Pediatricians' focus of sight at pain assessment during a neonatal heel puncture / Foco do olhar do pediatra na avaliação da dor neonatal durante uma punção de calcanhar

ABSTRACT Objective: To evaluate the focus of pediatricians' gaze during the heel prick of neonates. Methods: Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians' pain perception: absent/mild (score: 0-5) and moderate/intense (score: 6-10). Results: 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5-8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. Conclusions: At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.

RESUMO Objetivo: Avaliar o foco do olhar do pediatra durante a punção do calcanhar de neonatos. Métodos: Estudo prospectivo no qual pediatras, utilizando óculos de rastreamento visual, avaliaram a dor neonatal antes/depois de uma punção de calcanhar. Os pediatras pontuaram a dor de acordo com a sua percepção por meio de uma escala analógica verbal (0=sem dor; 10=dor máxima). Os desfechos analisados foram o número e o tempo das fixações visuais na face superior, face inferior e mãos, em dois períodos de 10 segundos, antes (PRÉ) e depois da punção (PÓS). Os resultados foram comparados entre os períodos e segundo a percepção da dor do pediatra: ausente/leve (escore: 0-5) e moderada/grave (escore: 6-10). Resultados: Vinte e quatro pediatras (31 anos, 92% sexo feminino) avaliaram 24 neonatos. A mediana do escore atribuído à dor do recém-nascido durante a punção do calcanhar foi 7,0 (intervalo interquartil: 5-8). Comparado ao período PRÉ, no período PÓS, o maior número de pediatras fixou o olhar na face inferior (63 vs. 92%; p=0,036) e o número de fixações visuais foi maior na face inferior (2,0 vs. 5,0; p=0,018). Não houve diferença no número e no tempo das fixações visuais de acordo com a intensidade da dor. Conclusões: À beira do leito, os pediatras mudam seu foco de atenção visual na face do recém-nascido após um procedimento doloroso, focando o olhar principalmente na parte inferior da face.

Comparative clinical trial of intracameral ropivacaine vs. lignocaine in subjects undergoing phacoemulsification under augmented topical anesthesia

Purpose: To compare intracameral Ropivacaine to Lignocaine during phacoemulsification under augmented topical anesthesia, in terms of efficacy and safety. Methods: This prospective, randomized, double-masked clinical trial included subjects planned for phacoemulsification with posterior chamber intraocular lens implantation for visually significant uncomplicated senile cataract, under augmented topical anesthesia. Cases were randomized into two groups, Group A (Ropivacaine 0.1%) or Group B (Lignocaine 1.0%). The pain experienced by the patients during the surgery, mydriasis, post-op inflammation and endothelial cell change at six weeks after the procedure was evaluated. Surgeon's feedback was recorded to evaluate the cooperation of the patient during surgery. Results: A total of 210 subjects were screened and 184 were randomized to have 92 subjects in each group. There was no statistically significant difference seen on comparing Group A and B with respect to Age (P = 0.05), painful surgical steps (P = 0.85), visual analog scale scores (P = 0.65), surgeon's score (P = 0.11), postoperative inflammation (P = 0.90) and average ultrasound time during phacoemulsification (P = 0.10). Subjects in Group A fared better when compared to Group B with respect to endothelial cell loss (P = 0.0008), and augmentation in mydriasis (P < 0.001). Conclusion: Intracameral Ropivacaine and Lignocaine, both are equally effective in providing analgesia during phacoemulsification. However, intracameral Ropivacaine is superior to Lignocaine with regards to corneal endothelial cell safety, and augmenting mydriasis.

Ultrasound guidance versus the blind method for intrauterine catheter insemination: A randomized controlled trial / 대한생식의학회지

OBJECTIVE: The primary objective of this study was to compare clinical pregnancy rates in intrauterine insemination (IUI) treatment cycles with transabdominal ultrasound guidance during intrauterine catheter insemination (US-IUI) versus the “blind method” IUI without ultrasound guidance (BM-IUI). The secondary objective was to compare whether US-IUI had better patient tolerability and whether US-IUI made the insemination procedure easier for the clinician to perform compared to BM-IUI. METHODS: This was a randomized controlled trial done at the Reproductive Medicine Unit of General Hospital Kuala Lumpur, Malaysia. We included women aged between 25 and 40 years who underwent an IUI treatment cycle with follicle-stimulating hormone injections for controlled ovarian stimulation. RESULTS: A total of 130 patients were recruited for our study. The US-IUI group had 70 patients and the BM-IUI group had 60 patients. The clinical pregnancy rate was 10% in both groups (p> 0.995) and there were no significant difference between the groups for patient tolerability assessed by scores on a pain visual analog scale (p= 0.175) or level of difficulty for the clinician (p> 0.995). The multivariate analysis further showed no significant increase in the clinical pregnancy rate (adjusted odds ratio, 1.07; 95% confidence interval, 0.85–1.34; p= 0.558) in the US-IUI group compared to the BM-IUI group even after adjusting for potential covariates. CONCLUSION: The conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment. The use of ultrasound during the insemination procedure increased the need for trained personnel to perform ultrasonography and increased the cost, but added no extra benefits for patients or clinicians.

Evaluation of Efficacy of Ultrasonography in the Assessment of Transcutaneous Electrical Nerve Stimulation in Subjects with Myositis and Myofascial Pain

BACKGROUND: The study aimed to determine if ultrasonography of masseter can be used to evaluate the outcome of transcutaneous electrical nerve stimulation (TENS) in subjects with temporomandibular disorders (TMDs) such as myositis and myofascial pain. METHODS: Fifteen TMD subjects with myofascial pain/myositis who satisfied the RDC/McNeil criteria were included in the study. All the subjects were administered TENS therapy for a period of 6 days (30 minutes per session). The mouth opening (in millimeters) and severity of pain (visual analogue scale score) and ultrasonographic thickness of the masseter (in millimeters) in the region of trigger/tender areas was assessed in all the subjects both prior and post TENS therapy. A comparison of the pre-treatment and post-treatment values of the VAS score, mouth opening and masseter thickness was done with the help of a t-test. RESULTS: There was a significant reduction in the thickness of masseter muscle (P = 0.028) and VAS scores (P < 0.001) post TENS therapy. There was also a significant improvement in the mouth opening (P = 0.011) post TENS therapy. CONCLUSIONS: In the present study, ultrasonography was found to be an effective measuring tool in the assessment of TENS therapy in subjects with myositis and myofascial pain.

Satisfação e qualidade de vida de paciente com prótese unitária implantossuportada: caso clínico / Satisfaction and quality of life in a patient with implant-supported single-tooth crown: a case report

Questionários que quantificam dados subjetivos podem ser úteis para registrar a opinião dos pacientes. O objetivo deste estudo foi relatar a aplicação dos questionários de satisfação e de qualidade de vida em uma paciente tratada por meio de prótese unitária implantossuportada. Para isto, foi incluída uma paciente que teve implante dentário osseointegrável instalado em área estética. A satisfação estética e funcional focando a mastigação, fonação e autoestima foi avaliada por meio de uma Escala Visual Analógica (escala de zero a dez) e a Qualidade de Vida o foi por meio do questionário OHIP-14. O valor de satisfação estética obtido foi de 9,7, enquanto no quesito fonação, o valor encontrado foi de 9,9 resultando em média de 9,8, mostrando efetividade do tratamento e uma alta satisfação da paciente. O valor total obtido pela avaliação do OHIP-14 foi de 0,45, o que sugere boa qualidade de vida. Dentro dos limites do presente caso clínico, sugere-se que os questionários empregados sejam de fácil preenchimento, eficientes em quantificar as sensações da paciente e que a reabilitação implantossuportada levou à melhora na satisfação e qualidade de vida...

Questionnaires that quantify subjective data may be useful to register the opinion of the patients. The objective of this study was to test the use of questionnaires concerning the satisfaction and quality of live in a patient treated by means of a single-tooth implantsupported crown. Thus, a patient was included that had an osseointegrated implant installed in esthetic area. The satisfaction concerning esthetics and function focusing on mastication, speech and self-esteem was evaluated using a visual analog scale (ranging from zero to ten), and Quality of Live by means of the OHIP-14 questionnaire. The esthetic satisfaction value obtained was 9.7, while in the item speech, the value was 9.9 (range from 0 to 10), resulting in an average of 9.8, showing effectiveness in the treatment and high patient satisfaction. The total value obtained with OHIP-14 was 0.45, suggesting good quality of live. Within the limits of this case report, it may be suggested that the questionnaires are easy to fill, efficient to quantify the feelings of the patient, and that the implant-supported rehabilitation led to improved satisfaction and quality of life...

Effect of Spinal Decompression Therapy Compared with Intermittent Mechanical Traction in Lumbosacral Disc Herniation

OBJECTIVE: To compare the effects of intermittent mechanical traction with spinal decompression therapy (SDT), using the newly introduced device DRX 3000(R), in patients suffering from low back pain associated with lumbosacral disc herniation documented on MRI. METHOD: Thirty-five patients with low back pain with or without lower extremity radiating pain were prospectively enrolled in this study. They were all diagnosed with lumbosacral disc herniation according to physical examinations and MRI. Patients over age 60 years or those with previous spinal surgery, spondylolisthesis, severe osteoporosis, rheumatic diseases, hypertension, and other serious medical problems were excluded. Patients were randomly assigned to intermittent mechanical traction group (15 patients) or SDT group (20 patients) and compared visual analog pain scale (VAS) pre- and post-treatment. RESULTS: There was a significant improvement in VAS in SDT group compared to intermittent mechanical traction group. The mean reduction in VAS for intermittent mechanical traction group equaled 1.93+/-0.83 (from 6.4+/-1.28 to 4.5+/-1.22) while the mean reduction in VAS in SDT group equaled 4.35+/-2.21 (from 6.9+/-1.86 to 2.6+/-1.43) (p=0.0006). CONCLUSION: Spinal decompression therapy can be used as an effective treatment for discogenic low back pain without serious complications.

Estudio comparativo entre bupivacaina + fentanyl vs. Bupivacaina sola por vía peridural para el control del dolor obstétrico / A comparative study between bupivacaine + fentanyl vs. Bupivacine alone for a peridural to control obstetric pain

Objetivo: Evaluar la calidad y duración de la analgesia obstétrica que se obtiene al utilizar bupivacaína + fentanyl, en comparación a cuando solo se utiliza bupivacaína.Método: Se realizó un estudio comparativo, prospectivo, longitudinal, evaluándose 120 pacientes, las cuales fueron divididas en 2 grupos: Grupo A: Bupivacaína 20mg + Fentanyl 50ucg y Grupo B: Bupivacaína sola 20mg, vía peridural administrados en embarazadas de 38 a 40 semanas de gestación. Los datos fueron recolectados mediante un formato, en el cual se incluyó valoración del dolor (EVA), Frecuencia cardiaca (FC),Tensión Arterial Sistólica (TAS), Tensión Arterial Diastólica (TAD), Presión Arterial Media (PAM), Frecuencia Cardiaca Fetal (FCF).Resultados: En el presente estudio la edad promedio fue de 25años (28%), la mayoría primigestas (54.5%), con una dilatación promedio de 6 cm. (37.5%), valoradas preanestésicamente con ASA 1 (95%), y ASA 2 (5%), para ambos grupos; se valoró la EVA (escala visual análoga de dolor) siendo de 10 (valor máximo) al inicio del estudio y a los 45 minutos 0 para el grupo A y 2 para el grupo B.Conclusiones: La administración de narcóticos por vía peridural, con fines de analgesia, es una técnica que ha dado excelentes resultados, especialmente en el ámbito médico, en el campo de la obstetricia, ya que ha demostrado ser una técnica muy efectiva para el control del dolor en el trabajo de parto.

Objectives: To evaluate the quality and duration of the obstetric analgesic that is obtained by using bupivacaine + fetanyl in comparison to just using bupivacaine.Method: A comparative, prospective, longitudinal study was done in with 120 patients were divided in two groups:1.Group A: Bupivacaine 20 mg + Fentanyl 50ucg2.Group B: Bupivacaine 20 mg aloneIn which it was administered by peridural in expecting women in there 38 – 40 week.The data was collected using a format with include evaluating the visual analog pain scale, heart rate, Systolic pressure, Diastolic Pressure, mean arterial blood pressure and fetal heart rate.Results: In this study the average age is 25 years old (28%), the majority were primipara 54.5% with a dilatation of 6 cm (37.5%). When analyzed pre- anesthesia with an ASA 1 (95%) and ASA 2 (5%). For both groups we evaluated the visual analog pain scale being 10 the maximum score at the beginning and after 45 minutes 0 for group A and 2 for group B.