Retraction: The Verbal Numerical Rating Scale and Faces Pain Scale-Revised for Children With Acute Pain: A Comparative Study for Determining the Need for Analgesia.

[This retracts the article DOI: 10.7759/cureus.56854.].

The Verbal Numerical Rating Scale and Faces Pain Scale-Revised for Children With Acute Pain: A Comparative Study for Determining the Need for Analgesia.

Introduction The primary complaint in all age groups of patients, including children, is pain, which drives the patient to the hospital. A good assessment of pain severity is necessary to determine the right therapy for this primary complaint. Pain scales, especially in children, are given little importance in all hospitals in India. We need more data about its effectiveness. As a result, we conducted this study to compare the effectiveness of two pain scales in an admitted patient. Methods An observational study was conducted on pediatric patients aged 8-17 admitted to a tertiary care unit in pediatric wards included in the study. The study team identified the participants with painful and nonpainful conditions by asking patients of the above age group if they had "any pain" or "any hurt." The verbal numerical rating scale (vNRS) was determined by asking, "On a scale of zero to 10, where zero signifies no pain and ten means severe pain." The child was advised to select from among the six faces using the faces pain scale-revised (FPS-R), showing increasing levels of pain intensity (from left to right), with score options 0, 2, 4, 6, 8, and 10 demonstrated below each face. Result We enrolled 140 children, of which 22 of vNRS and 15 of FPS-R were removed from the study as these children did not understand vNRS and FPS-R. The two-tailed t-test revealed that the p-value was 0.9144. By conventional criteria, in the context of statistical analysis, conventional criteria typically refer to commonly accepted thresholds for determining statistical significance. The most common threshold for significance is a p-value of 0.05 or less. In the provided scenario, the two-tailed t-test resulted in a p-value of 0.9144. By conventional criteria (i.e., using the threshold of 0.05), this p-value is considered not significant. This means that there is not enough evidence to reject the null hypothesis, which suggests that there is no significant difference between the two groups being compared (in this case, the efficacy and reliability of the two scales). Therefore, based on conventional criteria, the difference in efficacy and reliability between the two scales is considered not significant, indicating that they are likely to be equally effective and reliable. This difference is considered not significant. Hence, it is suggestive of equal efficacy and reliability on both scales.  Conclusion Pain scales are a practical guide for managing and recognizing pain in children. It needs to be considered in identifying children's pain. They can provide a valuable outcome for measuring pain, which, when practiced regularly, can save time and extra burden on health staff. In the present study, both pain scales (vNRS and FPR-R) have equal efficacy.

Correlation Between Hypothyroidism and Gallstone Disease in Central India.

Introduction The decreased thyroid-stimulating hormone (TSH) levels affect almost every nucleated cell in our body, which directly affects the basal metabolic rate (BMR). It tends to affect multiple organ systems in the human body. In recent times, there have been changes in lifestyle and the consumption of processed foods has increased. Thus, cholelithiasis and hypothyroidism are being encountered frequently, even in rural populations. In recent times, the overt clinical presentation of hypothyroidism is rare due to early diagnosis and treatment of the subclinical hypothyroidism state itself. Aim The aim is to determine the correlation between cholelithiasis and hypothyroidism. Methods This was a cross-sectional study done on the patients presenting to the surgical department at Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India between the duration from December 2020 to December 2022, having gallstone disease or with symptoms suggestive of gall bladder stones. The admitted patients were then evaluated for hypothyroidism by thyroid profile tests, and the results were documented. Using the collected data, factors such as clinical spectrum, correlation between cholelithiasis and hypothyroidism, relation with the demographic data, and body mass index (BMI) were studied. Results A total of 52 gallstone patients were included in the study. A greater number of patients were found to be above the age of 40 years (82.7%), with female preponderance (61.5%). More patients with cholelithiasis were from the group with having BMI more than normal (57.6%). More patients having both cholelithiasis and hypothyroidism were also from the group with having BMI more than normal. Most symptomatic patients complained of pain in the right hypochondriac region (88.5%). Of these 52 patients, nine (17.3%) were found to have hypothyroidism (seven were subclinical, two patients had overt clinical symptoms and signs) and the remaining 43 patients were euthyroid. Conclusions Our study supports that there is a correlation between cholelithiasis and hypothyroidism. Out of all the 52 patients, nine had hypothyroidism, seven were subclinical, and two had overt symptoms. Thus, we conclude that there is a correlation between cholelithiasis and hypothyroidism.

Evaluation of Different Approaches for Pain Management in Postoperative General Surgery Patients: A Comprehensive Review.

The treatment of postoperative pain is a crucial component of postoperative patient care. To reduce discomfort, encourage early mobilisation, reduce complications, and improve overall recovery, effective pain management is crucial. To maximise pain relief and reduce the need for opioids and their accompanying adverse effects, a multimodal analgesic strategy, combining several drugs and procedures, is frequently used. Opioids continue to be a crucial part of postoperative pain treatment for moderate to severe pain; however, due to potential side effects and dependency concerns, their usage should be carefully controlled. Non-opioid analgesics, such as non-steroidal anti-inflammatory medications (NSAIDs) and paracetamol, are widely used as a component of a multimodal regimen and play an important role in pain management. Postoperative pain management ultimately aims to deliver efficient analgesia, enhance patient comfort, and foster a speedy recovery while minimising the dangers and adverse effects connected with pain medicines. To create a thorough and unique pain management strategy for each patient, close coordination between the surgical team, anesthesiologists, and pain management specialists is essential.

Immunological Nuances and Complications of Pediatric Organ Transplant: A Narrative Review.

Organ transplantation is considered an exaggerated immune state in which the body reacts in an elaborate cascade of reactions against the lifesaving graft transplanted. Unrepairable organ damage is the main indication for a pediatric patient to undergo a transplant. The host and the donor must fulfill the criteria for a successful transplant to have as few side effects as possible. There has been much-needed research in the domain of surgery of organ transplantation, thereby extending into the pediatric age group. This article elaborates on the post-transplant management, the immuno-biochemistry aspect, and its post-surgery treatment. The post-surgery period requires great emphasis as morbidity and mortality are highest. There is much to understand about managing transplant patients to avoid complications such as infections, hypertension, or side effects of immunosuppressive drugs. The treating clinician faces the challenges of managing the dose and frequency of immuno-suppressive medicines to prevent complications in the patients. If the dose is inadequate, there are chances of graft rejection. If the immuno-suppression is prolonged, there may be chances of infections in the patient. This article aims to summarize the mechanism of graft rejection and put forth the need for further research about creating a universal protocol for managing a patient's immune system post-transplant. The authors hope this protocol will help the clinician better understand the patient's current state and help in appropriately using immuno-suppressive drugs. It calls upon the need for a reliable and easily repeatable battery of investigations that will help solve this dilemma.

Unveiling the Health Ramifications of Lead Poisoning: A Narrative Review.

The presence of lead (Pb) in children's toys and paint is a significant global public health concern. Numerous studies conducted worldwide have measured lead concentrations in these products. This article aims to examine the research findings and shed light on the implications for human health, including legal consequences and public awareness. Despite regulations on lead levels in polyvinyl chloride (PVC) paints and children's toys in many countries, several reviewed documents indicate that these products often contain substantial amounts of lead, frequently surpassing legal limits. Particularly high levels of lead in paints have been found in countries such as China, Thailand, and Brazil. It is crucial to raise awareness among parents by educating them about this issue and empowering them to take proactive measures to protect their children from lead poisoning associated with toys and colored paints. There is also global support for eliminating lead pigments and regulating the amount of lead in PVC toys.

Enhanced Recovery After Surgery: Exploring the Advances and Strategies.

Enhanced recovery after surgery (ERAS) has emerged as a paradigm-shifting approach in perioperative care, aimed at optimizing patient outcomes, accelerating recovery, and minimizing hospital stays. This review delves into the latest advances and strategies within the field of ERAS, encompassing a comprehensive examination of preoperative, intraoperative, and postoperative interventions. By analyzing an array of clinical studies, meta-analyses, and implementation experiences, this review highlights the multifaceted elements contributing to the success of ERAS programs. Key components such as preoperative patient education, minimally invasive surgical techniques, tailored anesthesia protocols, judicious fluid management, optimized pain control, early ambulation, and structured nutritional support are thoroughly explored. Furthermore, the review delves into the intricacies of ERAS implementation across diverse surgical specialties, emphasizing the significance of multidisciplinary collaboration, protocol customization, and sustained quality improvement initiatives. The analysis not only showcases the tangible benefits of ERAS, including reduced complication rates, shortened hospital stays, and enhanced patient satisfaction, but also underscores the challenges and barriers that medical professionals encounter during program adoption. By synthesizing the current state of ERAS research and practice, this review provides clinicians, administrators, and researchers with valuable insights into the evolving landscape of perioperative care, fostering a deeper understanding of ERAS as a holistic approach that transcends traditional surgical pathways.

Effects of Prenatal Stress on Behavior, Cognition, and Psychopathology: A Comprehensive Review.

Prenatal stress is increasingly recognized as a significant factor impacting an individual's life from the beginning. This comprehensive review explores the intricate relationship between prenatal stress and its effects on behaviour, cognition, and psychopathology. Key findings reveal that prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. These effects' mechanisms involve epigenetic modifications, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, neurodevelopmental alterations, inflammatory processes, and changes in brain structure and function. Moreover, moderating factors such as maternal stress levels, maternal mental health, socioeconomic status, social support, and early-life adversity can significantly influence the impact of prenatal stress. The review also discusses intervention and prevention strategies, emphasizing the importance of prenatal stress reduction programs, maternal mental health support, nutritional interventions, and targeted early interventions for at-risk populations. These findings have substantial implications for public health and clinical practice, highlighting the need for a holistic approach to prenatal care that prioritizes maternal well-being and mitigates the lasting effects of prenatal stress. Addressing this critical issue promises healthier generations and stronger communities in the future.

Stevens-Johnson Syndrome Induced by Herbal Kadha.

Stevens-Johnson syndrome (SJS) is a dreaded hypersensitivity reaction and a rare immune disorder. We present a Stevens-Johnson syndrome induced by herbal kadha, which may be the first case. A ten-year-old boy presented with massive sloughing, redness, oedematous skin, an oral ulcer, and an inability to feed or drink for two days. The present symptoms started after 12 hours of consuming herbal Kadha, given by a private practitioner in clinics where he was treated for fever. After not responding to earlier treatment, the patient was referred to the present Institute. The patient had a history of seizure disorder and had been on tablet phenytoin for seven months with no history of adverse reactions to it. He was treated in the intensive care unit. Fortunately, he responded to treatment and recovered fully. He received treatment in the form of immunoglobulin and steroids. Phenytoin and herbal kadha were withdrawn, and Clobazam was continued. Natural herbal medicines can develop severe adverse effects. Physicians should remain aware that drug interactions can likely be seen with drugs with a narrow therapeutic index combined with herbal preparations. Clinicians should do more research on the interaction between herbal and prescription medications.

Management of Uremic Xerosis and Chronic Kidney Disease (CKD)-Associated Pruritus (CKD-ap) With Topical Preparations: A Systematic Review and Implications in the Indian Context.

Uremic xerosis and chronic kidney disease (CKD)-associated pruritus (CKD-ap) are the most commonly occurring dermatological problems faced by most of the CKD patients on hemodialysis which are not only annoying and draining to the patients but also have an intense effect on patients' quality of life. The PubMed, Scopus, Google Scholar, and Web of Science databases were searched for the literature with the following search terms: uremic xerosis OR CKD-ap OR uremic pruritus AND topical therapy OR topical ointment OR natural oil from the year 2002 -2022, and finally, 22 articles were chosen to write this review. Out of 22 studies, six used pharmacological preparations and remaining 16 studies used natural oils and components. All the articles were experimental studies (Pre/Quazi/RCT/True experimental) focusing on managing itch and xerosis associated with CKD and hemodialysis by topical application. The topical agents tried in various research studies are effective in managing itch and xerosis associated with CKD. They are safe, easy to use, and without allergic reactions. Natural oils like almond, chia seed, clove, glycerin, paraffin, and virgin coconut oil are readily available in home-care settings and can be used as a nurse-led intervention. Topical preparations for uremic xerosis and pruritus are effective, safe, and easy to apply on large body surface areas without systematic side effects. Natural oil-based topical preparations are cost-effective, safe, and easy to use.

A Chondroblastic Osteosarcoma of the Patella: A Case Report.

Osteosarcoma is a form of bone cancer that can originate in any bone throughout the body, although it is most commonly detected in the long bones of the arms and legs. Chondroblastic osteosarcoma, a rare variation of osteosarcoma, is associated with a greater likelihood of recurrence and metastasis. The term "chondroblastic" indicates that certain portions of the tumor have undergone changes, resembling a connective tissue called cartilage. In this report, we present an exceptional case of osteosarcoma affecting the patella. A 54-year-old patient sought consultation at our outpatient clinic, reporting a 10-year history of swelling in the left leg. Magnetic resonance imaging revealed the presence of a large, diverse mass lesion located near the proximal region of the left leg. A Tru-cut biopsy confirmed the presence of chondroblastic osteosarcoma.

A Female Infant with Rectovestibular Fistula and Imperforate Hymen.

In a female neonate with anorectal malformation (ARM), the diagnosis is usually simple. But when there are two openings in the introitus and absent anal opening at the normal site, the scenario poses a diagnostic challenge. Careful and detailed evaluation of anomaly is therefore necessary before planning definitive correction. Imperforate hymen, although is not commonly associated with ARM should always be kept in mind as a differential diagnosis and other vaginal anomalies like Mayer-Rokitansky-Küster-Hauser syndrome should be ruled out before definitive surgical correction.

Role of Helicobacter pylori in Gastric Carcinoma: A Review.

Gastric cancer (GC) is one of the leading causes of cancer-related deaths globally. Gastritis caused by Helicobacter pylori (H. pylori) is a potent cause of gastrointestinal malignancies. The majority of all humans on the planet have H. pylori invasion in their stomachs, yet only a few diseased people develop GC. The human gastrointestinal system contains a broad population of microorganisms in addition to H. pylori. H. pylori heterogeneity has been studied because not all H. pylori diseases result in cancer. Individuals in the adult age group account for the bulk of gastric carcinoma cases. H. pylori has various strains, which is beneficial for its survival in host cell epithelium for a longer duration of time. Along with H. pylori, oral microbes have a major role in the pathogenicity of gastric carcinoma. The complex ecology of oral microbiota helps to defend against infections, preserve homeostasis, and regulate the immune system. In contrast, oral microbiota is involved in various mechanisms like anti-apoptotic activity, suppression of the immune system of the host, and initiation of chronic inflammation. These oral microbes are also responsible for the development of mutations. Interactions between the host immune system and bacteria promote the progression of cancer. For this review, various research articles were studied, and information was collected using databases like PubMed and Google Scholar. This review emphasizes on the role of H. pylori in gastric carcinoma, its pathogenesis, the role of various virulence factors and risk factors related to it, the role of oral microbiota in gastric carcinoma pathogenesis, diagnostic modalities, treatment options, and preventive measures for gastric carcinoma.

Gastric Necrosis: A Rare Complication of Gastric Mucormycosis.

Mucormycosis is an invasive fungal infection. The prevalence is low for this disease, and the most common site of its occurrence in the gastrointestinal system is the stomach. The clinical signs and symptoms of gastric mucormycosis are vague such as pain in the abdomen, nausea, vomiting, haematemesis, etc. In the current study, a 42-year-old male patient came with complaints of pain in the abdomen associated with vomiting and mild-grade fever based on vague clinical presentation and imaging like upper gastrointestinal endoscopy and computer tomography angiography of the abdomen. Our preoperative diagnosis was gastrocolic fistula secondary to acute on chronic pancreatitis, which was managed by emergency exploratory laparotomy, resection, and anastomosis. Histopathological examination was successful in confirming the diagnosis of mucormycosis. Through this case report, we intend to draw surgeons' and physicians' attention to gastrointestinal mucormycosis, an emerging cause of gastric necrosis in young patients in the post-coronavirus disease era, and that physicians need to be more aware of the consequent high mortality and morbidity. Early diagnosis followed by aggressive debridement, antifungal therapy, and managing the underlying disease is the most efficient way to reduce mortality associated with the disease.

Intra-Uterine Perforation Presented as a Giant Cystic Abdominal Mass in a Neonate: A Giant Meconium Pseudocyst.

A meconium pseudocyst is formed following meconium peritonitis. At present, antenatal diagnosis and planned management of meconium pseudocyst have reduced the mortality rate significantly. We presented a case of a neonate with abdominal distension and non-passage of meconium who experienced respiratory distress and was taken for exploratory laparotomy at a tertiary care center due to suspected bowel perforation. The neonate was diagnosed with a meconium pseudocyst intraoperatively as maternal ultrasound and ultrasound of the abdomen of the neonate after birth failed to make a definitive diagnosis; even an X-ray abdomen did not reveal pathognomonic egg-shell calcification. An interesting aspect of this case is the mother's complex obstetric history, which compelled us to conjecture whether it was possible to predict the chances of meconium peritonitis and take steps to prevent it. It must be noted that, despite rigorous research, the researchers could not find reliable literature co-relating the obstetric history of the mother with the formation of a meconium pseudocyst in the neonate.

A Comparative Study Between Conventional Sutures, Staples, and Adhesive Glue for Clean Elective Surgical Skin Closure.

As long as medicine has subsisted, wound closure has existed. When assessing a surgical wound, physicians are more than ever confronted with various sutures and other closure materials. The surgeon must choose the most appropriate material for that specific closure because not one substance is perfect in all circumstances. The history of suturing wounds is intertwined with the history of surgery. Wound suturing is a critical component of wound therapy, including suturing materials and techniques. Suturing has been practiced for thousands of years. Although suture materials and techniques have changed, the goals like closing dead space, supporting and strengthening wounds until healing increases their tensile strength, approximating skin edges for an aesthetically pleasing and functional result, and reducing the risk of bleeding and infection remain the same. Traditional skin closure with sutures requires time and effort, creates an unsightly scar, and requires infection removal. In this modern era, patients find it appealing when the operated location has a decent cosmetic appearance. The quicker, more comfortable, and most aesthetically pleasing method of skin closure is what surgeons are searching for. Assessing whether newer methods are superior to sutures and staples is necessary. Better cosmesis, flexibility, water resistance, painless sealed skin closure, and ease of application are all advantages of 2-octyl cyanoacrylate. This article aims to provide an overview of the critical characteristics of traditional sutures, common suture materials, sticky glue, and staples, as well as additional closure materials.

Adenocarcinoma of the Stomach With Situs Inversus Totalis: A Rare Case.

Situs inversus is a scarce congenital anomaly. Situs inversus totalis (SIT) is a mirroring of the normal. Thoracic and abdominal viscera transposition is a characteristic feature of situs inversus. It is considered to be a premalignant condition. This uncommon genetic disorder is often identified incidentally during thoracic and abdominal imaging. The coexistence of SIT and gastric cancer is rare. Because this anomaly is known to have associated anatomical and vascular anomalies, due care is required to identify it preoperatively and during the surgical procedure. At centers with prior experience, consistent with oncological practices, open surgeries, laparoscopic surgeries, and robotic surgeries can be done. We present a patient with a stomach adenocarcinoma with SIT who underwent distal gastrectomy with gastrojejunostomy along with resection and anastomosis of the transverse colon and capecitabin-oxaliplatin chemotherapy. The postoperative course was favorable. To our knowledge, only 13 cases of diffuse-type gastric cancer in a patient with SIT have been reported in the English-language literature.

Endometrial Cyst Presenting as a Vague Abdominal Lump in a Postmenopausal Woman.

A postmenopausal woman presented with a predominantly right-sided abdominal lump, insidious in onset and not associated with any aggravating or relieving factors. Physical examination revealed a soft cystic mass extending from the right hypochondrium to the right iliac fossa region crossing the midline. Ultrasonography of the abdomen and pelvis showed a large cystic anechoic area noted in the abdomen extending from the epigastric region to the pelvis. Contrast-enhanced CT of the abdomen and pelvis showed a large non-enhancing cystic lesion in the pelvis suggesting the possibility of a right ovarian cyst or mesenteric cyst. Laparotomy was performed and the excised specimen was sent for histopathological analysis, which confirmed it to be an endometrial cyst.

Coincident Double Tumor of the Breast and Gastrointestinal Stroma: A Rare Case.

The most common metastasis sites of malignant stromal tumors are the liver, peritoneum, lung, and bones. Metastasis to the breast is extremely rare. Therefore, this is a very rare combination. Both being primary concomitantly is a further rare combination. Gastrointestinal stromal tumors (GISTs) and other primary carcinomas in the same patient are not unusual, and they are frequently discovered by chance. GISTs are uncommon mesenchymal tumors of the gastrointestinal (GI) system. There is a scarcity of information on the prevalence of mesenchymal tumors and other primary tumors in the literature. Therefore, more studies are required to establish the same. Concomitant GISTs accompany the most prevalent epithelial malignancies of the gastrointestinal system. More research is needed to shed insight into the molecular and genetic pathways of GIST and synchronous tumor oncogenesis and progression. This case report brings to light a synchronous double tumor of the breast and gastrointestinal stroma.