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Perioperative Medicine (London, England) Apr 2024This trial aimed to study the efficacy of articaine in pain management during endodontic procedures in pediatric patients.
OBJECTIVE
This trial aimed to study the efficacy of articaine in pain management during endodontic procedures in pediatric patients.
METHODS
Ninety-eight children who received endodontic painless treatment were collected and randomly divided into the control group and observation group, with 49 cases in each group. The control group received infiltration anesthesia with lidocaine, and the observation group received infiltration anesthesia with articaine. Anesthesia effect, anesthesia onset time, sensory recovery time, duration of anesthesia, pain intensity, blood pressure, heart rate, and adverse reactions were compared.
RESULTS
The effective rate of anesthesia in the observation group was higher than that in the control group. The anesthesia onset time and sensory recovery time were shorter, the duration of anesthesia was longer, and the VAS score and facial expression score were lower in the observation group than in the control group. The heart rate of the observation group was lower, and diastolic blood pressure was higher than those of the control group. The total incidence of adverse reactions in the observation group was lower than that in the control group.
CONCLUSION
In the treatment of dental pulp diseases in children, the use of articaine can achieve better anesthesia effect and rapid onset of anesthesia and has less impact on the patient's blood pressure and heart rate, but it also can relieve pain and has good safety after the use of medication. It is worthy of clinical application.
PubMed: 38689354
DOI: 10.1186/s13741-024-00389-5 -
The Ocular Surface Jul 2024Corneal neuropathy involves corneal nerve damage that disrupts ocular surface integrity, negatively impacting quality-of-life from pain and impaired vision. Any ocular... (Review)
Review
Corneal neuropathy involves corneal nerve damage that disrupts ocular surface integrity, negatively impacting quality-of-life from pain and impaired vision. Any ocular or systemic condition that damages the trigeminal nerve can lead to corneal neuropathy. However, the condition currently does not have standardized diagnostic criteria or treatment protocols. The primary aim of this systematic review was to evaluate the efficacy and safety of interventions for treating corneal neuropathy. Randomized controlled trials (RCTs) that investigated corneal neuropathy treatments were eligible if the intervention(s) was compared to a placebo or active comparator. Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase and clinical trial registries from inception to July 2022. The Cochrane Risk-of-Bias 2 tool was used to assess study methodological quality. Certainty of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Overall, 20 RCTs were included. Evaluated interventions comprised regenerative therapies (n = 6 studies), dietary supplements (n = 4), anti-glycemic agents (n = 3), combination therapy (n = 3), supportive therapies (n = 2) and systemic pain pharmacotherapies (n = 2). Nine RCTs were judged at high risk of bias for most outcomes. Definitions for corneal neuropathy in the populations varied substantially across studies, consistent with lack of consensus on diagnostic criteria. A diverse range of outcomes were quantified, likely reflecting absence of an agreed core outcome set. There was insufficient evidence to draw definitive conclusions on the efficacy or safety of any intervention. There was low or very low certainty evidence for several neuroregenerative agents and dietary supplements for improving corneal nerve fiber length in corneal neuropathy due to dry eye disease and diabetes. Low or very low certainty evidence was found for neuroregenerative therapies and dietary supplements not altering corneal immune cell density. This review identifies a need to standardize the clinical definition of corneal neuropathy and define a minimum set of core outcome measures. Together, this will provide a foundation for improved phenotyping of clinical populations in studies, and improve the capacity to synthesize data to inform evidence-based care. Protocol registration: PROSPERO ID: CRD42022348475.
Topics: Humans; Cornea; Corneal Diseases; Randomized Controlled Trials as Topic; Trigeminal Nerve Diseases; Quality of Life
PubMed: 38688453
DOI: 10.1016/j.jtos.2024.04.004 -
The Primary Care Companion For CNS... Apr 2024Current therapies for multiple sclerosis (MS) often have limited efficacy and side effects, necessitating alternative approaches. Noninvasive brain stimulation (NIBS),...
Current therapies for multiple sclerosis (MS) often have limited efficacy and side effects, necessitating alternative approaches. Noninvasive brain stimulation (NIBS), such as transcranial direct current stimulation and transcranial magnetic stimulation (TMS), offers potential solutions. Among NIBS techniques, theta burst stimulation (TBS) is notable for its ability to modulate cortical activity. The objective of this systematic review is to assess the impact of TBS on MS symptoms. The study conducted rigorous systematic searches in PubMed, Google Scholar, and Scopus databases up to June 2023, using specific Medical Subject Headings terms related to NIBS and MS, such as TMS and TBS, in conjunction with terms like MS or demyelinating disease. Additionally, the bibliographic references of included studies, book chapters, and original articles were manually reviewed. The study selection process involved a 2-tiered screening mechanism, beginning with an evaluation of titles and abstracts, followed by a full-text review of selected articles. Inclusion criteria incorporated randomized controlled trials (RCTs) focusing on TBS with MS patients. Exclusion criteria included non-qualitative, non-MS, and non-TBS studies. Risk of bias assessment was conducted using the 2008 Cochrane Risk of Bias 2 Scale for RCTs. Data extraction was conducted by thoroughly reviewing each research article and systematically recording the relevant information using a standardized data extraction form, ensuring consistency and accuracy throughout the process. In a systematic review encompassing 5 randomized controlled trials involving 117 individuals with relapsing-remitting or secondary progressive MS across Italy, France, and Russia, various forms of TBS were applied. These interventions ranged from intermittent TBS (iTBS) to continuous intermittent TBS (c-iTBS) that demonstrated favorable outcomes. Notably, TBS interventions led to significant reductions in spasticity, fatigue, and pain, with c-iTBS combined with vestibular rehabilitation showing additional improvements in vestibular-ocular reflexes, gait, and balance. While specific protocols varied among the studies, collectively, the results suggest promise for TBS approaches in alleviating MS-related symptoms. The findings of this review suggest that TBS may hold promise in addressing specific MS symptoms, notably fatigue and spasticity. Future research should include a more diverse participant pool to explore TBS effects across different MS subtypes and aim for larger sample sizes to enhance statistical power and result reliability. .
Topics: Humans; Multiple Sclerosis; Transcranial Magnetic Stimulation; Theta Rhythm
PubMed: 38684013
DOI: 10.4088/PCC.23r03645 -
Journal of Current Ophthalmology 2023To report a case of multiple bilateral retinal pigment epithelial detachments (PEDs) in a woman with systemic lupus erythematosus (SLE).
PURPOSE
To report a case of multiple bilateral retinal pigment epithelial detachments (PEDs) in a woman with systemic lupus erythematosus (SLE).
METHODS
Case Report.
RESULTS
A 28-year-old female with mild blurred bilateral vision in both eyes (OU) without pain or any other symptom was admitted to the hospital due to worsening renal function and uncontrolled high blood pressure (HBP). Best-corrected visual acuity (BCVA) was 20/30 and 20/40, right and left eyes, respectively. She had SLE, glucose-6-phosphate dehydrogenase deficiency, and immune thrombocytopenic purpura. BP was over 150/90 mmHg for more than 1.5 years, and she used corticosteroids at varying doses for more than 4 years. During hospitalization, she was taking prednisone 60 mg daily as Class IV lupus nephritis was diagnosed. On fundoscopy, she had a lacy retinal pattern, remarkably on the macula in OU. Spectral-domain optical coherence tomography revealed multiple bilateral serous PEDs and pachychoroid. Angiofluoresceinography displayed multiple pooling hyperfluorescence areas. Six months afterward, while she was on prednisolone 10 mg daily, and antihypertensive medications, BCVA was improved to 20/25 OU. Nevertheless, she had no retinal or choroidal changes. Her findings could be related to SLE choroidopathy, central serous chorioretinopathy-like disease, and/or hypertensive choroidopathy.
CONCLUSIONS
Ocular involvement affects nearly one-third of SLE patients. The findings are variable and can include nearly any part of the eyeball. Multiple bilateral PEDs have been described in the literature; however, in this case, it is probably multifactorial and not only related to SLE.
PubMed: 38681692
DOI: 10.4103/joco.joco_267_22 -
Journal of Current Ophthalmology 2023To compare the surgical and clinical outcomes of 27-gauge vitrectomy and 23-gauge vitrectomy.
PURPOSE
To compare the surgical and clinical outcomes of 27-gauge vitrectomy and 23-gauge vitrectomy.
METHODS
We conducted a single-center, prospective, randomized study. Fifty-three patients affected by vitreoretinal interface disorders (epiretinal membranes and macular holes) were randomly scheduled to undergo 27-gauge (28 patients) or 23-gauge (25 patients) pars plana vitrectomy. The presence of any potential factor of increased baseline inflammation or eye anatomy influencing the surgery was criteria for exclusion. The time of surgery, postoperative intraocular pressure (IOP), state of sclerotomy wounds, rate of complications, postoperative pain, and indicators of inflammation were studied. We also introduced a new parameter to compare intraocular inflammation after surgery, given by the change in the number of intraretinal hyperreflective foci (HRF).
RESULTS
The 27-gauge vitrectomy was 1.28 min longer than 23-gauge vitrectomy ( < 0.05). The day after surgery, the mean IOP value was significantly higher in the 27-gauge group (16.12 mmHg versus 13.04 mmHg in the 23-gauge group, < 0.05), but this difference disappeared in successive follow-ups and the sclerotomy wounds closed after 2 weeks in the both groups. The rate of postoperative hypotony did not significantly differ in the two groups (10.71% in the 27-gauge group and 8% in the 23-gauge group the day after the surgery, = 0.94). Less postoperative eye redness was seen in 27-gauge eyes (value 1 on the scale) compared to 23-gauge (value 2 on the scale) ( < 0.05), but there was no significant difference in intraocular inflammation (cells, Tyndall, and number of HRF, > 0.05 for all).
CONCLUSIONS
The 27-gauge vitrectomy may have better outcomes in terms of IOP maintenance and cause less redness after the surgery but with a slightly prolonged surgery time and no other differences under other parameters (inflammation, rate of complications, postoperative pain, visual gain, and closure of the sclerotomy wounds).
PubMed: 38681686
DOI: 10.4103/joco.joco_318_22 -
Journal of Current Ophthalmology 2023To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination.
Efficacy of Oral Dextrose versus Acetaminophen versus Placebo on Pain Relief during Retinopathy of Prematurity Eye Examinations: A Randomized, Double-Blind Controlled Clinical Trial.
PURPOSE
To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination.
METHODS
In this prospective randomized, double-blind controlled clinical trial study performed in the ophthalmology clinic of Shafa Hospital (referral hospital for eye disease), Kerman, Iran, 105 premature neonates with birth weight ≤2000 g and gestational age between 28 and 34 weeks were studied. Pain score measurement with Premature Infant Pain Profile-Revised (PIPP-R) during ROP examination in three intervention groups, acetaminophen group (15 mg/kg oral acetaminophen), dextrose group (one cc of oral dextrose 50%), and placebo group (one cc of distilled water), was done.
RESULTS
Out of 105 infants, 33 infants received acetaminophen drops, 35 infants received dextrose drops, and 37 infants received placebo. The mean pain score of the group receiving acetaminophen was 11.39, dextrose 12.17, and placebo 11.54. The acetaminophen group had a lower average PIPP-R score. This difference was not significant between the three groups ( = 0.38).
CONCLUSIONS
Acetaminophen and dextrose in comparison with distilled water did not show a significant difference in reducing neonatal pain during ROP examinations. However, the PIPP-R score in the acetaminophen group was lower compared to the other groups.
PubMed: 38681685
DOI: 10.4103/joco.joco_5_23 -
Cureus Mar 2024Dimethyl sulfate (DMS) is a drug widely used as a pharmaceutical and synthetic raw material. On the other hand, it is highly toxic and requires management and treatment...
Dimethyl sulfate (DMS) is a drug widely used as a pharmaceutical and synthetic raw material. On the other hand, it is highly toxic and requires management and treatment as a hazardous substance. A mass outbreak of chemical burns resulting from DMS poisoning occurred at a drug factory. All three patients were brought to our hospital, a tertiary emergency medical facility, several hours after exposure. Their vital signs were stable, with only eye pain and a sore throat. However, after admission, two patients required emergency tracheostomy or endotracheal intubation due to laryngeal edema. Improvement was achieved through the administration of steroids, but a severely injured patient required an extended treatment period. DMS poisoning is rare; however, it can be fatal depending on the exposure concentration. Furthermore, even if the initial symptoms are mild, laryngeal edema may develop later, requiring careful monitoring and appropriate airway interventions.
PubMed: 38681359
DOI: 10.7759/cureus.57060 -
International Journal of Surgery Case... Jun 2024Colorectal cancer (CRC) presenting with synchronous liver metastasis is relatively common, occurring in approximately 20 % of patients. Herein we report an atypical...
INTRODUCTION AND IMPORTANCE
Colorectal cancer (CRC) presenting with synchronous liver metastasis is relatively common, occurring in approximately 20 % of patients. Herein we report an atypical case of a patient who presented with a new, obstructing colon mass with synchronous liver metastasis, biopsy proven to be malignant melanoma.
CASE PRESENTATION
An 81-year-old male presented to the hospital emergency department with abdominal pain, diarrhea, and 30-pound unintentional weight loss over the past 4 months. Investigations revealed an obstructing cecal mass with multiple large, hypodense hepatic masses suspicious for metastatic disease. A multidisciplinary evaluation ensued, and the decision was made to treat with palliative intent. The patient was surgically treated with a diverting stoma and an intraoperative biopsy of the hepatic masses demonstrated metastatic melanoma. The patient did report a remote history of malignant melanoma and underwent curative-intent resection a decade earlier. There was no evidence of a new primary cutaneous melanoma. A tentative plan for checkpoint inhibitor therapy was discussed, but his medical issues worsened, and the patient died before any anti-cancer therapy could be started.
CLINICAL DISCUSSION
The clinical picture of obstructing colon mass with synchronous liver masses most commonly represents a colon primary with synchronous liver metastasis. The capacity for melanoma to mimic other pathologies is unusual but has been described, with case reports describing metastasis to the eye, biliary hilum, liver, pancreas, colon, small bowel and brain. This case serves as a good reminder that melanoma may mimic a variety of oncologic presentations, even after a very long disease-free interval.
CONCLUSION
Our patient suspected to have metastatic colon cancer was found instead to have metastatic melanoma, with significantly different therapeutic options and prognosis.
PubMed: 38677254
DOI: 10.1016/j.ijscr.2024.109686 -
Medicina (Kaunas, Lithuania) Apr 2024Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is... (Observational Study)
Observational Study
Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT). Patients received usual pain therapy in an unstandardized individual manner. Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0-8), 3.29 ± 3.24 (range, 0-8) on the day of surgery, 4.67 ± 1.90 (range, 2-10) on day 1, 3.25 ± 1.39 (range, 1-6) on day 2, and 2.71 ± 1.30 (range, 1-6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0-10) preoperatively, 4.04 ± 3.78 (range, 0-10) on the day of surgery, 5.75 ± 2.01 (range, 2-10) on day 1, 4.25 ± 1.89 (range, 2-10) on day 2, and 3.88 ± 1.54 (range, 2-8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.
Topics: Humans; Pain, Postoperative; Prospective Studies; Female; Male; Middle Aged; Aged; Eye Enucleation; Adult; Pain Measurement; Surveys and Questionnaires; Aged, 80 and over
PubMed: 38674260
DOI: 10.3390/medicina60040614 -
Anesthesiology Apr 2024The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.
BACKGROUND
The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.
METHODS
We assessed pain 90 days after ambulatory surgery in an international, multicentre prospective cohort study of patients ≥45 years old with comorbidities or ≥65 years old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change ≥1 in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain as a score ≥4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression.
RESULTS
Between November 2021 and January 2023, a total of 2054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain prior to surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were: active smoking (OR 1.82; 95% CI 1.20 to 2.76), orthopaedic surgery (OR 4.7; 95% CI 2.24 to 9.7), plastic surgery (OR 4.3; 95% CI 1.97 to 9.2), breast surgery (OR 2.74; 95% CI 1.29 to 5.8), vascular surgery (OR 2.71; 95% CI 1.09 to 6.7), and ethnicity (i.e., Hispanic/Latino ethnicity OR 3.41; 95% CI 1.68 to 6.9 and First Nations/Native persons OR 4.0; 95% CI 1.05 to 15.4).
CONCLUSIONS
Persistent postsurgical pain after same-day surgery is common, usually moderate to severe in nature, and occurs mostly in patients without chronic pain prior to surgery.
PubMed: 38669010
DOI: 10.1097/ALN.0000000000005030