mental health and DM (FMI scores and sub-scores: −0.48 < r < − 0.29; 0.001 < p < 0.004); and a positive correlation was found between DM and daytime awareness (0.22 < r < 0.26; 0.01 < p < 0.03).ConclusionThe prevalence of depression, symptoms of PTSD, and sleep disorders in our sample of EMD is significant, and confirms findings reported in the literature. The EMD population may benefit from specific, multi-level interventions that target mindfulness, sleep, and ergonomics to improve their mental and physical health.

The Impact of Music Perception on Quantitative Sensory Testing (QST).

Objective: The impact of listening to music on pain perception has been evaluated using questionnaires and numeric/visual analogue scales. In this study, the impact of music perception on sensory pain functions was measured by means of quantitative sensory testing. Methods: We enrolled 10 female and 10 male healthy subjects (10 of them were professional musicians). All subjects underwent, in total, four quantitative sensory testing measures (first: baseline; second: after pleasant music [Johannes Brahms, 3rd symphony, 3rd movement]; third: after unpleasant music [Krzysztof Penderecki, Threnos]; fourth: after a longer break). The pleasantness of music was evaluated using the Ertel differential scale. Results: After the participants listened to pleasant music, an increased sensitivity to cold stimuli (both threshold and pain), to mechanical stimuli (only for threshold), and to repeated stimuli (wind-up reaction) was noted. Listening to unpleasant music was not associated with changes in sensitivity. We did not observe any significant differences between male and female subjects or between musicians and non-musicians. There was no significant correlation between the rating of the music as pleasant/unpleasant and the different quantitative sensory testing measures. Conclusions: Our data show that listening to music inducing a pleasant feeling can increase the sensitivity to stimuli applied during a quantitative sensory testing session. This should be considered when performing or interpreting quantitative sensory testing examinations. Interestingly, this finding is in contrast to the observation that listening to music can decrease pain perception during painful procedures.

The significance of cervical discopathy diagnosis in patients with mastalgia.

The primary aim of this study was to explore the involvement of cervical discopathy in the development of non-cyclic mastalgia by employing cervical magnetic resonance imaging (MRI). A total of 407 patients were included in the study. Individualized management plans were developed for each patient. Pathological findings in MRI results were assessed by specialists in physical therapy and neurosurgery, and appropriate treatment was administered. Visual assessments of patients were conducted. The Analog Scale (VAS) scoring system was used at the initial presentation, and patients were evaluated at 1 and 3 months following the treatment. In the MRI examinations of the patients included in the study, simultaneous cervical disc protrusion was observed in 29% (n: 124) of those with annular bulging. Comparing the VAS scores of patients before treatment, at the 1st and at the 3rd month showed a significant decrease in mastalgia pain (p < 0.001). The diagnosis of cervical discopathy holds significant importance in the treatment of mastalgia patients. Therefore, clinicians should keep the cervical spine in mind as a potential contributing factor to mastalgia.

Experimental analysis of the melt fraction - mechanical strength relationship for iron ore sinter analogues

This study examined the strength of sinter analogue tablets for different types of iron ore under varying sintering conditions. A steel tamper was designed to quantify strength based on the percentage of 1 mm retained size after a drop weight test. The study found a linear relationship between total melt fraction M and strength index S quantified by mass fraction of the +1 mm retained size: S=0.88M. Importantly, a relationship was found between the total melt and a combined F factor incorporating the thermodynamic liquid fraction (α, representing sintering conditions) and the mineralogical factor loss on ignition (LOI ratio, β, representing ore types), where F=6.5α+β−1. This factor F was found well correlated the total melt via an asymptotic exponential relationship as M=1−2.6e−F. The results also suggested that, to achieve an acceptable strength of 80% +1 mm for a typical basicity B = 2, a sintering temperature range between 1273 and 1370 °C is required for the LOI range between 1.6% to 10.7% respectively. Finally, an analogous analysis was also carried out which proposed a similar trend between sinter yield obtained in a kilogram-scale by lab-scale studies and the present 0.6-g analogue scale.

Recovery pattern after decompression of central lumbar spinal stenosis: a prospective observational cohort study

BackgroundDetailed preoperative information is associated with superior outcomes. We aimed to describe the recovery pattern after decompression of central lumbar spinal stenosis (CLSS).Methods50 patients aged 51–85 years who underwent decompression without fusion due to CLSS were followed from before to after surgery (post-op day 1, 7, and 14). Back and leg pain were evaluated using the Numeric Rating Scale (NRS; 0 = no pain 0, 10 = worst pain) and quality of life using the EuroQol-5D index (0 = death, 1 = best), and EQ-5D-visual analogue scale (VAS; 0 = worst, 100 = best).ResultsNRS leg pain was reduced from preoperative to first postoperative day by 5.2 (6.1, 4.3) (mean (95%CI)], and NRS back pain from postoperative day 1–7 by 0.6 (1.2, 0.03) and from day 7 to 14 by 0.7 (1.3, 0.2)]. In contrast, EQ-5D index increased from preoperative to first postoperative day by 0.09 (0.06, 0.13) and from day 1 to 7 by 0.05 (0.02,0.08), and EQ-5D VAS from preoperative to first postoperative day by 13.7 (9.1, 18.3) and from day 1 to 7 by 6.0 (2.0, 10.0). After two weeks, 51% of the patients had improved above the minimal clinically important difference (MCID) in back pain and 71% in leg pain.ConclusionsPatients scheduled for decompression due to CLSS should be informed that improvement in leg pain and quality of life in general can be expected within one day of surgery, that quality of life improves a little further in the first postoperative week, and that back pain improves in the first 2 postoperative weeks. In most patients, decompression without fusion due to CLSS seems to achieve clinically relevant improvement within 2 weeks.

A Cross-Sectional Survey to Assess the Preparedness of Healthcare Workers of Isolation Intensive Care Units for Anticipated Another Wave of the COVID-19 Pandemic in a Tertiary Care Center.

Our fight against coronavirus disease 2019 (COVID-19) has not ended yet. Another wave, possibly due to another variant, can put the healthcare system on its toes again. The outcome of the intensive care unit (ICU) depends on the teamwork of doctors, nursing staff, and care assistants (CAs). This survey was conducted to assess the level of preparedness of healthcare workers (HCWs) in isolation ICUs by recording and calculating the score of their responses, using a validated pre-formed questionnaire. A cross-sectional survey was conducted on 200 HCWs in isolation ICUs by using a pre-validated questionnaire form as an assessment tool. HCWs in isolation ICUs included doctors, nurses, and CAs who have worked in ICUs dedicated to COVID-19 patients. The response was documented and scores as per the response were assessed by analog scale. Most of the HCWs were anxious (53%) and 96.5% were either bothered or scared. HCWs with adequate knowledge have higher generalized anxiety disorderscores (χ2 = 15.287, p = 0.015). Despite having adequate/average knowledge, most of the HCWs have insufficient knowledge of the correct steps of donning and doffing. HCWs were aware of the COVID-19 pandemic but were not prepared for the anticipated second wave.

Colonoscopy and the psyche – pain and discomfort associations with affect and cognitive functions

Introduction: Colonoscopy is an important diagnostic and therapeutic procedure, however it causes considerable discomfort in patients. Their psychological functioning is sometimes not sufficiently taken into account by the medical staff, preoccupied with somatic conditions. The aim of this study was to reveal affective and cognitive aspects of how patients undergoing colonoscopy function in order to better understand periprocedural discomfort and pain and suggest interventions to reduce them. Material and methods: A total number of 101 patients, undergoing colonoscopy during their stay at the internal ward, were asked to participate in this prospective, observational study. Three measurements were made: the day before the examination, on the colonoscopy day (after bowel cleansing, before the procedure) and the following day. The State-Trait Anxiety Inventory, Beck Depression Inventory II, Montreal Cognitive Assessment, short version of The Illness Perceptions Questionnaire , as well as analog scales (measuring pain, sadness, anxiety, irritability, general discomfort and distress) were used. Ultimately, 50 people completed the study. Results: It has been shown that pain and discomfort on the colonoscopy day correlate positively with all measured aspects of negative affect. On the colonoscopy day 18% of the subjects revealed depressive symptoms matching a depressive episode, while 56.6% of the subjects displayed a high level of state anxiety. The worse the patient's understanding of the disease, the more periprocedural pain he/she experiences. Their cognitive functioning is worse on the colonoscopy day. Conclusions: The results suggest that it is advisable to educate patients early enough (not on the day of the procedure) about their ailments and planned colonoscopy. Keywords: psychiatry, colonoscopy, pain, emotions, cognitive function

The comparative burden of chronic spontaneous urticaria, atopic dermatitis and psoriasis in five European countries

AbstractBackgroundSkin diseases can have a significant impact on the physical, psychological and social well‐being of patients. Quantification of the burden of chronic spontaneous urticaria (CSU) compared to other dermatological conditions is limited.ObjectivesTo evaluate the comparative humanistic and economic burden of CSU, atopic dermatitis (AD), and psoriasis (PSO) in five European countries (EU5).MethodsThis cross‐sectional analysis compared data from adult respondents with a physician diagnosis of CSU, AD and PSO from the 2020 National Health and Wellness Survey in EU5 (France, Germany, Italy, Spain and the United Kingdom). Outcomes included Short Form (SF)‐12v2 [mental (MCS) and physical component (PCS) summary scores], SF‐6D, EQ‐5D, EQ‐Visual Analogue Scale (VAS), Dermatology Life Quality Index (DLQI), General Anxiety Disorder‐7 (GAD‐7), Patient Health Questionnaire‐9 (PHQ‐9), Work Productivity and Activity Impairment (WPAI) and healthcare resource utilization (HRU). Multivariable analyses comparing CSU to AD and PSO, respectively, were conducted for each outcome.ResultsThis analysis included 379 CSU, 788 AD and 2,636 PSO patients. Adjusted MCS and PCS scores were lower among CSU patients than AD (MCS, p = 0.006; PCS, p &lt; 0.001) and PSO (p &lt; 0.001 for all). SF‐6D and EQ‐5D scores were consistently lower among CSU patients versus AD and PSO (p &lt; 0.001 for all), whereas the EQ VAS was lower in CSU cohort versus PSO cohort (p = 0.003). Higher DLQI scores were reported in the CSU cohort versus AD and PSO (p &lt; 0.001 for both) and the proportion of patients with anxiety and depression, respectively, (GAD‐7 and PHQ‐9 scores ≥5) was greater among the CSU cohort versus AD and PSO (p &lt; 0.001 for all). Finally, higher HRUs and worse WPAI scores (p &lt; 0.005) were observed in the CSU cohort relative to AD and PSO cohort.ConclusionsCSU is associated with significantly worse health‐related quality of life, more mental comorbidities, negative impact on patients' daily lives and the ability to work, ultimately leading to higher HRU compared with AD and PSO.

Impact of sexual function domains on sexual satisfaction and quality of life: Importance across the age spectrum.

Sexual satisfaction is an important component of global quality life for many adult men. Substantial gaps exist in our appreciation of how age mediates sexual satisfaction in the context of functional sexual measures. We sought to evaluate modifiable factors associated with overall sexual satisfaction and health-related quality of life (HRQoL) in a large, age-stratified community-based sample of adult men. A sample of adult males registered with the online research service ResearchMatch completed a 75-item online questionnaire in this cross-sectional study. Queries included demographics, general health data, and validated sexual health measures including International Index of Erectile Function-5 (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT). Multivariable regression was performed to assess associations with self-reported sexual satisfaction (defined by "moderately satisfied" or "very satisfied" on the 5-level Likert scale) and overall HRQoL (as measured by the EQ-5D-visual analog scale (VAS) stratified by age. One thousand thirty-three men completed the survey and were stratified by age cohorts. IIEF-5 and PEDT scores were higher in younger cohorts. On multivariable regression analysis, higher IIEF-5, lower PEDT, better overall health-related quality of life, and the presence of a sexual partner within the last month were associated with an increased likelihood of overall sexual satisfaction. When stratified by age cohort, higher IIEF-5 scores were consistently positively associated with sexual satisfaction (Odds Ratio (OR) 1.18, 95% CI 1.15-1.22, P < 0.001), as well as independently associated with improved overall HRQoL by EQ-5D-VAS (β = 0.71, Standard Error (SE) = 0.08, P < 0.001). The erectile function was independently associated with sexual satisfaction and quality of life across all age strata and predictive of both sexual satisfaction and global HRQoL. Low overall rates of sexual satisfaction across cohorts highlight the critical importance of evaluation and treatment of sexual health, regardless of age.

Laparoscopic adenomyomectomy combined with levonorgestrel-releasing intrauterine system is effective for long-term management of adenomyosis

BackgroudLaparoscopic adenomyomectomy combined with intraoperative placement of levonorgestrel-releasing intrauterine device (LNG-IUS) is a novel conservative surgical procedure for adenomyosis. Our study aimed to compare the efficacy of surgery with or without intraoperative placement of LNG-IUS treatment in adenomyosis.MethodsWe retrospectively reviewed the medical records of adenomyosis patients who received laparoscopic adenomyomectomy from January 2014 to April 2020, finally including 70 patients undergoing surgery-LNG-IUS as group A and 69 patients undegoing surgery only as group B. Risk factors for three-year relapse were analyzed using Cox’s multivariate proportional hazard analysis.ResultsVisual analog scale and Mansfield-Voda-Jorgensen Menstrual Bleeding Scale scores of group A at 3, 6, 12, 24, and 36 months were significantly lower than those of group B at the corresponding points (P < .001 for both scales). Individuals in both groups showed statistically significant symptom relief. The recurrence rate in group A was significantly lower than that in group B at 36 months after the surgery (2.94% vs. 32.84%, P < .001). A cox proportional hazard model showed that relapse was significantly associated with coexisting ovarian endometriosis (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.33–7.02, P = .015). Patients who received surgery-LNG-IUS had a lower risk of recurrence than those with surgery-alone (aHR, 0.07; 95% CI, 0.016–0.31, P < .001).ConclusionsConservative surgery with intraoperative placement of LNG-IUS is effective and well-accepted for long-term therapy with a lower recurrence rate for adenomyosis. Coexistent ovarian endometriosis is a major factor for adenomyosis relapse.

THE EFFECT OF LUMBAR STABILIZATION EXERCISES ON CHRONIC LOW BACK PAIN PATIENTS

Objective&#x0D; The aim of this study is to investigate the effect&#x0D; of lumbar stabilization exercises (LSE) on pain,&#x0D; functional capacity, quality of life, and balance in&#x0D; patients with chronic low back pain (CLBP), and also&#x0D; to evaluate the effect on the cross-sectional area of&#x0D; the lumbar multifidus muscle.&#x0D; Material and Method&#x0D; Sixty-six patients with CLBP were enrolled,&#x0D; randomized, and divided into two groups. LSE,&#x0D; transcutaneous electrical nerve stimulation (TENS),&#x0D; and hot pack treatments were performed in Group&#x0D; 1 (n=28). In Group 2 (n=37), TENS and hot pack&#x0D; treatments were performed only. Pre and 8-week&#x0D; post-treatment assessments were made. Visual&#x0D; Analog Scale (VAS) was used to evaluate pain.&#x0D; Modified Oswestry Disability Index (ODI) and Roland&#x0D; Morris Disability Questionnaire (RMDQ) were used&#x0D; to evaluate the functional disability. Short Form-36&#x0D; (SF-36) was used to measure the quality of life. In&#x0D; the assessment of balance, a Tetrax® posturography&#x0D; device (Sunlight Medical Ltd, Israel) was used and fall&#x0D; index (FI) was calculated. The cross-sectional area of&#x0D; multifidus muscles was measured by ultrasonography.&#x0D; Results&#x0D; Significant improvements regarding the crosssectional&#x0D; area of multifidus musclesand subparameters&#x0D; of SF-36 named physical role, pain,&#x0D; mental health, and energy/vitality were determined in&#x0D; Group 1 compared to Group 2 (p˂0.05). No significant&#x0D; difference was present between the groups regarding&#x0D; FI, VAS score, RMDQ, ODI, and balance.&#x0D; Conclusion&#x0D; Lumbar stabilization exercises in patients with chronic&#x0D; low back pain multifidus positively affects crosssectional&#x0D; area and quality of life. For our sample,&#x0D; the addition of lumbar stabilization exercises to&#x0D; the conventional physical therapy program does&#x0D; not provides an additional contribution in terms of&#x0D; balance, pain and disability.

Comparing the Efficacy of Paracetamol, Ibuprofen, and a Combination of the Two Drugs in Relieving Pain and Fever in the Pediatric Age Group: A Prospective Observational Study.

Introduction Fever and pain are common afflictions in the pediatric population, prompting the use of paracetamol and ibuprofen as primary treatment options. However, a comprehensive understanding of their comparative efficacy, safety profiles, and potential combined use remains crucial for informed clinical decision-making. In this prospective observational study, we aimed to delve into these aspects, shedding light on the optimal management strategies for fever and pain in pediatric patients. Methodology A total of 108 children were enrolled and categorized into three groups, namely, paracetamol monotherapy, ibuprofen monotherapy, and a combination of both drugs. Axillary temperature monitoring and assessment of pain on the Face, Legs, Activity, Cry, and Controllability (FLACC) scale/Visual Analog Scale (VAS) were employed as critical indicators. Concurrently, associated symptoms encompassing discomfort, activity levels, and appetite were meticulously recorded. To ensure safety, laboratory parameters including serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), serum creatinine, platelet count, and stool for occult blood were closely monitored before and after drug administration. The study duration spanned 48 hours post-initiation of the initial drug dose. Results A total of 108 pediatric cases were included in the study, spanning ages from six months to 18 years. Among them, the majority fell within the age group of six months to five years (n = 77). Participants were categorized based on the duration of fever, with 81 cases having a fever lasting more than 24 hours and 27 cases having a fever lasting less than 24 hours. The majority of cases presented with temperatures ranging from 38°C to 39°C. Comparison of drug efficacy in defervescence within the first four hours revealed that paracetamol alone took significantly longer than ibuprofen monotherapy or the paracetamol and ibuprofen combination (p = 0.026). In terms of the onset of effect, the paracetamol and ibuprofen combination showed comparable efficacy to ibuprofen alone. Regarding the total time without fever in 48 hours, significant differences were observed among the three drug regimens (p = 0.001 by the one-way analysis of variance (ANOVA) test). Paracetamol and ibuprofen were superior to paracetamol alone (p < 0.001) and ibuprofen alone (p = 0.014), while paracetamol alone and ibuprofen alone exhibited similar efficacy (p = 0.197). Based on the laboratory results as well as the clinical profile observed over 48 hours, we confirm safety based on this study. The combination of paracetamol and ibuprofen showed enhanced effectiveness in fever and pain relief. Conclusion This study demonstrates the favourable efficacyof paracetamol, ibuprofen, and their combination in the pediatric population. The combination of paracetamol and ibuprofen showed enhanced effectiveness in fever and pain relief, with minimal adverse effects and no significant derangements in biochemical parameters. This study thus contributes valuable insights to optimize the therapeutic approach to fever and pain in pediatric patients.

Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort

BackgroundFollowing traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis.MethodsA prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) ‘Health Today’ analogue scale (0–100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses—accounting for covariates including cultural identity—were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis.ResultsFrom 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting ‘good or better’ global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), ‘no’ anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ ‘Health Today’ (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar.ConclusionsDespite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.

Safe and Effective Is Not Always Acceptable: The Case for PASS Scores in Foot and Ankle Orthopaedic Surgery

Category: Other Introduction/Purpose: Determining the success of a clinical intervention can be challenging even with modern patient-reported outcomes. Traditionally studies have used the Minimum Clinically Important Difference (MCID), the smallest difference in an outcome that is felt to have clinical significance. More recently some authors have emphasized the alternative model of the Patient Acceptable Symptomatic State (PASS), the threshold of a PRO defining where patients consider their overall status to be acceptable. PASS scores have not yet seen wide use in the foot and ankle literature, but may add insight to surgical outcomes beyond simply measuring the minimal changes implied by the MCID. Methods: The most universal patient-reported outcome in the foot and ankle literature is the simple Visual Analog Pain Scale (VAS), in which a patient rates their pain along an analog scale between 0 to 10 cm. Articles in Foot and Ankle International from December 2020 to August 2022 that reported VAS pain scores and variance following an intervention were included. Although specific PASS thresholds for VAS scores in many conditions in the foot and ankle have not been determined analytically, values ranging from 2.0 to 3.0 are typical for orthopaedic conditions, corresponding to the intuitive statement “I would like my pain to be less than 2 or 3 out of 10.” A PASS threshold of 2.0 has been used previously in the foot and ankle literature. The studies were therefore analyzed against PASS thresholds for the VAS of 2.0, 2.5, and 3.0. Results: Twenty-one studies were included. Five had multiple internal groups, yielding a total of 27 total sets of VAS scores.All 27 (100%) showed improvements well beyond the MCID and were considered successful. 17 (81%) of the 21 studies subjectively described their intervention as “reliable”, “good”, “effective” or “satisfactory”. Despite this, 8 (38%) of the 21 studies reported final mean VAS scores for all internal groups above a PASS threshold of 2.0. An analytically calculated weighted average final VAS pain score for all studies was 1.78 +/-1.89. Based upon this, the expected percentages of patients included in FAI studies whose results failed to meet VAS PASS thresholds were 45% for a threshold of 2.0, 35% for a threshold of 2.5, and 26% for a threshold of 3.0. Conclusion: Studies in the foot and ankle literature almost universally report positive results, both subjectively in their discussions and by statistically demonstrating improvement of patient-reported outcomes beyond the MCID. PASS threshold analysis yields a much less positive interpretation and emphasizes the number of negative outliers in the population who do not find their outcome acceptable. A fuller picture of the outcome of foot and ankle procedures and overall patient satisfaction can be gained from reporting both changes in the mean and comparing final outcomes to PASS thresholds.

Big number, big body: Jersey numbers alter body size perception.

Vision has been shown to be an active process that can be shaped by top-down influences. Here, we add to this area of research by showing a surprising example of how visual perception can be affected by cognition (i.e., cognitive penetration). Observers were presented, on each trial, with a picture of a computer-generated football player and asked to rate the slenderness of the player on an analog scale. The results of two experiments showed that observers perceived athletes wearing small jersey numbers as more slender than those with high numbers. This finding suggests that the cognition of numbers quantitatively alters body size perception. We conjecture that this effect is the result of previously learned associations (i.e., prior expectations) affecting perceptual inference. Such associations are likely the result of implicit learning of the statistical regularities of number and size attributes co-occurrences by the nervous system. We discuss how these results are consistent with previous research on statistical learning and how they fit into the Bayesian framework of perception. The current finding supports the notion of top-down influences of cognition on perception.

Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint

BackgroundUlnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PurposeIn this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. Study DesignThis was a prospective cohort study. MethodsForty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher’s exact if the expected cell count was less than five. ResultsPatients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) ConclusionsThe weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without.