Visual Analogue Scale Scale Research Articles

Evidence of trospium’s ability to mitigate cholinergic adverse events related to xanomeline: phase 1 study results

RationaleThe M1/M4 preferring muscarinic receptor agonist xanomeline demonstrated antipsychotic and procognitive effects in patients with Alzheimer’s disease or schizophrenia in prior studies, but further clinical development was limited by cholinergic adverse events (AEs). KarXT combines xanomeline with the peripherally restricted muscarinic receptor antagonist trospium with the goal of improving tolerability and is in clinical development for schizophrenia and other neuropsychiatric disorders.ObjectiveTest the hypothesis that trospium can mitigate cholinergic AEs associated with xanomeline.MethodsHealthy volunteers enrolled in this phase 1 (NCT02831231), single-site, 9-day, double-blind comparison of xanomeline alone (n = 33) versus KarXT (n = 35). Rates of five prespecified cholinergic AEs (nausea, vomiting, diarrhea, excessive sweating, salivary hypersecretion) were compared between treatment arms. Vital signs, electrocardiograms (ECGs), safety laboratory values, and pharmacokinetic (PK) analyses were assessed. A self-administered visual analog scale (VAS) and clinician-administered scales were employed.ResultsCompared with xanomeline alone, KarXT reduced composite incidences of the five a priori selected cholinergic AEs by 46% and each individual AE by ≥ 29%. There were no episodes of syncope in KarXT-treated subjects; two cases occurred in the xanomeline-alone arm. The rate of postural dizziness was 11.4% in the KarXT arm versus 27.2% with xanomeline alone. ECG, vital signs, and laboratory values were not meaningfully different between treatment arms. The VAS and clinician-administered scales tended to favor KarXT. PK analysis revealed that trospium did not affect xanomeline’s PK profile.ConclusionsTrospium was effective in mitigating xanomeline-related cholinergic AEs. KarXT had an improved safety profile compared with xanomeline alone.

Relationships between quality of life and comprehensive geriatric assessment among seniors - a cross-sectional study in Krakow, Poland.

B a c k g r o u n d: Due to current increased life expectancy, the quality of life (QoL) of senior patients is gaining in importance. The aims of this study were: to estimate QoL in a group of patients, aged above 64 years, that is cared for by general practitioners (GPs) in Krakow, Poland, and to find relation- ships between elements of QoL and the results of comprehensive geriatric assessment (CGA) and other important medical and social factors. M e t h o d s: We designed a cross-sectional, questionnaire study among patients who attended GPs' surgeries from April 2018 to April 2019. To examine the patients, we used the Euro-Quality of Life Questionnaire (EQ-5D-5L) and eight scales forming CGA: the Activities of Daily Living, the Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment, Clinical Frailty Scale and Athens Insomnia Scale. R e s u l t s: The lowest QoL was observed in dimensions of pain/discomfort and mobility, where 70% and 52% of patients, respectively, reported problems in these areas. Only 91 (21%) respondents had highest results in all five dimensions of QoL. The average score in the Visual Analogue Scale (VAS) of the EQ-5D-5L (representing self-rated health on a given day) was 62.36 ± 18.98 points. Statistically significant relationships were observed between QoL and age, physical activity and multimorbidity (in all cases p <0.001). The results of QoL were correlated with every aspect of CGA, while the strongest relationship was noticed between scores in the EQ-5D-5L VAS scale and scales assessing depression and frailty (p <0.001; r = -0.57 both).

Early results of revision acetabular endoprosthetics using individual designs

BACKGROUND: 3D-printed implants are one of the options for acetabulum reconstruction. The popularity of this technique is increasing every year.&#x0D; AIM: To evaluate the early clinical, radiological and functional results of revision arthroplasty using individual acetabular components in patients with acetabulum bone defects.&#x0D; MATERIALS AND METHODS: Revision endoprosthetics was performed in 50 patients. There were 36 female and 14 male patients. The patients mean age was 60.413.4 (2389) years. According to the Paprosky classification, the defects in 1 case corresponded to type IIC, in 12 cases to type IIIA, in 37 cases to type IIIB, including 8 cases with violation of the acetabulum integrity. Hip joint function was assessed using the Harris Hip Score (HHS), pain severity using the Visual Analogue Scale (VAS), and social adjustment using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).&#x0D; RESULTS: Significant improvement was obtained on all assessment scales. The HHS score improved on average from 33.6 to 87.1 points, the VAS scale from 78.1 to 4.7 points, and the WOMAC from 75.8 to 11.6 points. There were 8 cases (21%) with complications in total. In one case with a violation of the acetabulum integrity we observed migration of the sciatic bone from the lower flange of the construct.&#x0D; CONCLUSION: Thus, the results of the acetabulum reconstruction using individually fabricated acetabular components are promising.

Correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery

BackgroundThe correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery were explored with the Beck Anxiety Inventory (BAI) scale, 10-point Visual Analogue Scale (VAS), and Confusion Assessment Method Chinese Reversion (CAM-CR) scale.MethodsA total of 120 patients aged 65 years old who receiving gastrointestinal cancer surgery were enrolled in the study. Perioperative anxiety, pain, and delirium were assessed by the BAI scale, VAS scale, and CAM-CR scale, respectively. The correlation and influencing factors of preoperative high anxiety, postoperative high pain, and postoperative delirium were analyzed.ResultsPreoperative high anxiety had a moderate positive correlation with postoperative high pain (P < 0.001, r = 0.410), and had a weak positive correlation with postoperative delirium (P = 0.005, r = 0.281). postoperative high pain had a weak positive correlation with postoperative delirium (P = 0.017, r = 0.236). Type of cancer and surgical approach were considered to be independent risk factors of preoperative high anxiety (P = 0.006 and P = 0.021). Preoperative high anxiety was considered to be an independent risk factor of postoperative high pain (P< 0.001). Age and preoperative high anxiety were considered to be independent risk factors of postoperative delirium (P< 0.001 and P = 0.010).ConclusionsElderly patients undergoing gastrointestinal cancer surgery had a higher incidence of preoperative anxiety, as well as first-day postoperative pain and first-day postoperative delirium. Factors such as type of cancer, surgical approach and preoperative anxiety had been identified as influencing preoperative anxiety levels; preoperative anxiety had been linked to postoperative pain; and age and preoperative anxiety have been identified as influencing factors of postoperative delirium.Trial registrationhiCTR2000032008, 17/04/2020, Title: “Effects of different analgesic methods on postoperative recovery of elderly patients with digestive tract tumor”. Website: https://www.chictr.ogr.cn.

Post-Operative Complications and Risk Predictors Related to the Avulsion of Lower Impacted Third Molars

Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.

Effect of inflammatory bowel diseases on household chores.

More than a half of inflammatory bowel disease (IBD) patients experienced a moderate negative effect on their household chores due to their IBD. The negative effect was more common amongst women.

НЕКОТОРЫЕ ОСОБЕННОСТИ СОСТОЯНИЯ ТВЕРДЫХ ТКАНЕЙ ЗУБОВ И ПАРОДОНТА У ПАЦИЕНТОВ С ВОСПАЛИТЕЛЬНЫМИ ЗАБОЛЕВАНИЯМИ КИШЕЧНИКА, ПРОЖИВАЮЩИХ В РЕСПУБЛИКЕ БАШКОРТОСТАН

The work presents the results of assessing the spread of pathology of hard tissues of teeth and periodontal in patients with chronic inflammatory bowel diseases (IBD). Objective. Assessment of the intensity and spread of pathology of dental hard tissues and inflammatory periodontal diseases in patients with Crohn's disease (CD) and chronic ulcerative colitis (CUC). Materials and methods. A comprehensive clinical and dental examination of 70 patients with CD and CUC was carried out. The complex of dental examination included the analysis of complaints, anamnesis, assessment of the condition of hard tissues of teeth, periodontal tissues. Assessment of the intensity level of nociceptive pain was carried out using a visual analog scale (VAS). Results and discussion. As a result of the clinical examination, a high prevalence of caries (K02) was revealed in CD and CUC, respectively, in 97.2% and 91.4% of cases, high and very high intensity of the carious process according to the CP index ≥ 10. With CD, the symptom of hyperesthesia, increased erasure of mixed teeth and wedge-shaped defects were most often observed in 100, 77.14 and 60.0% of cases, in 68.57% chronic periodontitis prevails (K05.3), with CD, the symptom of hyperesthesia (K03.80) and increased tooth erasure (K03.0) were 1.2 times less common) (p &lt; 0.05), chronic gingivitis prevails in 62.85% (K05.10). The level of intensity of the pain symptom for patients with CD and CUC corresponds to the VAS scale from moderate to significant (p &lt; 0.001). Results. As a result of a comprehensive dental examination of patients with CD and CUC, a high prevalence and intensity of caries and non-carious dental hard tissue lesions, inflammatory periodontal diseases, the level of dental care in persons with CD and CUC is insufficient. Conclusion. The connection of dental status with clinical manifestations of chronic inflammatory bowel diseases is beyond doubt. The ambiguity of the etiology and pathogenesis of CD and CUC as well as the significant similarity of their clinical manifestations, dictate the need for an integrated approach to the development of methods for diagnosing pathology of hard tissues of teeth and periodontal and assessing their clinical features.

The efficacy of honey or olive oil on the severity of oral mucositis and pain compared to placebo (standard care) in children with leukemia receiving intensive chemotherapy: A randomized controlled trial (RCT)

BackgroundOral mucositis (OM) is a significant complication occurring in approximately 40 to 80% of patients receiving chemotherapy regimens. Although a wide variety of agents have been tested to prevent OM or reduce its severity, none have provided conclusive evidence. ObjectivesTo determine the efficacy of honey or olive oil on the severity and OM pain in children with leukemia and suffering from OM compared to placebo (standard care) and, to assess which of the two interventions is more beneficial. MethodsA single blind randomized controlled study (RCT) was used to evaluate the effect of Manuka honey or olive oil, in the treatment of chemotherapy-related OM in 42 children with leukemia. The primary outcome was the severity of mucositis, using the World Health Organization (WHO) scale and the secondary outcome was the pain assessed using the Visual analogue scale (VAS). ResultsChildren who received the honey had less severe OM (assessed on the (WHO) scale), p = 0.00 and less pain (assessed on the VAS scale), p = 0.00, compared to the control group. Children who received the olive oil had less pain than the control group, p = 0.00), although not lower than the honey group. ConclusionManuka honey or olive oil can be used as alternative therapies by nurses to children with leukemia and suffering from OM, especially in low and middle-income countries where more expensive therapies may not be available or economical. Practice implicationsPediatric nurses may recommend Manuka honey to treat OM in children with leukemia as it is safe and inexpensive compared to other treatment modalities.

Assessment of postoperative pain in patients undergoing temporomandibular joint arthroscopy with infiltration of dexamethasone disodium phosphate in different concentrations. A randomized controlled trial

The main aim of this work was to evaluate the effect of intra-articular, sub-synovial steroid injections (IASSSI) with different doses during temporomandibular joint (TMJ) arthroscopy. Using a single-blind, randomized clinical trial, the investigators enrolled a sample of subjects who underwent TMJ arthroscopy with vs. without IASSSI for treating TMJ disorder (TMD). The predictor variable was the treatment group classified as no treatment (A - without IASSSI) or active treatments (IASSSI (B) with 2 mg or (C) 4-mg dexamethasone). Study medications were randomly assigned. Only subjects were blinded to treatment assignment. The main outcome variables included the following: 1) pain assessed up to postoperative day 30 with the McGill Pain Questionnaire and visual analog scale (VAS); 2) maximum mouth opening (MMO); and 3) analgesic and anti-inflammatory drug consumption. Other variables were demographic (age, sex) or pathologic (disease manifestations and classifications). Descriptive and bivariate statistics were computed. Statistical significance was set at p ≤ 0.5, one-tailed test of hypothesis. The sample comprised 36 patients (n = 12 per study group). In the active group with 4 mg corticosteroids, pain reduction measured by VAS (odds ratio [OR] = 0.18; p = 0.013) and McGill scale scores (OR = 0.15; p = 0.048) was significantly higher than in the control group. The McGill scale scores significantly decreased in both IASSSI groups, compared to the control group, at the final follow-up (all p < 0.012), and IASSSI was significantly associated with reduced analgesic consumption at postoperative days 7 and 14 (p = 0.003). However, there was no significant difference regarding MMO among the three groups. Within the limitations of the study, it seems that intra-articular, sub-synovial steroid injections (IASSSI) with 4 mg dexamethasone should be preferred whenever appropriate when pain relief is the priority of the procedure.Brazilian Registry of Clinical Trials (ReBec)- 28yb2g

Topical Hyperbaric Oxygen Therapy Versus Local Ozone Therapy in Healing of Venous Leg Ulcers.

the treatment of venous leg ulcers still poses a difficult interdisciplinary medical problem. The aim of this study was to compare the therapeutic efficacy of local hyperbaric oxygen therapy with local ozone therapy in the treatment of venous leg ulcers. this study included 114 patients; 60 males (52.63%) and 54 females (47.36%) of ages ranging between 39 and 88 years (mean age: 68.9 ± 9.8 years) with venous leg ulcers, who underwent topical hyperbaric oxygen therapy (group I) and local ozone therapy (group II). In each of the study groups, the patients underwent 30 therapeutic procedures lasting 30 min each. The progress in wound healing was evaluated by computerized planimetry, and the intensity of pain was assessed with the use of the Visual Analogue Scale (VAS). in both groups of treated patients, a statistically significant (p = 0.000001) reduction in the area of treated ulcers was achieved. In group I, the wound area decreased by an average of 69.67 ± 22.52%, from 7.55 ± 2.99 cm2 to 2.78 ± 2.43 cm2, and in group II, by an average of 41.33 ± 21.31%, from 7.36 ± 2.82 cm2 to 4.62 ± 2.76 cm2. In both groups of patients, a statistically significant (p = 0.000001) reduction in the intensity of pain ailments was observed: in group I, by an average of 0.55 ± 0.54 points, and in group II, by an average of 2.33 ± 0.82 points on the VAS scale. local hyperbaric oxygen therapy and local ozone therapy cause a statistically significant reduction in the surface area of venous leg ulcers as well as in the intensity of pain. Better results were observed after the application of local hyperbaric oxygen therapy procedures.

Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome.

Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies. Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function. Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV. Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended. Level IV, Case series.

A retrospective study regarding the influence of COVID-19 disease on asthma

BackgroundDuring the Covid-19 pandemic patients suffering from asthma raised many concerns regarding the outcome ofthe impact of COVID-19 disease on their preexisting condition. The 2021 GINA report indicates that people with asthma do not appear to be at increased risk of a severe form of COVID-19.MethodThis study is a retrospective study of patients (n = 163) median age = 27.8 years, M:F = 1:1.26, with asthma evaluated using ACT (asthma control test) and VAS (visual analog scale) before and after COVID-19 disease. An ACT score over 20 points placed patients in the controlled asthma group.ResultsThe overall evaluation for COVID-19 in our asthma patients revealed that 22.7% of the studied group had the COVID-19 disease (21.5% in the controlled asthma group and 24.5% in uncontrolled asthma group). Asthma disease history was longer in the uncontroled asthma group (128 ± 96.8 months vs. 296 ± 59.7 months, p = 0.05). Asthma treatment was conducted according to the GINA guideline, and 18.4% (30 pts) of the patients were on allergen immunotherapy treatment. Significantly more uncontrolled patients were significantly more in Step 1 and 5 of treatment (p = 0.05 and p = 0.03). During the COVID-19 pandemic, patients in the GINA step 5 of treatment experienced a worsening of asthma, often twice as severe as compared to patients with asthma in GINA step 1–4. In these patients, even mild COVID-19 disease led to worsened asthma symptoms, while severe COVID-19 led to a severe asthma impairment measured by ACT score (p = 0.03) and VAS scale (p = 0.02), with increased oral corticosteroids consumption.ConclusionMaintaining optimal asthma control should be able to reduce risk of severe outcomes after COVID-19 disease. Communication via phone with the specialist involved in their asthma care was very comforting for patients, thus confirming the necessity to include phone calls, smart phone’s application or online evaluations and counseling in long-term care of chronic diseases.

Efficacy and predictors of rapid response to omalizumab therapy in patients with seasonal allergic rhinitis: a cohort study

BACKGROUND: The availability of anti-IgE therapy for allergic rhinitis has actualized the need to develop variants of this treatment according to predictors of rapid response and techniques of treatment initiation.&#x0D; AIM: To study the efficacy and predictors of response to omalizumab in patients with seasonal allergic rhinitis.&#x0D; MATERIALS AND METHODS: Patients with moderate or severe seasonal allergic rhinitis in which traditional treatment for at least 3 months was not effective in the previous pollen season or in the current season were included. The decision to prescribe omalizumab was made based on the visual analog scale (VAS) in the previous or current season. The dosage and frequency of administration (every 2 or 4 weeks) were determined according to the table of values provided in the instructions. The patients were observed for 2 months. At follow-up visits (1 and 2 months later), allergic rhinitis symptom control was assessed using VAS and total nasal symptoms score (TNSS). Therapy was considered effective when the VAS remained 30 or decreased 30 after 4 and 8 weeks from the start of therapy, depending on the initiation period.&#x0D; RESULTS: The study enrolled 30 patients with allergic rhinitis history of 14 years, sensitization to 2 groups of allergens in 19 (63.3%) cases and bronchial asthma in 18 (60%). Omalizumab was initiated before the pollen season in 6 (20%) patients and during the season in 24 (80%) patients. After 4 weeks, allergic rhinitis manifestations were controlled in 23 (77%) patients, and by week 8, 100% of the patients with allergic rhinitis had fully responded to therapy. By 4 weeks of follow-up, the severity of allergic rhinitis symptoms on the VAS and TNSS scales decreased by 2.7 and 4.7 times, respectively. The proportion of patients with a slow response by week 4 of therapy was 23%. Body mass index (lower in the slow response group) and history of bronchial asthma (2.6 times longer in the slow responders) were associated with the achievement of this outcome. No adverse events were recorded.&#x0D; CONCLUSIONS: In patients with seasonal allergic rhinitis, omalizumab allows the control of disease manifestations after 4 weeks of therapy with its maintenance in the follow-up. Predictors of rapid response have been revealed; however, their clinical significance requires further study.

New Perspectives in Peripheral Nerve Surgery for Neuropathic Pain

Background and Aims: Neuropathic pain can occur following intentional or unintentional peripheral nerve injury. The purpose of this review was to determine in patients who have post-traumatic trigeminal neuropathic pain or required ablative mandibular operations with transection of the nerve, do those who undergo immediate or early surgical interventions, when compared to those whose nerves are not repaired or delayed, have a decreased or increased risk for resolving neuropathic pain? Methods: Two single-site and one multi-site retrospective observatory studies of patients who had neuropathic pain prior to operative treatment of the injured nerve and in patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair were analyzed for the presence or absence of neuropathic pain at 6 months post-surgery. The primary predictor variable in the surgical treatment of neuropathic pain pre-existing surgery was the time from injury to repair and the preoperative pain intensity rated by Visual Analogue Scale (VAS). The primary predictor variable in the study of intentional transected nerve was the immediate repair or no repair of the nerve at the time of resection. Results: There was statistically significant difference in the primary outcome based on time from injury to repair. When the time to surgery was less than 200 days, the percentage of patients with no neuropathic pain was greater than 60%. There was a significant difference in mean VAS between those who had no neuropathic pain (6.4,SD 2.68) and those with recurrence (7.75,SD 1.95). Following mandibular resection there was statistically significant difference between the immediate repair and no repair group. Post-hoc logistic regression modeling showed an inverse relationship between the immediate repair and the incidence of chronic postoperative pain and neuropathic pain with an odd ratio &lt;1. Conclusions: In patients with neuropathic pain, earlier diagnosis and treatment, including peripheral nerve surgery, should be considered with the best outcomes when operative interventions occur within 200 days of the injury and pain intensity are mild or moderate on VAS scales. The immediate repair of an intentionally transected trigeminal nerve appears to reduce and possibly eliminate the development of neuropathic and chronic postoperative pain compared to avoiding nerve repair.

Results of Operative Endoscopic Treatment of Urological Patients Depending on Hospital Stay Duration

Objective. The objective of the study was to investigate the results of operative endoscopic treatment of patients with urological profile depending on the duration of hospitalization.. Patients and methods. The study examined the treatment results of 1647 urological patients aged from 41 to 69 years (mean age 57.1 years), including 791 (48.03 %) males and 856 (51.97 %) females. A comparative analysis of the results of operative endoscopic treatment of patients in two groups was conducted. The interventions were comparable in volume. The first group consisted of patients who were observed in a hospital setting for 3-4 days; the second group consisted of patients who were discharged home within the first day. The visual analog scale (VAS) was used to assess pain. Quality of life was determined using the SF-36 questionnaire. Results. The average pain score on the VAS scale in the first day after surgery in both patient groups was 5.45±0.3 and 5.16±0.2 points, respectively, which was considered «tolerable» pain. The quality of life of patients in the two groups during the first day of the postoperative period indicated comparability of data on the PR, PF, BP, and GH scales. Better parameters were recorded in the second group of patients, compared to the first, on the SF, RE, and MH scales. Analysis of the quality of life questionnaire three days after surgery showed improvement in all scales; better results were achieved in the second group of patients, compared to the first, on the VT, SF, RE, and MH scales, which characterized better social functioning and higher vitality. Conclusion. Endoscopic interventions in urology allow for better pain tolerance, especially in the first day after surgery, which has a positive impact on the quality of life of patients. Shortening the length of hospital stay to one day without increasing the pain syndrome increases the socio-economic significance of endoscopic techniques and emphasizes the prospects for further research.

A comparison of patient reported outcomes in rheumatoid arthritis treated by tofacitinib versus methotrexate

Background: Rheumatoid arthritis (RA) is a chronic and debilitating autoimmune disease characterized by systemic inflammation, persistent synovitis, and joint destruction. 1 Patients and physicians rate RA disease differently — while physicians focus on RA-specific clinical and radiographic outcomes, patients focus on how their general health is affected by RA, which may lead to discordance. Aim and Objectives: The present study plans to compare the patient reported outcomes (PRO) in RA patients treated with Methotrexate or Tofacitinib. This study was done to compare the PRO in patients taking Tofacitinib or Methotrexate. Data from a 6-month analysis are reported here. Material and Methods: Patients presenting to outpatient department of department of orthopedics were included in this study. Patients above 18 years of age who have been previously or newly diagnosed with RA according to American College of Rheumatology criteria were included in this study. Patients were randomized into two groups who received either Tofacitinib 5 mg twice a day or Methotrexate 10 mg/week which was increased by 2.5 mg/week every 15 days to a maximum of 20 mg/week. Patient assessment was done by Visual Analog Scale (VAS) for pain and health assessment questionnaire-disability index (HAQ-DI). This will be done at starting of treatment and then at months 1, 2, 3, and 6. Results: Seventy-five patients received tofacitinib and 77 patients received methotrexate. There was an improvement in the disease condition as seen by VAS scale and HAQ-DI score of patients taking tofacitinib compared to methotrexate at 2, 3, and 6 months, and this difference was statistically significant. Conclusion: Tofacitinib has a safety and efficacy profile which is similar to or superior to methotrexate.

Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

The Epley Maneuver versus Betahistine in Treatment of Benign Paroxysmal Positional Vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is considered the most common cause of vertigo. The necessity for early and effective management resulted in the improvement of the patient’s life quality. The objective was to compare the efficacy between Epley’s maneuver and betahistine dihydrochloride in BPPV treatment. Patients and Methods: A prospective follow-up comparative study on 60 patients with BPPV, who diagnosed with a positive Dix–Hallpike test, were divided equally and randomly into two groups; Group “A” treated with Epley’s maneuver and Group “B” treated with betahistine dihydrochloride. The efficacy of each modality was assessed, regarding the sense of vertigo and its associated symptoms, data of vertigo scales as the Visual Analog Scale (VAS), and Dizziness Handicap Inventory (DHI). Results: There were 23 males (38.33%), and 37 females (61.66%), with mean age (54 ± 7.521) years. The total vertigo improvement was (78.33%); being (93.33%) in group “A” and (63.33%) in group “B”, nausea and vomiting symptoms improvement was (76.66%) in group “A”, and (70%) in group “B”. The baseline VAS score in Group “A” (7.69 ± 1.235 SD) and in Group “B” (6.35 ± 3.267 SD) after treatment improved to 0.56 ± 0.731 SD and 1.86 ± 1.375 SD, respectively, as well as the baseline DHI value in Group “A” (51.86 ± 23.583 SD) and in Group “B” (49.37 ± 18.152 SD) then improved to 2.31 ± 3.986 and 7.98 ± 9.512 SD, respectively. Conclusions: The Epley maneuver was more effective and “statistically significant” in relieving vertigo, and both the VAS and DHI scales compared to betahistine, while regarding associated nausea and vomiting symptoms, it shows no statically significant difference.

Does Laminectomy Affect Spino-Pelvic Balance in Lumbar Spinal Stenosis? A Study Based on the EOS X-Ray Imaging System.

Lumbar spinal stenosis (LSS) is a degenerative disorder causing the forward bending of the trunk and pelvic retroversion with the consequent loss of lumbar lordosis; surgical treatment is intended to enlarge the canal and foramina and decompress the nerve roots. The purpose of our study is to determine whether and to what extent facet-sparing laminectomy affects the spino-pelvic balance. The spino-pelvic balance of 26 patients was analysed before and after surgery through the EOS X-ray Imaging System. The following parameters were considered: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Clinical data were expressed in numeric values according to the Oswestry Disability Index (ODI), the visual analogue scale (VAS) and the modified Japanese Orthopaedic Association (mJOA) scoring system. Significant SS decreases and PT increases were noticed after surgery, without modification in LL, axial vertebral rotation (AVR) and the general alignment. Pain and disability had a significant improvement, as represented by a decrease in scores on the VAS and ODI scales and an increase in scores on the mJOA functional scale. The most important parameter seems to be a congruence between pelvic and spinal parameters, which achieves an economic posture with the physiologic position of the axis of gravity. According to the literature, a standard sagittal balance (SB) has not been defined.

The relationship of pain, sleeping pattern, quality of life, and kinesiopobia with depressive symptoms in patients with lumbar disc hernia

Pain, muscle spasms, loss of muscle strength, and deteriorated posture adversely affect the patient's daily life activities and quality of life. Within the scope of this research, we aimed to elucidate pain, sleep quality, quality of life, and kinesiophobia levels in patients with lumbar disc herniation and to determine their relationship with depressive symptoms. The data of 74 patients who applied to our institution between 01/01/2020 – 01/04/2023 with a diagnosis of lumbar disc herniation have been analyzed retrospectively Sociodemographic information form (SIF), Nottingham Health Profile (NHP), Tampa Kinesiophobia Scale (TKS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Scale (BDS), and Visual Analogue Scale (VAS) were applied to the participants in the study. A statistically significant difference has been achieved between the groups in the VAS pain severity, TAMPA, Pittsburgh sleep quality scale, 1, 2 in the NSP scale, and the sub-dimensions of emotion, sleep, social, physical and energy (p&lt;0.05). All scale scores of patients with depressive symptoms were higher than those without depressive symptoms. A statistically significant relationship existed between BDS scores and all scale scores (p&lt;0.05). The patients' BDS scale score and VAS pain severity, TAMPA, NSP (pain), and NSP (physical) scale scores were low, Pittsburgh, NSP (emotion), NSP (sleep), NSP (social), NSP (energy), NSP 1. It was observed that there was a moderate relationship between the 2 scale scores. Regarding the outcomes of this research, one could say that depressive symptoms negatively affect sleeping patterns and the quality of life of patients with lumbar disc hernia.