Mean Pain Score Research Articles

Jasminum grandiflorum oral gel as an add-on to standard of care in radiation induced grade 2 oral mucositis - an open label pilot clinical trial

BackgroundRadiation-induced oral mucositis is one of the most critical dose-limiting toxicities associated with radiation therapy for oral cancer which can result in treatment interruption and compromise the quality of the life of cancer patients. Jati (Jasminum grandiflorum) is used in Ayurveda to treat oral conditions like stomatitis and mouth ulcers. ObjectiveTo test the feasibility of Jati oral gel as an add on therapy in grade 2 radiation-induced oral mucositis. Materials and methodsA prospective, open-label, non-randomised pilot trial was conducted on 20 patients with grade 2 radiation-induced oral mucositis at a tertiary cancer hospital. The control group received sodium bicarbonate mouthwash 4–5 times daily as the standard of care, while the intervention arm also received Jati oral gel twice daily. We used the ImageJ software for objective assessment and the Visual Analogue Scale for subjective pain assessment. The study was continued for 15 days or until the mucositis progressed to grade 3 or resolved to grade 1. ResultThere was a significant reduction in the mean pain score and mean area of mucositis in the intervention group compared to the control group. ConclusionJati oral gel is a suitable medicament as an add-on therapy in managing grade 2 radiation-induced oral mucositis.

Effect of music therapy on pain and anxiety during third molar surgery

Music therapy has been used with promising results to reduce pain and anxiety in surgical specialties. It is suggested to reduce anxiety and pain perception during dental surgeries and thereby improving clinical outcomes. Aim: The aim of this study is to determine whether listening to music during trans-alveolar mandibular third molar extraction reduces pain perception and anxiety. Methods: One hundred and forty-six adult participants were randomized into music and non-music groups, with each group comprising seventy-three participants. Each participant had trans-alveolar third molar extraction with or without music intervention depending on the group randomly assigned. Pain scores of participants were measured at one minute after consent, during and after administration of local anaesthetic, during osteotomy, after tooth delivery, and one minute after flap closure. Postoperative pain scores were recorded at one-hour, 3-hour, 6-hour, 24-hour and 48-hour after the last stitch. Pre- and post-operative anxiety scores were also recorded. Descriptive statistics was used to describe sociodemographic data. Student t-test was used to compare the mean of quantitative variables between the groups while chi-square test was used to compare proportions and to investigate association between categorical variables. The statistical significance was defined at p<0.05. Results: The study showed similar sociodemographic characteristics, baseline clinical features and duration of surgery between groups. Pain score peaked during local anaesthetic administration (p = 0.254) and at 3 hours after surgery (p = 0.170) but no statistically significant difference was observed in the mean pain score. The mean anxiety scores also revealed no statistically significant differences. Conclusion: Music was found to add no significant anxiolytic and adjunctive analgesic benefit to participants who underwent third molar surgeries in this study.

Vitamin D Levels in Growth-Paining Children

The most common cause of non-inflammatory recurrent musculoskeletal pain in children is growing pains. History and physical examination are often sufficient to diagnose these patients. Since the exact etiology is not known, different treatments can be applied. The effect of vitamin D levels on children with growing pains was investigated. Clinical and laboratory findings of 138 pediatric patients with growing pain and 30 healthy control subjects were examined and then the changes in pain scores of children and their families with follow-up and treatment were evaluated. The pain was most commonly seen in the form of lower extremity pain at night and in girls. Although growing pains can be treated with nonpharmacological methods, there were also patients who required pharmacological treatment. Vitamin D deficiency was observed in children with growing pain. Vitamin D treatment was given to 46 patients with vitamin D deficiency. Pain scores made by both themselves and their families decreased in 91.4% of the patients who came for control. After the use of vitamin D in children with growing pains, the mean pain score reported by the children decreased from 7.26±1.757 to 2.46±2.38. The mean pain score reported by families about their children decreased from 7.56±1.97 to 2.51±2.53 after vitamin D supplementation. Although most of the time growing pain is a self-limiting clinical picture, vitamin D supplementation may be necessary after a differential diagnosis was made because of the high level of anxiety in the families of children who do not respond to non-pharmacological approaches.

Total hip arthroplasty with porous tantalum trabecular metal pads in patients with Crowe IV developmental dysplasia of the hip: a midterm followup study

PurposeCrowe IV developmental dysplasia of the hip (DDH) is a catastrophic hip disease. Moreover, obtaining ideal clinical efficacy in conventional total hip arthroplasty (THA) is often difficult. In this study, we aimed to assess the mid-term clinical results of THA with porous tantalum trabecular metal (TM) pads for acetabular reconstruction in the treatment of Crowe IV DDH.MethodsA cohort of 28 patients (32 hips) diagnosed with Crowe type IV DDH who underwent acetabular reconstruction during THA using TM pads with scheduled follow-up between 2011 and 2018, were included in this study. Eight cases were men and 24 were women, with a mean age of 48.4 years (range, 36–72 years) and a mean follow-up was 74.3 months (range, 42–132 months). All patients underwent acetabular reconstruction using TM pads and total hip replacement with subtrochanteric osteotomy.ResultsAt the final follow-up, 28 hips (87.5%) demonstrated mild or no postoperative limping. The Harris Hip Score improved from 58.4 ± 10.6 preoperatively to 85.6 ± 8.9. The mean pain, stiffness, and function scores on the Western Ontario and McMaster University Osteoarthritis index were 86.5 ± 10.2, 87.3 ± 12.4 and 85.4 ± 11.6 respectively. The mean score of patient satisfaction was 90.4 ± 7.6. Additionally, the SF-12 physical summary score was 41.8 ± 5.6 and the SF-12 mental summary score was 51.6 ± 5.4. TM construct survivorship due to all-cause failure was 90.6% at 5 years with 3 hips at risk, 87.5% at 10 years with 4 hips at risk. The survivorship due to failure from aseptic loosening was 96.9% at 5 years with 1hips at risk and 93.75% at 10 years with 2 hips at risk.ConclusionThis study demonstrated satisfactory mid-term clinical and radiological results with the application of TM pads for acetabular reconstruction combined with THA in patients with Crowe IV DDH.Trial registration numberChiCTR1800014526, Date: 18/01/2018.

Impact of Music Therapy on Pain, Stress, and Physiological Parameters Among Postoperative Patients

ABSTRACT Introduction: Post-surgery acute pain is often uncontrolled, causing significant harm to patients, despite improvements in pain management. Music therapy can help to reduce physiological and psychological stress, making it a valuable tool for stress and pain Alleviation. Objectives: To evaluate the effectiveness of music therapy on pain, stress, and physiological parameters among postoperative patients. Methods: With 60 samples that matched the inclusion criteria, a quasi-experimental pretest and posttest study methodology was used. Before the music intervention, after the postoperative day 0, and after the intervention on the 7th postoperative day, the physiological parameters for both groups were collected together with the pain score and stress level using a Numerical Rating scale (NRS) and Perceived Stress Scale. Both descriptive and inferential statistics have been used for the data. Result: In comparison to the control group, there was a significant decrease in the study group’s mean scores for pain and stress, and found significant changes in physiological variables such as pulse rate, SPO2, respiration rate, and systolic and diastolic BP. Conclusion: Among postoperative patients, music was found to have positive effects on pain, stress, and physiological markers.

Poster 169: Preliminary Outcomes of Revision UCL Repair With Suture Tape Augmentation for Failure of Primary UCL Reconstruction in Professional and Collegiate Pitchers

Objectives: Injury of the ulnar collateral ligament (UCL) is common in baseball players and pitchers, in particular. The gold standard surgical treatment has been UCL reconstruction with autograft, although, UCL repair with collagen-coated suture tape has shown promise as an alternative recently. The outcomes of UCL reconstruction and UCL repair are well-studied, demonstrating high rates of return to sport and a predictable postoperative course of recovery. However, revision UCL reconstructions with allografts do not demonstrate comparable outcomes when compared with primary procedures. This pilot case series reports on the preliminary outcomes of collegiate and professional pitchers who underwent revision UCL repair with collagen-coated suture tape following failure of primary UCL reconstruction. Methods: We performed a retrospective query of a prospectively collected data repository to identify patients at our institution who had undergone UCL repair with internal brace. Additional inclusion criteria included: 1) prior failed UCL reconstruction with autograft; 2) aged between 15 and 45 years; 3) at least 1-year post-operative. From the included cohort, we collected demographic, clinical, and surgical data from the electronic health record. We further collected patient-reported outcomes data using either a web-based database platform or via telephone, including the American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E; satisfaction, pain, and function subscales), the Kerlan Jobe Orthopaedic Clinic Shoulder and Elbow score (KJOC), Andrews Carson score, and information on return-to-sport timing and success. To evaluate outcomes, we reported the proportions of athletes that were able to successfully return-to-sport at the preinjury level or higher as well as return-to-sport timing and level of competition. Additionally, we reported summary statistics for patient-reported questionnaires evaluated at follow-up (ASES-E, KJOC, and Andrews Carson). Results: A total of 10 patients met inclusion criteria, and all were professional or collegiate pitchers at the time of their revision UCL repair surgery (40% professional and 60% collegiate). The mean follow-up time was 3.0 years (Table 1; range: 1-5 years). Table 1 shows complete return-to-sport data. All patients were able to return-to-sport at the same or higher level, and the mean time from surgery to return-to-sport was 9.3 months. Table 2 shows complete patient-reported outcomes data. Mean scores on elbow-related function questionnaires were high (ASES-E Function = 35.8 out of a maximum best of 36; KJOC = 88.3 out of a maximum best of 100; Andrews Carson = 94.5 out of a maximum best of 100) and mean pain scores were low (ASES-E Pain = 1 out of a maximum worst score of 50). Conclusions: This pilot case series demonstrated promising results of a novel UCL repair approach utilizing collagen-coated suture tape for high-level pitchers with recurrent medial elbow instability following initial UCL reconstruction with autograft. Specifically, we found excellent return-to-sport success and patient-reported outcomes in this preliminary cohort. Further study is warranted with larger sample sizes to further evaluate outcomes following revision of UCL reconstruction with UCL repair utilizing internal bracing.

Evaluation of Pain and Discomfort Associated with Orthodontic Adjustments.

Orthodontic treatment is commonly associated with pain and discomfort, impacting patient experience and treatment compliance. Understanding the factors influencing pain perception is crucial for improving pain management strategies during orthodontic adjustments. Pain levels were assessed using a "Visual Analog Scale (VAS)" before and after each adjustment session. Qualitative data were collected through semi-structured interviews conducted immediately post-adjustment. Statistical analyses were performed to compare mean pain scores before and after adjustments, and thematic analysis was conducted to identify common themes in qualitative data. Quantitative analysis revealed a significant increase in mean pain scores following orthodontic adjustments (P < 0.001). Qualitative analysis identified themes related to pain experiences, including anticipation of discomfort, adaptation over time, and coping strategies employed by patients. Orthodontic adjustments induce varying levels of pain and discomfort among patients. By integrating quantitative and qualitative assessments, this study provides comprehensive insights into patient experiences during orthodontic treatment, informing strategies for pain management and patient care.

Multiligament Knee Reconstruction With Suture Tape Augmentation: Patient-Reported Outcomes at Minimum 2-Year Follow-up.

Multiligament knee injury (MLKI) is a severe subclass of orthopedic injury and can result in significant functional impairment. Novel MLKI graft constructs such as suture augmentation aim to enhance graft strength and optimize knee stability. The purpose of this study was to present patient-reported outcome measurements of a cohort at a minimum follow-up of 2 years after multiligament knee reconstruction (MLKR) with suture augmentation. A retrospective chart review was performed to identify patients who underwent MLKR with suture augmentation. Demographic and injury-specific variables were gathered preoperatively and postoperatively. Patients were contacted at a minimum of 2 years postoperatively to collect Patient-Reported Outcomes Measurement Information System, Multiligament Quality of Life, and Lysholm knee scores. Twenty-seven patients underwent MLKR with suture augmentation, with 15 being female (55.6%) and 12 being male (44.4%). The mean pain score was 49.93±9.96, the mean physical function score was 49.56±10.94, and the mean mobility score was 47.56±8.58. The mean physical impairment score was 33.96±23.69, the mean emotional impairment score was 36.55±26.60, the mean activity limitation score was 28.00±25.61, and the mean societal involvement score was 30.09±27.45. The mean Lysholm knee score for the cohort was 67.93±22.36. Patients who underwent MLKR with suture augmentation had satisfactory scores across all patient-reported outcome measurements. On the basis of these criteria, the average patient achieved an acceptable clinical outcome, demonstrating that MLKR with suture augmentation is a safe and efficacious surgical technique for the treatment of MLKI. [Orthopedics. 2024;47(4):238-243.].

Effectiveness of Brassica juncea (Mustard) Plaster on Reduction of Knee Pain and Inability among Geriatrics with Osteoarthritis.

Pre-experimental one-group pretest posttest research design was adopted to investigate the effectiveness of Brassica juncea (mustard) plaster on reduction of knee pain and inability among 60 geriatrics with osteoarthritis. The inability was assessed using the Western Ontario McMaster University (WOMAC) Index, which includes 24 parameters under three major headings: joint pain, joint stiffness, and difficulty in performing daily activities, and the severity of pain level was assessed using a numerical pain rating scale. Mustard plaster is applied against the knee for 15 minutes once a day for seven days. On day 8, study participants were re-assessed using the WOMAC Osteoarthritis Index in the interventional group. The pretest mean score of pain was 77.80 ± 5.65, and the posttest mean score was 38.88 ± 11.76. The mean difference score was 38.92. The calculated paired 't' test value of t = 24.428 was statistically significant at P < 0.001 level.

Determining Efficacy of Intracanal Cryotherapy on Post Endodontic Pain in Irreversible Pulpitis

Endodontic cryotherapy is a procedure that reduces pain and inflammation by applying cold to tissues, aiming to decrease post-endodontic pain. Objectives: To compare the effectiveness of cryo-treated endodontic irrigant in reducing post-endodontic pain in mandibular molars with irreversible pulpitis. Methods: This comparative analytical study was conducted from December 2023 to February 2024 in the Department of Operative Dentistry at Lahore Medical and Dental College. It included patients of both genders, aged 18 to 60, with symptomatic irreversible pulpitis in mandibular molars and pre-endodontic pain of VAS 7-10 for 10 days or less. Patients were divided into two groups: Group A (normal saline) and Group B (cryotherapy). Patients were instructed on using the Visual Analogue Scale (VAS) to assess pain. Group B received final irrigation with 20 ml normal saline at 2.5°C for 5 minutes, while Group A received 20 ml normal saline at room temperature. Pain scores were recorded preoperatively and at 24 and 48 hours’ post-treatment via telephone interviews. Data were analyzed using SPSS version 25 and a repeated measures ANOVA test assessed VAS scores across time points. A p-value &lt;0.05 was considered significant. Results: 45 (46%) were male and 53 (54%) were female patients, with mean age of patients being 35.71 ± 10.71years. At 24 hours postoperatively, the mean VAS score was 1.51 ± 1.2 for the normal saline group and 0.98 ± 0.9 for the cryo-treated saline group. By 48 hours postoperatively, the mean VAS score further decreased to 0.27 ± 0.5 for the normal saline group and 0.12 ± 0.4 for the cryo-treated saline group. The mean differences in VAS scores at 24 hours showed significant difference in mean pain score (P-value&lt;0.05) but at 48 hours between the two groups showed no significant difference (p = 0.104). Conclusions: Both saline groups significantly decreased pain, the type of saline, normal or cryo-treated, did not significantly impact overall pain scores differently between the groups.

Implementation of an Outpatient Cervical Ripening Program: Outcomes and Provider and Patient Perspectives

Purpose: The purpose of this study is to evaluate the implementation, outcomes, and patient/provider acceptance of an outpatient cervical ripening program for induction of labor (IOL) at a teaching hospital. Methods: In an effort to reduce patient risk resulting from congestion in the Labor and Delivery (L&amp;D) unit of a level III maternity hospital with 3400 annual births, our department promoted the use of outpatient cervical balloon ripening. Over the course of 5 months, educational materials were distributed, Grand Rounds were held, an appeal to use outpatient cervical ripening was issued, and providers received written personal requests to consider outpatient balloons for each of their upcoming eligible scheduled inductions. Despite these efforts, uptake was minimal, as determined by a manual review over a 1-month period. Beginning in September 2022, new workflows were mandated: all patients needing cervical ripening and not meeting a defined list of exclusions were required to have outpatient balloons placed 6-18 hours prior to IOL in L&amp;D, or to be scheduled for IOL over the weekend. Routine practice for inpatient balloons included planned removal after 6 hours and use of a ripening agent (vaginal misoprostol 25 ug every 3 hours for 1-2 doses or intravenous oxytocin). The institution’s Data Warehouse was queried to obtain clinical outcomes for all IOL requiring cervical ripening occurring over a 3-month period beginning one month after implementation of the new workflow (October-December 2022). A survey was distributed to all L&amp;D providers 1 month prior to and 5 months following initiation of the mandatory outpatient cervical ripening program. Providers were asked their perception on benefits, risks, barriers, and likeliness to recommend outpatient cervical ripening. Patients who delivered following IOL over the same 3-month period were contacted via telephone and/or email and consented to complete a survey regarding their delivery experience. Outcomes were compared using chi square and t-test Results: Outpatient cervical balloon utilization increased to 27.7% of eligible patients during the 3-month auditing period after implementation of mandatory outpatient cervical ripening from 7.2% at baseline. Among 141 subjects with inpatient and 54 with outpatient cervical balloons, there were no significant differences between groups in the rates of cesarean delivery (24.8% vs 18.5%, p=0.35), operative vaginal delivery (6.4% vs 11.1%, p=0.27), chorioamnionitis (12.1% vs 16.7%, p=0.40), postpartum hemorrhage (17.0% vs 13.0%, p=0.49), or NICU admission (12.1% vs 9.3%, p=0.58). Length of stay in L&amp;D was significantly less in the outpatient group (1606 minutes vs 1366, p=0.02). Fifty-three providers responded to the pre-implementation survey. Perceived benefits to outpatient ripening included less time in the hospital (94.3% of respondents), and patient comfort (37.7%). There were 34 respondents to the post-implementation survey. Decreased time in the hospital (94.3% pre vs 91.2% post, p=0.16) remained a perceived benefit, however patient comfort did not (37.7% pre vs 17.6% post, p=0.046). Concern over incorrect placement diminished significantly on post survey (50.9% pre vs 29.4% post, p=0.049). Respondents additionally reported concerns regarding delays in L&amp;D causing balloons to remain in situ for longer than scheduled and subsequent effect on patient anxiety. Barriers to outpatient ripening before and after implementation included office workflow (58.5% pre vs 52.9% post, p=0.65), and provider comfort with the procedure (32.1% pre vs 41.2% post, p=0.39). Over time, respondents were increasingly “somewhat” to “very likely” to recommend outpatient ripening to their patients (64.2% pre vs 91.7% post, p=0.004). On post survey, most respondents were “somewhat” to “very satisfied” with the current program (64.7%), and “somewhat” to “very likely” to recommend to their colleagues (82.4%). A total of 188 patients who underwent balloon cervical ripening were contacted, and 63 (33.5%) responded. Forty-five (71.4%) patients surveyed had a spontaneous vaginal delivery, 4 (6.35%) required operative vaginal delivery, and 14 (22.2%) underwent cesarean delivery. The majority (61.9%) were nulliparous. Seventeen (27%) patients had an outpatient balloon. Mean pain scores were not statistically significant between outpatient and inpatient groups (6.13 vs 5.28, p=0.25). There was no difference in patient self-perceived preparedness for balloon placement (41.2% outpatient vs 41.3% inpatient, p=0.99). There were no differences in delivery-related anxiety between groups (47.1% outpatient vs 60.9% inpatient, p=0.32) or in likelihood to recommend the experience (41.2% outpatient somewhat to very likely to recommend versus 32.6% inpatient, p=0.53). Conclusion: Adoption of outpatient cervical ripening required a mandatory program, as persuasion and education were insufficient to induce a change in practice. No differences were seen in delivery outcomes between inpatient and outpatient balloon ripening, though this analysis is not powered to assess outcomes. A 4-hour decreased length of stay on L&amp;D was observed in those who had an outpatient balloon. Providers are overall satisfied with outpatient cervical ripening. Patient satisfaction remains mixed regardless of cervical balloon placement location.

Colostrum supplementation enhance mental health status and alleviate pain in patients with acetabular fracture: A randomized, controlled, clinical trial

IntroductionRole of oral colostrum on mental health status, pain, and inflammatory markers in patients with acetabular fracture was investigated. Materials and MethodsFor 21 days, the intervention group received 40 g of colostrum daily and the control group received a placebo. Changes in mental health status, pain, and serum levels of CRP and IL-6 were evaluated over 90 days. ResultsThe risk of depressive symptoms and sleep disturbances in the colostrum group (n = 41) was significantly lower than the control group (n = 39), 14 and 60 days after surgery. The risk of anxiety symptoms in the colostrum group, 2 and 3 months after surgery, was significantly lower than the control group.Generalized estimating equation showed that the mean pain score and serum levels of CRP and IL-6 in the colostrum group were significantly lower than the control group during 90 days of follow-up. ConclusionColostrum improves mental health status, pain, and inflammatory markers.Iranian Registry of Clinical Trials: IRCT20220424054643N1.

Erector Spinae Plane Block Versus Thoracolumbar Interfascial Plane Block in Lumbar Spine Surgery: A Meta-Analysis of Randomized Controlled Trials.

Meta-analysis. To compare the effectiveness of postoperative pain control between erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block in lumbar spine surgery. PubMed, Embase, and MEDLINE electronic databases were searched for articles containing randomized controlled trials (RCTs) published between January 1900 and January 2024. We extracted the postoperative mean pain score, the first 24-h postoperative morphine consumption, and their standard deviation from the included studies. Meta-analysis was performed using the functions available in the metafor package in R software. We pooled continuous variables using an inverse variance method with a random-effects model and summarized them as standardized mean differences. Five RCTs that directly compared the ESPB and TLIP block in lumbar spine surgery were included, enrolling 432 participants randomly into the two groups with 216 participants in each group. The pooled analyses showed that there was no significant difference between the ESPB and TLIP groups in terms of lower pain scores during the early (1h) (standardized mean difference [SMD] -1.49, 95% confidence interval [CI], -3.10; 0.11), middle (12h) (SMD -3.12, 95% CI, -6.86; 0.61), and late (24h) (SMD -1.38, 95% CI, -3.01; 0.24) postoperative periods. There was also no significant difference in the first 24-h postoperative morphine equivalent consumption between the ESPB and TLIP groups (SMD -0.46mg, 95% CI -1.23; 0.31). No significant difference was observed between the ESPB and TLIP block in terms of postoperative pain control and 24-h morphine equivalent consumption for lumbar spine surgery.

Questionnaire-based screening of adolescents and young adult women can identify markers associated with endometriosis.

Do adolescents and young adult women (YAW) with histologically proven endometriosis present a specific clinical history? Questionnaire screening of adolescents and YAW can identify clinical markers associated with histologically proven endometriosis. Some validated questionaries can contribute to an earlier endometriosis diagnosis in adults. None of these scores, however, have been validated for adolescents or YAW. This was an observational cross-sectional study using prospectively recorded data performed between January 2005 and January 2020 in a single university tertiary referral centre for endometriosis diagnosis and management. After a thorough surgical examination of the abdomino-pelvic cavity, women with histologically proven endometriosis were allocated to the endometriosis group, and symptomatic women without evidence of endometriosis were allocated to the endometriosis-free control group. The endometriotic patients were allocated into two sub-groups according to their age: adolescent (≤20 years) and YAW (21-24 years). Adolescents and YAW ≤24 years of age were operated for a symptomatic benign gynaecological condition with signed informed consent. A standardized questionnaire was prospectively completed in the month before the surgery and included epidemiological data, pelvic pain scores, family history of endometriosis, and symptoms experienced during adolescence. The study searched for correlations by univariate analysis to determine clinical markers of endometriosis in adolescents and YAW compared with endometriosis-free control patients. Of the 262 study participants, 77 women were adolescents (≤20 years of age) and 185 patients (70.6%) were YAW. The endometriosis group included 118 patients (45.0%) and 144 (55.0%) were assigned to the control group. A family history of endometriosis, absenteeism from school during menstruation, history of fainting spells during menstruation, and prescription of oral contraceptive pills for intense dysmenorrhea were significantly more frequently observed in the endometriotic patients. The prevalence and mean pain scores for dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain and gastrointestinal and lower urinary tract symptoms were significantly greater in the endometriosis group, as was experienced rectal bleeding. The study was performed in a single referral centre that treats patients with potentially more severe disease. This questionnaire was evaluated on a population of patients with an indication for endometriosis surgery, which can also select patients with more severe disease. Women with asymptomatic endometriosis were not considered in this study. These factors can affect the external validity of this study. Patient interviews are relevant to the diagnosis of endometriosis in adolescents and YAW. Combined with imaging and clinical examination, this approach will enable earlier diagnosis and treatment, while remaining non-invasive and rapid. The study received no funding from external sources. There are no conflicts of interest. N/A.

Unveiling the Pathophysiology of Osteoarthritis in Joint Anatomy

Background: Osteoarthritis (OA) is a prevalent and debilitating joint disorder characterized by the degeneration of articular cartilage and underlying bone. Understanding the pathophysiology of OA is essential for developing targeted therapies and improving patient outcomes. Objective: To explore the underlying pathophysiological mechanisms of osteoarthritis within the context of joint anatomy, focusing on cartilage degradation, synovial inflammation, and subchondral bone changes. Methods: This prospective study was conducted at private hospitals in Karachi from June 2022 to December 2022. Eighty patients aged 45 to 70 years, diagnosed with OA, were included. Detailed clinical evaluations were performed, including pain assessment using the Visual Analog Scale (VAS) and functional status assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic analysis was conducted using the Kellgren-Lawrence grading scale. Biochemical analysis of serum and synovial fluid was performed to measure levels of collagen type II cleavage products (C2C), cartilage oligomeric matrix protein (COMP), and inflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). Synovial fluid and tissue samples were collected during arthroscopy or joint replacement surgery for molecular pathway analysis. Data were analyzed using SPSS version 25, with correlations and regression analyses performed to identify predictors of disease progression. Results: OA was associated with significant pain and functional impairment, with a mean pain score of 7.2 ± 1.3 on the VAS and WOMAC scores averaging 55 ± 10 for physical function and 30 ± 5 for stiffness. Radiographic analysis showed 25% of patients classified as grade II, 50% as grade III, and 25% as grade IV. Biochemical markers indicated elevated levels of C2C (serum: 150 ± 20 ng/mL; synovial fluid: 200 ± 25 ng/mL) and COMP (serum: 10 ± 2 µg/mL; synovial fluid: 15 ± 3 µg/mL). Inflammatory cytokines were also elevated (IL-1β: 50 ± 5 pg/mL; TNF-α: 75 ± 10 pg/mL; IL-6: 100 ± 12 pg/mL). A strong positive correlation (r = 0.85, p &lt; 0.01) was observed between VAS pain scores and synovial IL-1β levels. Conclusion: The pathophysiology of osteoarthritis involves a complex interplay of biomechanical, biochemical, and cellular factors. The findings from this study enhance the understanding of OA mechanisms and provide a foundation for developing more effective therapeutic strategies aimed at halting or reversing the progression of OA.

Comparing sucrose solution with distilled water for pain management in premature infant venipuncture: randomized clinical trial.

Managing pain is critical, especially for premature infants undergoing frequent painful procedures. Uncontrolled pain can lead to lasting harm in growth, cognitive development, and future pain responses. A double-blinded clinical investigation involving 150 premature infants was performed in a neonatal intensive care unit. They were randomly divided into three groups: Sucrose 20% (50 infants), distilled water (50 infants), and a control group (50 infants). The infants' behavioral responses were assessed using an infant pain measurement tool before, at 2, and 7 min after the intervention through direct observation. The study revealed that mean pain scores before, 2 min after, and 7 min after the intervention in the sucrose group were (4.78±0.91), (3.18±1.15), and (2±1.02), respectively. In the distilled water group, scores were (4.66±0.89), (3.04±1.15), and (3.08±1.10), while in the control group, they were (4.0±0.79), (4.94±0.79), and (4.72±0.96). The trend of pain scores varied among the groups over time, with a significant difference in mean pain scores at different time points (P<0.001). Initially comparable, pain scores notably decreased after 2 min in the sucrose and distilled water groups (P<0.001), differing from the control group. The study indicated that 20% sucrose and distilled water equally reduce infant pain post-venipuncture, suggesting their viability for clinical pain management. Distilled water, however, provides additional benefits, including economic considerations and ease of preparation.

COMPARISION OF LICHTESTEIN OPEN TENSION-FREE VERSUS LAPROSCOPIC TOTALLY EXTRAPERTIONEAL TECHNIQUE FOR INGUINAL HERNIA REPAIR

Objectives: The study aimed to assess and compare Litchtenstein’s open tension-free and laparoscopic totally extraperitoneal (TEP) mesh repair. Methods: This hospital-based comparative type of observational study was conducted on 50 cases for each of two groups at upgraded Department of General Surgery, SMS Hospital, Jaipur, between January 2014 and January 2016. All the cases of elective inguinal hernia coming to SMS outpatient department in a single surgical unit operated by a single surgeon in the given period which meet the inclusion and exclusion criteria. Thus, collected data were entered in Microsoft Excel sheet and analysis was done by Epi info software of CDC. Results: Total 100 patients were included in this study; 50 each in the two groups, the laparoscopic TEP group and open Lichtenstein group. Mean age in the laparoscopic group was 39.54 years and the open Lichtenstein group was 42.78 years. The mean pain score out of 10 at 24 h was 2.96 (±0.638) and 3.60 (±0.969) in TEP and Lichtenstein groups, respectively. The mean return to work for open group was 17.00 and TEP group was 11.34 days. There is no any recurrence and readmission in both groups. Conclusion: Laparoscopic TEP repair may be done in all uncomplicated inguinal hernia by an experienced surgeon for those desiring less pain, better cosmotic results, less post-operative complications, less hospital stay, and early return to work.

A Prospective Study of Patients Presenting With Pre-sternal Keloids.

Keloid represents a pathological form of scarring. They are very common in the anterior chest area; nearly 50% of all keloids occur in this location. One of the reasons for this is that folliculitis and acne, known for triggering the development of keloids, are common on the anterior chest. The other reason is the tension load in this area due to the frequent movements of the upper limbs and the respiratory movements. These movements stretch the skin of the anterior chest horizontally. When this cyclical tension is imposed on the anterior chest wounds, there is an exacerbation and prolongation of the inflammation in the reticular dermis of the wound. These stresses induce the growth of keloids along the prevailing lines of skin tension. We performed a prospective study in which patients were recruited over a period of one year. Patients presenting with symptomatic pre-sternal keloids and requesting treatment but were unwilling to undergo surgical intervention were included in this study. Patients with a history of previous thoracic surgery were excluded. Baseline assessment and documentation of the lesion were performed. The study patients received three sessions of intralesional injections of a combination of triamcinolone acetonide and hyaluronidase at four weekly intervals. The final assessment was performed four weeks after the third session. The study included 47 lesions in 47 patients with ages of the patients ranging from 16 to 70 years. Pre-sternal keloids were found to be more common among males than females, with a male-to-female ratio of 2.35:1. Patients presented with pre-sternal keloids that had been present for varying periods ranging from three to 81 months. All of our 47 patients completed the three sessions of the treatment. Following the treatment, there was an improvement in the patient's symptoms, as evidenced by the reduction in the mean pruritis scores and pain scores. There was an overall reduction in the size of the lesion. The decrease in the height of the lesions was more evident than the reduction in the craniocaudal or transverse dimensions of the lesions. There were improvements in Vancouver Scar Scale(VSS) vascularity scores and pliability scores following the treatment. We conclude that pre-sternal keloids should be considered as a distinct clinico-pathological entity. There are differences with regard to pathogenesis, clinical presentation, and management when compared to keloids elsewhere. Treatment with intralesional injections of a combination of triamcinolone acetonide and hyaluronidase effectively relieves the symptoms and may be considered in patients not willing to undergo surgical intervention. Recurrences can occur and need further treatments.

INTRA-ARTICULAR HAEMATOMA BLOCK VERSUS PROCEDURAL SEDATION FOR MANIPULATION OF CLOSED ANKLE FRACTURE DISLOCATIONS: AN EFFICACIOUS, RESOURCE-SPARING SOLUTION?

BackgroundProcedural sedation (PS) requires two suitably qualified clinicians and a dedicated monitored bed space. We present the results of intra-articular haematoma blocks (IAHB), using local anaesthetic, for the manipulation of closed ankle fracture dislocations and compared resource use with PS.MethodsPatients received intra-articular ankle haematoma blocks for displaced ankle fractures requiring manipulation between October 2020 to April 2021. The technique used 10ml of 1% lignocaine injected anteromedially into the tibiotalar joint. Pain scores (VAS), time from first x-ray to reduction, and acceptability of reduction were recorded. A comparison was made by retrospective analysis of patients who had undergone PS for manipulation of an ankle fracture over the six month period March – August 2020.ResultsDuring the periods assessed, 25 patients received an IAHB and 28 received PS for ankle fractures requiring manipulation (mean age 57.8yr vs 55.1yr). Time from first x-ray to manipulation was 65.9 min (IAHB) vs 82.9 min (PS) (p = 0.087). In the IAHB group mean pain scores pre, during and post manipulation were 6.1, 4.7 and 2.0 respectively (‘pre’ to ‘during’ p &lt; 0.05; ‘pre’ to ‘post’ p &lt; 0.01). In the IAHB group, 23 (92%) had a satisfactory reduction without need of PS or general anaesthetic. In the PS group 23 (82%) had a satisfactory reduction. There was no significant difference in the number of unsatisfactory first attempt reductions between the groups. There were no cases of deep infection post operatively in either group.ConclusionIntra-articular haematoma block of the ankle appears to be an efficacious, safe and inexpensive means of providing analgesia for manipulation of displaced ankle fractures. Advantages of this method include avoiding the risks of procedural sedation, removing the requirement of designated clinical space and need for qualified clinicians to give sedation, and the ability to re-manipulate under the same block.

Multifactorial Nature of Fatigue in North Indian Rheumatoid Arthritis Patients.

Fatigue is a common, disabling, and poorly understood aspect of Rheumatoid arthritis (RA) treatment. Better understanding of fatigue is required for holistic treatment of RA. The present study was conducted to evaluate factors (disease activity, pain, sleep quality, and vitamin D) contributing to fatigue in RA. A cross-sectional study was conducted on 204 patients of RA. Fatigue was measured using CFQ-11 scale, pain and sleep impairment were assessed on visual analogue scale, disease activity by DAS 28 ESR, and vitamin D levels by enzyme chemiluminescence immunoassay. Univariate and multivariate binary logistic regression analyses were done to study association. Mean age of study subjects was 51±11.63 years with majority (89.7%) being females and mean duration of RA was 8.54 years. Prevalence of fatigue was 66.2% (CFQ-11 score >4/11). Deficiency of vitamin D was found in 12.3% subjects. Mean sleep impairment and pain score on VAS were 32.60±21.53 and 26.37±21.65 respectively. Univariate analysis revealed that CFQ-11 fatigue score was independently associated with disease activity, pain, sleep, and vitamin D deficiency. Further Multivariate binary logistic regression analysis showed strongest association of vitamin D deficiency with fatigue (OR of 6.38 with 95% confidence interval of 1.58, 25.71). Disease activity (OR - 1.714, 95% CI- 1.14, 2.55) and sleep impairment (OR - 1.038, 95% CI- 1.005, 1.071) have also been found to be significantly associated with fatigue. Fatigue in RA is multifactorial, and it is mediated by disease-related factors (disease activity, sleep impairment) and non-disease-related factors (vitamin D deficiency).