Nevin Manimala

Environ Manage. 2022 Oct 26. doi: 10.1007/s00267-022-01731-7. Online ahead of print.

ABSTRACT

Chromium (Cr) is a potentially toxic metal occurring in the soil as a result of natural and anthropogenic activities and is mainly found in Cr³⁺ and Cr⁶⁺. The hexavalent chromium has toxic effects on plants, animals, humans and microorganisms depending on exposure level, duration and doses. Biochar is a stable carbon-based material that has been widely documented to immobilize metals in contaminated soils and for soil remediation effectively. The present 90 days incubation study was conducted to investigate the potential use of rice stubble and sawdust-derived modified biochars on Cr⁶⁺ remediation and their effects on nutrient availability. Among the treatments, modified rice stubble biochar (RSB-M) contained the highest surface area, pore volume and CEC. The unmodified and modified biochars significantly increased soil pH, EC, CEC, and N, K availability ((p < 0.001)). Statistical analysis showed that modified rice stubble (RSB-M) and sawdust biochars (SDB-M) significantly reduced the Cr⁶⁺ with incubation days compared to unmodified biochars, possibly due to the greater porous structure and various functional groups. The submerged incubation condition also greatly impacted Cr⁶⁺ reduction since a gradual decrease (up to ~70 mg kg-1 of Cr⁶⁺) was observed in control treatments. Therefore, applying modified biochars is imperative to alleviate Cr⁶⁺ polluted soils and improve soil fertility.

PMID:36289071 | DOI:10.1007/s00267-022-01731-7

Pain Physician. 2022 Oct;25(7):E1121-E1128.

ABSTRACT

BACKGROUND: Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro-destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia (SN). However, the long-term effectiveness and safety of this technique in SN has not been reported yet.

OBJECTIVES: To investigate the outcomes of PRF on supraorbital neuralgia (SN) in multi-centers and a long-term perspective.

STUDY DESIGN: Retrospective case series.

METHODS: Patients who underwent PRF for SN at 4 hospitals in Beijing between Jan 2007 and Jan 2021 were identified and reviewed for inclusion. Their demographic data and baseline conditions were statistically described, and their conditions of pain control were analyzed using Kaplan-Meier survival analyses. A survival curve was plotted, the cumulative proportion of pain-free at specific time points was determined, and the median pain-free time was estimated. Complications related to PRF treatment were summarized. The risk factors for initial pain control and pain-free survival were analyzed using logistic regression and Cox regression.

RESULTS: A total of 116 patients were included; 91 (78.4%) patients got initial pain control with just one attempt of PRF. The maximum length of follow-up was 127 months, with a median of 18 months. During follow-up, 29 (31.9%) patients suffered from pain recurrence, and 11 (12.1%) were lost. The cumulative pain-free survival at 6 months, 1 year, 2 years, 3 years, 5 years, 8 years, and 10 years were estimated as 70%, 64%, 59%, 55%, 44%, 37%, and 37%, respectively. The median pain-free time was 52 months. No severe complications were observed or reported. Duration of disease could significantly influence initial pain control, while no risk factors for pain-free survival were recognized.

LIMITATIONS: A retrospective study setting without a control group.

CONCLUSION: The performance of PRF for the treatment of SN was confirmed to be favorable in a multicentric, relatively large scale, and long-term perspective.

PMID:36288599

Pain Physician. 2022 Oct;25(7):E1087-E1094.

ABSTRACT

BACKGROUND: Percutaneous cervical nucleoplasty (PCN) is a minimally invasive technique used for the treatment of cervical disc herniation. However, if the lesion is located at the neural foramen, complete access and effective neural decompression are often challenging because of the special anatomical condition of the uncovertebral joint, osteophyte, and facet joint of the cervical foraminal space.

OBJECTIVES: To investigate the effect of PCN on radiculopathy caused by foraminal cervical disc herniation (FCDH).

STUDY DESIGN: Retrospective case series.

SETTING: Single-center tertiary hospital.

METHODS: This study included 44 patients with radiculopathy caused by FCDH who were treated with PCN. Visual analog scale (VAS) scores, preoperative, 1 week, and 3 months postoperatively, and at the last follow-up, as well as the Macnab criteria, were used to evaluate clinical outcomes. A paired t-test was used to compare the preoperative and follow-up VAS scores. The percentage of patients with VAS scores <= 3 at each follow-up time point was also investigated. Statistical significance was set at P < 0.05.

RESULTS: Twenty-seven men (62.4%) and 17 women (38.6%) were enrolled in this study. The mean age was 54.5 years (range 31-81). The average follow-up period after the operation was 15.4 months (range 3.7-30.8). The mean preoperative VAS was 7.50 ± 1.21. The VAS scores at 1 week, 3 months, and the last follow-up were 4.36 ± 2.46, 3.20 ± 2.58, and 2.91 ± 2.74, respectively, showing a significant improvement in pain compared to before the operation (P < 0.001 for all). The number of patients (percentage) with a VAS score of <= 3 was 20 (45.5%), 28 (63.6%), and 31 (70.5%) of 44 patients at 1 week, 3 months, and the last follow-up, respectively. The number of patients (percentage) with excellent, good, fair, or poor satisfaction according to the Macnab criteria was 17 (38.6%), 9 (20.5%), 8 (18.2%), and 10 (22.7%) of 44, respectively. No patients experienced postoperative complications.

LIMITATIONS: This study was retrospective and included a small number of patients from a single center.

CONCLUSIONS: Although PCN for radiculopathy caused by FCDH is thought to have limitations because of the surrounding bony structure, the clinical outcome seemed favorable. If PCN is not contraindicated, it may be a viable treatment option for CR due to FCDH.

PMID:36288595

Pain Physician. 2022 Oct;25(7):E1081-E1085.

ABSTRACT

BACKGROUND: Lumbar epidural steroid injection (LESI) is an effective treatment for low back pain. However, it may result in increased blood glucose levels, decreased plasma cortisol concentrations, and suppression of the adrenocorticotropic hormone axis.

OBJECTIVE: We investigated the effects of 4 mg and 8 mg of dexamethasone as an LESI on back pain and the resulting changes in serum cortisol and glucose levels.

STUDY DESIGN: Prospective study.

SETTING: Department of Anesthesiology and Pain Medicine, Neurosurgery at Daegu Wooridul Spine Hospital.

METHODS: Sixty-three patients were randomized into 2 LESI groups: one received 4 mg of dexamethasone (n = 25) and the other received 8 mg of dexamethasone (n = 28). Visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) were determined. In addition, serum cortisol and glucose concentrations were measured before treatment, at the second LESI (one month follow-up), and at 2 months. All patients received LESI.

RESULTS: Blood glucose and serum cortisol concentrations were not significantly different within a group and between groups. There was no difference in serum cortisol and glucose levels, VAS, and ODI between the first LESI and second LESI in both groups. The VAS and ODI were reduced in both groups and the difference between groups was not statistically significant.

LIMITATIONS: The dexamethasone dosage was not variable; hence, we could not use larger doses of dexamethasone. Secondly, the blood draw interval was longer in this study than in previous studies.

CONCLUSION: After the first lumbar epidural injection of either 4 mg or 8 mg of dexamethasone, there was a reduction in pain in both groups. There was no significant difference in serum cortisol and glucose levels before treatment and during follow-up. Therefore, 4 mg or 8 mg of dexamethasone can be considered a treatment for patients who have low back pain.

PMID:36288594

Pain Physician. 2022 Oct;25(7):E1039-E1045.

ABSTRACT

BACKGROUND: Recurrent LDH (rLDH) is one of the most common causes of unsatisfactory outcomes after discectomy, which usually needs secondary surgery and leads to physical and psychological suffering for patients and substantial costs for society.

OBJECTIVES: This study was conducted to analyze the risk factors of early rLDH (<= 6 months) and to reduce the incidence of early rLDH.

STUDY DESIGN: A clinical retrospective study.

METHODS: A total of 1,228 patients received percutaneous endoscopic lumbar discectomy surgery from January 2013 through December 2016; there was a minimum 5-year follow-up. Seventy-seven of them (6.27%) developed recurrences and were included in this study. According to the differences in recurrent time, patients were divided into 2 groups (<= 6 months and > 6 months). Clinical and radiological parameters were retrospectively collected through chart review and preoperative imaging. All related risk factors were collected and analyzed relative to the time of recurrent herniation.

RESULTS: Patients with rLDH at <= 6 months and > 6 months were 49 and 28, respectively. Recurrence most often occurred within 6 months postoperatively, which was 63.6% of the total patients with rLDH. Of those risk factors, Modic changes, disc height index (DHI), and facet orientation (FO) showed significant statistical differences P = 0.003, P = 0.036, and P = 0.007, respectively). A logistic regression analysis was performed and showed there was an independent significant relationship between Modic changes (P = 0.042) and FO (P = 0.005) and early rLDH.

LIMITATIONS: First, this was a retrospective nonrandomized study, and the number of patients with rLDH included in this study was relatively small. Second, limited risk factors were assessed in this study, and some relevant risk factors that were identified as significant independent predictors in other studies were not included in this study, such as canal diameter, annular defect size, migrated disc, and foraminoplasty. Third, this study compared the clinical and radiological parameters of patients with rLDH at different times, and one case-control study is needed for further study, especially in terms of standardized sampling and data classification.

CONCLUSION: This study demonstrated that the recurrence rate of LDH at 5-year follow-up was 6.27% and there was a significant statistical relationship between FO, DHI, and Modic changes and early rLDH. Surgeons should take FO angles, DHI, and Modic change into consideration before surgery to achieve a satisfactory postoperative outcome and a relatively lower early recurrence rate. More patients and further investigation should be taken to assess the risk factors for early rLDH.

PMID:36288589

Pain Physician. 2022 Oct;25(7):E1009-E1019.

ABSTRACT

BACKGROUND: Postoperative pain after colorectal cancer surgery has a significant impact on postoperative physical and mental health. Vitamin D deficiency has been correlated with both acute pain states, including postoperative and post-traumatic pain, and several chronic pain diseases. The effects of hypovitaminosis D on preoperative pain threshold and perioperative opioid use in colorectal cancer surgery still need to be studied.

OBJECTIVES: To find the relationship between hypovitaminosis D on pain threshold, perioperative opioid use, and postoperative complications in colorectal cancer surgery.

STUDY DESIGN: A total of 112 patients, who were enrolled in this prospective, observational trial, were divided into 2 groups based on their preoperative serum 25-hydroxyvitamin D (25 [OH] D3) levels: (1) group D: vitamin D-deficient group (< 20 ng/mL); and (2) group S: vitamin D-sufficient group (>= 20 ng/mL).

METHODS: Primary outcomes were pain threshold indexes, perioperative dosages of opioid use, and postoperative pain. Secondary outcomes were other postoperative complications.

RESULTS: Preoperative serum level of vitamin D was 14.94 ± 3.10 ng/mL in group D and 24.20 ± 4.80 ng/mL in group S. Significant differences were showed in the 3 indexes of pain threshold and analgesic consumption between the 2 groups (P < 0.05). A low 25 (OH) D3 level was associated with a higher opioid dose of sufentanil. There was an association between 25 (OH) D3 and pain enduring threshold (PET), beta coefficient beta = 0.532, 95% confidential interval (0.440, 0.623), P < 0.001. The history of diabetes mellitus (DM) and vitamin C and vitamin D levels may be risk factors of surgical site infections (SSI), and the binary logistics regression model is statistically significant, chi-squared = 35.028, P < 0.001.

LIMITATIONS: There is room for further expansion in the sample size. Our study lacked objective indicators to measure pain threshold. Intestinal recovery time and total hospital stay were not included in the final analysis. In the follow-up study, the vitamin D supplementation group should be set and the specific site of colorectal cancer surgery also needs to be divided more carefully.

CONCLUSIONS: On the basis of the study results, hypovitaminosis D is associated with increased perioperative opioid consumption in colorectal cancer surgery. Sensory perception and pain threshold of patients with insufficient 25 (OH) D3 concentration were more sensitive, and PET was lower. History of DM, vitamin D, and vitamin C may be factors related with SSI. Future studies are needed to investigate their relationship further and discover if postoperative pain and pain threshold can benefit from vitamin D supplementation in these patients.

PMID:36288586

Pain Physician. 2022 Oct;25(7):E999-E1008.

ABSTRACT

BACKGROUND: Laparoscopic cholecystectomy is the most common surgical procedure performed in the Western world. While it is performed with minimally invasive procedures, patients often complain of moderate to severe postoperative pain, and the role of the anesthesiologist for its effective management remains crucial. Modern anesthesiology practices have embraced trunk blocks which can contribute to perioperative, multimodal analgesia. There is emerging literature about the favorable effect of erector spinae plane block in the reduction of pain after laparoscopic cholecystectomy.

OBJECTIVE: The aim of this study was to explore the efficacy of preoperative bilateral erector spinae plane block when dexmedetomidine is added in the local anesthetic mixture in patients undergoing elective laparoscopic cholecystectomy.

STUDY DESIGN: This study is a double-blind, randomized, controlled, prospective study.

SETTING: Georgios Papanikolaou General Hospital of Thessaloniki, Greece.

METHODS: After Local Ethics Committee approval (No: 1146/7.10.2019, October 2019) and in accordance with the principles outlined in the Declaration of Helsinki, the study was submitted to clinicaltrials.gov with reference number: NCT04587973. Sixty patients were randomized into 3 equal groups. Erector spinae plane block was performed in Group C with normal saline (N/S) 0.9%, in Group DR with ropivacaine 0.375% and dexmedetomidine 1 mcg/kg, and in Group R with ropivacaine 0.375%. The perioperative opioid consumption, pain intensity, time of first mobilization, hospitalization days, and satisfaction score of patients were recorded. Statistical analysis was performed with ANOVA, Kruskal-Wallis and Spearman test, as appropriate.

RESULTS: The perioperative opioid consumption was significantly lower in Groups R and DR as compared to Group C (P < 0.001). The median numerical rating scale (NRS) scores of patients at all time points were statistically different between Groups C and DR, as well as between groups C and R. Satisfaction score was significantly higher in Group DR as compared to Group C (P < 0.001), and mobilization time was significantly shorter in group DR in comparison to Group C as well as in Group R as compared to Group C (P = 0.015 and P = 0.035, respectively). Intraoperative remifentanil consumption was lower in Group DR in comparison to Group R (P < 0.001). There was no difference in postoperative nausea and vomiting and duration of hospital stay of patients.

LIMITATIONS: The limitation of the study is the small sample size of the patients recruited, which may be the reason why no statistically significant differences were found in postoperative morphine consumption and postoperative NRS scores between Groups R and DR and in postoperative nausea and vomiting among the 3 groups.

CONCLUSION: Erector spinae plane block performed either with ropivacaine or with a combination of ropivacaine and dexmedetomidine is a novel and safe method, which was found to be more effective compared to standard analgesia protocols in patients undergoing laparoscopic cholecystectomy and thus, it can improve the quality of perioperative analgesia.

PMID:36288585

Pain Physician. 2022 Oct;25(7):E987-E998.

ABSTRACT

BACKGROUND: Ultrasound-guided Quadratus Lumborum block (QLB) is a regional analgesia approach that has been reported to provide effective post-operative pain relief for both abdominal and retroperitoneal surgery. Bupivacaine is the most often used and well documented local anesthetic medication in children. Dexamethasone is a systemic glucocorticoid that is often used to minimize postoperative nausea, vomiting, and pain to improve recovery quality after surgery.

OBJECTIVES: To evaluate postoperative analgesia of QLB in pediatric patients undergoing renal surgeries by the addition of dexamethasone to bupivacaine compared to intravenous administration.

STUDY DESIGN: A prospective, randomized, controlled clinical trial.

SETTING: Pediatric surgery unit in a university hospital.

METHODS: One hundred and five patients (6-12 years old) scheduled for renal surgeries were randomly allocated into 3 groups, with 35 patients in each group. Randomization was based on computer-generated codes. The groups were DEX1 (QLB with IV dexamethasone group), DEX2 (QLB dexamethasone group), and QLB CONTROL (QLB alone). The 1st time for rescue analgesia request, total morphine consumption, Pediatric Objective Pain Scale (POPS), and parents’ satisfaction score were measured in 24 hours follow-up to evaluate postoperative pain control.

RESULTS: The time to 1st rescue analgesics request (hours), total morphine consumption (mg), and the parents’ satisfaction scores were much better in groups DEX1 and DEX2 as compared to group CONTROL with statistical significance. However, group DEX2 was better than DEX1 in the previous outcomes but without statistical significance. In respect, the pediatric objective pain scale was much lower with a significant difference in groups DEX1and DEX2 in comparison with group CONTROL up to 18 hours postoperatively.

LIMITATIONS: Difficult to assess the block as all children were sedated, plus this was a unilateral surgical procedure with limited surgical incision, so the effect of QLB needed to be studied when there is a bilateral surgical procedure.

CONCLUSIONS: Dexamethasone may be more effective when added to bupivacaine than when given systemically in analgesic effects without any impact on the other secondary pain-related outcomes. Dexamethasone as an adjuvant to bupivacaine has a marked hand on prolongation of the postoperative duration of analgesia, less request for rescue analgesia, and fewer side effects as compared to bupivacaine if used as a sole agent in QLB.

PMID:36288584

Pain Physician. 2022 Oct;25(7):E977-E985.

ABSTRACT

BACKGROUND: Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated.

OBJECTIVES: This study aimed to determine the efficiency and safety of one bolus injection thoracic paravertebral block (PVB) and erector spinae plane block (ESB) in individuals with acute thoracic herpes zoster (HZ) in preventing PHN.

STUDY DESIGN: A prospective randomized controlled trial.

SETTING: Tanta University Hospitals, Tanta, Egypt.

METHODS: Ninety participants over the age of 50 years with chest wall herpetic eruption, lasting shorter than a week along with moderate to severe pain, who got adequate antiviral medication. Patients were chosen at random and classified into 3 equal groups. Group C (control group) did not receive any intervention. Group ESB received US-guided ESB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume). Group PVB received US-guided PVB with 25 mg bupivacaine 0.5%, plus 8 mg dexamethasone (10 mL volume).

RESULTS: Numerical rating scale (NRS) showed insignificant differences at baseline. NRS for pain at 1, 3, 4, 12, and 24 weeks was significantly reduced in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. Doses of pregabalin and acetaminophen were comparable at 1 week among the studied groups. Doses of pregabalin and acetaminophen at 3, 4, 12, and 24 weeks were significantly lesser in group ESB compared to group C and in group PVB than group C and insignificantly different between group ESB and group PVB. After 3 months, the incidence of persistent herpetic pain was not significantly different between the study groups. After 6 months, the incidence of persistent herpetic pain was statistically significantly lower in groups ESB and PVB than in group C (P = 0.037 and 0.015, respectively) without significant difference between group ESB and group PVB.

LIMITATIONS: Small sample size, single center study.

CONCLUSIONS: Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).

PMID:36288583

Emerg Infect Dis. 2022 Oct 26;28(12). doi: 10.3201/eid2812.220215. Online ahead of print.

ABSTRACT

SARS-CoV-2 likely emerged from an animal reservoir. However, the frequency of and risk factors for interspecies transmission remain unclear. We conducted a community-based study in Idaho, USA, of pets in households that had >1 confirmed SARS-CoV-2 infections in humans. Among 119 dogs and 57 cats, clinical signs consistent with SARS-CoV-2 were reported for 20 dogs (21%) and 19 cats (39%). Of 81 dogs and 32 cats sampled, 40% of dogs and 43% of cats were seropositive, and 5% of dogs and 8% of cats were PCR positive. This discordance might be caused by delays in sampling. Respondents commonly reported close human‒animal contact and willingness to take measures to prevent transmission to their pets. Reported preventive measures showed a slightly protective but nonsignificant trend for both illness and seropositivity in pets. Sharing of beds and bowls had slight harmful effects, reaching statistical significance for sharing bowls and seropositivity.

PMID:36288573 | DOI:10.3201/eid2812.220215