Patient Degree Research Articles

Local anesthesia for Reduction of Nasal Bone Fracture: our experience

Introduction: Nasal bone fractures are very common injuries, reduction under local anesthesia is the usual management, yet there is controversy about the efficacy of this management and if it satisfies the patient's functional and cosmetic needs. Objective: To assess both efficacy of nasal bone reduction under local anesthesia and patient's degree of satisfaction in regards to aesthetic and functional results. Patients and Methods: Retrospective analysis and review of 31 patients underwent nasal bone reduction under local anesthesia in Prince Hashim Military hospital in Zarqa, Jordan between May 2015 and June 2016. Digital and instrumental reduction under local anesthesia was performed with and without splint application after clinical and radiological assessment. Results were evaluated by objective clinical examination and subjective functional and cosmetic satisfaction. Results: Patients were divided into two groups according to gender, group A: males 23 (74.19%), group B: females 8 (25.8%), 20 patients of group A (86.95%) were happy with the functional and cosmetic outcome, 3 patients of group A (13.04%) were not happy with the cosmetic outcome but happy regarding the functional outcome, 5 patients of group B were happy with the functional and cosmetic outcome, 3 patients of group B were not happy regarding the cosmetic outcome but satisfied with the functional outcome, all patients in both groups except one patient in group A were had patent nasal airway on clinical and endoscopic examination. 2 patients from both groups sought revision surgery for cosmetic concerns only. Conclusion: Use of local anesthesia for reduction of nasal bone fractures offers both patent nasal airway and satisfactory cosmetic results.

¿Eco-FAST o tomografía computarizada multidetectora en el paciente hemodinámicamente inestable tras traumatismo de urgencias?

This critically appraised topic (CAT) study aims to evaluate the quality and extent of the scientific evidence that supports the use of focused assessment with sonography for trauma (FAST) versus multidetector computed tomography (MDCT) in hemodynamically unstable trauma patients in the emergency room. An efficient search of the literature yielded several recent articles with a high level of evidence. The CAT study concludes that FAST is an acceptable initial imaging test in hemodynamically unstable patients, although its performance is limited in certain circumstances. The decision whether to use MDCT should be determined by evaluating the patient's degree of instability and the distance to the MDCT scanner. Nevertheless, few articles address the question of the distance to MDCT scanners in emergency departments.

Factors affecting medication adherence in elderly people.

BackgroundLittle is known about the functional health literacy (FHL) associated with medication adherence in elderly patients. The aim of this study was to examine the FHL among older adults and identify influencing factors that can predict medication adherence.MethodsThis was a cross-sectional survey. Participants (n=160) aged 65 years and older were selected from outpatient clinics of 3 tertiary care hospitals, 6 community pharmacies, and 2 senior centers between November 1 and 30, 2014. The participants’ FHL was measured using the Korean Functional Health Literacy Test, which consists of 15 items including 8 numeracy and 7 reading comprehension items. Medication adherence was measured by the Adherence to Refills and Medication Scale. Descriptive statistics, chi-square or Fisher’s exact test, and multiple regression analyses were used to analyze the data.ResultsThe mean score of the total FHL was 7.72±3.51 (range 0–15). The percentage of the total number of correct answers for the reading comprehension subtest and numeracy subtest were 48.1% and 54.4%, respectively. Among 160 participants, 52.5% showed low adherence to medication. The factors affecting medication adherence included the patient’s degree of satisfaction with the service (β=−0.215, P=0.022), sufficient explanation of medication counseling (β=−0.335, P=0.000), education level (β=−0.153, P=0.045), health-related problems (β=−0.239, P=0.004), and dosing frequency (β=0.189, P=0.018).ConclusionIn this study, we found medication adherence of elderly patients was associated with education level, health-related problems, dosing frequency, satisfaction with patient counseling, and explanation of medication, but no association was found with FHL. Pharmacists should consider elderly patients’ individual characteristics such as educational background and specific patient-related health problems, provide sufficient information and explanation of medication, and ensure patient satisfaction with the counseling.

Influence of Body Mass Index on Subjective and Objective Measures of Pain, Functional Impairment, and Health-Related Quality of Life in Lumbar Degenerative Disc Disease

To analyze the influence of body mass index (BMI) on subjective and objective measures of pain, functional impairment, and health-related quality of life in patients with lumbar degenerative disc disease undergoing surgery. Prospective institutional review board-approved 2-center study, measuring visual analog scale (VAS) back and leg pain, Roland-Morris Disability Index (RMDI), Oswestry Disability Index (ODI), EuroQol 5D questionnaire, and Short Form-12 at baseline, 6 weeks, 6 months, and 1 year postoperatively. T-scores of objective functional impairment (OFI) were determined using the Timed Up and Go (TUG) test. A total of 375 patients with a median BMI of 26.6 kg/m2 (94 obese patients [BMI ≥30 kg/m2]) were included. Obese patients presented more VAS back pain (mean, 4.7 vs. 3.6; P= 0.001) and greater disability on the RMDI (mean, 12.6 vs. 11.3; P= 0.045). The prevalence and severity of OFI were similar in obese and nonobese patients. There was a weak positive correlation between BMI and VAS back pain (r= 0.1552; P= 0.0026), on both RMDI (r= 0.1138; P= 0.0276) and ODI (r= 0.1075; P= 0.0374). There was no correlation between BMI and TUG T-scores (r= 0.0475; P= 0.3585). Obese patients were as likely as nonobese patients to show a positive 6-week treatment response, and the outcome up to 1 year was similar. BMI positively correlates with VAS back pain, RMDI, and ODI. Standardized TUG T scores reflect the patient's degree of OFI well, irrespective of BMI. The TUG test appears to be a good means to estimate functional impairment in populations with a high prevalence of obesity.

Predictors of burden and depression among caregivers of relapsing-remitting MS patients in Spain: MS Feeling study.

To assess potential predictors for burden and depression among caregivers of relapsing-remitting multiple sclerosis patients in Spain. Family functioning and social support were also assessed. Multicenter and cross-sectional study in relapsing-remitting multiple sclerosis adult patients and their respective informal caregivers (n = 180). Assessment performed: Zarit Scale (Burden), Center for Epidemiologic Studies Depression-7 Scale (depression), Family APGAR (Adaptation, Partnership, Growth, Affection, Resolve) Questionnaire (family functioning) and Duke UNC-11 Functional Social Support Questionnaire (social support). Multivariate logistic regression analysis assessed burden and depression predictors among caregivers. Caregivers suffered burden (19.4%) and depression (20.6%) and perceived poor social support (9.4%) and family dysfunction (10.6%). Burden predictors were patient's degree of disability, caregiver time and number of medications administered to patient. Depression predictors were patient's age and daily caregiving time. The factors reported here could help clinicians to identify caregiver groups particularly at risk of burden and depression for timely intervention.

Symptoms as the Main Predictors of Caregivers' Perception of the Suffering of Patients With Primary Malignant Brain Tumors.

The perception of suffering causes distress. Little is known about what predicts the perception of suffering in caregivers. The aims of this study were to determine the predictors of caregivers' perceptions of the suffering of patients with a primary malignant brain tumor and to find to what extent perceived suffering predicts the caregivers' burden and depression. Data were obtained as part of a descriptive longitudinal study of adult family caregivers of persons with a primary malignant brain tumor. Recruitment took place in outpatient neuro-oncology and neurosurgery clinics. Caregiver perception of care recipient suffering was measured by 1 item on a scale from 1 to 6. The sample of caregiver interviews 4 months after recipients were diagnosed consisted of 86 dyads. While controlling for age, years of education, tumor type, being a spousal caregiver, spiritual well-being, and anxiety, perception of overall suffering was predicted by such symptoms as difficulty understanding, difficulty remembering, difficulty concentrating, feeling of distress, weakness, and pain. Caregivers' perception of the patient's degree of suffering was the main predictor of caregiver burden due to schedule 4 months following diagnosis. Care recipient symptoms play an important role in caregivers' perception of the care recipients' suffering. Perception of care recipient suffering may influence caregiver burden. Identifying specific predictors of overall suffering provides meaningful information for healthcare providers in the field of neuro-oncology and neurosurgery.

Evaluation of developmental dental anomalies in digital panoramic radiographs in Southeast Iranian Population.

Objectives:The objective of this study was to evaluate the prevalence of dental developmental anomalies in digital panoramic radiographs of the patients referred to the Zahedan medical imaging center and to evaluate the frequency of anomalies regarding the disorders in shape, position and number in the Southeast of Iran.Materials and Methods:A total of 1172 panoramic radiographs from 581 males and 586 females aged over 16 years were obtained from the files of the Zahedan medical imaging center between the years of 2014 and 2015. The selected radiographs were evaluated in terms of the anomalies such as dilacerations, taurodontism, supernumerary teeth, congenitally missing teeth, fusion, gemination, tooth impaction, tooth transposition, dens invagination, and peg lateral. Then, the anomalies were compared to each other regarding the frequency of the anomaly type (morphological, positional and numerical). Data were evaluated using descriptive statistics such as frequency and percent, and statistical tests such as X2 at 0.05 significant level using the Statistical Package for the Social Sciences version 16.5.Results:The prevalence of dental anomaly was 213 (18.17%), which was higher in females (9.90) than male, (8.28), however, this difference was not statistically significant (P > 0.05). The prevalence of dilacerated teeth was 62 (5.29%), taurodontism 63 (5.38%), supernumerary teeth 6 (0.51%), congenitally missing teeth 13 (1.11%), fusion 1 (0.09%), gemination 1 (0.09%), impaction 40 (3.41%), transposition 2 (0.18%), dens invagination 16 (1.37) and peg lateral was 9 (0.77%). The prevalence of morphological anomaly was 152 (71.36%), malposition 42 (19.72%) and numerous anomaly was 19 (8.92%).Conclusions:Dental anomalies are relatively common; although their occurrence is not symptomatic, they can lead to several clinical problems in patients. Detailed clinical and radiographic assessment and counseling during patient visits is a critical factor in assessing the patient's degree of difficulty to help the dentist for better preparedness for the treatment.

Effects of pulsed electromagnetic fields on swelling and pain after implant surgery: a double-blind, randomized study

The aim of this split-mouth, double-blind, randomized study was to determine whether pulsed electromagnetic field therapy (PEMF) can improve swelling and the management of pain after full-arch immediate loading implant surgery. Eleven patients were selected for the study. Each patient received four distal tilted implants in the upper or lower jaw and underwent full-arch immediate loading rehabilitation. After surgery, two PEMF devices were applied to each patient, one on each cheek. In a random manner, one of these PEMF devices was switched on (test side); the other served as a placebo (control side). Forty-eight hours after surgery clinicians estimated postoperative swelling through photographic documentation, comparing the condition before and after surgery, while pain was assessed using a verbal rating scale. The patient's degree of comfort in relation to the PEMF devices was analyzed by questionnaire using a numerical rating scale. No statistically significant difference was observed between the test and control sides for swelling or pain (P>0.05). Most of the patients did not present swelling or pain at 48h after surgery, regardless of whether the PEMF device was activated or not. Various outcomes were found in the comfort evaluation. Within the limitations of this study, PEMF does not reduce postoperative swelling or pain after implant surgery.

A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia.

BackgroundKetorolac has been used as a postoperative analgesia in combination with opioids. However, the use of ketorolac may produce serious side effects in vulnerable patients. Propacetamol is known to induce fewer side effects than ketorolac because it mainly affects the central nervous system. We compared the analgesic effects and patient satisfaction levels of each drug when combined with fentanyl patient-controlled analgesia (PCA).MethodsThe patients were divided into two groups, each with n = 46. The patients in each group were given 60 mg of ketorolac or 2 g of propacetamol (mixed with fentanyl) for 10 minutes. The patients were then given 180 mg of ketorolac or 8 g of propacetamol (mixed with fentanyl and ramosetron) through PCA. We assessed the visual analogue pain scale (VAS) at the time point immediately before administration (baseline) and at 15, 30, and 60 minutes, and 24 hours after administration. Also, the side effects of each regimen and each patient's degree of satisfaction were assessed.ResultsThere was a significant decline in the VAS score in both groups (P < 0.05). However, there were no significant differences in the VAS scores between the groups at each time point. Satisfaction scores between the groups showed no significant difference.ConclusionsThe efficacy of propacetamol is comparable to that of ketorolac in postoperative PCA with fentanyl.

Bronchial Colonization in Patients with Non–Small Cell Lung Cancer / Kolonizacija bronha kod bolesnika sa nesitnoćelijskim karcinomom pluća

SUMMARY Lower airways are sterile, but many researchers have reported the existence of bronchial colonization with pathogenic and non-pathogenic microorganisms in smokers and patients with chronic obstructive pulmonary disease (COPD) and lung cancer. The aim of this study was to determine the existence and type of bronchial colonization in patients with non-small cell lung cancer (NSCLC), as well as to determine whether colonization depends on patient's age, smoking habit, pulmonary function and body mass index (BMI). Another aim was to estimate whether colonization causes early postoperative complications. Fifty-five subjects with pathohistologically confirmed non-small cell lung cancer in the resectable stage and good performance status (ECOG 0 or 1) participated in this cross-sectional study. We assessed patient's degree of smoking, calculated their BMI and determined the existence and severity of chronic obstructive pulmonary disease if there was one. The patients underwent a flexible bronchoscopy when biopsy samples were taken with protected specimen brush (PSB) and bronchoalveolar lavage (BAL); the retrieved samples were inoculated. Colonization was marked by an increase in the number of bacteria, yielding &gt;10³CFU⁄L. In our study, bronchial colonization was found in 21 patients (38%). Potentially pathogenic microorganisms were isolated in 13 patients (Streptococcus pneumonia was found in five patients, Streptococcus B haemoliticus and Pseudononans in three patients each, Haemophilus influencae and Enterobacter in one patient each). Potentially non-pathogenic microorganisms were isolated in 8 patients (Streptococcus viridans was found in 7 patients and Achromobacter xylosoxidans in 1 patient). Patients' sex, age, smoking habit, body mass index and severity of chronic obstructive pulmonary disease were not statistically significant for developing bronchial colonization. Only one operated patient developed postoperative pneumonia, but he had not previously been diagnosed with bronchial colonization

Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia

ObjectiveTo analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia. Method138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n=16); those with osteopenia, group 2 (n=33); and normal individuals, group 3 (n=55). ResultsIn analyzing the University of California at Los Angeles (UCLA) scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p=0.070). Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p=0.027). ConclusionThe results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry.

Influence of leptomeningeal collateral pattern on the prognostic value of mismatch in acute anterior circulation stroke.

This study aimed to investigate whether and to what degree leptomeningeal collateral flow as detected on angiography influences the prognostic value of computed tomography perfusion-estimated mismatch in interventional treatment of acute anterior circulation stroke. Thirty-eight consecutive patients with acute anterior circulation stroke who received interventional neuroradiologic treatment were assigned one of 2 groups depending on the patient's degree of collateral flow (18 patients with poor collaterals, 20 patients with high degree collaterals) according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system. In a multiregression model, we investigated a possible interaction between 2 independent variables mismatch ratio and degree of collateral flow using a "centered" variable approach. The mismatch ratio per se showed a significant correlation with final clinical outcome (β coefficient, -0.79; P = 0.02); whereas, there was no interaction shown between mismatch degree of collateral flow (β coefficient, 0.54; P = 0.1). This study suggests that the predictive value of computed tomography perfusion-estimated mismatch is not influenced by the degree of leptomeningeal collateral flow.

The Correlation between the Psoas Muscle/Vertebral Body Ratio and the Severity of Peripheral Artery Disease

The measurement of psoas muscle area is a new and potentially useful tool for assessing the frailty of patients in the context of various disease states ranging from cancer to abdominal aortic aneurysms (AAAs). Considering the similarity of risk factors for frailty and atherosclerosis, we sought to investigate whether patients with peripheral artery disease (PAD) have smaller psoas muscle areas in general. Furthermore, we investigated whether PAD symptom severity correlates with psoas muscle size. A chart review was conducted on 146 patients with PAD. Of these patients, 85 (58%) had a computed tomography scan within the last 5 years and were included in the study. Fifty-five patients with AAA and no occlusive disease were included as controls. Cross-sectional areas of the psoas muscles and L4 vertebral body were collected at the mid-L4 level for all patients. Total psoas muscle area was calculated and divided by L4 area to correct for body habitus. Ankle-brachial indices and Rutherford classification were collected as measures of PAD severity. Logistic and multiple regressions were run to assess the difference in psoas muscle/vertebral body ratio between patients with PAD and AAA and within PAD patients, respectively. PAD patients have a lower psoas muscle/vertebral body ratio controlled for sex and age than patients with AAA (P<0.05). However, among patients with PAD, psoas muscle/vertebral body ratio does not correlate with severity of symptoms. Using psoas muscle area as a measure of frailty, patients with PAD may be frail as a group. However, the severity of each patient's symptoms does not appear to correlate with the patient's degree of frailty. Prospective studies with larger populations are needed to clarify whether the psoas muscle area has any prognostic value in PAD.

CYP3A4 polymorphism and lopinavir toxicity in an HIV-infected pregnant woman.

Cytochrome P450 (CYP) 3A4 has been considered to be the most important enzyme system for metabolism of lopinavir/ritonavir (LPV/r), a widely used HIV protease inhibitor (PI) recommended during pregnancy. Herein we present a clinical case of a pregnant HIV-infected woman who was taking standard doses of LPV/r, 400/100 mg twice daily. The trough plasma concentrations for LPV were fourfold above that recommended for PI-pretreated patients and toxicity associated with LPV/r and PI regimens was observed. These high concentrations continued after delivery in spite of a dosage reduction. The pharmacogenetic analysis revealed a genetic polymorphism in the CYP3A4 gene that encodes a non-functional protein. The pharmacokinetic study could indicate the occurrence of a phenomenon of non-linear pharmacokinetics which would justify why dosage reduction after pregnancy did not proportionally affect the patient's degree of exposure to the drug. In addition, an increment in CYP3A activity during pregnancy could explain lower LPV/r exposure during this period compared to postpartum, despite the impaired activity of CYP3A4 caused by the polymorphism.

Use of the semitendinosus tendon for foot and ankle tendon reconstructions

ObjectiveTo demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated. MethodsThis was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients’ degree of satisfaction were evaluated. ResultsThree patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion. ConclusionThe semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.

Análise comparativa da sutura artroscópica de lesões grandes e extensas do manguito rotador com relação ao grau de osteopenia

Objectiveto analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia. Method138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16); those with osteopenia, group 2 (n = 33); and normal individuals, group 3 (n = 55). Resultsin analyzing the University of California at Los Angeles (UCLA) scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070). Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027). Conclusionthe results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry.

Uso do tendão semitendíneo em reconstruções tendíneas do pé e do tornozelo

ObjectiveTo demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated. MethodsThis was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients’ degree of satisfaction were evaluated. ResultsThree patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion. ConclusionThe semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.

FRI0529 Occupational Status of Patients with Childhood Onset Rheumatologic Diseases

ObjectivesTo assess the labour market entry and the labour market performance of a cohort of patients followed in the transition program of a Pediatric Rheumatology Unit.MethodsA survey of patients followed...

Enhanced Medial Prefrontal-Default Mode Network Functional Connectivity in Chronic Pain and Its Association with Pain Rumination

Rumination is a form of thought characterized by repetitive focus on discomforting emotions or stimuli. In chronic pain disorders, rumination can impede treatment efficacy. The brain mechanisms underlying rumination about chronic pain are not understood. Interestingly, a link between rumination and functional connectivity (FC) of the brain's default mode network (DMN) has been identified within the context of mood disorders. We, and others, have also found DMN dysfunction in chronic pain populations. The medial prefrontal cortex (mPFC) is a key node of the DMN that is anatomically connected with the descending pain modulatory system. Therefore, we tested the hypothesis that in patients with chronic pain, the mPFC exhibits abnormal FC related to the patient's degree of rumination about their pain. Seventeen patients with idiopathic temporomandibular disorder (TMD) and 17 age- and sex-matched healthy controls underwent resting state functional MRI, and rumination about pain was assessed through the rumination subscale of the Pain Catastrophizing Scale. Compared with healthy controls, we found that TMD patients exhibited enhanced mPFC FC with other DMN regions, including the posterior cingulate cortex (PCC)/precuneus (PCu) and retrosplenial cortex. We also found that individual differences in pain rumination in the chronic pain patients (but not in healthy controls) were positively correlated to mPFC FC with the PCC/PCu, retrosplenial cortex, medial thalamus, and periaqueductal/periventricular gray. These data implicate communication within the DMN and of the DMN with the descending modulatory system as a mechanism underlying the degree to which patients ruminate about their chronic pain.

Functional evaluation of patients with injury of the distal insertion of the biceps brachii muscle treated surgically

Objectiveto functionally evaluate patients with injury of the distal insertion of the biceps brachii muscle that was treated surgically. Methodsbetween April 2002 and June 2011, 15 elbows of 14 patients underwent surgical treatment performed by the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. The minimum follow-up was six months, with a mean of 28 months. The patients’ ages ranged from 28 to 62 years, with a mean age of 40 years. All the patients were male and the dominant arm was affected in 64.2%. The clinical evaluation on the results was conducted using the criteria of the American Medical Association (AMA), as modified by Bruce, with evaluation of the joint range of motion (flexion–extension and pronosupination), the presence of pain and the patient's degree of satisfaction. Resultsfrom the AMA criteria, as modified by Bruce, we obtained 100% satisfactory results, of which 85.7% were considered to be excellent and 14.3% good. We observed that when distal injuries of the biceps brachii muscle affected young and active patients, surgical treatment was a good option.