Category: Nevin Manimala

Exp Oncol. 2021 Mar;43(1):67-72.

ABSTRACT

BACKGROUND: Ovarian cancer (OC) is one of the most demanding unresolved issues in oncogynecology. In Ukraine, there are over 3000 new cases of the disease annually. 24.6% of patients die within the first year after diagnosis. It indicates the relevance of developing new and optimizing existing OC treatment programs.

AIM: To analyze the short-term results of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary (non-recurrent) advanced serous OC, in comparison with the group of patients after standard cytoreductive surgery (CRS) of high and medium complexity, according to the following indicators: the effect on metabolism, postoperative complications, length of stay in intensive care unit and hospital, timing of adjuvant chemotherapy initiation.

MATERIALS AND METHODS: Cases of 35 patients with advanced serous OC who underwent the treatment at the Oncogynecology Department of the National Cancer Institute from December 2018 to April 2020 were analyzed. For the assessment of surgical procedures volumes, a surgical complexity scoring system was used. HIPEC was performed in 20 patients (57.1%), while 15 patients (42.9%) underwent standard CRS.

RESULTS: At the beginning and end of the HIPEC procedure, a shift in acid-base state and the development of hyperthermia were evident. At the end of the 1st day of the postoperative period, statistically significant changes (p < 0.05) were revealed in pH, base excess, body temperature, alanine transaminase and aspartate transaminase levels in patients from HIPEC group indicating the development of metabolic acidosis and toxic liver damage. The negative effects of HIPEC developed at the end of the procedure may persist at the end of the first postoperative day. While metabolic acidosis diminishes, the signs of hepatotoxicity persist. Toxic liver damage is the most frequent complication of the postoperative period detected more often (p < 0.05) after HIPEC in comparison with standard CRS. Standard adjuvant chemotherapy began on average in 31.9 ± 4.4 days in HIPEC group and 18.6 ± 1.6 days in CRS group (p < 0.05).

CONCLUSIONS: The data obtained indicate that HIPEC negatively affects metabolism and aggravates the severity of disorders that develop during the CRS phase. The use of HIPEC postpones the initiation of adjuvant chemotherapy, which is probably associated with a longer period of restoration of the functions of organs and systems of patients (in particular, liver function). The feasibility of HIPEC in advanced serous OC treatment requires further research.

PMID:33785709

Korean J Pain. 2021 Apr 1;34(2):217-228. doi: 10.3344/kjp.2021.34.2.217.

ABSTRACT

BACKGROUND: The purpose of this study was to assess the effectiveness of transcutaneous electrical nerve stimulation (TENS) in chronic low back pain and neuropathic pain.

METHODS: Seventy-four patients aged 18-65 with chronic low back pain were included in the study. Baseline measurements were performed, and patients were randomized into three groups. The first group received burst TENS (bTENS), the second group conventional TENS (cTENS), and the third group placebo TENS (pTENS), all over 15 sessions. Patients’ visual analogue scale (VAS) scores were evaluated before treatment (preT), immediately after treatment (postT), and in the third month after treatment (postT3). Douleur Neuropathique 4 Questions (DN4), the Modified Oswestry Low Back Pain Disability Questionnaire (MOS), the Beck Depression Inventory (BDI), and sympathetic skin response (SSR) values were also evaluated preT and postT3.

RESULTS: A statistically significant improvement was observed in mean VAS scores postT compared to preT in all three groups. Intergroup comparison revealed a significant difference between preT and postT values, that difference being assessed in favor of bTENS at multiple comparison analysis. Although significant improvement was determined in neuropathic pain DN4 scores measured at postT3 compared to preT in all groups, there was no significant difference between the groups. No statistically significant difference was also observed between the groups in terms of MOS, BDI, or SSR values at postT3 (P > 0.05).

CONCLUSIONS: bTENS therapy in patients with low back pain is an effective and safe method that can be employed in short-term pain control.

PMID:33785674 | DOI:10.3344/kjp.2021.34.2.217

J Public Health Manag Pract. 2021 May-Jun 01;27(Suppl 3):S164-S167. doi: 10.1097/PHH.0000000000001318.

ABSTRACT

CONTEXT: Electronic-cigarette use, or vaping, among youth has increased substantially in recent years. Tobacco smoking shows a strong association with other risk behaviors, but the association between vaping and other risk behaviors has rarely been explored. We examine the relationship between youth vaping and substance use, risky driving behaviors, and lack of bicycle helmet use.

PROGRAM: Data from the 2015 and 2017 New Mexico Youth Risk and Resiliency Survey were analyzed to evaluate the association between the use of e-cigarettes and other youth risk behaviors. Study participants were high school students, grades 9 to 12. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI).

EVALUATION: A majority of students reported ever using e-cigarettes (54%). In 2015, e-cigarette users were more likely than nonusers to be Hispanic (65% vs 54%, P ≤ .001) and 16 years of age or older (58% vs 42%, P = .018). We found strong, statistically significant associations between e-cigarette use and not wearing a bicycle helmet (OR = 2.62, 95% CI: 1.95-3.51), texting while driving (OR = 2.18, 95% CI: 1.79-2.66), driving after drinking (OR = 2.95, 95% CI: 1.61-5.40), current marijuana use (OR = 6.38, 95% CI: 4.65-8.76), current painkiller use (OR = 2.47, 95% CI: 1.63-3.77), and current heroin use (OR = 0.15, 95% CI: 0.06-0.33). Driving after drinking was not significantly associated with e-cigarette use in 2017.

DISCUSSION: E-cigarette use is associated with multiple other risk behaviors among youth. Further research should focus on environmental and policy efforts to reduce access to e-cigarettes by youth as well as interventions that address the underlying causes of the constellation of risk behaviors.

PMID:33785690 | DOI:10.1097/PHH.0000000000001318

J Public Health Manag Pract. 2021 May-Jun 01;27(Suppl 3):S186-S190. doi: 10.1097/PHH.0000000000001317.

ABSTRACT

The United States continues to battle the addiction and overdose deaths with the opioid epidemic. Prescription opioids are responsible for more than half of these deaths. This before-after study was conducted to assess the effect of the Centers for Disease Control and Prevention’s (CDC’s) opioid prescription guidelines. Data were abstracted from electronic health records of adult patients presenting with low back pain seen in the emergency department during the study period. SAS statistical software was used to compare opioid prescription practices before and after the intervention. A total of 1006 patients were included in the analysis. Opioid prescriptions decreased by 11% post-CDC guidelines (45% vs 34%). Of patients receiving opioids (n = 383), there was a 6% reduction in the number of days (<5 days) for which opioids were prescribed post-CDC guidelines (14% vs 8%). CDC guidelines on opioid prescribing were associated with a significant reduction in opioid prescribing in terms of both quantity and length of time prescribed. Public health policies as guidelines may positively influence provider decision making and behaviors.

PMID:33785694 | DOI:10.1097/PHH.0000000000001317

BMJ Mil Health. 2021 Mar 30:bmjmilitary-2021-001814. doi: 10.1136/bmjmilitary-2021-001814. Online ahead of print.

NO ABSTRACT

PMID:33785585 | DOI:10.1136/bmjmilitary-2021-001814

Korean J Pain. 2021 Apr 1;34(2):201-209. doi: 10.3344/kjp.2021.34.2.201.

ABSTRACT

BACKGROUND: Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair.

METHODS: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects.

RESULTS: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically.

CONCLUSIONS: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following non-recurrent inguinal herniorrhaphy.

PMID:33785672 | DOI:10.3344/kjp.2021.34.2.201

Korean J Pain. 2021 Apr 1;34(2):210-216. doi: 10.3344/kjp.2021.34.2.210.

ABSTRACT

BACKGROUND: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN.

METHODS: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments.

RESULTS: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression.

CONCLUSIONS: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

PMID:33785673 | DOI:10.3344/kjp.2021.34.2.210

Arch Dis Child. 2021 Mar 30:archdischild-2020-320007. doi: 10.1136/archdischild-2020-320007. Online ahead of print.

ABSTRACT

BACKGROUND: Attention deficit and hyperactivity disorder (ADHD) is one of the most common behavioural disorders, affecting around 5% of the global population. Methylphenidate is recommended as the first-line drug treatment for ADHD for children over the age of 5 in the UK. It can have many side effects and it is important that families are well informed. Other than their healthcare professionals and friends, the major information source for families is the internet.

AIMS: To evaluate the validity of online information regarding the adverse effects of methylphenidate.

METHODS: Side-effects of methylphenidate hydrochloride listed in the British National Formulary for Children (BNFC) were taken as the ‘gold standard’ and compared with online websites for accuracy. The first 10 websites found on each of nine different search engines were used as comparators.

RESULTS: From the 90 hits, 10 top hits found in each of 9 search engines, 25 unique websites were identified. A quarter (six sites; 24%) documented only side-effects that all appeared in the BNFC. Three quarters (19 websites; 76%) had at least one side-effect that did not appear in the BNFC; with six websites documenting more than five side-effects not found in the BNFC.

CONCLUSIONS: Methylphenidate’s frequent use makes it important that the general public are provided with accurate, reliable and easily accessible information. Most websites have dependable quality information on side effects, but several seem to list excessive side-effects.

PMID:33785529 | DOI:10.1136/archdischild-2020-320007

Arch Dis Child. 2021 Mar 30:archdischild-2020-320592. doi: 10.1136/archdischild-2020-320592. Online ahead of print.

ABSTRACT

CONTEXT: The literature on melatonin as a sedative agent in children is limited.

OBJECTIVE: To conduct a systematic review of studies assessing the efficacy and safety of melatonin for non-operating room sedation in children.

METHODS: Medline, Embase, Cochrane Library and Cumulative Index to Nursing and Allied Health were searched until 9 April 2020 for studies using melatonin and reporting one of the prespecified outcomes of this review. Two authors independently assessed the eligibility, risk of bias and extracted the data. Studies with a similar study design, comparator and procedure were pooled using the fixed-effect model.

RESULTS: 25 studies (clinical trials=3, observational studies=9, descriptive studies=13) were included. Melatonin was used for electroencephalogram (EEG) (n=12), brainstem evoked response audiometry (n=8) and magnetic resonance imaging (MRI) (n=5). No significant differences were noted on meta-analysis of EEG studies comparing melatonin with sleep deprivation (SD) (relative risk (RR) 1.06 (95% CI 0.99 to 1.12)), melatonin with chloral hydrate (RR 0.97 (95% CI 0.89 to 1.05)) and melatonin alone with melatonin and SD combined (RR 1.03 (95% CI 0.97 to 1.10)) for successful procedure completion. However, significantly higher sedation failure was noted in melatonin alone compared with melatonin and SD combined (RR 1.55 (95% CI 1.02 to 2.33)) for EEG. Additionally, meta-analysis showed lower sleep latency for melatonin compared with SD (mean difference -10.21 (95% CI -11.53 to -8.89) for EEG. No major adverse events were reported with melatonin.

CONCLUSION: Although several studies were identified, and no serious safety concerns were noted, the evidence was not of high quality to establish melatonin’s efficacy for non-operating room sedation in children.

PMID:33785532 | DOI:10.1136/archdischild-2020-320592

Evid Based Nurs. 2021 Mar 30:ebnurs-2019-103217. doi: 10.1136/ebnurs-2019-103217. Online ahead of print.

NO ABSTRACT

PMID:33785540 | DOI:10.1136/ebnurs-2019-103217