Standard Visual Analog Scale Research Articles

The effect of Nigella sativa on appetite, anthropometric and body composition indices among overweight and obese women: A crossover, double-blind, placebo-controlled, randomized clinical trial

ObjectivesObesity is a global concern which is associated with several complications and disease. DesignPresent study is the first crossover, double-blind, placebo-controlled, randomized clinical trial aimed to evaluate the effect of Nigella Sativa (N. sativa) intervention on anthropometric and body composition parameters as well as dietary intake and appetite in a crossover design. MethodForty-five healthy women with obesity or overweight were randomized into two groups of intervention and placebo, and the study conducted in two 8-week periods of intervention separated by a 4-week washout period. Anthropometric and body composition indices and dietary intake were measured. Also, appetite sensation was evaluated via a standard visual analog scale (VAS) questionnaire. Pkcross procedure was performed for statistical analysis using STATA. Cohen’s d effect size was estimated for all outcomes to determine the magnitude of the effects. ResultsSupplementation with 2000 mg of N. sativa oil found to have a considerable increment in the measures of body mass index (P < 0.001, Cohen’s d = 0.5), body weight (P < 0.001, Cohen’s d = 0.6) and waist circumference (P = 0.020, Cohen’s d = 0.4) with a medium effect size measure, and a significant decrease in body fat mass (P = 0.019, Cohen’s d = 0.2), body fat percent (P < 0.001, Cohen’s d = 0.2) and visceral fat area (P = 0.011, Cohen’s d = 0.2) with a small effect size measure. ConclusionThe overall improvements in anthropometric and body composition parameters and a significant decrease in appetite represents the beneficial effects of N. sativa supplements in the treatment of obesity. More studies with different dosages, a larger number of participants, and longer intervention duration are recommended to illustrate the exact effects of N. sativa as a complementary therapy for obesity.

Red visual stimulation in the Ganzfeld leads to a relative overestimation of duration compared to green.

A Ganzfeld is a homogenized visual and auditory perceptual field which can induce altered states of consciousness (ASC; Metzger, 1929; Schmidt & Prein, 2019). Using a balanced intrasubject design, we compared participants' experience during two differently colored (red, green) 25-min Ganzfeld sessions with brown noise as acoustic stimulation. Participants were exposed to the colored visual field through commercially available goggles and to brown noise over headphones. We selected 67 participants with some prior meditation experience to increase the probability that they would engage meaningfully with this specifically restricted stimulus situation. We tested the functional components of the standard cognitive model of time perception (Zakay & Block, 1997) in a path analysis for direct (red vs. green light) and indirect effects (arousal, attention) on subjective duration and perceived passage of time. Subjective arousal and valence states were measured using the Self-Assessment Manikin (SAM). The amount of attention directed to time and the perceived passage of time were rated with standard visual analog scales (VAS). Participants also estimated the duration of each Ganzfeld exposure. The session with the red visual field lasted significantly longer than did the green session (μred = 23.1 min; μgreen = 19.8 min). After the green session, participants rated their arousal level to have significantly decreased; after the red session, individuals on average felt emotionally less positive. Multiple path analyses revealed that the effect of color on estimated duration is completely mediated through higher arousal levels during the red Ganzfeld session. In turn, the higher arousal level generates a longer subjective estimate of duration. For induction of relaxation in studies probing altered states of consciousness employing the Ganzfeld technique, we recommend using the green light.

Effect of Foot Reflexology on Postoperative Pain in Patients Undergoing Tibia Plating Surgery: A Randomized Clinical Trial

Objective: One of the major problems of patients after orthopedic surgeries is acute pain. The present study aims to evaluate the effect of foot reflexology massage on postoperative pain in patients undergoing plating surgery for tibia fracture. Methods: This study is a randomized clinical trial conducted on 96 patients who were candidates for tibia plating surgery referred to Imam Ali Hospital in Bojnourd, Iran, randomly divided into intervention and control groups. Foot reflexology massage in the intervention group was performed on patients’ healthy feet for 10 minutes, one hour before surgery. In the control group, the foot sole was touched for one minute without any pressure. Pain intensity was measured using the standard Visual Analog Scale before and immediately after the intervention and 2, 4, 6, 12 and 24 hours after surgery. Data were analyzed using chi-square test, t-test, repeated measures ANOVA, Mann-Whitney U and Friedman tests. Results: The baseline pain scores in the intervention and control groups were reported 8.1±0.9 and 8.4±0.9, respectively. After the intervention, the pain score in these groups was reduced to 6.9±1.1 and 8.1±1.0, respectively (P&lt;0.001). At other times, up to 24 hours after surgery, the pain reduction was higher in the intervention group (P&lt;0.05). Conclusion: Foot reflexology massage reduces postoperative pain of patients undergoing tibia plating surgery. Therefore, this method can be used to reduce pain and anxiety in orthopedic surgery patients.

Characterization of vascular stains associated with high flow

High-flow vascular stains (HFVS) arelesions that have the appearance of capillary malformations/port wine stains but are associated with increased arterial flow. To identify features of HFVS that differentiate them from typical "slow-flow" port wine stains. Retrospective multicenter cohort study of HFVS evaluated across 7 centers was conducted. HFVS were characterized by clinical features (warmth, thrill, rapid capillary refill), radiologic findings (fast flow), or mutations associated with capillary malformation-arteriovenous malformation syndrome. Investigators reviewed photographs. The study reviewed 70 patients with HFVS (47 multifocal and 23 solitary). Most were flat (77%), warm to the touch (60%), and red or pink-red in color (35%), with heterogeneous color saturation (73%) and well-defined borders (71%). Regional soft tissue swelling/overgrowth was common (47%). Head and neck location was most common (38%). Among 34 HFVS with photographic review over time, all demonstrated changes in appearance. Retrospective design, recall bias, lack of standardized time points or visual analog scale, and image variability. Heterogeneity of stain color saturation, warmth to touch, peripheral pallor, and overgrowth/soft tissue swelling help distinguish HFVS from port wine stains. Darkening of color and increased border demarcation may develop over time. These findings raise suspicion for HFVS and provide an indication to assess for extracutaneous involvement.

Comparing the Potential for Irritation of a Ceramide-Based Moisturizer with a Urea-Based Moisturizer for Pediatric Atopic Dermatitis.

IntroductionMoisturizers are one of the mainstays of the topical treatment of atopic dermatitis (AD). One of the adverse effects of moisturizers is skin irritation, especially on excoriated AD skin. We compared the potential for irritation of two commercially available moisturizer products for the treatment of AD: a ceramide-based moisturizer (Ceradan® Cream; Hyphens Pharma Pte Ltd, Singapore) and a urea 5% moisturizer (Aqurea Lite Cream; ICA Pharma Pte Ltd, Singapore).MethodsWe performed a prospective single-blind randomized controlled study recruiting AD patients aged between 8 and 16 years with symmetrical or near symmetrical scratch marks (excoriations) of at least grade 2 to 3 severity score, according to the Eczema Area and Severity Index (EASI), over bilateral antecubital fossae. Subjects were randomized to receive the ceramide-based moisturizer to either the left or right antecubital fossa or urea 5% cream to the other antecubital fossa. Subjects were asked to grade the immediate skin irritation of both creams on a standard visual analogue scale (VAS) and which cream they would prefer to use as a daily moisturizer. Primary outcome was the mean irritant score of each cream, and secondary outcome was the subjects’ preference of either cream as their daily moisturizer.ResultsA total of 42 participants were enrolled with a mean age of 11 years 5 months. The ceramide-based cream had a significantly lower mean VAS score (mean 0.69, SD = 1.63) for irritation compared with urea 5% cream (1.43, SD = 1.64) (p = 0.035). More participants also preferred the ceramide-based cream over urea 5% cream (62% versus 38%) as their daily moisturizer, but this did not reach statistical significance (p = 0.164).ConclusionsA ceramide-based moisturizer may be considered as a suitable choice for children to minimize irritation from moisturizer treatment for AD.

Efficacy of Sedation by Midazolam in Association With Meperidine or Fentanyl and Role of Patient Distress During Elective Colonoscopy.

Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.

The Health Utility and Valuation of Cosmetic Rhinoplasty.

Importance: The importance of this study is to understand the impact of rhinoplasty as perceived by society and to conceptualize the health utility metric of cosmetic rhinoplasty in relation to other health interventions. Objective: This novel study seeks to measure and quantify the health state utility and valuation of cosmetic rhinoplasty. Design, Setting, Participants: This is a cross-sectional survey administered through public online forums to 161 casual observers in America. Main Outcomes and Measures: Participants were shown pre- and postoperative photographs of six patients who underwent cosmetic rhinoplasty and two patients who did not undergo surgery. Observers were asked to imagine that the external nose in each image was on their own face and rated (1) their health state utility and (2) how much they were willing to pay (WTP) to have the ideal nose. Results: Established metrics of standard gamble and visual analog scale were explored in detail. Using these valuation and health utility data, we calculated WTP per quality-adjusted-life-year (WTP/QALY). The WTP/QALY for cosmetic rhinoplasty is $12,264 per QALY, which is significantly below cost-effective thresholds. Participants were willing to accept 10% risk of death to undergo cosmetic rhinoplasty. Conclusions and Relevance: Calculating WTP/QALY as a metric, we assess and quantify the social importance of rhinoplasty. This is the first study to demonstrate that elective cosmetic rhinoplasty can be a high-value intervention as perceived by society. Furthermore, the high percentage of risk of death that participants are willing to accept for cosmetic rhinoplasty suggests there is a profound psychosocial impact of external nasal deformity. These findings have implications for patients, surgeons, and health policy makers.

Comprehensive Health-State Utilities in Contemporary Patients With Cirrhosis.

Cost‐effectiveness analysis depends on generalizable health‐state utilities. Unfortunately, the available utilities for cirrhosis are dated, may not reflect contemporary patients, and do not capture the impact of cirrhosis symptoms. We aimed to determine health‐state utilities for cirrhosis, using both the standard gamble (SG) and visual analog scale (VAS). We prospectively enrolled 305 patients. Disease severity (Child‐Pugh [Child] class, Model for End‐Stage Liver Disease with sodium [MELD‐Na] scores), symptom burden (sleep quality, cramps, falls, pruritus), and disability (activities of daily living) were assessed. Multivariable models were constructed to determine independent clinical associations with utility values. The mean age was 57 ± 13 years, 54% were men, 30% had nonalcoholic steatohepatitis, 26% had alcohol‐related cirrhosis, 49% were Child class A, and the median MELD‐Na score was 12 (interquartile range [IQR], 8‐18). VAS displayed a normal distribution with a wider range than SG. The Child‐specific SG‐derived utilities had a median value of 0.85 (IQR, 0.68‐0.98) for Child A, 0.78 (IQR, 0.58‐0.93) for Child B, and 0.78 (IQR, 0.58‐0.93) for Child C. VAS‐derived utilities had a median value of 0.70 (IQR, 0.60‐0.85) for Child A, 0.61 (IQR, 0.50‐0.75) for Child B, and 0.55 (IQR, 0.40‐0.70) for Child C. VAS and SG were weakly correlated (Spearman's rank correlation coefficient, 0.12; 95% confidence interval, 0.006‐0.23). In multivariable models, disability, muscle cramps, and MELD‐Na were significantly associated with SG utilities. More clinical covariates were significantly associated with the VAS utilities, including poor sleep, MELD‐Na, disability, falls, cramps, and ascites. Conclusion: We provide health‐state utilities for contemporary patients with cirrhosis as well as estimates of the independent impact of specific symptoms on each patient’s reported utility.

Plastic Surgery Patient Expectations for Postoperative Opioid Prescriptions.

The opioid epidemic is a healthcare crisis perpetuated by analgesic overprescribing. Despite public health attention on this issue, expectations for pain management and opioid use by plastic surgery patients are poorly understood. This study aimed to evaluate patient expectations of postoperative pain, concern for opioid dependence, and anticipated analgesic plan after plastic surgery. New patients presenting to an academic plastic surgery clinic were prospectively enrolled from November 2017 to September 2018. These patients completed a preconsultation survey regarding their pain history and anticipated postoperative pain and analgesics regimens. Responses between cohorts expecting and not expecting postoperative opioids were compared using descriptive and univariate analyses. A total of 168 patients (63.9% female, 36.1% male; mean ± SD age 46 ± 17 years) completed the survey before breast (21.9%), cosmetic (5.3%), craniofacial (3.0%), general reconstruction (13.0%), hand (3.0%), and skin and soft tissue (49.1%) surgeries. Twenty-eight percent of patients expected opioid prescriptions. On a standard visual analog scale, patients who expected opioids anticipated greater postoperative pain (6.9 vs 4.6, P < 0.05). They were more concerned about experiencing pain (5.8 vs 4.9, P < 0.05), expected a longer duration of opioid use (63.0% vs 37.0%, P < 0.05), and were less interested in nonnarcotic analgesic alternatives (57.9% vs 19.8%, P < 0.05). Less than one-third of plastic surgery patients in this study expect opioid pain medications after surgery. This supports broader use of nonopioid, multimodal pain regimens. Identification and management of patient pain expectations, especially among those anticipating a need for opioids, provide a critical opportunity for preoperative education on the benefits of nonopioid analgesics, thus minimizing opiate prescribing.

Subjective and objective evaluation of pain for older adults with knee osteoarthritis in Saudi Arabia: A reliability study

This study establishes the reliability and validity of pain pressure threshold (PPT) in evaluating pain for older adults with knee arthritis, and explores the importance of using a standard tool to measure pain in older adults. The study consisted of a group of 31 older adult patients with bilateral symptomatic knee osteoarthritis, intra- and inter-rater reliability, and concurrent validity that were assessed for PPT and were compared with standard visual analogue scale (VAS). Physical therapy intervention was provided to combat the pain. The PPT showed excellent intra-assessor reliability by not only meeting acceptable standards but also representing very high values. The intra-assessor reliability between test sessions was excellent. The inter-assessor agreement was also very high before treatment. The highest ICC showed very good agreement (0.860) during the initial treatment for pain pressure measurement. The study also established concurrent validity of VAS and PPT (before treatment and after treatment), where the rho correlation was high (-0.708 and -0.625) and significant, indicating that PPT is adequately sensitive for detecting changes over time. PPT is a reliable and valid tool for measuring pain, and it helps clinicians understand the prognostic effect of the intervention, especially in older adults. The tool is consistent at measuring pain and is a valid tool compared to subjective pain scoring.

Patient-controlled analgesia and morphine consumption in sickle cell anemia painful crises: A new protocol.

The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous administrations of various doses (increased/decreased) within the following hours. This study aims to retrospectively evaluate the effects of a structured protocol based on standardized Visual Analogue Scale (VAS) and Patient-controlled analgesia (PCA) patient demand count on morphine consumption in painful crises. A total of 177 painful crises of 93 patients who were administered morphine using the PCA method according to appropriate analgesia protocol between 2004-2018 were evaluated in this study. The demographic data, hemoglobin chromatography and genotypes, painful episode follow-up time, VAS scores before and after treatment, and daily morphine consumption of the patients were recorded. Morphine consumption during the crisis according to age groups and sex were compared. Of the patients, 57% were homozygous hemoglobin type SS (HbSS). Mean morphine consumption with PCA method was 56.9±35.4 mg (min-max: 10-232 mg) and mean follow-up time was 3.4±2.1 days (min.-max.: 1-11). VAS scores were significantly lower after treatment (6.8±2.3 pre-treatment; 0.8±0.6 post-treatment) (p<0.05). To our knowledge, our study is the first structured protocol based on VAS and PCA demand data. We believe lower morphine dosage using PCA protocol according to the rapidly changing pain levels of the patients will provide effective analgesia. Prospective studies with fewer limitations will more effectively demonstrate the effectiveness of this protocol.

Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Postoperative Foot and Ankle Patients

Category:Patient Reported Outcome MeasuresIntroduction/Purpose:The relativity of pain adds to the increasing ambiguity of deciding proper treatment procedures. Reliable and validated patient reported outcome measures have attempted to solve this problem, but there are still flaws due to the subjective nature of pain. This study is the third part to two previous studies that found both operative and new nonoperative patients overemphasize their pain scores when reporting to the treating physician as compared to a nurse. This current study aims to examine if this phenomenon holds true with orthopedic postoperative patients. The importance of this study is to observe this phenomenon, as to better understand subjective pain scores. We hypothesize there will be no differences in postoperative patients’ pain scores when reporting to a treating physician versus a nurse.Methods:This study is a retrospective cohort of consecutive postoperative foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal visual analog scale (VAS) 0 to 10, from “no pain” to “worst pain” at 2, 6, and 12 weeks postoperatively. Differences in reported pain levels were analyzed within each clinic visit.Results:Two hundred and one patients each with 3 follow up encounters were included in our cohort. The mean 2, 6, and 12- week postoperative VAS scores reported to the physician were 2.85, 2.04, and 2.33 respectively; in comparison, the scores reported to the nurse were 2.52 (p=0.0005), 1.77 (p=0.002), and 2.02 (p=0.005) respectively. There was no significant relationship between time and type of provider.Conclusion:This study found that postoperative patients report their pain more consistently to physicians and nursing staff with no clinically significant differences noted. These findings stand in stark contrast to our two previous studies which noted new and preoperative patients reported significantly higher VAS scores to the physician. The reason for reporting inconstancies is unclear, but postoperatively patients no longer need to emphasize their impairments or injury. Postoperatively, they also have a defined time interval and more acute recollection of their pain potentially leading to more consistency in reporting.

Fixation of os acromiale using polyester sutures: a novel surgical treatment.

Patients with unstable os acromiale often complain of shoulder pain. Numerous surgical treatment options have been introduced with inconsistent clinical results. In this study, a novel surgical treatment using polyester sutures to fix unstable os acromiale was introduced, and clinical results were reported. We retrospectively studied 10 shoulders that were diagnosed with os acromiale from January 2014 to January 2016. All 10 cases were of the meso-acromion type. Except for the first case in our series, cases of os acromiale were fixed using polyester sutures arthroscopically. The standardized scores and visual analog scale (VAS) were recorded preoperatively and at each follow-up. A computed tomography (CT) scan was ordered at the follow-up of 12 months. The average follow-up length was 28.7 months, ranging from 26 to 33 months. The average Constant score before surgery was 40.50±4.53 points, which significantly improved to 75.60±5.17 points after surgery. The average VAS score was reduced from 5.20±1.14 points to 1.60±0.84. At the follow-up of 12 months, a CT scan was ordered. All the patients showed a bony union of the os acromiale. On the CT scan, two small pits could be seen on the medial and lateral side of the acromion, which indicated the level of the os acromiale. The position of the os acromiale was good, and no evident sclerosis was found on the edges of the fragments. Polyester sutures could provide reliable strength for the fixation of os acromiale without any irritation from hardware.

Comparison of the effect of ginger capsule and diclofenac tablet on the relief of pain following inguinal hernia surgery

Background and aims: Postoperative pain control decreases negative effects on the health domains of the patients and their relatives in addition to reducing the costs and the duration of hospitalization. The aim of the present study was to comparatively investigate the analgesic effects of ginger and diclofenac tablets. Materials and Methods: In this clinical trial, 80 patients undergoing inguinal hernia surgery were randomly divided into two groups of 40. One group received 250 mg ginger capsule while the other one received 100 mg diclofenac tablet. Then, the patients were examined within 6 hours (every two hours) and their pain was assessed using the standard 10-point visual analogue scale. Finally, the data were analyzed using the SPSS, version 22. Results: Based on the results, there was no significant difference in pain severity between the two groups at 0, 2, 4, and 6 hours after recovery (P&gt;0.05). In addition, no significant difference was observed in the duration of pain since the time of patient recovery between the two groups (P&gt;0.05). Further, as regards the number of patients receiving pethidine, no difference was found between the two groups (P&gt;0.05). Conclusion: In general, both ginger capsule and diclofenac tablet were similarly effective in relieving the pain after inguinal hernia surgery

Mean Nocturnal Baseline Impedance Correlates With Symptom Outcome When Acid Exposure Time Is Inconclusive on Esophageal Reflux Monitoring

Abnormal acid exposure time (AET) is associated with good outcomes of symptoms from antireflux therapy. Low esophageal mean nocturnal baseline impedance (MNBI) is an additional marker of reflux disease. We aimed to evaluate the value of MNBI when analysis of AET produces borderline or inconclusive results. We studied a retrospective cohort of 371 patients (mean age, 54.5 ± 0.7 y; 60.0% female) who had persistent reflux symptoms after treatment and underwent ambulatory pH-impedance monitoring off antisecretory therapy at 1 tertiary center in Europe or 1 in the United States. Total AET was determined from pH impedance studies (pathologic, >6%; physiologic, <4%; borderline or inconclusive, 4%-6%). Baseline impedance values were calculated at the 5-cm impedance channel at 3 nocturnal 10-minute periods and averaged to yield MNBI (abnormal, <2292 ohms). The primary outcome was response to antireflux therapy, defined as global symptom improvement of 50% or greater on patients' answers on standardized visual analog scales. Among the 371 patients, 107 (28.8%) had pathologic AET and 234 (63.1%) had abnormal MNBI. Low MNBI was concordant in 99.1% of patients with pathologic AET, in 91.2% with borderline AET, and in 33.7% with physiologic AET. During 38.7 ± 0.8 months of follow-up evaluation, 43.0% of patients had improved symptoms with medical therapy and 76.2% had improved symptoms with surgical antireflux therapy (P < .0001). When MNBI was low, response to medical therapy did not differ significantly between patients with borderline AET and patients with pathologic AET (P= .44), but did differ significantly when each group was compared with patients with physiologic AET, regardless of whether MNBI was normal or low (P < .0001 for each comparison). When low, MNBI identifies patients with pathologic and borderline AET who respond to antireflux therapy. MNBI analysis complements AET in defining esophageal reflux burden. MNBI correlates with response of symptoms to antireflux therapy.

Noninvasive Interactive Neurostimulation Therapy for the Treatment of Low-Grade Lateral Ankle Sprain in the Professional Contact Sport Athlete Improves the Short-Term Recovery and Return to Sport: A Randomized Controlled Trial

Ankle injuries are very common between professional athletes and recreational sports. Lateral stable ligaments injury can be treated conservatively. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of this prospective, double-blinded, randomized controlled trial was to compare the results in terms of improvement of a foot functional score, lower level of reported pain, and return to sports in 2 groups of contact sport athlete affected by a grade I or II lateral ankle sprain. Patients were randomized using random blocks to the NIN program (group I) or a sham device (group II). The outcome measurements were the use of a self-reported Inability Walking Scale, patient-reported subjective assessment of the level of pain using a standard visual analogue scale, and daily intake of nonsteroidal antiinflammatory drugs (etoricoxib 60 mg). Patients were also reached by telephone at 2 and 4 months of follow-up to register their return to sport activity. Beyond baseline evaluation, follow-ups were done after 5 (1 week) and 10 sessions (2 weeks) of treatment, and then at 30 days after the end of therapy. Of the 70 athletes admitted to the study, 61 eligible patients were randomized using random blocks to group I (n = 32) and group II (n = 29). Group I patients showed better improvement in terms of functional impairment (Inability Walking Scale), reported pain (visual analogue scale), and daily intake of etoricoxib 60 mg. Athletes of group I registered a faster resuming of sport activities. This prospective, randomized trial showed NIN can improve short-term outcomes in athletes with acute grade I or II ankle sprain and that it can hasten resuming of sport activities.

Comparative evaluation of unstimulated whole salivary flow rate and oral symptoms in healthy premenopausal and postmenopausal women - An observational study

Introduction: Menopausal women undergo many physiological changes, most of which are due to decreased estrogen production. Little is understood about the relationship between menopause and oral health. Aim and Objectives: To evaluate the association of menopausal status on subjective reports of oral discomfort and on the objective measurement of unstimulated whole salivary flow rate in healthy women. Materials and Methods: A total of 200 women, including 100 postmenopausal and 100 premenopausal women, were divided into two groups based upon their menstrual status. Group I consisted of 100 postmenopausal women in the age group of 44–76 years. Group II consisted of 100 premenopausal women in the age group of 31--45 years. Settings and Design: A standardized visual analog scale questionnaire was administered to obtain subjective sensation of oral discomfort. Unstimulated whole saliva was collected for 5 min by spitting method and the flow rate of saliva was measured per minute. Statistical analysis used: Chi-square, Student's t test, and analysis of variance (ANOVA) were applied. Results: The prevalence and intensity of the subjective symptoms of oral discomfort was significantly higher in postmenopausal women as compared to the premenopausal women (P < 0.001). The unstimulated whole salivary flow rates in pre- and postmenopausal women were 0.4 ± 0.13 and 0.2 ± 0.11 ml/min, respectively (P < 0.001). A significant association between symptoms of oral discomfort [burning sensation (P = 0.001), taste disorders (P < 0.001), dry mouth (P < 0.001)], and unstimulated salivary flow rate was seen in postmenopausal women. Conclusion: The results from this cross-sectional study of healthy females not being treated for any systemic disease, and not taking medications for any medical disorders indicated that the objective measurements of unstimulated whole salivary flow rate are influenced by menopause. In addition, subjective symptoms of oral discomfort are also associated with menopause.

Effects of Dexmedetomidine Combined with Sufentanil on Postoperative Delirium in Young Patients After General Anesthesia.

BackgroundThis study was designed to evaluate the effects of combined usage of dexmedetomidine (DEX) and sufentanil on young patients with postoperative delirium (POD) after general anesthesia.Material/MethodsWe randomized 100 young patients with POD into 4 groups: Group D, Group S, Group DS1, and Group DS2, with loading and maintenance doses of DEX and/or sufentanil administered according to the experimental protocol. Hemodynamic variables, standard visual analogue scale (VAS) scores, sedation agitation scale (SAS) scores, stress hormones, and inflammatory biomarkers were assessed at 5 time-points: baseline (T1); 1 h (T2), 2 h (T3), 4 h (T4), and 8 h (T5) after completion of the loading dose.ResultsAt T3–T5, hemodynamic indicators in group D were obviously higher than in the other groups (P<0.05). At T2–T5, the VAS and SAS scores were noticeably lower than those at T1 in each group (P<0.05). The VAS and SAS scores were remarkably higher in group D than those in the other groups (P<0.05). Compared with DS1, the incidence of respiratory distress decreased and the incidence of POD increased in group DS2. Compared to T1, plasma concentrations of epinephrine, norepinephrine, IL-6, and TNF-α all decreased at T2 and T5 (P<0.05).ConclusionsDEX and sufentanil decrease the incidence of POD, ameliorate the abnormities of hemodynamic indicators, and decrease VAS scores, SAS scores, stress hormones, and inflammatory biomarkers, but increase the incidence of respiratory distress. DEX combined with sufentanil may play a synergistic reaction in causing respiratory distress, but remarkably decreases the incidence of POD.

The Perceptions of Dentists Working in Saudi Arabia of the Utility of Different Restoration Options for a Shortened Dental Arch in Patients of Different Ages.

This study aimed to assess dentists' views of the utility of an unrestored shortened dental arch (SDA) compared to the utility of various prosthetic treatment options. A total of 142 dentists working at four sites in Riyadh, Saudi Arabia, were interviewed and presented with 18 scenarios for patients of different ages with SDAs that lost molar teeth. Participants were asked to indicate on a standardized visual analog scale (VAS) how they would value the health of the patient's mouth if the SDAs were left unrestored or restored with five prosthetic dental restorations. With a utility value of 0.0 representing the worst possible health state for a mouth and 1.0 representing the best, dentists' mean utility value for unrestored SDAs was 0.43 (standard deviation [SD] = 0.28). For implant-supported fixed dental prostheses (ISFDPs), cobalt-chromium removable partial dentures (RPDs), acrylic RPDs, cantilever conventional fixed dental prostheses (CFDPs), and cantilever resin-bonded fixed dental prostheses (RBFDPs), the mean utility values were 0.64 (SD = 0.27), 0.54 (SD = 0.20), 0.48 (SD = 0.20), 0.42 (SD = 0.28), and 0.39 (SD = 0.27), respectively. Neither patient age nor dentists' clinical experience had an impact on dentists' perceptions of the utility of unrestored SDAs and outcomes of this treatment concept (P > .01). Restoration of SDAs by ISFDPs received the highest utility value among the surveyed group of dentists. Although the assigned value for unrestored SDAs was low, this value was comparable to the value of SDAs that were restored by acrylic RPDs or cantilever FDPs of either type.

Impact of the route of clean intermittent catheterization on quality of life in children with lower urinary tract dysfunction.

To compare the impact of the different routes for clean intermittent catheterization on the quality of life of children with lower urinary tract dysfunction. In this cross-sectional study, all children and adolescents under treatment in our clinic from August 2011 to May 2012 who were on CIC for bladder dysfunction were included. To evaluate the technical difficulty and the discomfort associated with the procedure we used a standard visual analog scale. Quality of life was measured using the Pediatric Quality of Life Inventory Version 4.0. A total of 70 children including 38 (54.3%) boys and 32 (45.7%) girls with a mean age of 11.8 ± 3.6 years (range 5 to 18 years) were evaluated. The mean daily number of catheterizations was 4.2 ± 1.1. CIC was performed through the urethra in 51 (72.9%) subjects and a stoma in 19 (27.1%). A 45 (64.3%) were assisted by a caregiver to perform a catheterization. No differences in both difficulty and discomfort for performing CIC were observed between groups. Children who performed CIC through a stoma had a better quality of life scores for the physical (P = 0.015) and social functioning domains (P = 0.011). The quality of life of children and adolescents performing CIC appears to be affected by the route of catheterization, with a worse performance for those using urethral catheterization.