Visual Analogue Scale In Group Research Articles

Comparison of the effectiveness of temporomandibular joint osteoarthritis treatment with corticosteroids, hyaluronic acid, and platelet-rich plasma mono-therapy

The prevalence of temporomandibular joint (TMJ) osteoarthritis is 18–85 % of all TMJ dysfunctional conditions. Most patients are elderly, especially women. Today, intra-articular injections are often used for treatment, so it is necessary to study the effectiveness of drug administration on the course of the disease. The number of studies on the effectiveness of certain drugs most commonly used to treat TMJ osteoarthritis is limited, that does not allow correct treatment planning in each individual case. Aim: to evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy with hyaluronic acid, corticosteroids, and platelet-rich plasma. Materials and methods. We included 90 patients who received intra-articular injections. Patients were randomly divided into 3 groups: group I, which received platelet-rich plasma (PRP, n = 30), group II, which received hyaluronic acid (HA, n = 30), group III, which received corticosteroids (CS, n = 30). To objectively evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy of hyaluronic acid, corticosteroids and platelet-rich plasma, the following indicators were used: filling in the visual analogue pain scale, maximum mouth opening (mm) and cortical plate density of the articular head of the mandible according to the Hounsfield scale using CBCT. Results. PRP therapy demonstrated the highest efficacy in the form of monotherapy for all study parameters (p < 0.05). The fastest pain reduction was achieved with the use of corticosteroids (p < 0.05). In general, during the treatment period, the reduction of pain according to the visual analogue scale in group I was 85.71 %. In patients of group II (HA) and group III (CS) – by 71.42 %. Maximum mouth opening after treatment in group I increased by 24.32 %, in group II – by 15.79 %, in group III – by 18.92 %. The density of the articular head according to the Hounsfield scale after treatment in group I increased by 12.56 %, in group II – by 6.97 %, in group III – by 4.87 %. Conclusions. All of the studied drugs demonstrated a positive effect on the treatment of TMJ osteoarthritis, but monotherapy with intra-articular PRP injections demonstrated the highest effectiveness according to the studied parameters (p < 0.05).

Application of cantharidin, retinoic acid cream and salicylic acidy in multiple palmoplantar warts.

Multiple palmoplantar warts, caused by human papillomavirus (HPV) infection, were investigated for clinical efficacy using cantharidin, retinoic acid cream, and salicylic acid cream. A total of 110 patients with multiple palmoplantar warts were enrolled. The experimental group (54 cases) received a 1:1:1 combination (CRS) of 0.25% cantharidin, 0.1% retinoic acid cream, and 5% salicylic acid, applied with pressurized encapsulation for 8h every night, three times per week. The control group (56 cases) underwent conventional liquid nitrogen freezing. Monthly follow-ups assessed cure rate, effective rate, dermatological life quality index (DLQI), visual analog scale (VAS), and cost, with evaluations conducted after 3 months. The treatment group exhibited a cure rate of 85.19% and a total effective rate of 96.30%, surpassing the control group with rates of 39.29% and 51.79%, respectively (p<0.05). The treatment group's DLQI score (1.84±1.06) was significantly lower than the control group's score (6.04±1.78) (p=0.0005). Additionally, the treatment group's VAS score (1.84±1.06) was notably lower than the control group's score (8.56±1.07) (p<0.0001). The treatment group's total cost (43.20±2.85) was markedly lower than the control group's cost (206.38±90.81), with a statistically significant difference (p<0.0001). The combination of cantharidin, retinoic acid cream, and salicylic acid with local encapsulation is a safe, effective, economical, and convenient treatment method for multiple palmoplantar warts, exhibiting few side effects and showing promise.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy.

A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Efficacy and safety of pulsed radiofrequency combined with gabapentin in the treatment of acute herpetic neuralgia

Objective: To explore the clinical efficacy and safety of pulsed radiofrequency (PRF) combined with gabapentin in the treatment of acute herpetic neuralgia (AHN). Methods: A total of 123 AHN patients were retrospectively selected in Henan Provincial People's Hospital from November 2019 to July 2022, who were divided into two groups based on treatment methods: control group (treated with gabapentin, n=61) and study group (treated with gabapentin and PRF, n=62). The visual analog scale (VAS) was utilized for pain severity assessment and the self-rating scale for sleep (SRSS) was utilized for sleep quality evaluation. The differences in serum levels of interleukin (IL)-10, chemokine ligand 10 (CXCL-10), prostaglandin E2 (PGE2), cyclooxygenase-2 (COX-2), IL-2 and IL-6 before and after treatment were compared between the two groups. The overall treatment effectiveness and the occurrence rates of postherpetic neuralgia and adverse reactions were evaluated in both groups. Results: Among the study group patients, 28 were male and 34 were female, and the age was (62.8±8.5) years. Among the control group patients, 35 were male and 26 were female, and the age was (64.0±7.8) years. The VAS scores of the study group before and after treatment were 7.96±1.33 and 1.52±0.60, respectively, while the control group were 7.68±1.52 and 2.70±0.64. The SRSS scores before and after treatment in the study group were 31.74±5.90 and 12.06±2.81, respectively, while those in the control group were 33.10±5.54 and 14.14±2.96, respectively. Before treatment, there were no statistically differences of the VAS scores and SRSS scores in both groups (all P>0.05). After treatment, the VAS scores and SRSS scores in both groups decreased compared with before treatment (all P<0.05), the study group's VAS scores and SRSS scores were lower than those in the control group (all P<0.05). Before treatment, there were no statistically differences of the serum levels of IL-10, CXCL-10, PGE2, COX-2, IL-2 and IL-6 in both groups (all P>0.05). After treatment, the serum levels of IL-10, CXCL-10, PGE2, COX-2 and IL-6 in both groups decreased compared with before treatment, while the IL-2 level increased. Additionally, the study group had lower serum levels of IL-10, PGE2, COX-2 and IL-6 compared with the control group (all P<0.05). After treatment, the study group had 35 cases of cure, 26 cases of effectiveness, and 1 case of ineffectiveness, while the control group had 22 cases of cure, 31 cases of effectiveness, and 8 cases of ineffectiveness. The overall treatment efficacy of the study group was better than that of the control group (P=0.012). The incidence of postherpetic neuralgia in the study group after treatment was 16.1% (10/62), which was lower than that in the control group, which was 37.7% (23/61) (P<0.05). There were no statistically differences of the occurrence rates of adverse reactions in both groups (all P>0.05). Conclusion: Combining PRF with gabapentin for the treatment of AHN demonstrates better overall efficacy and safety, which can more effectively alleviate pain, improve sleep, and reduce inflammatory cytokine levels.

Autologous Whole-Blood Versus Corticosteroid Local Injection in Treatment of Plantar Fasciitis: A Randomized Single Blind Placebo-Controlled Study.

Autologous whole-blood intralesional injection has attracted interest as a possible means of treatment for chronic plantar fasciitis. We contrasted its effectiveness with that of corticosteroids, which have a longer history of success in treating tendinopathies such as plantar fasciitis. In order to monitor the disease's progress naturally, we also compared them with a placebo. Sixty clinically diagnosed patients were taken up for intralesional injection of autologous whole blood (AWB), corticosteroid, and normal saline as placebo mixed with 2 mL of lignocaine after dividing them into three groups. Two doses were given and followed up in the third, sixth, and 12th weeks. The evaluation was done according to the visual analog scale (VAS) and the number of tablets of paracetamol (PCM) 500 mg consumed for the following period. When compared to the placebo group in the third, sixth, and 12th weeks, the corticosteroid group exhibited a significant improvement with a p<0.001 in the VAS score, whereas the autologous whole blood group showed no meaningful difference. When compared to the placebo group at the sixth and 12th weeks, the AWB group's VAS score showed a statistically significant difference with a p>0.001. At each follow-up, the placebo group consumed more analgesics than the corticosteroid group, with a p<0.001. Only in the third week of follow-up did AWB demonstrate a statistically significant difference in PCM consumption as compared to the corticosteroid group. Statistically significant improvement was seen in both the AWB group and corticosteroid group as compared to the placebo group. The corticosteroid group achieved earlier and superior relief of pain while AWB had a longer lasting effect. Therefore, study results indicate almost similar results in short-term studies.

The Use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) Technique for Distal Fibula Hardware Removal

Ankle fracture is one of the most common fractures that are mainly treated with open reduction and internal fixation. Wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for hand and wrist surgeries, this method has been scarcely utilized in ankle surgery. To the best of our knowledge, only one study has evaluated the safety and efficacy of the WALANT technique in distal fibula hardware removal surgeries. This study aimed to investigate the result of using the WALANT technique in distal fibula hardware removal surgery. From April 2020 until March 2021 randomized clinical trial was performed on 60 patients between the ages of 18 and 60 years in our educational orthopedic center. In group A, an anesthesiologist administered spinal anesthesia and in group B the WALANT technique was used for anesthesia. The results of the current study showed that the visual analog scale in group B a day after the surgery was significantly lower, in comparison to group A. The outcome of our study demonstrated lesser blood loss in patients operated under the WALANT. This finding could be related to the vasoconstrictive properties of epinephrine used in the WALANT solution. Our findings suggest that the WALANT technique application in the proper setting and appropriate patient selection could lead to reduced postoperative pain, minimal bleeding, and shorter admission time. Other advantages include the simplicity and safety of the technique, it is being time and cost-effective. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

High-Level Competitive Athletes Who Undergo Hip Arthroscopy Demonstrate Durable 5-Year Outcomes and Lower Subjective Pain: A Propensity-Matched Analysis.

Hip arthroscopy (HA) has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes (CA) and non-CA at short-term follow-up. However, there is a paucity of literature investigating midterm outcomes comparing athletes with Controls. Athletes would have significant improvements at 5 years, with favorable outcomes compared with their control counterparts, and high return-to-sport (RTS) rate. Propensity-matched retrospective comparative cohort study. Level 3. CAs who underwent primary HA for FAIS from January 1, 2012 to April 30, 2017 were identified and propensity matched on a 1:4 basis to Controls by age, sex, and body mass index (BMI). Patient-reported outcomes (PROs) were collected preoperatively and at 5 years. Minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) rates were calculated using previously published thresholds. Rate and duration of RTS were collected retrospectively. A total of 57 high-level CA (33 female, 24 male; age, 21.7 ± 4.2 years; BMI, 23.1 ± 2.8 kg/m2) were propensity matched to 228 Controls (132 female, 96 male; P > 0.99; age, 23.3 ± 5.8 years; P = 0.02; BMI, 23.8 ± 4.3 kg/m2, P = 0.24). Significant differences were observed in preoperative Hip Outcome Score Sports Specific and Activities of Daily Living (HOS-ADL) subscales (CA, 74.9 ± 13.7 vs Controls, 66.4 ± 18.4; P = 0.01) and modified Harris Hip Score (mHHS) (CA, 64.7 ± 12.9 vs Controls, 59.7 ± 14.3; P = 0.04). Both groups demonstrated significant postoperative improvements in all outcome scores measured (P ≤ 0.01). At 5 years postoperatively, there were significant differences between groups in Visual Analog Scale (VAS) Pain (CA, 17.3 ± 17.6 vs Controls, 24.7 ± 25.9; P = 0.02). There were no significant differences in achieving MCID or PASS. Athletes RTS at a median of 25.2 weeks (Q1 22.4-Q3 30.7) with an overall RTS rate of 90%. Similar rates of revision were seen between CA patients (n = 3; 5.3%) and Control patients (n = 9; 3.9%) (P = 0.66). CAs demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates after primary HA, which were comparable with those of Controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than Controls and achieve lower average self-reported pain at 5 years postoperatively. In addition, CA patients demonstrate high rates of RTS at a median of 25 weeks postoperatively. This study provides insight into CA versus Control PROs and rates of achieving MCID and PASS at a midterm follow-up of 5 years. Furthermore, this study offers perception into RTS rate, both in general as well as specified to individualized sports.

The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer.

Mind mapping is a combination of images and logical thinking in the form of pictures and texts. It presents a natural expression process that conforms to the divergent thinking of the brain, helping patients understand memory. This study aimed to investigate the impact of pain-education nursing with the aid of mind maps on postoperative pain scores and quality of life in patients with colorectal cancer. The medical records of 100 colorectal cancer patients treated from July 2020 to July 2022 were selected as retrospective research participants and divided into control and observation groups. The control group received routine pain care, and the observation group was given pain-education nursing based on a mind map. The effects on quality of life, pain, negative emotions, and comfort after nursing were compared between the 2 groups. There was no significant difference in quality of-life scores between the 2 groups before the nursing intervention (P > .05). After nursing, the physical, emotional, cognitive, and social functions of patients in the observation group were significantly higher than those in the control group. However, the overall quality of life and financial difficulties of patients in the observation group were significantly lower than those in the control group (P < .05). The observation group's social, physical, and psychological comfort scores were significantly higher than those in the control group after nursing intervention (P < .05). After nursing, the observation group's visual analog scale scores at different times after the operation were significantly lower than those of the control group. The scores on the self-rating anxiety scale and self-rating depression scale in the observation group were significantly lower than those in the control group (P < .05). Pain-education nursing based on mind maps can effectively improve the daily living ability, pain symptoms, and quality of life of patients after colorectal cancer, and there is a reference value for post-nursing care of patients after colorectal cancer.

Role of tamsulosin a selective alpha 1a-1d blocker vs. combination therapy of tamsulosin and solifenacin M3 antagonist in DJ stent related morbidity: obstructive and irritative scores

Background: nowadays Urolithiasis is very common in general population. Due to the advent of newer lithotripsy techniques, endoscopic procedures are used in most of the cases and to promote stone clearance DJ stents are kept after all the endoscopic procedures. Methods: This is a prospective study conducted among indoor patients from January 2021 to May 2022 in 90 indoor patients of tertiary care hospital. Results: In our study go 90 patients, pre DJ insertion, IPSS score in group A was 10.22 and Group B was 9.64, Mean Quality of Life in Group A was 1.77 and group B was 1.37, Visual analogue scale in group A was 2.08 and group B was 2.24. On Day 1 Post DJ insertion, IPSS score in group A was 12.26 and Group B was 11.68, Mean Quality of Life in Group A was 1.44 and group B was 1.28, Visual analogue scale in group A was 2.55 and group B was 2.28. Conclusions: Use of combination of selective alpha 1a-1d blocker and M3 antagonist significantly reduces the DJ stent related morbidity after endoscopic treatment for urolithiasis.

The Effect of the Overweight Condition on Arthroscopic Rotator Cuff Repair Outcomes.

This study sought to investigate the influence of a preexisting overweight condition (body mass index [BMI], 25-29.9 kg/m2) on functional outcomes after arthroscopic rotator cuff repair surgery. A retrospective review was performed examining the outcomes of arthroscopic rotator cuff repair in a normal-weight (BMI, 18.5-24.9 kg/m2) and an overweight (BMI, 25-29.9 kg/m2) population. Functional outcomes were assessed to include the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation score, and the visual analog scale (VAS) pain score, as well as range of motion in forward flexion, external rotation, and internal rotation. A total of 52 normal-weight patients (mean BMI, 23.7±2.1 kg/m2) and 57 overweight patients (mean BMI, 28.4±1.4 kg/m2) were included. Both groups demonstrated statistically and clinically significant improvements in VAS score, Single Assessment Numeric Evaluation score, and ASES score at final follow-up (P<.0001), with no difference in range of motion (P>.05). Overall, when comparing outcomes between the groups, there were significantly better outcomes in the normal-weight group's VAS scores (mean, 0.56±0.96 vs 1.3±1.7; P=.0064), ASES scores (mean, 96.1±5.8 vs 92.4±9.7; P=.0187), and internal rotation (mean thoracic vertebrae, 9.2±3.0 vs 10.4±2.6; P=.0289). However, these differences did not reach clinical significance regarding the threshold of patients meeting standard minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for rotator cuff repairs. Over-weight patients have improved outcomes after arthroscopic rotator cuff repair surgery with noninferior clinical results when compared with normal-weight patients. More data regarding outcomes of overweight patients will help physicians make better-informed decisions when considering rotator cuff repair. [Orthopedics. 2023;46(4):242-249.].

Comparison of programmed intermittent epidural bolus injection and continuous epidural injection in controlling nighttime pain and improving sleep quality after thoracotomy.

Postoperative pain after open thoracotomy is known to be very severe and affects sleep quality. This study aimed to investigate the effects of a programmed intermittent epidural bolus injection versus continuous epidural injection for controlling nighttime pain and improving sleep quality after thoracotomy. Seventy-six patients scheduled for open thoracotomy for lung cancer or other lung diseases were enrolled. The participants were divided into 2 groups. Group A was continuously injected with 0.2% levobupivacaine at 1.1 mL/h, and group B was injected intermittently with 3 mL 0.2% levobupivacaine at 3 hours intervals through a thoracic epidural catheter via a programmed infusion pump. Within 48 hours after surgery, the degree of pain control using visual analog scale and the patients' sleep conditions on postoperative day (POD) 0 and 1 were evaluated, and other adverse events were investigated. On POD 1 night, the visual analog scale in group B showed lower than group A (P = .009). Comparison of time to fall asleep showed no differences between 2 groups. Total sleep time was no difference on POD 0 but was longer in group B than that in group A on POD 1 (P = .042). Awakening from sleep on POD 0 was lower in group B than that in group A (P = .033), and satisfaction with sleep quality on POD 0 was superior in group B compared to group A (P = .005). Postoperative nausea and vomiting occurred more frequently in group B than in group A (P = .018). The programmed intermittent epidural bolus technique of patient-controlled epidural analgesia reduces postoperative nighttime pain and improves sleep quality in patients undergoing thoracotomy for lung cancer or other lung diseases.

Clinical Efficacy of Cervical Core Strengthening Exercise in the Treatment of Cervicogenic Headache

<bold>Objective</bold> To explore the clinical efficacy of cervical core strengthening exercise in the treatment of cervicogenic headache. <bold>Methods</bold> A total of 168 patients with cervicogenic headache who visited Rehabilitation Medicine Department of Beijing Jishuitan Hospital from January 2016 to December 2017 were randomly divided into control group and treatment group using a random number table sampling method, with 84 cases in each group. The patients in the control group were treated with conventional treatment, including taking rest, treating with therapeutic modalities, oral drugs. Therapeutic modalities included ultrashort wave, interferential current therapy, laser, magnetic therapy (15 minutes per time, once per day). On the other hand, drug therapy included nonsteroidal anti-inflammatory drugs, eperisone hydrochloride and gabapentin, etc. In addition of the conventional treatment, the treatment group also participated in strengthening exercise of anterior, posterior and lateral core muscles of cervical vertebra (each movement held for 10 seconds, 20 movements at a time, and 5 sets of exercise per day) for 4 weeks. Furthermore, it was changed to 2 sets of exercise per day for 12 months. In addition, visual analog scale (VAS) score, Hamilton's Depression Scale-17 (HAMD-17), Pittsburgh Sleep Quality Index (PSQI) and Patients' Global Impression of Change (PGIC) scale were evaluated before treatment and at 1 month, 3 months and 12 months of treatment. <bold>Results</bold> In terms of the intragroup comparison, the VAS score in control group improved at 1 month of treatment compared with that before treatment (<italic>P</italic>&lt;0.05). There were no significant changes in each index at each time point (<italic>P</italic>&gt;0.05). By contrast, the VAS, HAMD-17, PSQI and PGIC scores in the treatment group improved at 1 month, 3 months and 12 months of treatment compared with those before treatment (<italic>P</italic>&lt;0.05). The comparison between groups showed that no significant differences were found in VAS, HAMD-17, PSQI and PGIC scores between the two groups at 1 month of treatment (<italic>P</italic>&gt;0.05). Apart from that, the VAS, HAMD-17, PSQI and PGIC scores in the treatment group improved more than those in the control group at 3 months and 12 months of treatment (<italic>P</italic>&lt;0.05). Specifically, at 3 months of treatment, the scores of the treatment group were VAS (2.96±1.11), HAMD-17 (25.95±5.91), PSQI (4.55±0.81), and PGIC (4.87±1.47), while the scores of the control group were VAS (5.86±1.31), HAMD-17 (36.97±7.62), PSQI (6.97±1.21), and PGIC (2.36±0.74), and the difference was statistically significant respectively (<italic>P</italic>&lt;0.05). Last, at 12 months of treatment, the treatment group's VAS (1.92±0.91), HAMD-17 (21.94±7.52), PSQI (2.32±0.61), and PGIC (5.50±1.41) were better than the control group's VAS (6.97±1.01), HAMD-17 (41.38±9.02), PSQI (5.15±1.11), and PGIC (2.50±0.91), and the difference was statistically significant respectively (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> The cervical core strengthening exercise will relieve pain, improve scores of mood and sleep in patients with cervicogenic headache.

Effect of High Power Laser Therapy on Patients with Chronic Discogenic Sciatica: A Randomized Clinical Trial

Back Ground: Sciatica is a frequent clinical illness that may be intensely painful, disabling, and life-altering.&#x0D; Objectives: The goal of this research was to see how high-power laser therapy affects the intensity of pain, angle of straight leg raise, six-minute walk test and electrophysiological studies in patients with chronic discogenic sciatica.&#x0D; Methods: A lumbar disc herniation at L5-S1 caused chronic unilateral sciatica in thirty-six male patients were included in this study. The patients have been divided into 2 identical groups [the control group (G1) and the study group (G2)] randomly. Participants in the control group (G1) got a designed physiotherapy program that included ultrasound, stretching exercise, back muscles strengthening exercise and sciatic nerve flossing technique. While patients in the study group (G2) got the same designed physiotherapy program as G1 plus high power laser therapy (HPLT). The outcome measures were latency and amplitude of Hoffmann reflex (H-reflex) for evaluating S1 nerve root function, visual analog scale (VAS) for evaluating pain level, angle of straight leg raise (SLR) and six-minute walk test (6MWT) for assessing functional impairment. Both groups were assessed before and after 4 weeks of therapy.&#x0D; Results: The findings demonstrated that both groups showed a significant reduction in pain level and latency of H-reflex following therapy. The angle of SLR, 6-minute walking distance (6MWD), and the amplitude of the H-reflex all improved significantly in both groups. After therapy, the study group's VAS and H reflex latency were significantly decreased than the control group's (p &lt; 0.01). In addition, the study group's 6MWD, angle of SLR, and H reflex amplitudes were significantly increased than the control group's (p &lt; 0.01) following therapy. &#x0D; Conclusion: High power laser therapy (HPLT) is a successful treatment for patients suffering from chronic discogenic sciatica.

Intranasal Chlorpheniramine Maleate for the treatment of COVID-19: Translational and Clinical Evidence

Recently, the nasal cavity has been highlighted as an ideal route of administration for interventions as it is the portal of entry of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). The present study aimed to demonstrate the feasibility and efficacy of intranasally administered Chlorpheniramine Maleate (CPM) spray to treat coronavirus disease 2019 (COVID-19). Methods: The present study used a two-phase, non-clinical to clinical approach. The non-clinical phase evaluated CPM’s antiviral activity against SARS-CoV-2 delta (B.1.617.2) strain via a highly differentiated three-dimensional in vitro model of normal, human-derived tracheal/bronchial epithelial cells. CPM was tested in duplicate inserts of the tissue models of the human airway. Virus yield reduction assays measured antiviral activity on day six after infection. For the clinical phase, COVID-19 symptomatic (polymerase chain reaction positive) patients were recruited and assigned to a 7-day CPM treatment (n=32) or placebo (PLB; n=13). Close safety monitoring of all patients was conducted before and after administering the drug. The primary outcomes monitored were time to symptom resolution (days), progression to hospitalization, emergency room visits, and symptoms of the severity of the disease using a visual analog scale (VAS) on a scale of 1-10 (no symptoms to worst symptoms). Results: The virus yielded a reduction in the assay such that the CPM solution log reduction value was 2.69 and Remdesivir 0.12, demonstrating much high antiviral activity of CPM. Results of the clinical phase demonstrate that VAS scores between the groups were evident after using CPM for two days (day 3). The CPM group VAS were significantly lower (P&lt;0.001) starting from day three compared with day one. In contrast, there were no statistically significant (P&gt;0.05) changes in the PLB during the 7-day treatment window. No subjects in the intervention group were hospitalized, while two in the PLB required hospitalization (15.4%; X2=5.15, P=0.023). Besides some mild discomfort felt by subjects immediately after applying the spray, the participants reported neither adverse reactions nor side effects. Conclusion: If taken together, the results of the present two-phase study point towards the conclusion that CPM is an antiviral agent that can be administered intranasally to treat COVID-19 effectively.

Systematic review and meta-analysis of the efficacy of gabapentin in chronic female pelvic pain without another diagnosis

BackgroundWhile widely used for the treatment of chronic pelvic pain, limited data exists on efficacy of gabapentin, especially in the subgroup of women suffering from chronic pelvic pain without a known diagnosis, such as endometriosis.ObjectiveThis study aimed to assess the efficacy of gabapentin when administered to women with chronic pelvic pain without another diagnosis.Study DesignWe performed a Systematic Review and Meta Analysis including all controlled clinical trials addressing the use of gabapentin for the treatment of chronic pelvic pain without another diagnosis. We searched PubMed, Scopus, Web of Science, ClinicalTrials.Gov, MEDLINE, and The Cochrane Library from inception of each database to April 30, 2021. We included all the studies that fulfilled the following criteria: (1) population: women suffering from chronic pelvic pain without another identified diagnosis (such as endometriosis); (2) intervention: gabapentin (regardless of the dosage); (3) comparator:placebo; (4) outcomes: pain score (visual analog scale) after 3 months and pain score (visual analog scale) after 6 months as primary outcomes; and (5) study design: we only included randomized or controlled clinical trials. Our exclusion criteria included (1) uncontrolled clinical trials, (2) studies that did not report data or measures for any of our selected outcomes, (3) studies that included patients with surgically or clinically diagnosed endometriosis, or (4) studies with no full-text manuscript available. Risk of bias assessment was performed using the Cochrane risk of bias tool. We analyzed dichotomous outcomes as percentages and totals, whereas continuous outcomes were analyzed using mean difference, standard deviations, and relative 95% confidence intervals using the inverse variance method.ResultsWe included 4 placebo-controlled randomized controlled trials. Analysis was hindered because half of the studies (n=2) used the visual analog scale pain score and the other half (n=2) used the numerical rating scale. The analysis showed that when compared with the placebo, gabapentin significantly lowered the visual analog scale pain score at 3 months (mean difference, 0.79; 1.23 to 0.35; P=.005) and 6 months (mean difference, 1.68; 2.30 to 1.05; P=.001) and the numerical rating scale pain score at 3 months (mean difference, 0.20; 0.25 to 0.15; P=.001). However, in terms of the numerical rating scale pain score after 6 months, the 2 groups showed no significant difference (mean difference, 0.27; 0.80 to 0.26; P=.32).CONCLUSIONGabapentin may hold benefit for the management of chronic pelvic pain, with significant improvement in pain seen in both scales at 3 months when compared with the placebo, but only in the visual analog scale group at 6 months of usage. Secondary to the differences in the nature of the 2 scales, a further weighted combined analysis was not possible.

Comparative study of laparoscopic cholecystectomy with and without drains

Background: Gallstones and cholecystitis are very common pathologies in surgical practice. Laparoscopic cholecystectomy (LC) is the preferred procedure to remove the gallbladder (GB) worldwide. The main objective of this study was to evaluate the merits and demerits of placing drain after LC and to find out the clinico-pathologic conditions in which the placement of drain was justifiable.Methods: 100 patients who underwent LC were divided into 2 groups, group A (patients with drain) and group B (patients without drain). Interventional type, single-blind study was done. Complete history, evaluation and relevant data of both groups were done and analysed using descriptive statistics and Chi square test.Results: In group A, 44% were males and 56% females whereas in group B, 42% were males and 58% were females. There was a statistically significant difference (p value&lt;0.05) between 2 groups in Visual analog scale (VAS) grading. Wound infection was seen in 14% in group A and 02% in group B; mean hospital stay in group A was 8.38±1.86 days and in group B was 4.68±1.25 days. Nausea and vomiting were noted in 46% among group A and 04 % among group B.Conclusions: Placement of drain after LC has nothing to offer, in contrast, it was associated with more pain. It would be reasonable to leave a drain if there was worry about an unsolved or potential bile leak only.

COMPARISON OF EFFECTIVENESS OF CARBAMAZEPINE VERSUS TOPIRAMATE FOR THE MANAGEMENT OF TRIGEMINAL NEURALGIA

Objective: To compare the effectiveness of Carbamazepine versus Topiramate for the management of trigeminal neuralgia.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Oral and Maxillofacial Surgery department, Allied Hospital, Faisalabad Pakistan, from Nov 2017 to Nov 2018.&#x0D; Methodology: A total of 60 patients (30 in each group) were included. Group A was treated with Carbamazepine 100mg TDS and group B with Topiramate 25mg TDS. Visual analogue scale was used to access pain and was calculated at 1st visit (baseline), at 7th day, at 14th day and at 28th day.&#x0D; Results: Out of 60 patients, mean of age was 54.78 ± 8.49 years. Right and left side of the face was involved in 41 (68.3%) and 19 (31.7%) patients respectively. Maxillary branch was involved in 24 (40%) and mandibular branch was involved in 36 (60%) patients. The mean of visual analogue scale after 7 days in group A was 4.53 ± 0.93 and in group B was 7.1 ± 1.07, after 14 days mean of visual analogue scale in group A was 3.7 ± 1.02 and in group B was 4.03 ± 1.27. Mean of visual analogue scale after 28 days in group A was 3.27 ± 1.01 3.93 ± 1.28. The results were statistically significant with p-value of 0.03.&#x0D; Conclusion: Topiramate has comparable efficacy as that of Carbamazepine at dose of 75-100mg with lesser side effects. So Topiramate can be used as first line of treatment in trigeminal neuralgia.

Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial.

Background:Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing. However, it remains debatable whether PRP enhances tendon-to-bone healing.Purpose:To assess the efficacy of intraoperative augmentation and postoperative injection of PRP that was prepared using the double-spin method and calcium activation without thrombin in patients with ARCR.Study Design:Randomized controlled trial; Level of evidence, 1; and cohort study; Level of evidence, 3.Methods:A total of 58 patients underwent ARCR using intraoperative PRP augmentation. Half of the patients were randomly assigned to receive an additional ultrasound-guided PRP injection at the repair site at 2 weeks postoperatively (PRP-booster group); the other half did not receive the booster injection (PRP-only group). A control group that did not receive any PRP treatment was retrospectively matched using propensity score matching. Structural integrity was assessed using magnetic resonance imaging at 1 year postoperatively, and healing rates were compared between patients with tear sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of motion; and Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores at minimum 2-year follow-up.Results:In patients with tears >2 cm, the rate of healing failure at 1-year follow-up was significantly less in the overall PRP group than in the control group (12.9% vs 35.7%, respectively; P = .040), however, the PRP-booster group did not present a better healing rate than did the PRP-only group. The overall PRP group had lower VAS for pain scores compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively; P = .016) and higher VAS for satisfaction scores (9.2 ± 1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas no statistical difference was found between the PRP-only and PRP-booster groups in functional outcomes.Conclusion:Intraoperative PRP augmentation during ARCR demonstrated superior anatomic healing results in patients with rotator cuff tears >2 cm as well as reduced pain and increased subjective satisfaction. PRP booster injection provided no additional benefit to tendon integrity or functional recovery.

Psychological Well-being in Adults with Congenital Heart Disease

Background: Due to advances in medical care and treatment of congenital heart disease (CHD), the number of adults with CHD (ACHD) is constantly growing. The psychological situation of ACHD has recently received increasing attention. There is evidence that adaptation to CHD may be affected by psychological factors, especially in how patients integrate their illness into their identities. The present study examined illness identity as a mediator of the association between a self-rated health and emotional distress among ACHD. Materials and Methods: The study used a cross-sectional design. A sample of 229 ACHD (38 ± 12.5 [18–73] years; 45% female) provided background data and completed three questionnaires on self-rated health (EuroQol group's visual analog scale), illness identity (Illness Identity Questionnaire), and emotional distress (Hospital Anxiety and Depression Scale) at the German Heart Center Munich. Serial multiple mediator models were tested using PROCESS macro for SPSS. Results: Perceived health had a direct and indirect effect on emotional distress which was mediated by illness identity (P &lt; 0.05). Compared to all other dimensions of illness identity, engulfment fully mediated the relationship between self-rated health and emotional distress, when adjusted for sociodemographic and clinical confounders. The model explained 42% of variance in total emotional distress (R2 = 0.416). The extent of emotional distress did not differ as a function of CHD complexity. Conclusions: Illness identity emerged as a strong mediating factor between a patient's self-rated health and psychological outcomes. More importance needs to be directed toward assessing a patient's health perception and psychological state, independently of cardiac severity. Based on present findings, targeted psychocardiological interventions should include psychoeducational components and emotion-focused strategies.

Patient experience and satisfaction of surgically assisted rapid maxillary expansion and mandibular midline distraction

Little is known regarding patient experience and satisfaction with surgically assisted rapid maxillary expansion (SARME) and mandibular midline distraction (MMD). This study therefore aimed to assess patient experience and satisfaction with these techniques in two different groups. The first group answered the post-surgical patient satisfaction questionnaire on a 7-point Likert scale during a long-term follow-up recall. The second group answered a visual analogue scale questionnaire (range: 0–10) with different questions regarding experience and satisfaction, at different time points during the first year of treatment. In both groups, 17 patients were included. Regarding the post-surgical patient satisfaction questionnaire, a mean satisfaction rate of 6.4 (range: 4–7) was reported, with a mean follow-up of 6.5 years post-operatively. In the visual analogue scale group, the mean satisfaction rate was 8.0 and did not significantly differ from the expectations pre-operative (P = 0.96). Both procedures showed relatively low pain scores, although a significant higher score was observed in MMD post-operatively (P = 0.00051). Regarding hindrance, the scores were moderate; the bone-borne distractor in the mandible gained higher scores than the tooth-borne distractor in the mandible. In conclusion, both SARME and MMD gain high satisfaction rates.