Ten-point Visual Analogue Scale Research Articles

A Pilot Randomized Crossover Study on Stress Responses in Paramedicine Students: Virtual Reality Versus Live Simulation

Introduction: Emergency Medical Workers frequently encounter high-stress situations, such as traffic accidents and sudden deaths, which can negatively affect their mental health. Building psychological resilience through training is essential, and recent methods like virtual reality (VR) gamification have been introduced to improve learning outcomes. Aim: This pilot randomized crossover study aims to compare the stress responses of third-year Paramedicine students during a severe traffic accident scenario using either a live actor simulation or a VR-based platform (XVR simulation). Methods:Ten third-year Paramedicine students were randomly assigned to start with either a live actor simulation or a virtual reality scenario using the XVR program. After completing the first scenario, participants underwent a 7-10 day washout period before switching to the alternate scenario. Physiological stress markers, including salivary cortisol, testosterone, and heart rate variability (HRV), were measured before and after each scenario. Subjective stress was assessed using a ten-point visual analog scale (VAS). Results: No significant differences were observed in cortisol concentration changes (p = 0.576), testosterone levels (p = 0.878), or HRV (p = 0.156) between the virtual reality and live actor simulations. However, students perceived the live actor scenario as more stressful than the virtual reality simulation (p = 0.001). Conclusion: Both virtual reality and live simulations effectively recreate high-stress scenarios, but students reported higher stress during live actor simulations. These results indicate that VR could be a viable and cost-effective alternative for training Paramedicine students. Larger studies are needed to confirm these findings and assess the long-term impact of VR training on stress adaptation.

Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up.

We retrospectively reviewed our series of primary total wrist arthroplasty with the Freedom® prosthesis. The primary outcome measure was revision, and secondary measures included radiographic loosening, pain, complications, movement range, grip strength and patient-reported measures. We reviewed 12 implants in 11 patients (mean age 59 years, range 45-80) with a mean radiological and clinical follow-up of 2.7 and 3 years, respectively. One radial component failed to integrate and was revised at Day 84. Four carpal components demonstrated areas of lucency. There was a statistically significant reduction in pain, and total flexion-extension increased. Despite high patient satisfaction on a ten-point visual analogue scale score (mean 8.7 out of 10), the mean patient-rated wrist evaluation, Quick Disabilities of the Arm, Shoulder and Hand and Patient Evaluation Measure scores were 52, 55 and 53, respectively. The Freedom® implant reduced pain and preserved wrist movement in our patients; however, annual surveillance is recommended due to the high incidence of early carpal component lucency.Level of evidence: IV.

Opioid requirement and pain intensity after mandibular surgeries with dexmedetomidine administration in two ways: intraoperative infusion versus bolus injection.

The purpose of this study is to compare the opioid requirement and pain intensity after surgeries of mandibular fractures with administration of dexmedetomidine by two approaches of infusion and single bolus. In this double-blind clinical trial, the participants were randomized and matched in terms of age and gender in two groups (infusion and bolus). In both groups, the amount of narcotic used, hemodynamic indices, oxygen saturation, and pain intensity were collected based on the ten-point Visual Analogue Scale (VAS) at 7 time points for 24 h. SPSS version 24 software was used for data analysis. A significance level of less than 5% was considered. A total of 40 patients were included in the study. There was no significant difference between the two groups in terms of gender, age, ASA class, and duration of surgery (P>0.05). There was no significant difference between the two groups in terms of nausea and vomiting and subsequently receiving anti-nausea medication (P>0.05). The need for opioid consumption after surgery was not different in two groups (P>0.05). Infusion of dexmedetomidine reduced postoperative pain more rapidly than its single bolus dose (P<0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation variables (P>0.05). Homodynamic indices including heart rate, systolic blood pressure, and diastolic blood pressure in the bolus group were significantly lower than the infusion group (P<0.05). Administration of dexmedetomidine in the form of infusion can reduce postoperative pain better than bolus injection, with less probability of hypotension and bradycardia.

A comparison of hernia sac ligation versus invagination in Lichtenstein tension-free mesh hernioplasty: does the type of hernia play a role in outcomes?

Management of the indirect hernial sac in inguinal hernia repairs has long been a subject of debate among general surgeons. Although hernial sac high ligation (HL) is a time-honored concept in groin hernia surgery, non-ligation/invagination is gaining popularity. This study was intended to compare the effects of hernia sac ligation and invagination in patients undergoing Lichtenstein mesh hernioplasty (LMH). Another aim was to investigate the possible association between the hernial defect size and postoperative early pain in both groups. Patients with indirect inguinal hernia undergoing elective LMH under spinal anesthesia were included in this prospective randomized study. Patients were classified according to European Hernia Society (EHS) criteria and were randomized into two groups, HL and non-HL/invagination. Postoperative pain levels at 6, 12, and 24h, 7 days, and 1 year were compared using a ten-point visual analog scale (VAS). In addition, recurrence was examined in the postoperative first year. Postoperative complications, length of hospital stay, drain use, and surgery times were evaluated as secondary outcomes. This study was registered at www. gov . (The clinicaltrials.gov ID number is: NCT05308251). Ninety-three out of a total of 108 patients were included in the study between January 2020 and January 2021 (HL group n = 44, non-HL group n = 49). Demographic characteristics were comparable between the groups. Mean VAS scores were significantly higher in the HL group at 6 and 12h postoperatively (p < 0.05 and p = 0.036 respectively). While there was no difference in pain levels between the groups in EHS 1 and EHS 2 hernias (p > 0.05 for all), VAS scores were significantly higher in the ligation group in EHS 3 hernias (p < 0.05 for all). Recurrence and complication rates were unaffected with non-ligation at a median 18months follow-up. Hernia sac invagination was superior to ligation in patients who underwent LMH, as it reduced early postoperative pain levels without disturbing repair integrity. We therefore recommend that ligating the hernial sac be avoided, especially in EHS 3 patients who undergo LMH.

Impact of Effortful Word Recognition on Supportive Neural Systems Measured by Alpha and Theta Power.

The goal of this study was to use theta and alpha electroencephalography (EEG) frequency power and self-report measures to examine performance monitoring, cognitive inhibition, and perceived effort required for speech understanding in noise. It was hypothesized that with a linear increase in word recognition task difficulty, there would be a linear increase in listening effort and word recognition performance would decrease in the challenging conditions. In addition, theta and alpha power would have an inverted U-shape across easy to challenging listening conditions. The inverted U-shape would reflect the neural underpinnings of listening effort that cannot be measured by task performance alone. EEG data were collected in 34 normal-hearing adults (18 to 33 years old) during the Words-In-Noise (WIN) test, which was presented in sound field. EEG frequency data were averaged and analyzed at three frontal channels for theta power (4 to 8 Hz), which is thought to reflect performance monitoring, and three parietal channels for alpha power (8 to 12 Hz), which is thought to reflect cognitive inhibition. A ten-point visual analog scale was administered after each WIN signal-to-noise ratio (SNR) condition to capture self-reported required and invested listening effort (RLE and ILE, respectively). The WIN SNR conditions were presented in descending and random order. The SNR presentation (descending or random SNR) had a null effect on word recognition performance; however, presentation did have an effect on theta power, alpha power, and ILE. When controlling for presentation, there were significant effects of SNR and presentation on both theta and alpha frequency power. Theta and alpha power had an inverted U-shape as a function of SNR from easy to challenging, with peak power in the moderate SNR conditions. RLE and ILE both significantly increased as task difficulty increased as expected; however, RLE showed a stronger relation to task performance than ILE. Alpha power was a significant predictor of RLE, ILE, and WIN performance when controlling for SNR. The elevated theta and alpha power in the easy to moderate SNRs and alpha power predicting self-reported listening effort suggest the activation of supportive neural systems during word recognition that could be considered a marker of listening effort. Moreover, the measures of neural support systems and listening effort were independent from task performance, which is a key element to further understanding the neural bases for listening effort. In the context of the broader literature, these results are consistent with (1) a parietal alpha role in supporting inhibitory control to suppress irrelevant information and (2) a frontal theta role in supporting performance monitoring in difficult listening conditions where speech recognition is feasible.

Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations\u2014a systematic review and meta-analysis

BackgroundPathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions.MethodsWe performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model.ResultsWe included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes.ConclusionTenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief.

Heat can treat: long-term follow-up results after uterine-sparing treatment of adenomyosis with radiofrequency thermal ablation in 60 hysterectomy candidate patients.

Adenomyosis may induce pelvic pain, abnormal uterine bleeding or bulk symptoms. If hormonal treatment proves ineffective or contraindicated, hysterectomy may be necessary. For patients who desire to conserve the uterus despite severe symptomatology, uterine-sparing techniques have been introduced. Radiofrequency thermal ablation (RFA) consists of the local application of high temperature to eliminate diseased tissue, applied recently for adenomyosis treatment. The objective of the study was to analyze the efficacy of RFA for avoiding hysterectomy in patients with adenomyosis-related symptoms. This is a single-center, retrospective cohort study performed in a referral center for endometriosis. The study population consisted of all consecutive patients who underwent Radiofrequency thermal ablation (RFA) treatment as an alternative to hysterectomy for adenomyosis between March 2011 and June 2019 in our institution. RFA was performed using laparoscopic access. To evaluate the impact of RFA treatment on symptoms, follow-up findings were compared to preoperative symptomatology using the ten-point visual analog scale (VAS) for pain assessment. Sixty patients were included in the study, 39 of them (65%), underwent a concomitant surgery for endometriosis in association to RFA. On a long-term follow-up (mean 56months (range 10-115, SD 29), hysterectomy was performed in 8 patients (13%). The mean VAS score before vs after surgery was 7.4 vs 3.3 for dysmenorrhea, 3.7 vs 0.3 for dyschezia, 4.7 vs 0.7 for dyspareunia, and 4.0 vs 1.4 for chronic pelvic pain, being significantly reduced after RFA for all these pain components (p < 0.0001 in every case). Thirty-one patients (52%) suffered from AUB before RFA, this symptom persisted in 10 patients (16%) during follow-up (p < 0.001). Bulk symptoms were present in 16 patients (27%) and disappeared after RFA in all cases. RFA allows for hysterectomy avoidance in most cases. It leads to marked improvements in pain symptomatology, uterine bleeding and bulk symptoms.

Prevalence of Depression, Anxiety and Quality of Life in Adolescent Girls with Dysmenorrhoea in a Remote Area of Western Rajasthan.

The aim of this study was to examine depression and anxiety in adolescent girls with dysmenorrhoea in a remote area of western Rajasthan, as well as their quality of life. The present research employed a cross-sectional descriptive design. A total of 492 girls between the ages of 13 and 19years were randomly selected from two secondary schools in a remote area of western Rajasthan. The menstrual issues were studied using the semi-structured health performa. The magnitude of dysmenorrhoea was calculated using a ten-point visual analogue scale. The GAD-7 scale was used to measure anxiety, and PHQ-9 was used to measure depression. Depression and anxiety were substantially more prevalent in girls with dysmenorrhoea than in girls without dysmenorrhoea, with an overall prevalence of 29.25% and 37.11%, respectively (p value 0.00). Girls with dysmenorrhoea had an average pain level of 5.14 (SD = 2.45) over the previous three menstrual cycles (p value 0.00). 186 girls (58.62%) suffered moderate pain during dysmenorrhoea. 124 girls (38.99%) reported that dysmenorrhoea interfered with their regular sleep and compelled them to skip class (50.31%) (p value < 0.05). 175 girls (55.03%) reported that dysmenorrhoea had a mild effect on their daily lives, while 88 girls (27.67%) said dysmenorrhoea made them feel stressed (p value < 0.05). A greater prevalence of dysmenorrhoea had a negative impact on mental health. Teenage girls are particularly vulnerable to these mental health problems. It is important to have a tenuous understanding of the menstrual problems associated with disease in adolescent females, especially in rural areas.

Observation of the Effect of the Application of Neurodynamic Principles in Lumbar Nerve Entrapment Syndrome Therapy

The article focuses on the evaluation of special therapy with neural mobilization aimed at observation of the effect of neural mobilization on a subjective parameter - pain of patients who have been diagnosed with lumbar nerve entrapment syndrome. Neurodynamic disruption is an inseparable part of clinical manifestation connected with pathological processes and changes in strain in periradicular and perineural area manifested in symptomatology of nerve roots. For the purposes of clinical practice, it is necessary to define the meaning of changes in neural mobility and differentiate between individual natures of symptoms. The differentiation of these damages lies in the specification of the share of micro sensitivity of nervous tissue in the whole image of neuropathic pain.. For purposes of the analysis results of a research realised in a rehabilitation facility were used. Standardized tests modified for the aim and tasks of the research according to specific set of rules to get real data were used. The key points of the research were pain intensity, the scale of painless motion immediately after neural mobilization in LasĂŠgue's test and SLUMP test, and the phenomena of pain centralization assessed according to classification for spinal disorders according to Quebec Task Force of Spinal Disorders. Nerve mobilization techniques with standard rehabilitation were applied to patients. Pain intensity was evaluated by a ten-point Visual Analogue Scale. The results achieved point out the increase in efficiency of medical rehabilitation via additional application of neural mobilization which, thanks to its comprehensive method, enables to make the process of medical rehabilitation more efficient, better, and faster.

A randomized, open-label, multicentre, comparative study of therapeutic efficacy, safety, and tolerability of BNO 1030 extract, containing marshmallow root, chamomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark, dandelion herb, in the treatment of mild forms of COVID-19

BackgroundCOVID19 is a high burden for medicine and society as still no specific therapy exists. Most patients depend on symptomatic treatment, comparable to the symptomatic treatment in common respiratory infection e.g., Acetaminophen or Ibuprofen. Many cases of COVID19 show mild forms without need of hospitalization. In this randomized, open-label, multicentre, comparative trial we analysed the efficacy, safety, and tolerability of the herbal medicinal product BNO 1030 in mild cases of COVID-19 to offer an additional symptomatic relive.MethodsThe study was designed as an open label randomized, prospective, multicentred clinical trial. Out of 133 screened outpatients aged 18 to 70 with mild COVID-19 symptoms 120 patients were randomised (1:1) in 2 parallel groups. The main group received BNO 1030 in addition to symptomatic therapy (acetaminophen or ibuprofen). The control group got a symptomatic therapy only. The patients with laboratory proven COVID 19 were included for the final analyses: 47 – in the main group and 46 – in the control one. The evaluation criteria were dynamics of the symptoms: hyperthermia, myalgia, nasal congestion, nasal discharge, coughing, anosmia, rhinolalia, sore throat, duration of the use of antipyretics (clinically significant fever). These symptoms were assessed during the physician’s visit on a 4-point scale (0 — absent, 1 — insignificant, 2 — moderate, 3 — strong/pronounced) and self- assessed via ten-point visual analogue scale (VAS) daily in a patient’s diary. The primary endpoint was the decrease of the average score compared to the baseline defined as “therapeutic benefit” from the usage of BNO 1030.ResultsIn the comparison of both groups over the treatment time, the main group (n = 47) showed a greater decrease in the severity of symptoms of fever, myalgia, nasal congestion, coughing, anosmia and rhinolalia, assessed by the doctor on a 4-point scale on V2 (4th day) and V3 (14th day) compared to those on V1, as well as a reduction of the antipyretics intake duration (p < 0.05). Significant differences of the main group were obtained, too, based on the results of symptoms self-assessment by the patient. The “therapeutic benefit from the use of BNO 1030 was 3 days. There is an increase in the number of recovered patients from 73.9–96.6 % according to the average symptom score, and a decrease in the number of hospitalized patients from 8.6–4.4 % in the main group., as compared to the data of the control group (p < 0.05). All patients tolerated the herbal medicine well, with no adverse drug reactions being reported.ConclusionsBNO 1030 (Imupret®) offers a safe and effective treatment benefit in patients with mild forms of diagnosed COVID-19 aged 18–70 in addition to symptomatic treatment with acetaminophen or NSAIDs. COVID 19 positive patients treated with Imupret showed an earlier relive of symptoms when being treated with BNO 1030.Trial registrationThis trial was registered in ClinicalTrial.gov: NCT04797936.

Diagnostic Accuracy and Predictive Value of Clinical Symptoms for the Diagnosis of Mild COVID-19

Objective: To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. Methods: We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. Results: Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. Conclusion: The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.

Post operative sore throat: Comparison between Macintosh versus Video Laryngoscope in patients intubated by trainee anaesthetists - A Randomised Control Trial.

Objectives:Postoperative sore throat (POST) is a common complication related to endotracheal intubation. The aim of this study was to compare the incidence of POST in patients intubated by trainee anaesthetist using Video Laryngoscope™ (VDL) or Conventional Macintosh Laryngoscope (CL).Methods:Total 110 patient scheduled for elective laparoscopic cholecystectomy were included from main operating room of Aga Khan University Hospital between June 2017-2018. The standardized perioperative protocol was used for general anaesthesia. Selected patients were randomly allocated into conventional laryngoscopy (CL) group or video laryngoscopy (VDL) group. The evaluation of sore throat was done at 1st, 12th and 24th hour postoperatively using a ten-point visual analogue scale.Results:The demographic characteristics, including intubation time, related complications or any other maneuver required were similar between the groups. The incidence of POST at 1st hour was 47% patients in CL group and 38% in VDL group (p=0.335). At 12th hour, 34.5% patients in CL and 38% in VDL reported POST (p=0.692). Similarly at 24th hour, 25% patients in CL and 16% in VDL group reported POST (p=0.669).Conclusions:There was no significant difference in incidence of POST for patients intubated by trainee anaesthetists using either CL or VDL. Objective evidence of training and laryngoscope technique can impact of POST.

The effectiveness and safety study of topical corticosteroids for psoriasis in adolescent and adult population treatment

Aim: to determine the efficacy and safety of clobetasol propionate compared with fluticasone propionate in the form of ointment for the treatment of psoriasis patients. Materials and methods. A total of 65 psoriasis patients were included in the study, 40 healthy individuals were included in the control group, all aged 14 to 65. Psoriasis patients were divided into 2 therapeutic groups: I – received topical treatment with fluticasone propionate; II – with clobetasol propionate. The severity of psoriasis was assessed by BSA and PASI index. Assessment of itching severity was carried out by a ten-point visual analogue scale. The quality of life was assessed according to the Ukrainian version of DLQI questionnaire. Results. PASI index averaged 16.50 ± 0.65 points, and BSA index was 9.30 ± 0.94 % in the examined patients before the treatment. On average, the DLQI index in patients with psoriasis before the treatment was 13.80 ± 0.27 points. PASI index was lower in psoriasis patients treated with clobetasol propionate compared with the therapeutic group I patients. The ΔPASI indicator (%) at the end of the treatment was significantly lower in patients from the I therapeutic group, compared with the group of patients who used clobetasol propionate for treatment of psoriasis. Patients who used clobetasol propionate had lower scores for pruritus and excoriation at the end of the treatment compared with patients from the I therapeutic group. The DLQI index at the end of the treatment was significantly higher in the I therapeutic group compared with its values in patients who used clobetasol propionate in the complex treatment. Conclusions. The use of topical corticosteroid clobetasol propionate in the form of ointment is the effective treatment for psoriasis, which causes a rapid regression of psoriatic rashes, a decrease in PASI and BSA indices, a decrease in pruritus and its objective signs, and indirectly improves the quality of life.

High-Risk, Low-Volume: Evaluation of a Reusable Cricothyrotomy Model in Paramedic Difficult Airway Training

High-Risk, Low-Volume: Evaluation of a Reusable Cricothyrotomy Model in Paramedic Difficult Airway Training

Are postoperative pain and patient satisfaction influenced by the number of ports in VATS for malignant pleural effusion treatment?

ABSTRACTObjectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient’s satisfaction.Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure.Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P ˂ 0.0001) in comparison with the conventional method (P ˂ 0.0001). With regard to the patient’s satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach – average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach – average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach – 6.8 – neutral. Single-port VATS approach – 8.1 – prevailing satisfaction.Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the ‘Prof. Dr. Stoyan Kirkovich’ AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.

Development and clinical evaluation of transmucosal mucoadhesive patch of lornoxicam for the odontogenic pain management: A preliminary study

Background: Pain is the most common complaint of the patient that brings him/her to the dentist, pain often occurring in conjunction with inflammation and which considerably reduces the quality of patient's life. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the dental pain management. The gastrointestinal complications associated with NSAIDs can be effectively overcome if they are delivered by transmucosal route in the form of buccal patch. Aim: The study aimed to evaluate the efficacy of mucoadhesive lornoxicam patches in odontogenic pain management. Materials and Methods: The present study was conducted in 60 adult patients of either sex, diagnosed with odontogenic pain, and were attending the outpatient department. Informed consent was obtained from all the patients. A 1 cm × 1 cm mucoadhesive patch containing 4 mg of lornoxicam was applied on the attached gingival region of the tooth with pain. Pain was recorded using a ten-point visual analog scale score before and every 5 min till 30 min after the application of the patch. Statistical analysis was performed using repeated measure ANOVA with P

2138 Nodular Adenomyosis: A Single Center 8-Years Results on the Treatment Of 120 Cases by Radiofrequency Thermal Ablation

Study Objective to prospectively assess the effectiveness and safety of RadioFrequency Thermal Ablation (RFA) for uterine nodular adenomyosis Design all patients with nodular adenomyosis who desired to preserve the uterus and who were selected for RFA were included. Setting third-level Referral Center for Endometriosis Patients or Participants One hundred twenty women with symptomatic nodular adenomyosis, aged 24-51 years, were collected. Interventions All the procedures were carried out by laparoscopic access in order to perform a concomitant surgery for endometriosis (75% of the cases), if preoperatively detected. In order to evaluate the impact of the treatment on the intensity symptoms related to the presence of uterine adenomyosis, the intensity of uterine bleeding and pain during the follow-up was compared to the properative symptomatology, and the ten-point visual analog scale (VAS) was used for pain assessment. Patients were asked about any hormonal or surgical treatments performed during the follow-up period and pregnancies occurred after the radiofrequency thermal ablation. Measurements and Main Results The median number of nodular lesions treated per patient was 1 (range, 1-2). The median reduction in volume was 66%. Follow-up period ranged from 6 to 94 months. A significant progressive improvement in the symptoms score was observed at the follow-up. Conclusion In this study, laparoscopic RFA reduced uterine adenomyosis-related symptoms and volume, with significant improvement on quality of life in the treated patients.

Long-Term Outcomes and Alignment following Isolated Fibular Sesamoidectomy

Category:Bunion, Midfoot/Forefoot, SesamoidIntroduction/Purpose:Potential etiologies of sesamoid related pain include repetitive stresses, fracture, cartilage lesions, arthrosis, and/or osteonecrosis. When patients fail to respond to conservative treatment, surgical intervention may be indicated in the form of sesamoid bone grafting, shaving/debridement, and/or sesamoid excision. Minimal published literature exists regarding the long-term safety and efficacy of fibular sesamoidectomy. The purpose of this study was to evaluate patients following isolated, complete fibular sesamoidectomy for long-term pain relief, functional outcome, and changes in hallux alignment.Methods:A query of a tertiary referral center administrative database was performed using the CPT code 28135 for sesamoidectomy between 10/1/2005 and 9/1/2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted by their treating physicians with a recruitment letter, phone call, or e-mail to return for an office visit. The primary outcome measure was preoperative to final postoperative change in ten-point visual analog scale pain score. Secondary measures included satisfaction, hallux flexion strength, change in hallux alignment, and final post-operative functional outcome scores.Patients who met the 2-year clinical or radiographic follow-up minimum were included. Patients who underwent concomitant joint realignment procedures or had a medical history of either diabetes or peripheral neuropathy were excluded.Results:Ninety-three fibular sesamoidectomies were identified. Thirty-six sesamoidectomies (35 patients) met inclusion criteria (median follow-up 60 months). The average patient was 36-years-old with a BMI of 24.7 kg/m2 and underwent sesamoidectomy a mean 1.1 years after initial diagnosis. Median VAS scores improved 5 (6 to 1) points at final follow-up (p<0.0001). Final post- operative hallux valgus angle (HVA) did not differ from pre-operative values (10.5°/8.5°, p=0.12); similarly, intermetatarsal angle (IMA) did not differ (8.0°/7.9°, p=0.53). 88% of patients would have surgery again and 70% were “very satisfied” with their result. Hallux flexion strength (mean 14.7 pounds) did not differ following sesamoidectomy relative to the contralateral foot (mean 16.1 pounds) (p=0.23). Among the full 93 case cohort, 3 patients underwent 4 known reoperations.Conclusion:Fibular sesamoidectomy effectively provides long-term pain relief for patients with sesamoiditis, fracture, nonunion, osteonecrosis, and arthritis at long-term follow-up (median 5 years). Potential long-term sequelae, including hallux flexion weakness, change in hallux alignment, and deterioration of patient satisfaction/function were not encountered.

Does extracorporeal shock wave lithotripsy-related pain get affected by menstrual cycle and menopause?

The objective of the study was to investigate the effect of the menstrual cycle and menopause on extracorporeal shock wave lithotripsy (ESWL)-related pain outcome. Since March 2017, we evaluated a total of 145 women who underwent the first session of ESWL for renal or ureteral stones. Patients were divided into two groups, as menstruating and menopaused women. For menstruating women, the number of days between the last day of mens and ESWL was noted and women were separated as in the follicular phase (1-14days) or in the luteal phase (15-30days) of menstruation. To control these two female groups, 149 men of similar age were included in the study. After the procedure, the experienced pain was recorded on a ten-point visual analog scale (VAS) by the patient and they also rated the severity of pain as no, mild, tolerable, and intolerable on the pain questionnaire. The mean age of the patients was 43 ± 15years for the female group and 42 ± 13yearsfor the male group. While stone burden was not different between the female and male groups (p = 0.459), VAS score was not statistically different between genders (p = 0.293). However, men reported a higher rate of mild pain, while women reported a higher rate of tolerable pain (p = 0.008) in the pain questionnaire. Mean VAS score was significantly lower for the menopaused women group than menstruating women, young and old men (p = 0.001). In a subgroup analysis, menopaused women group reported lower VAS score and better pain questionnaire result than menstruating women (p < 0.001). There was no statistically significant difference between the follicular and luteal phase of the menstrual cycle in terms of mean VAS score and pain questionnaire results (p = 0.891 and 0.441, respectively). When compared with the young men group, the only significant difference was pain questionnaire results between women in the luteal phase (p = 0.014). Multiple regression analysis showed that only menstruation (β = 0.639, p < 0.001) was an independent factor for VAS score. Menstrual cycle phase had no effect on pain perception during the ESWL session and menopaused women felt less pain than menstruating women during this procedure. The control male group showed that the reduction of ESWL-related pain in menopause was not related to aging.

Lower Extremity Injuries in Novice Runners: Incidence, Types, Time Patterns, Sociodemographic and Motivational Risk Factors in a Prospective Cohort Study.

SUMMARY – The aim was to determine types and incidence of running-related lower extremity injuries and identify sociodemographic and motivational risk factors in novice runners attending an eight-month running school. Between January 2011 and October 2014, 349 novice runners were included. Sociodemographic, anthropometric, and data on running motivation and self-perceived health and fitness were collected. Subjects were screened for lower extremity injuries at regular three-month intervals. The cohort mean age was 35.46±7.31 years, and 271 (79.5%) were female. There were 173 (49.9%) injuries recorded, less frequently among women (42.9% vs. 62.7%, p=0.016; OR 0.878, 95% CI 0.788-0.977). The mean body mass index was 23.89±3.88 kg/m2 at baseline and 22.99±3.35 kg/m2 post-school (p<0.001). Median self-perceived fitness level on a ten-point visual analog scale was 4 (interquartile range (IQR) 3-5) at baseline and 8 (IQR 7-8) post-school (p<0.001). Median self-perceived overall health was 6 (IQR 5-8) at baseline and 8 (IQR 7-9) post-school (p<0.001). The knee had a significantly higher rate of injuries compared to other anatomic regions (p<0.001). Subjects listed improvement of fitness as the most common motivation for entering the school (n=159; 45.7%). In conclusion, novice runners should include strengthening exercises for knee injury prevention into their training routine.