VAS Values Research Articles

The clinical management and efficacy of metagenomic next-generation sequencing in patients with pyogenic spinal infection: a single-center cohort study

ObjectiveThis study aims to evaluate the clinical management and effectiveness of metagenomic next-generation sequencing (mNGS) in patients with pyogenic spinal infections.MethodsWe conducted a retrospective review of 17 patients diagnosed with pyogenic spinal infections and treated at our institution between October 2022 and February 2024. The cohort included 8 males and 9 females, with a mean age of 63.59 ± 10.18 years (range: 41–71 years). The infections comprised 9 epidural abscesses, 6 intervertebral space infections, and 2 deep abscesses. All patients underwent open surgical procedures and mNGS-based bacterial identification using intraoperative pus or tissue specimens, in addition to conventional blood bacterial cultures. Clinical outcomes were assessed using CRP, PCT, WBC inflammatory markers, and VAS scores postoperatively.ResultsAll 17 patients with pyogenic spinal infections underwent open surgery and mNGS bacterial detection at our institution. Among the 17 patients, mNGS yielded positive results in 14 cases (82.4%), significantly higher than the 5.9% positivity rate of conventional bacterial cultures (p < 0.001). The mNGS test time was notably shorter than conventional cultures (1.0 vs. 5.88 days, p < 0.001). Postoperative antibiotic therapy was adjusted based on mNGS findings. There were significant reductions in postoperative VAS, WBC, PCT, and CRP values compared to preoperative levels (p < 0.01).ConclusionMetagenomic next-generation sequencing is effective in managing pyogenic spinal infections by facilitating rapid and sensitive detection of pathogens. This technique improves the timeliness and accuracy of diagnosis, highlighting its potential for broader clinical use.

Sonographic Verification and Clinical Significance of the Features of Surrounding Structures in Knee Osteoarthritis

Background: Osteoarthritis (OA) of the knee joint is one of the most dangerous diseases, the most significant manifestation of which is chronic pain syndrome. There is a low correlation between the radiographic stage of OA and pain progression. First of all, this is a variety of pain syndromes, among which is the pathology of periarticular structures (AS). To date, the contribution of this type to the clinical picture of OA has been sufficiently studied, primarily due to the fact that the list and frequency of these lesions have not yet been described.Aim: to describe the basis of the main periarticular structures in patients with different radiographic stages of knee OA according to ultrasound data.Materials and methods: The observational study has currently included 88 patients who had an outpatient appointment with a rheumatologist for knee osteoarthritis between 2021 and 2023. The study assessed 110 knee joints using clinical and ultrasound techniques.Results: The most common periarticular ultrasound changes, regardless of radiographic stage, were pes anserine tendinopathy (57.3 %), Baker’s cyst (45.5 %), fibrosis of the severe Hoffa body (40 %) and ligamentopathy of the medial collateral ligament (36). ,4). %). A significant correlation was found between the number of changes according to ultrasound and the radiological stage (ρ=0.45 [95 % CI: 0.28, 0.59], p &lt;0.001) as well as between the VAS and the definition of identified ultrasound changes (ρ= 0.29 [95 % CI: 0.11, p=0.002); In addition, it was shown that late stages of OA are associated with a greater content of changes (p &lt;0.001).Conclusion: Changes in periarticular structures are present in most patients with knee osteoarthritis; their number correlates with the VAS value and radiographic stage of OA. Details of these changes, their clinical significance and pathogenetic contribution to the progression of knee OA require further study.

Social conditions impact functional outcome in patients with hand osteoarthritis: the low-income hand osteoarthritis (LIHOA) cohort

BackgroundHand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA).MethodsData from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [</≥ 9 school-years (SY)].Results107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3–5) and 8 (5–9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2–8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5–14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1–0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared </≥3 MW earnings, respectively. Most declared >9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone.ConclusionClinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort.

The effect of B-Lynch uterine compression suture performed for uterine atony on future menstrual pattern and reproductive outcome.

The effects of B-Lynch (UCS) compression sutures applied in postpartum hemorrhage cases due to uterine atony on menstrual pattern, fertility, obstetric outcomes, dysmenorrhea and dyspareunia were evaluated. Between January 2012 and March 2017, 77 patients (study group 37, control group 40) diagnosed postpartum hemorrhage in our clinic were included in the study. The long-term results of the patients were evaluated comparatively. In the B-Lynch UCS group, an increase in the postoperative menstrual cycle length and the intensity of dyspareunia measured by the VAS score, and a statistically significant decrease in the duration of menstrual bleeding were observed. In the control group, a decrease in the self-estimated time of postpartum menstrual bleeding and a statistically significant increase in dyspareunia VAS values ​​were observed. There was a statistically significant difference between the groups in terms of menstrual cycle length only after treatment. B-Lynch UCS can be used effectively and safely in PPH due to uterine atony without causing any additional pathology in menstrual pattern, fertility, dysmenorrhea and dyspareunia complaints other than the length of the menstrual cycle.

Comparison of the effects of submucosal hyaluronidase and dexamethasone on postoperative edema, pain, trismus, and infection following impacted third molar surgery

BackgroundLimiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications.MethodsIn groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days.Results60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate.ConclusionsHyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost–effective option if postoperative pain control is merely targeted.Trial registrationThis trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022.

Implementing routine collection of EQ-5D-5L in a breast cancer outpatient clinic.

A cross-sectional study was conducted to investigate the feasibility of implementing routine collection of the Euro-Qol 5 dimensions (EQ-5D) questionnaire, to inform drug and health technology reimbursement decision making. Women with breast cancer were recruited during scheduled clinic visits to an academic cancer centre. EQ-5D-5L was self-administered using electronic tablets. Diagnostic and treatment data were abstracted from patient charts. Feasibility was assessed primarily by the proportion of patients who fully completed EQ-5D-5L and by their willingness to complete the instrument at each clinic visit. 588 women were approached for study participation, 341 were enrolled. Fully completed EQ-5D-5L questionnaires were obtained in 323 participants (95% of participants, 95% CI 92-97%). Median time for EQ-5D-5L completion was 1.5 minutes (range:0.35 to 14.7). Mean age of participants was 58 years old. Most women who completed EQ-5D were White, born outside Canada and presented a high education level; one-quarter had metastatic disease. Most participants reported "No problems" in all EQ-5D-5L dimensions. Mean EQ-5D-5L index and mean EQ-5D-5L VAS values for all participants were respectively 0.83 (SD 0.13) and 75.7 (SD 17.45), with patients with metastatic disease scoring the lowest values. Seventy-eight percent of participants were willing to complete EQ-5D-5L at each clinic visit; lower Charlson comorbidity index and higher education level were predictors of willingness to continue to answer EQ-5D-5L. Tablet-based collection of EQ-5D-5L in the context of routine clinical practice proved to be feasible. However, many patients declined study participation or reported being in full health, raising concerns about whether this method of collecting EQ-5D adequately represents the health status of all breast cancer patients.

Efficacy and safety of intradetrusor abobotulinumtoxinA and incobotulinumtoxinA in women with overactive bladder and the value of local anesthesia: arandomized clinical study.

Anon-inferiority clinical study evaluated the efficacy and safety of abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections in women with overactive bladder and urge urinary incontinence. Also, the effect of local anesthesia on the pain level of the procedure was assessed. Patients were randomized to receive 20intradetrusor injections of either 300 U abobotulinumtoxinA or 100 U incobotulinumtoxinA. They were further randomized to receive either local anesthesia (40 ml 1% lidocaine solution) or placebo before botulinum toxin injection. Before the procedure and 4months after the procedure each patient reported urinary incontinence episodes, frequency, nocturia, completed the Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7), and Incontinence Quality of Life (I-QOL) questionnaire. Each patient completed apatient satisfaction survey 4 months after the procedure. During the procedure, the patients graded the pain intensity of every injection on avisual analog scale (VAS). The total score of each questionnaire was considered. A total of 54patients with amean age of 66 ± 13(SD) years completed the study. Total scores of UDI‑6, IIQ‑7, I‑QOL, patient satisfaction, urinary incontinence episodes, frequency, nocturia and VAS questionnaires did not show differences between the abobotulinumtoxinA (n = 26) or incobotulinumtoxinA (n = 28) group. Urinary retention requiring catheterization was noted in five patients. The VAS and patient satisfaction questionnaire values did not show significant differences between the group receiving bladder instillation with lidocaine solution (n = 28) or the group receiving placebo (n = 26). In women with overactive bladder and urge urinary incontinence where conservative treatment failed, abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections showed comparable results regarding improved clinical outcome and patient satisfaction. Local anesthesia before the procedure did not reduce the pain level in comparison with the placebo.

Intra-articular injections with Carboxymethyl-Chitosan in patients affected by knee osteoarthritis non-responders to hyaluronic acid: a pilot study.

Osteoarthritis (OA) is a disabling disease that causes pain and functional limitation. OA symptoms can be treated with intra-articular injections of anti-inflammatory, viscosupplementary, or viscoinductive products. Non-responders to these approaches have limited options, often surgical (e.g. knee replacement). This retrospective study aims to evaluate the efficacy of a single injection of Carboxymethyl-Chitosan for advanced (Kellgren-Lawrence ≥3) and symptomatic knee OA in non-responders to hyaluronic acid. We enrolled 10 patients (5 female, 5 male). Treatment efficacy was assessed through the Visual Analogue Scale (VAS, pain) and the Knee Injury and Osteoarthritis Outcome Score (KOOS, knee function). Data are acquired from rating scales were administered at the time of injection (T0), one month (T1), three months (T2), and six months (T3) after treatment as for clinical practice. Results showed a significant improvement in pain and function at T1, with a subsequent gradual resumption of symptoms. In conclusion, the treatment showed a better outcome in the short term (i.e. up to 1 month after treatment); however, raw values of VAS and KOOS did not return to baseline levels showing a maintenance of improvement albeit not statistically significant.

Assessing the impact of opioid-free anesthesia using the modified Mulimix technique on postoperative pain in bariatric surgery patients: a correlative randomized double-blinded trial

Background &amp; objective: The effective management of postoperative pain in bariatric surgery poses significant challenges to the anesthesiologists and the surgeons. Opioids have been the mainstay of postoperative pain management; but recently, opioid-free anesthesia (OFA) has been a popular option in an effort to prevent the opioid related side-effects. The objective of this study was to assess the effects of OFA utilizing the modified mulimix technique on the levels of plasma interleukin-2 (IL-2) and interleukin-6 (IL-6). In addition, the study aimed to evaluate the duration of analgesia and the analgesic requirements during the first 24 hours postoperatively. Methodology: A total of 60 patients were randomly assigned to the OFA Group, which received opioid-free anesthesia, and the OBA Group, which received Opioid-Based Anesthesia. The modified Mulimix technique was used in both groups. Serum samples were collected from all patients during skin incision and after the surgical procedure. Subsequently, these samples were assessed for IL-2 and IL-6 levels. The postoperative analgesic consumption was compared in both groups. Results: Regarding serum IL-2 and IL-6 levels in the two study groups, there was a statistically significant difference after the conclusion of surgery, and the skin incision was made. Regarding the initial rescue analgesia postoperatively assessment, the OBA group demonstrated a substantially greater overall consumption of analgesics within the first 24 h. The study revealed a significant difference in VAS values between the OBA Group and the OFA Group at 2 h, 4 h, and 6 h postoperatively. Conclusion: The modified mulimix technique effectively reduces postoperative plasma inflammatory mediators, interleukin-2 and interleukin-6, and results in decreased postoperative pain, thus reducing the postoperative analgesia consumption Abbreviations: OBA - Opioid based anesthesia; OFA - opioid-free anesthesia; IL-2 - interleukin-2; IL-6 - interleukin-6; VAS - visual analogue scale Keywords: Bariatric surgery, interleukin, Mulimix, opioid, pain, immunological response. Citation: Seyam SHA, Hassan AE, Elsayed MM. Assessing the impact of opioid-free anesthesia using the modified Mulimix technique on postoperative pain in bariatric surgery patients: a correlative randomized double-blinded trial. Anaesth. pain intensive care 2024;28(4):721−726; DOI: 10.35975/apic.v28i4.2516 Received: March 04, 2024; Reviewed: May 18, 2024; Accepted: May 19, 2024

Predictors of subacute postoperative pain after total knee arthroplasty: A secondary analysis of two randomized trials.

Methods for identifying high-pain responders undergoing total knee arthroplasty remain important to improve individualized pain management. This study aimed at evaluating pre- and perioperative predictors of pain on Days 2-7 after total knee arthroplasty. This is a secondary analysis of data from 227 patients participating in two randomized trials. Pain outcomes were mean pain during walking on Days 2-7 and on Days 2, 4 and 7. Multivariable linear and logistic regressions were carried out in two steps. First, only preoperative available variables including demographics, comorbidities, pain catastrophizing scale and preoperative pain were evaluated while controlling for trial intervention and recruitment site. In the second step, perioperative variables and pain during walking 24 h postoperatively were added. The model with only preoperative predictors for mean pain Days 2-7 showed preoperative pain (R-squared 0.097) as the only predictor. In the second model, adding postoperative available variables, only pain 24 h postoperatively (R-squared 0.248) was significant, with a significant main effect of recruitment site. Results for the separate day analysis similarly showed preoperative pain and pain during walking 24 h postoperatively as predictors. The overall best sensitivity (60%) and specificity (74%) for predicting a high-subacute postoperative pain response on Days 2-7 was with cut-off values of VAS 45.5 (out of 100) for pain during walking 24 h postoperatively. Postoperative pain during walking at 24 h is predictive of subacute postoperative pain on Days 2-7 after total knee arthroplasty, while preoperative pain was only a weak predictor. This study investigated factors associated with pain after total knee arthroplasty beyond the immediate postoperative period. The analysis revealed significant associations between preoperative pain levels and, particularly, pain 24 h postoperatively, with subsequent subacute pain the following week. These findings can assist in identifying patients who would benefit from enhanced, individualized analgesic interventions to facilitate postoperative recovery.

Recovery effect of self‐myofascial release treatment using different type of a foam rollers

Among athletes, foam rolling is popular technique of myofascial release aimed to support recovery processes and counteract delayed onset muscle soreness. However, there is no consensus on the optimal parameters of the roller texture used in the procedure. The study aimed to determine whether using rollers with different textures and hardness (smooth/soft, grooved/mid, serrated/hard) in myofascial release affects post-exertional restitution rate and the level of perceived DOMS (Delayed Onset Muscle Soreness) after intense anaerobic exercise. The study involved 60 healthy and physically active men randomly divided into three experimental groups and one control group (passive rest)—each consisting of 15 individuals: STH—rolling with a smooth roller; G—rolling with a grooved roller; TP—rolling with a serrated roller; Pass—passive rest group. After performing a exercise test (one-minute high-intensity squat), blood lactate (LA), creatine kinase (CK) and pain perception (VAS Scale) were monitored. The analysis of the average LA concentration in the blood 30 min post-exercise showed a statistical difference for all rolling groups compared to the passive rest group: STH (p < 0.001), G (p < 0.001), TP (p = 0.035). No statistically significant differences were found between the CK measurement results in individual assessments. Statistically significant differences in VAS values were observed between G (p = 0.013) and TP (p = 0.006) groups and the Pass group at 48 h, as well as between STH (p = 0.003); G (p = 0.001); TP (p < 0.001) groups and the Pass group at 72 h. Based on statistical data, a strong influence (η2 = 0.578) of time on the quadriceps VAS variable was noted. The research results confirm the effectiveness of rolling in supporting immediate and prolonged recovery. The conducted studies indicate a significantly better pace of post-exertional recovery after a rolling procedure lasting at least 120 s. The texture and hardness of the tool used did not matter with such a duration of the treatment.

Efficacy and Safety of Filgotinib in Rheumatoid Arthritis Patients Aged over and under 65 Years (ENANTIA-65).

According to recent data, the age of patients could represent an important risk factor for MACE (major cardiovascular events), cancer, and VTE (venous thromboembolism) during treatment with JAK inhibitors in rheumatoid arthritis. We decided to analyze the population involved in the ReLiFiRa study by identifying two groups of patients: 65 years or more and less than 65 years of age, evaluating the efficacy and tolerability of 200 mg of Filgotinib daily. Of the 120 ReLiFiRa patients, 54 were younger than 65 years old and 66 patients were 65 years old or older. The data of efficacy and tolerability of treatment with FIL 200 mg daily for 6 months were evaluated. After six months of treatment, FIL was effective in both age groups. In both groups, the median values of steroid DAS28, CDAI, ERS, PCR, tender joints, swollen joints, VAS, HAQ, PGA patients, and PGA physicians were reduced with a statistically significant difference comparing these values with the baseline values. The difference in age did not impact the effectiveness of the drug. The lipid profile data also did not demonstrate significant differences between the two age groups; however, the comparison between younger vs. older patients' populations regarding the total cholesterol/HDL ratio and LDL/HDL ratio shows a statistically significant difference: total cholesterol/HDL 3.4 (2.12-3.66) vs. 3.64 (3.36-4.13) p = 0.0004, LDL/HDL 1.9 (0.98-2.25) vs. 2.41 (2.04-2.73) p = 0.0002. There are no differences regarding the atherogenic index (LDL-C/HDL-C) and coronary risk index (TC/HDL-C) compared to baseline. After six months of treatment with FIL, the older population group showed a higher level of LDL and a lower level of HDL compared to younger patients. The atherogenic index and coronary risk index are higher in patients aged ≥ 65 years, but interestingly, there were no differences when comparing the 6-month data to baseline values. This condition highlights the impact of typical risk factors that act independently of treatment with Filgotinib.

Efficacy of McKenzie, Maitland Mobilisation and Myofascial Release in Chronic Low Back Pain

Objective: To compare the effectiveness of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain and find out the effects of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain. Background: Low back pain is defined as the pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks. It is one of the most common complain of working-age population. Low back pain is associated with deconditioning of spine and trunk due to lack of core strength and stability in which 60-80% of general population suffer with high recurrence rates of 60 - 85% within following three years. The global prevalence of LBP as 7.3%. Activities that are required for daily living are affected because of LBP. The significance of disability is created because of LBP. The lumbosacral, sacroiliac and lumbar regions are the main regions of LBP. Pain in the back region that lasts for more than three months is called chronic lower back pain (CLBP). Lower?back pain (LBP) is seen in all age groups. Half of the people encounter back pain in a year and nearly three-fourths of the population account for LBP in their lifetimes. It is one of the most disabling factors often preventing sports person for participation in sporting activities. In United States, the workers compensation claims account for about one fourth of all claims and one third of total compensation costs. It results in about 40% of absences from work. In total spinal pain cases low back pain accounts for 60-70%.Chronic Low back pain is the pain that persists longer than the expected time period for healing, with a duration of more than three months. The natural course of most low back pain is of self-limiting in nature, with vast majority of individuals improving within six weeks or less. Study design: Experimental study Methods: 51 subjects were selected through convenient sampling. All the subjects who were diagnosed with chronic low back pain from Orthopaedics OPD was referred to physiotherapy department and was screened and assessed according to inclusion and exclusion criteria. The eligible subjects were approached with proposal of the study. Aim and procedure of the study was explained to the subject and a written informed consent was taken from them in their preferred language. At first the demographic data (age, sex, duration) was collected forever subject. Then the baseline data (pre intervention) of CLP intensity, functional disability was taken before commencement of the study. Then the subjects were randomly allocated each 17 subjects. A final data of pain intensity, functional disability was recorded. Results: For all the outcome measures, no significant difference results were found for all three techniques. Whereas, Mc Kenzie techniques is the most effective and the least effective is Maitland Mobilisation. Mean Improvement calculated as Pre- post values of VAS and RMQ scores at follow-up on 7th and 14th day was compared between the 3 techniques. Its significance was tested by testing whether the 95% CI of the mean improvement included 0 or not. Mckenzie techniques howed maximum improvement 4.68 (2.29, 7.07) on Day 7th and Maitland mobilisation the least improvement, 1.56(0.95, 2.93). Improvement by all techniques was significant at 95% CI using paired t test. However, on day 14th McKenzie showed maximum improvement 5.56(2.72, 7.07)) Maitland mobilization remaining the least effective. Conclusion: LBP is a common condition and all age groups are facing it. Pain can be due to various causes and the line of treatment depends upon the cause of pain. In this review, we found out that LBP is a condition everyone is facing. Mc Kenzie is a better treatment approach over other two techniques to reduce chronic LBP. Pain and disability were the points considered while concluding. LBP affects the quality of life and to maintain or improve the quality of life strengthening the muscles plays an important role. This review gives a brief about the treatment methods available for treating CLBP clinically. Hence physiotherapy treating subjects with chronic low back pain may choose any one technique but Mc Kenzie Technique is the most effective technique for pain and for functional disability in CLBPis the most effective. However sufficient experience and expertise is necessary. Key words: Chronic Low Back Pain, Mc Kenzie, Maitland Mobilisation, Myofascial Release, VAS, RMQ

HEALTH-RELATED QUALITY OF LIFE IN POSTMENOPAUSAL WOMEN WITH ADVANCED BREAST CANCER RECEIVING ADJUVANT HORMONE THERAPY (RIBOCICLIB AND LETROZOLE)

Breast cancer is a type of cancer that affects many women in Indonesia. Adjuvant hormone therapies, such as letrozole and ribociclib, have succeeded in improving the patient's quality of life. This study aimed to assess the quality of life of postmenopausal women with advanced breast cancer who received adjuvant hormone therapy with ribociclib and letrozole. A cross-sectional study was conducted using retrospective data from postmenopausal female breast cancer patients at Dharmais Cancer Hospital between 2020 and 2023 who met the inclusion criteria. To determine the impact of sociodemographics on patient quality of life, data were examined using the quality of life score (EQ5D5L) and Spearman test. There were 29 patients, with a mean age of 54.9 years (SD = 8.65); the highest education level was high school (34.5%); The majority of occupations are housewives (69%), and the majority are stage IV (34.5%). The mean utility and VAS values of Ribociclib were 0.885 and 81.66, respectively, whereas those for letrozole were 0.725 and 78.46, respectively. Analysis of the relationship between quality of life and patient characteristics showed that the quality of life of patients with breast cancer treated with adjuvant ribociclib and letrozole therapy was influenced by the stage of breast cancer (p = 0.008). These findings indicate that patients receiving ribociclib and letrozole therapy have a good quality of life, which quality of life quality of life is influenced by the stage of malignancy. Keywords: breast cancer, quality of life, letrozole, ribociclib, post menopause

COMPARISON OF THE EFFECT OF TWO REHABILITATION PROGRAMS ON SPINAL MOBILITY AND PAIN INTENSITY IN PATIENTS WITH SPINAL DISCOPATHY

Introduction. Approximately 80% of people experience back pain throughout their lives. A common problem of patients with low back pain is a significant limitation of mobility. Rehabilitation programs are usually recommended. Programs should include exercises that build flexibility, endurance, and strength. Kinesiotherapy is complemented by physiotherapy procedures, which are mainly aimed at analgesic and relaxing effects.&#x0D; The aim of the study was to compare the effect of two rehabilitation programs that differ in the type of kinesiotherapy on the mobility of the lumbar spine and the level of pain intensity in people with L5-S1 segment discopathy.&#x0D; Materials and methods. The study involved 30 patients undergoing 14 days of rehabilitation treatment. The criterion for dividing the subjects into groups was the method of kinesitherapy. The first group (Gr1) consisted of 15 patients who did gymnastics in the pool twice a day, and the second group (Gr2) consisted of 15 patients who attended therapeutic gymnastics classes in the gym twice a day. The exercises were aimed at improving the range of motion of the spine, strength and endurance of postural muscles. A visual analog scale was used to assess the intensity of pain. The distance between standard anthropometric points in the resting position and in the extreme position of movement was measured to assess the range of spinal movements.&#x0D; Results. After rehabilitation, the amplitude of movements of the lumbar spine increased in most patients. In Gr1, an increase in the range of forward spinal flexion by 9.2 cm (p = 0.001), rotation to the right by 0.63 cm (p = 0.03), and to the left by 1.33 cm (p = 0.007) was detected. In Gr2, the range of forward flexion increased by 12.6 cm (p = 0.005), left rotation by 0.94 cm (p = 0.035), and right flexion by 1.41 cm (p = 0.002). In the case of other movements, no statistically significant changes were found.&#x0D; In Gr1, the average pain intensity according to the VAS was 4.9 ± 2.3 points before the start of the physiotherapy program and 3.6 ± 1.7 points after its completion (p = 0.04). In Gr2, the VAS values were 5.1 ± 2.5 points and 3.9 ± 1.8 points, respectively (p = 0.03). The magnitude of changes in pain intensity was similar (-1.3 points and -1.2 points) for both programs.&#x0D; Conclusions. 1. The applied rehabilitation programs increased the mobility of the lumbar spine and reduced pain in patients with L5-S1 segment discopathy. 2. Both the hydrokinesitherapy program and the gym program were equally effective in increasing the range of motion of the spine and reducing the intensity of pain.

Original research: Dexmedetomidine versus ketamine in erector spinae plane block for postoperative analgesia following modified radical mastectomy: A prospective randomized controlled blinded study

ABSTRACT Background A significant postoperative pain has been documented in numerous breast cancer cases following modified radical mastectomy (MRM). We evaluated the effectiveness of dexmedetomidine (DEX) versus ketamine as adjuvants to local anaesthetic in erector spinae plane block (ESPB) in MRM. Methods In this randomized controlled trial, 75 women with breast cancer scheduled for MRM were included. All patients underwent ESPB with 30 ml 0.25% bupivacaine and randomized into three equal groups: group A, ESPB group; group B: received 1 µg/kg DEX with the ESPB; and group C: given 0.5 mg/kg Ketamine with the block. Results Compared with group A, VAS score at rest as well as movement were lower considerably in groups B and C (p < 0.05) at 6 h, 12 h, and 24 h. Group B had lower VAS scores at rest at 12 h and 24 h and during movement at 6 h, 12 h, and 24 h (p < 0.05) than group C. In comparison to A Group; B and C Groups required considerably less time to rescue analgesia and consumed significantly fewer total opioids (p < 0.05 and p < 0.001, respectively). In addition, total number of patients who required additional analgesia was markedly reduced in groups B and C compared to group A ;(p < 0.05). Conclusion In MRM surgery, the postoperative opioids consumption and VAS values were lower in both groups DEX and ketamine as an adjuvant to bupivacaine which enhanced the analgesic profile and prolonged ESPB duration compared to ESPB alone, with DEX being superior to ketamine.

Effect of Work-Based Exercise Program Among Industrial Workers having Non-Specific Neck Pain Using ICF Core Set: A Pre-Post Experimental Study

Unfortunately, there are many causes of neck pain, the most prevalent ones are long periods of sitting, bad workplace ergonomics and keeping an unnatural neck posture. Studies show that small-scale industries lack awareness of and comprehension of ergonomics. Unpredictable schedules, long hours, hazardous workplaces, and all these problems, including inadequate vocational training, may negatively impact employees’ HRQOL and restrict their capacity to take part in and carry out activities. Progressive resisted training, neuromuscular training exercises, stretching, and ergonomic recommendations are all recommended. To enhance the quality of life of industrial workers, fitness programs must be implemented. The aim is to ascertain how a work-based exercise program affects industrial workers with nonspecific neck discomfort in terms of activity limitation and participation restriction. To determine the risk of nonspecific neck discomfort among industrial workers, the RULA scale was administered to 92 individuals in the study who had VAS values ranging from 3-6. Neck ROM was also recorded. An ICF documentation form was used to ascertain the engagement and involvement. Over the course of two weeks, the subjects received a work-based exercise program on alternate days. ROM, RULA, and ICF documentation were among the outcome variables that were assessed both before and after the intervention. The result was that there was a noteworthy distinction noted between the RULA, ROM pretest and post-test scores as well as ICF codes. Differences between the pre and post-test of VAS were significant difference (Z=8.3290, p=0.0001). To conclude the study found that industrial workers lacked knowledge about ergonomics. Therefore, exercises and ergonomics helped manage neck pain and improve the range of motion.

Evaluation of the effectiveness of polishing pastes used in teeth whitening

INTRODUCTION. To increase the effectiveness of preventive procedures, it is important to choose the right professional hygiene products. The most common complaint after professional oral hygiene is hypersensitivity of the teeth.AIM. To study the effectiveness of various polishing pastes.MATERIALS AND METHODS. The research was conducted on the basis of the Department of Therapeutic Dentistry of the Research Medical University, Nizhny Novgorod, the cytological laboratory, Dental Polyclinic No. 1 (Ryazan). A dental examination was performed on 39 patients of both sexes aged 18 to 45 years with discoloritis of hard tissues, who were exposed to harmful industrial factors and did not have dental hyperesthesia. The control consisted of 13 practically healthy people who do not work in hazardous industries from Ryazan. The patients underwent professional hygiene using 3 types of polishing pastes (based on corundum, perlite, R.O.C.S. PRO POLISHING toothpaste), depending on which the patients were divided into 3 groups of 13 people each.RESULTS. In all 3 groups, there was a significant difference in the values of IGZ, IRGZ, Schiff and VAS samples from the initial ones (p &lt; 0.05), i. e. hyperesthesia of varying degrees appeared after professional hygiene. The most significant differences between IIGZ, IRGZ, Schiff’s sample and VAS were revealed in groups 1 and 3, the Schiff sample revealed significant differences between groups 1 and 2, differences in the values of IIGZ, IRGZ and VAS were also recorded in groups 1 and 2 of observation. The most pronounced hyperesthesia was observed when using Corundum–based polishing paste, and the minimum was R.O.C.S. paste PRO POLISHING.CONCLUSION. The existing harmful production factors in workers lead to structural changes in the enamel. When carrying out occupational hygiene for people working in hazardous industries, the most preferable is the use of a paste based on ultrafine silicon dioxide.

The Effectiveness of Parecoxib on Inflammatory Cytokines, Prostaglandin Levels, and Visual Analogue Scale Value among Preeclamptic Patients that Undergo Caesarean Section

Introduction: Preeclampsia is produced by the maternal immune system and trophoblast proinflammatory cytokines. Effective perioperative analgesics reduce surgery-related pain and inflammation. It explores how parecoxib affects IL-1, IL-6, prostaglandin and VAS in preeclampsia patients who had a spinal anesthesia cesarean. Materials and methods: This experiment uses a 2-group pretest and posttest. Samples were taken consecutively. The study group (n = 18) received parecoxib 40 mg IV bolus every 12 h 4 times and paracetamol 1,000 mg IV infusion every 8 h until 48 h postoperatively, while the control group (n = 18) received placebo NaCl 0.9 % IV bolus every 12 h 4 times and paracetamol 1,000 mg IV drip every 8 to 48 h. Participants’ postoperative pain was assessed by VAS before, 12, 24 and 36 h after surgery. Statistical analysis was conducted on biomolecular examination data, including IL-1β, IL-6, PGE2 and VAS values. Results and discussion: The study group had lower IL-1β levels than the control group, although the difference was not significant (p &gt; 0.05). In the study group, IL-6 levels were 4,782 ± 5,673 lower than in the control group (6,147 ± 5,957). Study group IL-6 levels were higher than control group values, although not significantly (p &gt; 0.05). The study group had lower PGE2 than the control group, but not significantly (p &gt; 0.05). The study group’s mean VAS value was 1.722 ± 1.994, lower than the control group’s 1.833 ± 2.007 and not significant (p &gt; 0.05). The study group had considerably lower VAS values than the control group (p &lt; 0.05). Conclusions: In preeclampsia patients who underwent caesarean delivery under spinal anesthesia, parecoxib administration influences IL-1β levels after 24 h and VAS values after 12 h. It did not affect IL-6 or PGE2 levels in preeclamptic individuals who had spinal anesthesia caesarean sections. HIGHLIGHTS Parecoxib, a powerful analgesic, anti-inflammatory drug and moderately toxic maternal and newborn drug Parecoxib has the ability to reduce IL-1β levels after 24 h in preeclampsia patients undergoing cesarean section with spinal anesthesia After 12 h, parecoxib has an effect on the pain scale (VAS) values of preeclampsia patients who underwent a caesarean section under spinal anesthesia GRAPHICAL ABSTRACT

Clinical Efficacy and Metabolomics Modifications Induced by Polyphenol Compound Supplementation in the Treatment of Residual Dizziness following Semont Maneuver in Benign Paroxysmal Positional Vertigo (BPPV) of the Posterior Semicircular Canal (PSC): Preliminary Results.

Benign paroxysmal positional vertigo (BPPV) represents the most frequent cause of peripheral vertigo. In most cases, it is successfully treated using the canalith repositioning procedure, but it is often followed by continuous lightheadedness in the absence of vertigo or nystagmus (residual dizziness, RD). Our aim is to describe the clinical effectiveness and the urine metabolomics profile of treating these patients with polyphenol compound supplementation. We enrolled 30 patients reporting RD after BPPV of the posterior semicircular canal (PSC) successfully treated using the Semont maneuver. Supplementation with a polyphenol compound was administered for 60 days, and patients were evaluated after 30 and 60 days of treatment using self-administered questionnaires (Visual Analog Scales for Dizziness and Nausea, Dizziness Handicap Inventory, DHI) and urine metabolomics analysis performed using 1H-NMR spectroscopy and multivariate followed by univariate analysis. Most patients reported excellent or good efficacy in the treatment of RD with a significant decrease in VAS and DHI values. The metabolomics analysis identified six significant metabolites related to the treatment, namely 1-methylnicotinamide, anserine, hippurate, lysine, methyl succinate and urea, indicating the inflammatory activities and antioxidant properties of the polyphenol compound. These preliminary data suggest that supplementation with a polyphenol compound could induce some metabolic changes that can help in recovery from RD. However, future steps will require confirmation with a more significant cohort of patients and an extension of the metabolomics evaluation to other problems concerning the different clinical aspects of BPPV, such as the high rate of relapse.