Incidence Of Pain Research Articles

Predictors, Protective Factors, and Adverse Outcomes of Joint Pain among Malaysian Community-Dwelling Older Adults: Findings from the LRGS-TUA Longitudinal Study

Background: Joint pain has been recognized as one of the major causes of limitations in mobility, functional decline, and consequently declined quality of life in older adults. Hence, this study aimed to identify the predictors, protective factors, and adverse outcomes of joint pain in community-dwelling older adults. Methods: In this Long-term Research Grant Scheme—Towards Useful Ageing (LRGS-TUA) longitudinal study, a total of 1005 older participants aged 60 years and above who were successfully followed up after five years were included in the analysis. The participants self-reported their joint pain status at baseline and during the fifth year. Subsequently, the baseline characteristics were used to predict changes in joint pain status. Adverse outcomes related to joint pain were evaluated based on the participants’ joint pain statuses. Results: Results showed that being female, having diabetes mellitus, and higher body mass index were associated with the incidence of joint pain. Meanwhile, increased intake of pantothenic acid and higher levels of blood albumin levels were associated with recovery from joint pain. Participants with persistent joint pain at baseline and follow-up showed higher levels of depression and disability compared to individuals who never experience any joint pain. However, participants who had recovered from joint pain did not differ significantly from those without joint pain at baseline and follow-up in these measures. Conclusions: By identifying the modifiable risk factors, factors associated with recovery, and adverse outcomes related to joint pain, this study adds to current evidence that may contribute to further management strategies for joint pain in older adults.

Efficacy of POWERbreathe Medic Plus device on maximal inspiratory pressure, functional capacity and quality of life in coronary artery bypass graft patients: A randomized controlled trial protocol

Coronary artery disease (CAD) is a prominent cause of illness and mortality worldwide, with a significant amount of coronary artery bypass graft (CABG) surgeries performed each year. It is a complicated technique that results in several clinical and functional issues. While CABG is an effective treatment, it comes with clinical and functional challenges, including reduced lung volume, maximal inspiratory and expiratory pressure, and thoracic mobility after surgery. Incisional pain has been associated with a decline in postoperative lung function; however, this resolves a month following surgery. There is no documented association between respiratory muscle strength and lung function after heart surgery. The POWERbreathe Medic Plus is intended for patients who have extremely weak breathing muscles as a result of illness, hospitalization, or existing respiratory health disorders such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. To address these challenges, a study will investigate the efficacy of the POWERbreathe Medic Plus device in improving maximal inspiratory pressure, functional capacity, and quality of life in CABG patients. CTRI no. – CTRI/2023/04/052116 Link-https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODMxNTA=&Enc=&userName=CTRI/2023/04/052116 CTRI registration date – 28/04/2023

Prevalence of Neck Pain and Associated Disabilities among Students who Use Computers

Background: Neck pain is increasingly prevalent among computer users, leading to significant health concerns and impacting daily activities. Understanding the prevalence and associated disabilities of neck pain in this population is crucial for developing effective preventive measures and interventions. Objective: To investigate the prevalence of neck pain and associated disabilities among university students who use computers, and to identify the factors contributing to these conditions. Methods: This cross-sectional study was conducted over six months at Akhtar Saeed Medical and Dental College, Lahore. A sample of 144 students from DPT, MBBS, BDS, and Pharm-D programs, aged 20-28 years, was selected. Participants included both males and females who used computers for more than two hours daily and had no history of cervical trauma or underlying medical conditions. Data were collected using the Neck Disability Index (NDI) questionnaire and the Numeric Pain Rating Scale (NPRS). Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Data analysis was performed using SPSS version 25, with descriptive statistics summarizing demographic information and inferential statistics examining associations between neck pain and risk factors. Results: The study found that 29.2% of participants reported no pain, 20.8% had very mild pain, 45.8% had moderate pain, and 4.2% experienced severe pain. Weak correlations were observed between neck pain and disabilities, with 33.33% of participants able to care for themselves without pain, 62.50% able to care for themselves with extra pain, and 4.17% finding personal care difficult and slow. Regarding headaches, 16.67% reported no headaches, 20.83% had slight headaches infrequently, and 62.50% experienced moderate headaches frequently. Conclusion: The study concluded that a significant number of university students suffer from neck pain due to prolonged computer use, with most experiencing mild to moderate pain. Preventive measures, including ergonomic interventions and educational initiatives on proper posture and taking breaks, are essential to reduce the incidence of neck pain and improve the quality of life for computer users.

Stem cell therapy outcome for diabetic erectile dysfunction: A pilot analysis

Background Many males encounter the condition of erectile dysfunction (ED), particularly individuals diagnosed with type 2 diabetes mellitus (DM). Stem cell therapy is a burgeoning treatment modality being explored for individuals with erectile dysfunction in the context of type 2 DM. Nevertheless, the available body of clinical evidence supporting its efficacy remains limited. This study aims to assess the effectiveness and safety of umbilical cord-derived mesenchymal stem cell (MSC) therapy in managing erectile dysfunction (ED) resulting from type 2 DM. Methods A randomized, double-blind, placebo-controlled trial was conducted at Dr. Cipto Mangunkusumo Hospital in Indonesia from October 2020 to January 2023. A total of 26 eligible patients were randomly assigned to two groups: one receiving intracavernosal injections of MSC and the other receiving a placebo. Follow-up assessments were conducted at baseline, month one, and month three. The primary outcomes were measured using the IIEF-5 questionnaire and dorsal artery peak systolic velocity (PSV). Metabolic markers were used as secondary outcomes. Results The IIEF-5 scores for both groups showed a significant increase (p < 0.001) from baseline to month three. There was no significant difference observed between the MSC and placebo groups. Moreover, no significant differences were observed in the PSV of the dorsal artery between the two groups (p>0.05). There were no significant differences in metabolic markers between the groups. The incidence of mild post-injection pain was reported by only 11% of individuals, indicating a low occurrence of adverse events. Conclusions Intracavernous administration of MSC did not demonstrate superior efficacy compared to a placebo in improving metabolic or erectile function in diabetic males with erectile dysfunction. Additional research utilizing larger sample sizes and more extended follow-up periods is necessary.

Metal-backed or all-poly tibial components: which are better for medial unicompartmental knee arthroplasty? A propensity-score-matching retrospective study at the 5-year follow-up

BackgroundThis retrospective medium-term follow-up study compares the outcomes of medial fixed-bearing unicompartmental knee arthroplasty (mUKA) using a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component.Materials and methodsThe database of our institution was mined for primary mUKA patients implanted with an MB or an AP tibial component (the MB-UKA and AP-UKA groups, respectively) from 2015 to 2018. We compared patient demographics, patient-reported outcome measures (PROMs), and motion analysis data obtained with the Riablo™ system (CoRehab, Trento, Italy). We conducted propensity-score-matching (PSM) analysis (1:1) using multiple variables.ResultsPSM analysis yielded 77 pairs of MB-UKA and AP-UKA patients. At 5 years, the physical component summary (PCS) score was 52.4 ± 8.3 in MB-UKA and 48.2 ± 8.3 in AP-UKA patients (p < 0.001). The Forgotten Joint Score (FJS-12) was 82.9 ± 18.8 in MB-UKAs and 73.4 ± 22.5 in AP-UKAs (p = 0.015). Tibial pain was reported by 7.8% of the MB-UKA and 35.1% of the AP-UKA patients (p < 0.001). Static postural sway was, respectively, 3.9 ± 2.1 cm and 5.4 ± 2.3 (p = 0.0002), and gait symmetry was, respectively, 92.7% ± 3.7 cm and 90.4% ± 5.4 cm (p = 0.006). Patient satisfaction was 9.2 ± 0.8 in the MB-UKA and 8.3 ± 2.0 in the AP-UKA group (p < 0.003).ConclusionsMB-UKA patients experienced significantly better 5-year static sway and gait symmetry outcomes than AP-UKA patients. Although the PROMs of the two groups overlapped, MB-UKA patients had a lower incidence of tibial pain, better FJS-12 and PCS scores, and were more satisfied.

6302061 Obstetric patient's perspectives on the preoperative consent process, incidence of intraoperative pain, its management and overall satisfaction

6302061 Obstetric patient's perspectives on the preoperative consent process, incidence of intraoperative pain, its management and overall satisfaction

Post-Transplant Nephroptosis as a Cause of Recurrent Urinary Tract Infections: A Case Report

ObjectiveThe aim of this study is to present a rare cause of recurrent urinary tract infections (UTI) in a patient after kidney transplantation. MethodsPatient's consent was obtained and full medical documentation was reviewed. After analyzing the literature, only 3 case reports of post-transplant nephroptosis were found. ResultsA 32-year-old woman with a history of type 1 diabetes, after kidney and pancreas transplantation a year earlier, was admitted to hospital due to another incident of fever, dysuria and pain of lower abdomen. Recurrent UTIs had been occurring for several months despite prophylaxis, initially with co-trimoxazole and then with fosfomycin. There were no anatomic abnormalities and tacrolimus concentrations always remained at the lower range of normal. Kinking of the ureter was suspected because of a change in the position of the transplanted kidney. Ultrasonography performed in the standing and lying position confirmed the diagnosis. A DJ catheter was inserted into the ureter. In the following months, no recurrence of UTI or urinary retention was observed. Nephroptosis of a transplanted kidney is extremely rare. The standard place for graft implantation - the iliac fossa - significantly limits the potential for migration. Kidneys implanted intraperitoneally also do not show clinically significant mobility due to postoperative adhesions. Floating kidney potentially leads to serious complications. In addition to pain, a migrating graft may cause urine retention, predisposing to UTI and acute kidney injury. ConclusionsNephroptosis of transplanted kidney is extremely rare, therefore the diagnosis is not always obvious, which may result in treatment delay.

Association of using enteral nutrition containing probiotics and dietary inflammatory index with inflammatory factors serum levels and gastrointestinal complications in infected patients with COVID-19

Purpose This paper aims to examine the association between the dietary inflammatory index, the consumption of Enteral Nutrition Supplemented with probiotics with certain serum inflammation markers and gastrointestinal complications among individuals diagnosed with COVID-19. Design/methodology/approach This cross-sectional investigation involved 100 COVID-19 patients who were admitted to intensive care units in hospitals. These patients were administered two different types of Enteral Nutrition, so the dietary inflammatory index (DII), gastrointestinal complications and some serum inflammation markers have been compared between two groups. Findings The mean DII scores in all patients were significantly pro-inflammatory (probiotic formula 2.81 ± 0.01 vs usual formula group 2.93 ± 0.14 p = 0.19). The probiotic formula consumption had an inverse association with High-sensitivity C-reactive Protein concentration (coef = −3.19, 95% CI −1.25, −5.14 p = 0.001) and lead to a reduction of 2.14 mm/h in the serum level of Erythrocyte sedimentation rate compared to normal formula. The incidence of diarrhea, abdominal pain and vomiting in probiotic formula patients was respectively 94%, 14% and 86% less than in usual formula patients (p = 0.05). Originality/value In this cross-sectional study for the first time, the authors found that probiotic formula consumption was inversely associated with serum inflammation markers and gastrointestinal complications incidence. The high DII leads to more gastrointestinal complications incidence and inflammation markers. More studies are needed to prove this relationship.

Associations between back pain incidence, and physical activity and sedentary behaviours: A prospective cohort study with data from over 365,000 participants.

OBJECTIVE: To examine the associations between (i) various types of physical activity and the risk of back pain incidence, and (ii) the influence of substituting sedentary behaviours with physical activities on back pain incidence. DESIGN: A prospective cohort study. METHODS: We analyzed UK Biobank data collected from 365,307 participants who were free of back pain at baseline. The exposures were total, light, moderate and vigorous physical activity, and sedentary behaviours. The outcome was back pain incidence. The main statistical models were the Cox proportional hazard model and the isotemporal substitution model. RESULTS: In the follow-up time (median, 12.97 years; inter-quartile range, 12.10-13.71), 25,189 individuals developed back pain. The associations between all types of physical activity and incident back pain were significantly non-linear (p < 0.001) among the general population and other subgroups. High physical activity was associated with a decreased risk of back pain compared with no physical activity. The lowest risk occurred in the 1801-2400 MET-min/week subgroup of total physical activity (HR 0.64, 95% CI 0.59-0.69), approximately consisting of 1200, 600, and 600 MET-min/week of light, moderate and vigorous physical activity, respectively. Extremely high vigorous physical activity was related to high risk, specifically in males (HR 1.13, 95% CI 1.02-1.25). Replacing 1 hour/day of sedentary behaviours with an equal time of physical activity reduced the risk of incident back pain by 2%-8% (p < 0.05). CONCLUSION: Physical activity was related to a reduced risk of back pain incidence (except over-high vigorous physical activity). Substituting sedentary behaviours with physical activities reduced the risk of future back pain.

Comparative study of mesh fixation versus without mesh fixation in laparoscopic inguinal hernia repair by TAPP approach

Background: An inguinal hernia is a protrusion of abdominal contents through the inguinal canal. Laparoscopic TAPP inguinal hernia repair without mesh fixation is comparitively easy and safer than TAPP with mesh fixation with no increase in recurrence rate. Hence the current study was conducted to analyse complications after laparoscopic inguinal hernia repair (TAPP) with mesh fixation vs without mesh fixation in patients with inguinal hernia. Patients has provided informed consent for publication. Methods: It was an observational cohort study, comparing the outcome in 60 patients undergoing laparoscopic TAPP for inguinal hernia, where patients were randomly allotted into two groups as 30 with mesh fixation and 30 without mesh fixation over a period of two years October 2020 to September 2022. Results: In the current study, we observed that recurrence was reported among 3.33% study subjects without mesh fixation. While Recurrence reported among 6.67% study subjects with mesh fixation. However, the difference in the observations was statistically not found to be significant and there is significant reduction in postoperative pain, operation duration and hospital stay duration in laparoscopic TAPP without mesh fixation group. Conclusions: It was observed that laparoscopic TAPP repair without mesh fixation does not increase recurrence rate but reduces operative duration, hospital stay duration and decreases the incidence of postoperative pain compared to laparoscopic TAPP with mesh fixation.

A Comparison of the Immunogenicity and Safety of an Additional Heterologous versus Homologous COVID-19 Vaccination among Non-Seroconverted Immunocompromised Patients after a Two-Dose Primary Series of mRNA Vaccination: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to compare the immunogenicity and safety of an additional heterologous (viral vector) versus homologous (mRNA) COVID-19 vaccine dose among non-seroconverted immunocompromised patients after a two-dose primary series of mRNA vaccine. We searched studies published up to 21 June 2023 in PubMed, Scopus, and Embase. The meta-analysis was conducted to compare the seropositivity rates based on anti-SARS-CoV-2 spike protein IgG (anti-S IgG) and SARS-CoV-2-specific T-cell immune response rates, assessed by interferon-γ release assay at 4 weeks, and the incidences of serious adverse events (SAEs) within 28 days between the two vaccine regimens. In four included randomized controlled trials (RCTs), there were no statistically significant differences in the seropositive rate of anti-S IgG (risk ratio [RR]: 0.79, 95% CI: 0.48–1.29) and the concentration of SARS-CoV-2 interferon-γ (RR: 1.19, 95% CI: 0.96–1.48) between heterologous and homologous regimens. The heterologous regimen exhibited a significantly lower incidence of injection pain (RR: 0.55, 95% CI: 0.45–0.69), but a higher incidence of headache (RR: 1.44, 95% CI: 1.02–2.02) compared with the homologous regimen. No vaccine-related SAEs were reported within 28 days following vaccination. An additional heterologous or homologous COVID-19 vaccine dose was well tolerated and demonstrated a comparable vaccine immunogenicity among non-seroconverted immunocompromised patients who were initially vaccinated with a two-dose COVID-19 mRNA vaccine. This finding supports the recommendations of an extended primary series of COVID-19 vaccination in immunocompromised persons.

Incidence and risk factors of chronic postoperative pain in same-day surgery: A prospective cohort study.

The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting. We assessed pain 90 days after ambulatory surgery in an international, multicentre prospective cohort study of patients ≥45 years old with comorbidities or ≥65 years old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change ≥1 in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain as a score ≥4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression. Between November 2021 and January 2023, a total of 2054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain prior to surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were: active smoking (OR 1.82; 95% CI 1.20 to 2.76), orthopaedic surgery (OR 4.7; 95% CI 2.24 to 9.7), plastic surgery (OR 4.3; 95% CI 1.97 to 9.2), breast surgery (OR 2.74; 95% CI 1.29 to 5.8), vascular surgery (OR 2.71; 95% CI 1.09 to 6.7), and ethnicity (i.e., Hispanic/Latino ethnicity OR 3.41; 95% CI 1.68 to 6.9 and First Nations/Native persons OR 4.0; 95% CI 1.05 to 15.4). Persistent postsurgical pain after same-day surgery is common, usually moderate to severe in nature, and occurs mostly in patients without chronic pain prior to surgery.

Effect of propofol and ciprofol on the euphoric reaction in patients with painless gastroscopy: A prospective randomized controlled trial

ObjectiveTo explore the effects of propofol and ciprofol on patient euphoric reactions during sedation in patients undergoing gastroscopy and to investigate potential factors that may influence euphoric reactions in patients. MethodsA total of 217 patients were randomly divided into two groups: the propofol group (P group, n = 109) and the ciprofol group (C group, n = 108). The patients in the P group were given 2 mg/kg propofol, and those in the C group were given 0.5 mg/kg ciprofol. The patients were assessed using the Addiction Research Center Inventory-Chinese Version (ARCI-CV) to measure euphoric reactions at three time points: preexamination, 30 min after awakening, and 1 week after examination. Anxiety, depression, and sleep status were evaluated using appropriate scales at admission and 1 week after the examination. The dream rate, sedative effects, vital sign dynamics, and adverse reactions were documented during the sedation process. ResultsAfter 30 min of awakening, the P group and C group showed no statistically significant differences in the mean morphine-benzedrine group (MBG) score (8.84 vs. 9.09, P > 0.05), dream rate (42.2 % vs. 40.7 %, P > 0.05), or MBG score one week after the examination (7.04 vs. 7.05, P > 0.05). The regression analysis revealed that sex, dream status, Alcohol Use Disorders Identification Test (AUDIT) score, and examination time had notable impacts on the MBG-30 min score. No statistically significant differences were observed in sedative effects, anxiety, depression, or sleep status between the two groups (P > 0.05). The incidence of injection pain and severe hypotension was significantly lower in the C group (P < 0.05), and hemodynamics and SpO2 were more stable during sedation (P < 0.05). ConclusionThere was no significant difference between propofol and ciprofol in terms of euphoria experienced by patients after sedation in patients undergoing gastroscopy. Ciprofol has demonstrated addictive potential similar to that of propofol, warranting careful attention to its addictive potential during clinical application.

Incidence of Foot and Ankle Pain in Housemaids using Foot and Ankle Outcome Score

The aim is to find out incidence of foot and ankle pain among housemaids using foot and ankle outcome score since the physical demands of housemaids often go unrecognised ,particularly in relation to musculoskeletal disorders. Among these, foot and ankle pain stands out due to the extensive periods of standing, walking, and performing physically demanding tasks that are inherent to their roles. So to reduce the risk of injury following pain, we have conducted this research.

Foramen Facet Spinal Classification for Ossification of the Posterior Longitudinal Ligament on Computed Tomography: Closely Related to Clinical Efficacy.

Retrospective study. To develop and validate computed tomography (CT)-based classification schemes to eliminate ambiguity as much as possible and evaluate the adequacy and clinical value of its classification. There is no objective criteria for laminoplasty of more than one million Chinese patients with ossification of the posterior longitudinal ligament (OPLL) every year. CT imaging can accurately show the location, size, and shape of ossification, it is very important to propose a recognized simple classification of ossifications. From 2016 to 2018, 100 patients with "moderate to severe" OPLL on CT were performed according to the following criteria. This study simply classifies the grade of the ossification as 1-2-3, the zone is A-B by the foramen facet spinal canal classification, and the interexaminer reliability is 96%. A prospective series of 60 patients for laminoplasty was performed between 2018 and 2019, and this classification scheme was verified according to the new standard. All patients with size 1 were selectively excluded from consideration for surgery. The Japanese Orthopedic Association scores from both series are superior to most published results for patients with OPLL. The first and second series reported good to excellent results of 89% and 93.3%, respectively, and 80% and 85% for 24 months. The difference in the incidence of C5 paralysis and axial pain was statistically significant among the different zones, and most of them recovered within 6 months. The most common size and location types are 2-AB, 3-AB, and 2A. The most severe type is 3-AB. The foramen facet spinal classification of OPLL is a simple and reliable method for objectively evaluating the ossification of patients with OPLL based on CT research. Level III.

Efficacy and safety of ciprofol for sedation in outpatient gynecological procedures: a phase III multicenter randomized trial.

Ciprofol (also known as cipepofol and HSK3486), is a compound similar to propofol in chemical structure and hypnotic effect. Herein we evaluated the efficacy and safety of ciprofol for sedation in outpatient gynecological procedures. This phase III multicenter randomized trial with a non-inferiority design was conducted in nine tertiary hospitals. We enrolled 135 women aged 18-65 years who were scheduled for ambulatory gynecological procedures. Patients were randomly assigned to receive either ciprofol (0.4 mg/kg for induction and 0.2 mg/kg for maintenance) or propofol (2.0 mg/kg for induction and 1.0 mg/kg for maintenance) sedation in a 2:1 ratio. Patients and investigators for data collection and outcome assessment were blinded to study group assignments. The primary outcome was the success rate of sedation, defined as completion of procedure without remedial anesthetics. The non-inferiority margin was set at -8%. Secondary outcomes included time to successful induction, time to full awake, time to meet discharge criteria, and satisfaction with sedation assessed by patients and doctors. We also monitored occurrence of adverse events and injection pain. A total of 135 patients were enrolled; 134 patients (90 patients received ciprofol sedation and 44 patients propofol sedation) were included in final intention-to-treat analysis. The success rates were both 100% in the two groups (rate difference, 0.0%; 95% CI, -4.1 to 8.0%), i.e., ciprofol was non-inferior to propofol. When compared with propofol sedation, patients given ciprofol required more time to reach successful induction (median difference [MD], 2 s; 95% CI, 1 to 7; p < 0.001), and required more time to reach full awake (MD, 2.3 min; 95% CI, 1.4 to 3.1; p < 0.001) and discharge criteria (MD, 2.3 min; 95% CI, 1.5 to 3.2; p < 0.001). Fewer patients in the ciprofol group were dissatisfied with sedation (relative risk, 0.21; 95% CI, 0.06 to 0.77; p = 0.024). Patients given ciprofol sedation had lower incidences of treat-emergent adverse events (34.4% [31/90] vs. 79.5% [35/44]; p < 0.001) and injection pain (6.7% [6/90] vs. 61.4% [27/44]; p < 0.001). Ciprofol for sedation in ambulatory gynecological procedures was non-inferior to propofol, with less adverse events and injection pain. ClinicalTrials.gov, identifier NCT04958746.

The Effects of Perineural Dexamethasone on Rebound Pain After Nerve Block in Patients with Unicompartmental Knee Arthroplasty A Randomized Controlled Trial

Objectives: A single nerve block provides excellent analgesia in a short time, but rebound pain after the nerve block disappears has attracted researchers’ attention. The aim of this study is to evaluate the effect of perineural dexamethasone on rebound pain after sciatic nerve block and femoral nerve block in patients undergoing unicompartmental knee arthroplasty (UKA). Methods: In a double-blinded fashion, We recruited 72 patients undergoing UKA, each of whom received sciatic and femoral nerve block. Patients were randomly assigned to two groups (n=36): X (ropivacaine only) and D (ropivacaine combined with dexamethasone). The primary outcome was the incidence of rebound pain. The secondary outcomes were rebound pain score, the duration of rebound pain, the duration of nerve block, pain score, sufentanil consumption and rescue analgesic, patient-controlled intravenous analgesia, distance walked, sleep quality score, C-reactive protein levels, and adverse effects. Results: Compared with group X, the incidence of rebound pain in group D was higher, the rebound pain score was higher and the duration of nerve block was prolonged (P&lt;0.05). At 12, 16, and 20 hours postoperatively, the pain scores at rest in group D was lower. At 32 and 36 hours postoperatively, the pain scores at rest in group D was higher (P&lt;0.05). Moreover, patients in group D had lower levels of C-reactive protein after surgery (P&lt;0.05). Discussion: Addition of dexmedetomidine to ropivacaine for UKA effectively prolonged the duration of nerve block and decreased c-reactive protein levels, but increased the incidence of rebound pain and rebound pain score, and had no beneficial effects on the postoperative analgesia.

HARMONIZING DHARMA AND DEMOCRACY:

We Humans are the finest creation of the ultimate creator and thus the most complex. We have emotions, strength, intellect, ambitions and various other attributes. With Civilizations, came our greed for power, to attain supremacy and gradually the world became an interconnected, interdependent and interdisciplinary whole, where existence is more about the way one has carved their position in the society rather than how he survives. This tendency of human beings has created various nations, various powers and organizations with their rules, principles and procedures. The supreme laws of the countries represent the very principles which the citizens of that nation believe in. Likewise, in India, the Constitution; even though inspired by various other constitutions of world, is embodiment of those fundamental principles which Bharat as a nation has practiced since time immemorial. When we discuss the principles of ancient Bharat, (which ultimately became India of today) Bhagwad Gita stands in the forefront being the soul and spirit of all the prominent scriptures of ancient Bharat which forms the foundation of the ever-living Sanatan Dharma. This paper, therefore, attempts to discuss all such aspects of human life, where the principles of Gita are either applied to or should be applied for upliftment. It deals with the basic principles which Gita proposes, one among them is ‘Nishkamkarmyog’ or the principle of ‘Sthitpragya’ individual who doesn’t get affected by the everyday incidents of sorrow, pleasure or pain, but focuses on his/her goal understanding the true meaning of life which uplifts one from materialistic approach to a higher approach. How relevant these principles are to the legal fraternity, to the other dimensions of human lives, what principles our Constitution embodies? All such questions have been addressed through this paper.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Long-term outcomes after terminalization for acute fingertip injuries.

The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain.