Ice Packs Research Articles

Heat preparedness and exertional heat illness in Paralympic athletes: A Tokyo 2020 survey

ABSTRACT Paralympic athletes may be at increased risk for exertional heat illness (EHI) due to reduced thermoregulatory ability as a consequence of their impairment. This study investigated the occurrence of heat-stress related symptoms and EHI, and the use of heat mitigation strategies in Paralympic athletes, both in relation to the Tokyo 2020 Paralympic Games and previous events. Paralympic athletes competing in Tokyo 2020 were invited to complete an online survey five weeks prior to the Paralympics and up to eight weeks after the Games. 107 athletes (30 [24–38] years, 52% female, 20 nationalities, 21 sports) completed the survey. 57% of respondents had previously experienced heat-stress related symptoms, while 9% had been medically diagnosed with EHI. In Tokyo, 21% experienced at least one heat-stress related symptom, while none reported an EHI. The most common symptom and EHI were, respectively, dizziness and dehydration. In preparation for Tokyo, 58% of respondents used a heat acclimation strategy, most commonly heat acclimatization, which was more than in preparation for previous events (45%; P = 0.007). Cooling strategies were used by 77% of athletes in Tokyo, compared to 66% during past events (P = 0.18). Cold towels and packs were used most commonly. Respondents reported no medically-diagnosed EHIs during the Tokyo 2020 Paralympic Games, despite the hot and humid conditions in the first seven days of competition. Heat acclimation and cooling strategies were used by the majority of athletes, with heat acclimation being adopted more often than for previous competitions.

Comparative effectiveness of ice packs versus topical lidocaine-prilocaine mixture for pain control in laser hair removal of the axilla: A rater-blinded randomized controlled trial

Laser hair removal is associated with moderate acute pain. To compare effectiveness of ice pack to topical lidocaine-prilocaine for pain reduction during axillary laser hair removal. Participants were randomly assigned to receive topical anesthetic to one axilla and ice packs to the other before each of three, monthly 810-nm diode laser sessions. The primary endpoint was participant-reported pain on the visual analog scale (VAS) immediately following and 5 minutes after laser. Post-treatment erythema, overall edema, and perifollicular edema were assessed by two blinded photoraters. Skin temperatures, patient preferences, and adverse events were recorded. Eighty-eight of 90 (98%) planned laser treatments were delivered, and randomized. Participants reported higher VAS scores immediately after laser with lidocaine-prilocaine compared to ice (p=0.03). Five minutes after, participants reported higher VAS scores with ice (p=0.03). After 53 of the 88 treatments (60.2%), participants reported preferring ice (p=0.055). No serious adverse events were reported. All participants were Caucasian or Asian with Fitzpatrick skin type I-III and coarse dark axillary hair, which may limit generalizability. While pain control with ice and topical anesthesia is associated with time after treatment, the two modalities do not differ in terms of degree of pain reduction associated with axillary laser hair removal.

118 High unmet medical need in brachioradial pruritus: results from a large patient survey

A patient survey that aimed to best identify the unmet needs in brachioradial pruritus (BRP) was conducted from 10/2021 to 04/2022 in English online. The survey, created in collaboration with BRP patients and experts in BRP, included 36 questions focusing on the most significant elements of living with BRP: journey to diagnosis, severity and frequency of symptoms, treatment history, and impact on quality of life. 545 anonymous respondents worldwide participated in the survey, with 322 having reported a confirmed BRP diagnosis by a physician. The majority of patients were 50-69 years old (62%), female (94%), and in the US (74%). Data showed it took at least three years since first experiencing BRP symptoms for 43% of patients to receive a correct diagnosis, and 52% visited at least three different physicians before the diagnosis was made. Misdiagnosis [other diagnoses prior to final diagnosis of BRP] was common (in 39%). Most (85%) patients had severe itch (itch score ≥7) in their last episode, and 88% had visible scratch marks or bleeding. 78% suffer from itch at least three months per year, of which 28% suffer for over nine months per year. Patients often tried several drug treatments (mean >4) for itch, with the most helpful receiving only 21% of responses. Sleep quality is highly affected in 77% of patients, and 71% use ice packs at night. For the vast majority (92%), their itch frustrates them often or all the time. These data show that a substantial proportion of BRP patients endure a difficult path to diagnosis, suffer from severe itch for the majority of the year, lack a clear treatment option, and experience a highly negative impact on their quality of life. These results emphasize the need to increase awareness of BRP, address patients’ unmet needs, and develop effective treatments for BRP.

A Review of Episiotomy and Modalities for Relief of Episiotomy Pain.

Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used forepisiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bathis a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focuson infrared lamp therapy and sitz baths.

Molecular characterization and prevalence of Bacillus species isolated from Saudi hospitals

ObjectiveThis study highlighted the dissemination of Bacillus species (including drug-resistant species) in public hospital environments and calls for the design of optimal strategies to curb their spread. This a critical consideration for all health care systems such as caring for the increasing number of immune-compromised patient. MethodsA total of 528 swab samples were collected from the environments of different Saudi hospitals. Swab samples were collected by swabbing approximately 5 cm2 of different surfaces at each site using pre-moisturized cotton swabs with 1 mL of neutralizing buffer. The swabs were transported in cool boxes with ice packs within 2 h of collection. Isolation and identification were performed according to conventional bacteriological, semi-automated and molecular characterization methods. Antibiogram typing was carried against different groups of antimicrobial agents. ResultsThe most prevalent of the isolated Bacillus species were Bacillus cereus (46.6%) followed by Bacillus subtilis (38.1%); the least prevalent was Bacillus pumilus (1.1%). Most Bacillus isolates (25.6%) were isolated from the Department of Internal Medicine followed by the Emergency Department (18.8%), while the operating rooms had the lowest prevalence (4.5%). Antimicrobial susceptibility testing revealed high levels of resistance in Bacillus isolates to β-lactams and tetracycline. Overall, 21.6% of isolates showed multi-drug resistance to three or more antibiotics (21.6%). Antibiogram typing of the 176 isolates revealed 45 antibiotypes; the most common was antibiotype 31, which included 32 isolates (18.2%); this particular antibiotype was resistant to both penicillin and cefoxitin. ConclusionsAnalyses identified the high dissemination of Bacillus species in several hospital environments with high resistance to β-lactams and tetracycline antibiotics. Molecular analysis also revealed the existence of genetic diversity among the Bacillus isolates investigated. Thus, monitoring the hospital environment is an important tool in the prevention of hospital-associated infection by Bacillus species.

Ice-Pop: Ice Packs for Post-Operative Pain, a Randomized Controlled Trial

<h3>Study Objective</h3> To evaluate the benefit of ice packs as a supplement to standard pain management following laparoscopic hysterectomy. <h3>Design</h3> This IRB approved randomized control trial involved patients undergoing outpatient laparoscopic hysterectomy for benign indications. Subjects were randomized to receive standard enhanced recovery after surgery (ERAS) pain management or standard ERAS plus ice packs and followed for two weeks post-operatively. <h3>Setting</h3> Postoperative care unit in two academic tertiary care centers. <h3>Patients or Participants</h3> Patients at two large academic institutions undergoing outpatient laparoscopic hysterectomy via conventional laparoscopic technique with the minimally invasive gynecologic surgery team between February 2019 and November 2020 were considered for participation. Patients with chronic pain, current opioid use more than 1 week, or requiring planned overnight hospitalization were excluded. Primary outcome data was available for 51 subjects (24 control, 27 intervention). <h3>Interventions</h3> Ice packs were placed on the abdomen in the operating room. <h3>Measurements and Main Results</h3> Pain was assessed at multiple time points throughout the study using Visual Analogue Scale (VAS). Narcotic requirement was assessed using morphine milligram equivalent (MME). MME requirements at all time points were not different between the groups (<i>p=0.63)</i>. Postoperative day 1 (POD#1) VAS scores were not different (<i>p=0.</i>89). 84.8% of subjects felt their pain was adequately controlled. All subjects were prescribed 20 tablets oxycodone and on average used 2.9 (SD 3.4) tablets after discharge. 87% of intervention subjects would use ice again in the future and 82.6% would recommend ice to others. <h3>Conclusion</h3> Ice packs are an acceptable supplement for postoperative management with high patient satisfaction and no adverse effects; however, cryotherapy does not significantly impact postoperative reported pain or narcotic use. Providers caring for postoperative patients should be cognizant of unintentional consequences associated with overprescribing opioids and consider reducing the number of tablets prescribed given consistent evidence that patients require less than half the quantity given.

7547 Opioid-Sparing Versus Standard Postoperative Pain Regimen for Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

<h3>Study Objective</h3> This study investigated whether ICE-T, a multimodal opioid-sparing pain regimen using ice packs, acetaminophen (Tylenol), and ketorolac (Toradol) provided effective postoperative pain management compared with a standard pain regimen for total laparoscopic hysterectomy (TLH). <h3>Design</h3> This randomized controlled trial was designed to achieve over 90% power. Patients who underwent TLH were randomized to the ICE-T or standard pain regimen and outcomes were followed until postoperative day 4. <h3>Setting</h3> Intra-operatively patients were in dorsal lithotomy and Trendelenburg position. <h3>Patients or Participants</h3> Patients undergoing TLH for benign indications at the academic center from August 2019 until June 2021 were assessed for eligibility. Sixty-seven patients were enrolled preoperatively; 36 were randomized to the ICE-T regimen and 31 to the standard regimen. <h3>Interventions</h3> The ICE-T regimen prescribed around-the-clock ice-packs, acetaminophen and ketorolac. The standard protocol prescribed as needed ibuprofen and acetaminophen/oxycodone based on pain score. Both regimens included hydromorphone for breakthrough pain. These regimens were used inpatient and outpatient from post-anesthesia care unit discharge onwards. <h3>Measurements and Main Results</h3> Postoperative day 1 and 4 outcomes were evaluated using visual analog scales, validated Quality of Recovery Questionnaires, patient satisfaction scores, inpatient narcotic consumption and outpatient pain medication consumption. Patient and surgical demographics were evenly distributed. The median visual analog score and quality of recovery scores on postoperative day 1 were not significantly different; p=0.44 and p=0.85 respectively. However, the ICE-T arm median narcotic consumption on postoperative day 1 was significantly lower; 480.6 morphine milligram equivalents (MME) versus 619.2 MME, p=0.02. ICE-T arm postoperative day 4 median visual analog scores were also significantly lower in the per-protocol analysis (p=0.014). There were no significant differences in the postoperative day 4 median quality of recovery or satisfaction scores. <h3>Conclusion</h3> The ICE-T regimen is an effective multimodal opioid-sparing postoperative pain regimen for TLH. ICE-T has comparable pain control and patient satisfaction to the standard regimen while significantly decreasing narcotic consumption.

SEVERE PRURITUS AS A PRESENTING SYMPTOM OF HODGKIN'S LYMPHOMA

<h3>Introduction</h3> Pruritus has a broad differential diagnosis. Rarely, this symptom may be the sole manifestation of an underlying malignancy. A patient with 5 years of severe upper body pruritus with no other systemic symptoms was subsequently diagnosed with Hodgkin's lymphoma. <h3>Case Description</h3> A 43-year-old male presented to the allergy-immunology clinic for evaluation of severe pruritus of 3 years' duration; he reported nocturnal worsening awakening him from sleep. The pruritus was refractory to antihistamines but was partially responsive to ice packs. There were no associated constitutional or respiratory symptoms, or lymphadenopathy. CBC with differential and CMP were normal. Omalizumab therapy was administered for 3 months; however, the severe pruritus persisted. Neuropathy work-up by neurology was negative. Dermatology evaluation yielded a diagnosis of folliculitis. Work-up for auto-immune disease by rheumatology was negative. After a total of 5 years of pruritus without identifiable cause, he presented for evaluation of a new-onset supraclavicular mass. Chest CT revealed a large anterior mediastinal mass and a massive conglomerate of lymph nodes. Subsequent biopsy revealed classic Hodgkin's lymphoma. <h3>Discussion</h3> This case underscores that persistent pruritus may be the presenting symptom of malignancy. Pruritus associated with malignancy is classically refractory to antihistamines and may not be accompanied by classic systemic symptoms. While rare, it is important to keep this atypical presentation of malignancy in the differential.

The Effects of Temperature Management on Brain Microcirculation, Oxygenation and Metabolism.

Purpose: Target temperature management (TTM) is often used in patients after cardiac arrest, but the effects of cooling on cerebral microcirculation, oxygenation and metabolism are poorly understood. We studied the time course of these variables in a healthy swine model.Methods: Fifteen invasively monitored, mechanically ventilated pigs were allocated to sham procedure (normothermia, NT; n = 5), cooling (hypothermia, HT, n = 5) or cooling with controlled oxygenation (HT-Oxy, n = 5). Cooling was induced by cold intravenous saline infusion, ice packs and nasal cooling to achieve a body temperature of 33–35 °C. After 6 h, animals were rewarmed to baseline temperature (within 5 h). The cerebral microvascular network was evaluated (at baseline and 2, 7 and 12 h thereafter) using sidestream dark-field (SDF) video-microscopy. Cerebral blood flow (laser Doppler MNP100XP, Oxyflow, Oxford Optronix, Oxford, UK), oxygenation (PbtO2, Licox catheter, Integra Lifesciences, USA) and lactate/pyruvate ratio (LPR) using brain microdialysis (CMA, Stockholm, Sweden) were measured hourly. Results: In HT animals, cerebral functional capillary density (FCD) and proportion of small-perfused vessels (PSPV) significantly decreased over time during the cooling phase; concomitantly, PbtO2 increased and LPR decreased. After rewarming, all microcirculatory variables returned to normal values, except LPR, which increased during the rewarming phase in the two groups subjected to HT when compared to the group maintained at normothermia. Conclusions: In healthy animals, TTM can be associated with alterations in cerebral microcirculation during cooling and altered metabolism at rewarming.

Palm cooling temperatures on thermal, physiological, perceptual, and ergogenic indices from rowing workouts in a thermoneutral environment

ABSTRACT Gel pack temperatures were compared for responses to thermal, physiological, perceptual, and ergogenic indices from healthy women (n = 12) and men (n = 8). They did three rowing workouts to identify an ideal temperature. In a randomised sequence, and as subjects wore gloves equipped with mesh pouches during workouts, gel packs at one of the three average temperatures (10.6, 12.6, or 14.9°C) were inserted into the pouches. Data were collected before, during and after multi-stage workouts. Thermal, physiological, and perceptual data were each compared with three-factor (condition, gender, time) mixed effect model ANCOVAs, with repeated measures for condition and time, and gender as a between subjects’ factor. Distance rowed was assessed with two-factor (condition, gender) mixed effect model ANCOVAs, with repeated measures for condition, and gender as a between subjects’ factor. Within-subject contrasts was the post-hoc, and α = 0.05 denoted significance. Despite small differences for distance rowed, many dependent variables had significant inter-condition effects, whereby 10.6°C gel packs had the best thermal and physiological responses. The 10.6°C temperature 1): likely removed the most body heat, perhaps through cold-induced vasodilation and, 2): may be optimal, as it evoked the best thermal and physiological responses.

Effect of MFR Technique Versus Static Stretching on Pain Among Adults with Plantar Fasciitis

Background: Disorder of plantar fascia caused from overuse, excessive overload or prolonged standing time is called plantar fasciitis. Conservative treatment is a primary choice of treatment for plantar fasciitis and physiotherapist play a vital role. Interventions such as ultrasound, soft tissue massage, orthotics, taping, hot pack, cold pack, stretching and strengthening exercises are used by physiotherapists for treatment of this condition. Objectives: This study is aimed to evaluate and compare the effectiveness of myofascial release technique and static stretching of plantar fascia, on pain among adults with plantar fasciitis. Methods: All the subjects were screened as per the inclusion &amp; exclusion criteria. After getting their written consent, a total of 42 plantar fasciitis patients with mean age of 28 years were included in the study. They were randomly allocated into two groups with n= 21 in each group. Group A was given Myofascial Release Technique whereas Group B was given Static Stretching on the affected plantar fascia. The interventions were carried out for twice a week for two weeks. Visual Analogue Scale was used as the outcome measure and it was measured pre- and post-intervention at baseline during week one and at the end of treatment at week two. Results: The study demonstrated statistically significant difference between pre-treatment and post-treatment visual analogue scale scores, in both groups: MFR (p &lt; .0001) and Static Stretching (p &lt; .0011). Conclusion: Both MFR as well as static stretching are effective in reducing pain in plantar fasciitis patients. KEY WORDS: Plantar Fasciitis, Static Stretching, Myofascial Release, Pain, Visual Analogue Scale.

Stability of levothyroxine tablets in blister packaging versus bottles and vials under simulated in-use conditions

IntroductionLevothyroxine, the standard-of-care treatment for hypothyroidism, is susceptible to degradation when exposed to light and moisture and is an FDA-designated narrow therapeutic index drug. In this report, we examined how different packaging (e.g., cold form blister packs, manufacturer’s bottles, or pharmacy amber vials) affects the physicochemical integrity and potency of levothyroxine in conditions simulating real-world patient use.MethodsIn part 1 of this study, we evaluated changes in the physicochemical properties (e.g., moisture gain, hardness, and disintegration time) of levothyroxine tablets stored in high-density polyethylene (HDPE) bottles, amber vials, and blister packs when exposed intermittently to different relative humidities (RH), 25 °C/75% RH and 25 °C/90% RH for 90 days, or 54 °C/75% RH continuously for 2 days. In part 2 of the study, we compared the potency of levothyroxine tablets in bottles and aluminum/aluminum cold form blister packs exposed to 28 °C/65% RH intermittently over 105 days and continuously over 30 days.ResultsMoisture content, hardness, and disintegration time were relatively unchanged for blister-packaged levothyroxine tablets under all conditions studied. Conversely, the physicochemical properties of tablets stored in amber vials and bottles were altered over time. Levothyroxine potency remained relatively consistent for blister-packaged tablets (100.8% at baseline, 99.6% at day 105) and decreased for bottled levothyroxine (101.4% at baseline to 93.9% at day 105).ConclusionLevothyroxine packaging can influence tablet integrity. Blister packages preserved physicochemical properties and potency better than bulk bottles. Additional studies are needed to determine the impact of packaging and changes in tablet integrity on patient outcomes.

Bringing SAR capability to a safer ice navigation during Indian Antarctic Expedition in near real-time mode

The present study has been executed for providing sea ice advisory during the 40th Indian Scientific Expedition to Antarctica (ISEA) to carry out a smoother expedition. The near real-time knowledge of sea ice conditions along with safe, optimum and less fuel consumption routes is essential for expedition vessel movement through the Antarctic sea ice regions. The radar can distinguish between more navigable thinner/weaker sea ice and the hazardous, much thicker sea ice along with icebergs to help assure safe navigation in ice-covered regions. In the current study, considering the advantage of spatial and temporal resolutions along with acquisition modes of the Sentinel-1, we have standardized the procedure to find the penetrable passage within the sea ice packs. The pre-processing steps of Sentinel-1 data were performed to generate backscattered products. Further, for intensity images of Interferometric Wide (IW) mode and Extra Wide (EW) mode, the procedure for identification of different types of sea ice and ocean water has been discussed in the paper. Our study also highlights the use of ERA 5 reanalysis data for better interpretation of SAR data due to the presence of the blizzard footprint in the acquired image. And finally, a significantly improved near real-time Sea Ice Advisory (SIA) surrounding two Indian Antarctic Research Stations was produced and utilised to support safer navigation during the 40th ISEA voyage.

A POST-ARREST CARE BUNDLE IMPROVES QUALITY OF CARE AND CLINICAL OUTCOMES DURING THE NORMOTHERMIA ERA

A POST-ARREST CARE BUNDLE IMPROVES QUALITY OF CARE AND CLINICAL OUTCOMES DURING THE NORMOTHERMIA ERA

Infrasonic horn and ribbon microphone

Infrasound measurements normally utilize seismic sensors (geophones and accelerometers) with deployment on the ground surface, the seafloor, ice packs, etc. Here, the infrasound propagating in an overlying fluid medium such as air or water, interacts with the solid medium, thereby imparting its signature. These sensors primarily detect ground motion in terms of the particle velocity or acceleration (force) of the ground in contact with the sensor. Pressure microphone sensing of infrasound in the atmosphere has also been explored. We examine here the atmospheric sensing of infrasound, using the well-established technique of the ribbon microphone, which employs a thin metallic ribbon, suspended between two magnets to detect the particle velocity of the sound propagating in a fluid medium. Movement of the ribbon in the sound field generates a voltage according to Faraday’s Law. Although ribbon microphones are fixtures in audio band acoustics, their application to infrasound is not, and is explored here. Ribbon microphones made from suspension of conductive mylar tape between two neodymium magnets have been fabricated and tested in an infrasound band around a few Hertz. The results show a viable approach to vector sensing in this band. Work supported by ARL:UT Austin.

An Unusual Case of Tongue Entrapment in a Plastic Water Bottle

Background: Foreign bodies inside the oral cavity are commonly encountered among children. One peculiar occurrence is when the tongue gets entrapped in foreign bodies such as bottles. This happens as children often insert their tongues into the bottle and apply oral suction to ingest the last few drops from the bottle. There is a paucity of data in Indian literature and no recommended guidelines for the management of such cases. Clinical Description: The patient, a 12-year-old boy had a history of inability to remove a plastic water bottle sipper from around the tongue while swallowing water quickly. He was initially asymptomatic and then he started developing progressive pain and swelling on the anterior part of the tongue. On examination, the plastic sipper was constricting the tongue circumferentially and the patient felt a sharp pain on maneuvering the bottle. Minimal discoloration of the anterior part of the tongue had set in 1 h after the presentation. Management: Lubrication with 2% lignocaine jelly and ice packs circumferentially followed by attempts of gentle traction and manipulation to remove the foreign body were unsuccessful. Consequently, the patient was shifted to the emergency operation theater where the patient was sedated with intravenous (IV) ketamine and midazolam after securing a nasopharyngeal airway with 100% preoxygenation. An orthopedic bone cutter was used, and a radial cut was given on the impacted end of the bottle, and the constricted part was removed as pressure on the tongue was released, followed by 100% oxygenation with bag and mask ventilation. Conclusion: Immediate intervention in cases of the entrapped tongue can prevent grave consequences such as airway compromise and tongue ischemia and necrosis. Mechanical removal can be done safely using heavy scissors or orthopedic bone under IV sedation after securing the airway in collaboration with the anesthesia team.

Prevalence of hepatitis B among patients in Michael Okpara University of Agriculture, (Mouau) Clinic and Madonna Catholic Hospital Umuahia, Abia State

To determine the prevalence of Hepatitis B among patients in Michael Okpara University of Agriculture, (MOUAU) clinic and Madonna Catholic Hospital Umuahia, Abia State. Blood samples were collected aseptically using a sterile syringe and needle. About 2-5ml of blood was collected from each patient and conveyed in ice packs to Microbiology Laboratory for pre-vaccination tests. On-the-spot testing for HBsAg was conducted using Smart Check HBsAg (Globalemed, Cape Town, South Africa) according to the manufacturer’s instructions. This study revealed that about 46.5% of the study participants were positive for hepatitis B surface antigen, while the prevalence of age distribution of Hepatitis B surface antigen among male and female patients revealed that the rate of Hepatitis B Surface Antigen was highest in patients between the age 16-34 years at a percentage prevalence of 19(55.9%). This study also revealed that Hepatitis B virus prevalence rates were the most prevalent among female patients with a positive percentage value of 47.7%.The prevalence rate of HBsAg was higher in the 16-34 age group than in the other age groups tested. This high prevalence rate calls for more awareness on effective HBsAg immunization program in Nigeria. The importance of vaccination in the fight against hepatitis B cannot be overstated, emphasizing the necessity for universal immunization of all people in the study's age group and the creation of measures to prevent mother-to-child transmission. As a result, it is advised that adolescents born before the hepatitis B vaccine era in Nigeria receive public health education and vaccination against the infection.

Routine sample transportation of centrifuged barrier tubes impacts certain chemistry analytes

The preanalytical phase of testing, including sample transportation, is a common source of error in laboratory testing. Previous studies have shown inversion of centrifuged plasma separator tubes (PST) results in elevation in certain analytes. However, it remains unclear if routine transportation practices, without full inversion, can have a similar impact.This study used 12 residual samples submitted in PST and 4 PST tube samples collected from healthy donors. All samples were measured at baseline. Analytes measured were white blood cells (WBCs), red blood cells (RBCs), platelets (PLTs) using the Sysmex XN-1000 and potassium (K), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), sodium (NA), and alanine aminotransferase (ALT) using the Ortho Vitros 4600. The samples were split into two groups: 1 group was placed vertically in racks and the other group were laid horizontally in a messenger bag-style soft-sided cooler used by lab couriers. A cold pack was placed in the bag, equidistant from both groups of samples. To mimic courier transportation, the bag was carried for 30 min, returned to the laboratory and immediately analyzed. Subsequently, the samples were re-centrifuged and analyzed again. Statistics were performed using GraphPad Prism.LDH increased following transportation for vertical and horizontal samples and remained elevated despite re-centrifugation. K was only increased in the horizontal samples following re-centrifugation. Notably, AST as well as WBCs, RBCs, and PLTs all increased following transportation, but dropped to baseline concentrations following re-centrifugation.Centrifuged PSTs should be kept in a vertical position during transportation by courier. Re-centrifugation of plasma gel tubes after transportation may be necessary for certain chemistry tests.

32315 Postoperative care consideration: Cold panniculitis induced by cooling device after knee surgery

A 52-year-old woman presented with 1-week history of an asymptomatic eruption on the right knee. This started as blanched patches which progressed over a few days to raised urticarial papules. Prior to the onset of the eruption, she had been using a cold therapy device on this knee for three weeks after arthroscopy and medial meniscus repair. On examination, there were smooth indurated round papules localized to the right anterior knee. A punch biopsy was obtained revealing a superficial and deep perivascular lymphocytic infiltrate extending into the subcutis, consistent with cold panniculitis. Cold panniculitis refers to inflammation of the fat following exposure to very cold temperatures. It is most common in the cheeks of young children but has rarely been reported in adults, including in female equestrians and after use of ice packs for chronic lower back pain. There has also been a report of cold panniculitis after use of a cold device after shoulder surgery. Treatment frequently involves removing the source of thermal injury. Our patient was instructed to stop using her cold therapy device and over time her lesions resolved. Given the development and increased availability of such devices, it is possible a similar clinical picture may present more frequently in dermatology clinics in the future.

The Internet Knows More Than My Physician: Qualitative Interview Study of People With Rare Diseases and How They Use Online Support Groups.

BackgroundPatients struggling with rare diseases may face challenges caused by care providers being unfamiliar with their condition. The life span of people with rare diseases may be the same as that of healthy people, but their quality of life is different. Patients with chronic pain are constantly looking for ways to mitigate their pain. Pain killers are not a permanent solution. In addition to the medical and nonmedical costs of rare diseases for both patients and health care providers, there is a need for sustainable sources of information that are available to help with pain and improve their quality of life, with the goal of reducing physician visits and hospital admissions.ObjectiveThis study investigated the challenges that patients with genetic disorders face in managing their health conditions and finding disease-related information as well as the effect of online peer support groups on pain mitigation and care management.MethodsInterviews were conducted via Zoom between July 2021 and December 2021. Eligible participants were those who were aged >18 years, had a medical diagnosis of any type of Ehlers-Danlos syndrome (EDS) with chronic pain, and were members of any support group. Participants were recruited through an announcement in the research and survey section of The Ehlers-Danlos Syndrome Society web page. Interviews were analyzed using the framework approach. Data were systematically searched to identify patterns, analyze them, and identify themes. Interview audio files were transcribed and independently coded by two researchers (SA and AT). Through an iterative process, a final coding table was agreed upon by the researchers and used to thematically analyze the data.ResultsWe interviewed 30 participants (mean age 37.7, SD 15 years; n=28, 93% were women; n=23, 77% were residing in the United States). Thematic analysis revealed that participants (patients with EDS) were constantly in pain and most of them have not received accurate and timely diagnoses for many years. They expressed their challenges with health care providers regarding diagnosis and treatment, and complained about their providers’ lack of support and knowledge. Participants’ main sources of information were web-based searches, academic journals, The Ehlers-Danlos Syndrome Society web page, and online peer support groups on Facebook, Reddit, Twitter, and Instagram. Although pain killers, cannabis, and opioids are providing some pain relief, most patients (28/30, 93%) focused on nonmedical approaches, such as hot or ice packs, physical therapy, exercises, massage, mindfulness, and meditation.ConclusionsThis study highlights the information gap between health care providers and patients with genetic disorders. Patients with EDS seek access to information from different web-based sources. To meet the needs of patients with genetic disorders, future interventions via web-based resources for improving the quality of care must be considered by health care professionals and government agencies.