-
The American Surgeon Jun 2023Cholelithiasis is a common gallbladder finding leading to cholecystitis in 7% of cases. Sonographic imaging or computed tomography scans are commonly employed for the... (Review)
Review
BACKGROUND
Cholelithiasis is a common gallbladder finding leading to cholecystitis in 7% of cases. Sonographic imaging or computed tomography scans are commonly employed for the diagnosis of benign gallbladder disease. Air within the gallbladder might carry various diagnoses. As opposed to pathologic air in the gallbladder seen in emphysematous cholecystitis, gas-containing gallstones are no more pathological than the exclusive presence of gallstones. In the present report, we review the incidence, physiology, typical characteristics, and clinical significance of gas-containing gallstones within the gallbladder.
METHODS
We performed an institutional review of all patients with benign gallbladder disease over the past 16 years (2005 to 2021) to identify patients with gas-containing gallstones in the gallbladder. We performed a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to identify all reported cases of patients with gas-containing biliary calculi within the gallbladder.
RESULTS
Our institutional review identified 5 patients with gas-containing biliary calculi in 1252 consecutive cholecystectomies; 4 of which had cholecystitis, while 1 was an incidental finding. Our review of the literature identified 30 manuscripts documenting 54 unique patients with gas-containing biliary calculi. None of these patients had consequential pathology related to gas in the stones other than that caused by the gallstones (ie, biliary colic and cholecystitis).
CONCLUSIONS
Gas-containing biliary calculi are uncommon. How gas finds itself within gallstones within the gallbladder is not entirely clear. Gas-containing gallstones should not be interpreted as free gas within the gallbladder or within an abscess.
Topics: Humans; Gallstones; Cholecystitis; Calculi; Gallbladder Diseases
PubMed: 35969478
DOI: 10.1177/00031348221121553 -
Pain Practice : the Official Journal of... Jan 2023Chronobiology is the science of how physiological processes in the body follow a pattern of time. Pain has been shown to follow a circadian rhythm, with different types... (Review)
Review
BACKGROUND
Chronobiology is the science of how physiological processes in the body follow a pattern of time. Pain has been shown to follow a circadian rhythm, with different types of pain having variable expression along this rhythm.
OBJECTIVE
This article reviews the nature of diurnal variations in pain along with a discussion of the mechanisms of circadian rhythm of pain.
EVIDENCE REVIEW
We conducted a literature search on the PubMed and Google Scholar electronic databases, through April 2022. Publications were screened for English language, full-text availability, and human subjects. Randomized controlled trials and observational trials were included. Data were extracted from studies on patients with acute or chronic pain phenotypes, which provide pain severity data and corresponding diurnal time points.
FINDINGS
The literature search led to the inclusion of 39 studies. A circadian pattern of pain was found to be present in nociceptive, neuropathic, central, and mixed pain states. Postoperative pain, fibromyalgia, trigeminal neuralgia, and migraines were associated with higher pain scores in the morning. Temporomandibular joint pain, neuropathic pain, labor pain, biliary colic, and cluster headaches increased throughout the day to reach a peak in the evening or night. Arthritis and cancer pain were not associated with any circadian rhythmicity. Furthermore, the circadian rhythm of pain was not found to be altered in patients on analgesics.
CONCLUSION
The results of this review suggest that an understanding of diurnal variation may help improve therapeutic strategies in pain management, for instance through analgesic titration.
Topics: Pregnancy; Female; Humans; Analgesics; Chronic Pain; Fibromyalgia; Neuralgia; Trigeminal Neuralgia
PubMed: 35869813
DOI: 10.1111/papr.13149 -
Frontiers in Nutrition 2022During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice....
BACKGROUND
During Ramadan, many patients with diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy choose to fast even against their doctor's advice. The impact of this intermittent fasting on health and disease could be different in men and women. The aim of this study was to determine the effect of sex as a factor in diseases outcomes of patients who opt to fast during Ramadan.
MAIN BODY
The articles included in this study reported data on six diseases: diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy. A systematic search was performed on PubMed and Scopus for observational and clinical studies mentioning Ramadan, diabetes, renal, cardiovascular, gastrointestinal diseases, headaches, and epilepsy in both men and women. Data was extracted by two independent reviewers using a standardized data-collection form. From 381 original articles, 38 studies were selected, including 25,023 patients of which 44.4% were women. Sex-based differences were reported by 18 studies for several variables such as body mass index, blood glucose, the frequency of hypoglycemia, renal colic, mortality, thrombosis, and gastrointestinal diseases in patients fasting during Ramadan. Most of the differences between men and women were reported both in the baseline period before Ramadan and during Ramadan. Indeed, during the period outside Ramadan, the frequency of renal colic, cardiovascular, gastrointestinal diseases, were higher in men; while body mass index, Thrombosis, and headache were higher in women. In the remaining 21 studies, it was reported that the sex factor was not associated with the effect of Ramadan fasting in the frequency and other outcomes of these diseases.
CONCLUSION
Currently, small attention is paid to sex as a determinant factor in patients while fasting during Ramadan. There appeared to be differences in the frequency and incidence of diseases in men and women during Ramadan. Closer attention to sex differences regarding the frequency and the progression of the diseases during fasting may help to improve patient care, especially to benefit those patients willing to fast during Ramadan.
PubMed: 35845800
DOI: 10.3389/fnut.2022.908674 -
Evidence-based Complementary and... 2022Acute renal colic caused by urinary calculi has a considerable impact on the quality of life. Pain relief is the primary goal in the management of patients with acute... (Review)
Review
BACKGROUND
Acute renal colic caused by urinary calculi has a considerable impact on the quality of life. Pain relief is the primary goal in the management of patients with acute renal colic caused by urinary calculi. At present, there is no systematic evaluation of the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults.
OBJECTIVE
To evaluate the efficacy and safety of manual acupuncture in the treatment of acute renal colic caused by urinary calculi in adults.
METHODS
Databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Medical, VIP Database for Chinese Technical Periodicals (VIP), and China Biomedical Literature (SinoMed) were searched for literature and other randomized controlled registration platforms. We searched to identify the relevant randomized controlled trials from the establishment of the database to February 9, 2022. Only randomized controlled trials (RCTs) of manual acupuncture as the therapy for acute renal colic caused by urinary calculi in adults were included, whether or not the blind method is used. The patients were adults diagnosed with urinary calculi and renal colic. The control group was treated with commonly used analgesics and antispasmodics. The experimental group was treated with acupuncture as a monotherapy or as an adjuvant therapy (manual acupuncture combined with analgesics and antispasmodics). Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions, and outcomes from potentially relevant articles. Cochrane risk bias assessment tool was used to evaluate the quality of the included study, and RevMan5.4 software was used for meta-analysis. Our primary outcomes were response rate and time duration before pain remission. Secondary outcomes were the time of complete pain relief, pain variation, need for rescue analgesia, and adverse events.
RESULTS
Out of 1123 records identified, 15 were found to be of relevance to this study, and 1210 participants were included in the meta-analysis. The meta-analysis of the results shows that, in terms of response rate, compared with the control group, acupuncture as a monotherapy seems to have a slight advantage (RR = 1.10 (95% CI: 1.03, 1.18), = 28%, =0.004), while acupuncture as an adjuvant therapy has no advantage (RR = 1.06 (95% CI: 0.95, 1.20), = 77%, =0.30). In terms of duration before pain relief, acupuncture as a monotherapy had an advantage over the control group (MD = -10.28(95% CI: -14.40, -6.17), = 93%, < 0.00001). Acupuncture as a monotherapy was similar to positive medication in terms of complete pain relief (MD = -7.13 (95% CI: -20.19, 5.94), = 95%, =0.28). Pain variation: VAS scores at 10 min, acupuncture as a monotherapy (MD = -2.47 (95% CI: -3.40, -1.53), = 84%, < 0.00001) or as an adjuvant therapy (MD = -3.38 (95% CI: -4.33, -2.43), = 60%, < 0.00001) was better than the control group. VAS scores at 30 min, compared with the control group, there was no difference between acupuncture as a monotherapy (MD = -0.27 (95% CI: -1.43, 0.88), = 88%, =0.64) and acupuncture as an adjuvant therapy (MD = -1.17 (95% CI: -3.15, 0.81), = 96%, =0.25). VAS scores at 60 min, compared with the control group, there was no difference in the acupuncture as a monotherapy (MD = 0.58 (95% CI: -0.28, 1.45), = 77%, =0.19), while acupuncture as an adjuvant therapy was better (MD = -1.22 (95% CI: -1.93, -0.51), = 72%, =0.0007). VAS scores at 120 min, there was no difference in acupuncture as a monotherapy compared to the control group (MD = -0.24 (95% CI:-1.22, 0.75), = 0, =0.64). One study reported on rescue analgesia. Fewer adverse events occurred in the experimental group compared to the control group.
CONCLUSION
In the course of manual acupuncture treatment of acute renal colic caused by urinary calculi in adults, available evidence suggests that manual acupuncture is as effective as positive treatment drugs, either as a monotherapy or as an adjunctive therapy, with the advantage of acupuncture being its rapid onset of action. However, the number of existing clinical studies is small, and the quality of evidence is generally low, so it is recommended to use it with caution. In order to further verify the above conclusions, more high-quality clinical RCTs need to be carried out. . The present review protocol was registered with the International Prospective Register of Systematic Reviews (CRD42019134900).
PubMed: 35832526
DOI: 10.1155/2022/7140038 -
Scandinavian Journal of Urology Jun 2022Since the 1950s a small number of centres have used sterile water injections (SWI) to treat renal colic pain. We undertook this review to determine the efficacy of SWI... (Review)
Review
BACKGROUND
Since the 1950s a small number of centres have used sterile water injections (SWI) to treat renal colic pain. We undertook this review to determine the efficacy of SWI to manage the pain of renal colic.
METHODS
We searched the electronic databases PubMed, Cochrane Central Register, CINAHL, and Scopus from database inception to 7 November 2021 for randomized controlled trials that met the inclusion criteria.
RESULTS
Six trials were included in the review ( = 894 patients). Two placebo controlled trials were included in the meta-analysis. Other trials compared SWI to Diclofenac, Morphine, or oral Paracetamol. The overall quality of the trial was low. Compared to a placebo SWI demonstrated a significant reduction in self-reported pain at 30 min (Mean difference [MD] = -4.68, 95% Confidence Interval [CI] = -5.21, -4.15. < 0.001, I = 0%) and at or beyond 60 min post-injection (MD = -5.34 95% CI = -5.85, -4.82, ≤ 0.001, I = 0%). Pain relief provided by SWI was significantly better than oral paracetamol and equivalent to Diclofenac and Morphine. No significant side-effects were attributed to SWI use in any trials.
DISCUSSION/CONCLUSION
SWI could be a suitable alternative for management of renal colic pain where alternatives such as non-steroidal anti-inflammatory and opioid drugs are either unavailable or contraindicated. However, further research is required to establish the role of SWI in renal colic pain management.
Topics: Acetaminophen; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Humans; Morphine Derivatives; Pain; Renal Colic; Water
PubMed: 35481429
DOI: 10.1080/21681805.2022.2066719 -
F1000Research 2021Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a... (Meta-Analysis)
Meta-Analysis
Urolithiasis cases are a common condition, and the number is still growing today. The prevalence of urinary tract stones globally currently ranges from 2-20% with a recurrence rate of around 50%. The present study aims to investigate the efficacy of adjunctive alpha-blockers in improving the success rate of ureteroscopy (URS) procedure for urolithiasis. We reviewed articles obtained from MEDLINE, CENTRAL, CINAHL, and Elsevier from 14 August to 9 September 2020, comparing alpha-blockers as adjunctive therapy, versus either a placebo or no drug at all, in post-URS urolithiasis patients. There were no restrictions on the type of URS and alpha-blockers given to patients. The quality of studies included was assessed using Cochrane's Risk of Bias Assessment for Randomized-Controlled Trials. Forest plot analysis emphasizes the statistically significant difference among the group, where the adjunctive alpha-blocker group had pooled relative risk (RR) of being stone-free, readmitted due to initial URS failure, having an overall complication, having haematuria, getting their ureteral mucous injured, and suffering a colic episode was 1.71 (95% CI, 1.11-1.24), 0.50 (95% CI, 0.25-1.01), 0.41 (95% CI, 0.27-0.61), 0.42 (95% CI, 0.22-0.79), 0.31 (95% CI, 0.13-0.73), and 0.21 (95% CI, 0.06-0.69), respectively. Alpha blockers minimize the frequency and duration of ureteral contractions, allowing smooth stone expulsion. With this knowledge, it is expected to help clinicians decide the importance of adjunctive alpha-blocker administration.
Topics: Adrenergic alpha-Antagonists; Female; Humans; Male; Ureteral Calculi; Ureteroscopy
PubMed: 35464176
DOI: 10.12688/f1000research.52072.2 -
Nutrients Feb 2022Functional gastrointestinal disorders (FGIDs) refer to gastrointestinal tract issues that lack clear structural or biochemical causes. Their pathophysiology is still... (Review)
Review
Functional gastrointestinal disorders (FGIDs) refer to gastrointestinal tract issues that lack clear structural or biochemical causes. Their pathophysiology is still unclear, but gut microbiota alterations are thought to play an important role. This systematic review aimed to provide a comprehensive overview of the faecal microbiota of infants and young children with FGIDs compared to healthy controls. A systematic search and screening of the literature resulted in the inclusion of thirteen full texts. Most papers reported on infantile colic, only one studied functional constipation. Despite methodological limitations, data show alterations in microbial diversity, stability, and colonisation patterns in colicky infants compared to healthy controls. Several studies (eight) reported increases in species of (pathogenic) Proteobacteria, and some studies (six) reported a decrease in (beneficial) bacteria such as Lactobacilli and Bifidobacteria. In addition, accumulation of related metabolites, as well as low-grade inflammation, might play a role in the pathophysiology of infantile colic. Infants and toddlers with functional constipation had significantly lower levels of Lactobacilli in their stools compared to controls. Microbial dysbiosis and related changes in metabolites may be inherent to FGIDs. There is a need for more standardised methods within research of faecal microbiota in FGIDs to obtain a more comprehensive picture and understanding of infant and childhood FGIDs.
Topics: Child; Child, Preschool; Dysbiosis; Feces; Gastrointestinal Diseases; Gastrointestinal Microbiome; Humans; Infant; Microbiota
PubMed: 35267949
DOI: 10.3390/nu14050974 -
Frontiers in Pharmacology 2021Although multiple randomized controlled trials (RCTs) and systematic review and meta-analysis were performed to investigate the efficiency and safety of nonsteroidal... (Review)
Review
Although multiple randomized controlled trials (RCTs) and systematic review and meta-analysis were performed to investigate the efficiency and safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in the treatment of acute renal colic, the therapeutic regimen of renal colic is still controversial. Therefore, the aim of this study was to derive a more concise comparison of the effectiveness and safety between NSAIDs and opioids in the treatment for patients with acute renal colic by a systematic review and meta-analysis. We searched PubMed, Embase, and Cochrane Central Register of controlled trials for seeking eligible studies. The pooled mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) was calculated using the random effects model. The primary outcome was assessed according to the Grading of Recommendations Assessment, Development and Evaluation. A total of 18 studies involving 3,121 participants were included in the systematic review and meta-analysis. No significant difference between the NSAID and opioid groups was observed, with changes in the visual analog scale (VAS) at 0-30 min (MD = 0.79, 95% CI: -0.51, 2.10). NSAIDs in the form of intravenous administration (IV) had no better effect on the changes in the VAS at 0-30 min, when compared to opioids (MD = 1.25, 95% Cl: -4.81, 7.3). The NSAIDs group in the form of IV had no better outcome compared to the opioids group, as well as the VAS at 30 min (MD = -1.18, 95% Cl: -3.82, 1.45; MD = -2.3, 95% Cl: -5.02, 0.42, respectively). Moreover, similar results of this outcome were also seen with the VAS at 45 min (MD = -1.36, 95% Cl: -5.24, 2.52). Besides, there was a statistical difference in the incidence of later rescue (RR = 0.76, 95% CI: 0.66, 0.89), drug-related adverse events (RR = 0.44, 95% CI: 0.27, 0.71), and vomiting (RR = 0.68, 95% CI: 0.49, 0.96). There is no significant difference between the NSAIDs and opioids in the treatment of renal colic in many outcomes (e.g., the VAS over different periods using different injection methods at 30 and 60 min), which has been focused on in this study. However, the patients who were treated using NSAIDs by clinicians can benefit from fewer side effects.
PubMed: 35153734
DOI: 10.3389/fphar.2021.728908 -
Frontiers in Medicine 2021To compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.
OBJECTIVE
To compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.
METHODS
The electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were explored from 1st January 2000 to 30th March 2021 and randomized controlled trials (RCTs) comparing IV lidocaine with a control group of standard analgesics were included.
RESULTS
Twelve RCTs including 1,351 patients were included. The cause of pain included abdominal pain, renal or biliary colic, traumatic pain, radicular low back pain, critical limb ischemia, migraine, tension-type headache, and pain of unknown origin. On pooled analysis, we found no statistically significant difference in pain scores between IV lidocaine and control group at 15 min (MD: -0.24 95% CI: -1.08, 0.61 = 81% = 0.59), 30 min (MD: -0.24 95% CI: -1.03, 0.55 = 86% = 0.55), 45 min (MD: 0.31 95% CI: -0.66, 1.29 = 66% = 0.53), and 60 min (MD: 0.59 95% CI: -0.26, 1.44 = 75% = 0.18). There was no statistically significant difference in the need for rescue analgesics between the two groups (OR: 1.45 95% CI: 0.82, 2.56 = 41% = 0.20), but on subgroup analysis, the need for rescue analgesics was significantly higher with IV lidocaine in studies on abdominal pain but not for musculoskeletal pain. On meta-analysis, there was no statistically significant difference in the incidence of side-effects between the two study groups (OR: 1.09 95% CI: 0.59, 2.02 = 48% = 0.78).
CONCLUSION
IV lidocaine can be considered as an alternative analgesic for pain control in the ED. However, its efficacy may not be higher than standard analgesics. Further RCTs with a large sample size are needed to corroborate the current conclusions.
PubMed: 35111766
DOI: 10.3389/fmed.2021.706844 -
The Journal of Infection Sep 2022Antibiotics are amongst the most commonly used drugs in children. In addition to inducing antibiotic resistance, antibiotic exposure has been associated with adverse... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Antibiotics are amongst the most commonly used drugs in children. In addition to inducing antibiotic resistance, antibiotic exposure has been associated with adverse long-term health outcomes.
METHODS
A systematic search using PRISMA guidelines to identify original studies reporting associations between antibiotic exposure and adverse long-term health outcomes in children. Overall pooled estimates of the odds ratios (ORs) were obtained using random-effects models.
RESULTS
We identified 160 observational studies investigating 21 outcomes in 22,103,129 children. Antibiotic exposure was associated with an increased risk of atopic dermatitis (OR 1.40, 95% confidence interval (CI) 1.30-1.52, p < 0.01), allergic symptoms (OR 1.93, 95%CI 1.66-2.26, p < 0.01), food allergies (OR 1.35, 95%CI 1.20-1.52, p < 0.01), allergic rhinoconjunctivitis (OR 1.66, 95%CI 1.51-1.83, p < 0.01), wheezing (OR 1.81, 95%CI 1.65-1.97, p < 0.01), asthma (OR 1.96, 95%CI 1.76-2.17, p < 0.01), increased weight gain or overweight (OR 1.18, 95%CI 1.11-1.26, p < 0.01), obesity (OR 1.21, 95%CI 1.05-1.40, p < 0.01), juvenile idiopathic arthritis (OR 1.74, 95%CI 1.21-2.52, p < 0.01), psoriasis (OR 1.75, 95%CI 1.44-2.11, p < 0.01), autism spectrum disorders (OR 1.19, 95%CI 1.04-1.36, p = 0.01) and neurodevelopment disorders (OR 1.29, 95%CI 1.09-1.53, p < 0.01). Dose-response effects and stronger effects with broad-spectrum antibiotic were often reported. Antibiotic exposure was not associated with an altered risk of allergic sensitisation, infantile colic, abdominal pain, inflammatory bowel disease, celiac disease, type 1 diabetes, fluorosis, and attention deficit hyperactivity disorder.
CONCLUSION
Although a causal association cannot be determined from these studies, the results support the meticulous application of sound antibiotic stewardship to avoid potential adverse long-term health outcomes.
Topics: Anti-Bacterial Agents; Asthma; Attention Deficit Disorder with Hyperactivity; Child; Dermatitis, Atopic; Humans; Outcome Assessment, Health Care
PubMed: 35021114
DOI: 10.1016/j.jinf.2022.01.005