Reduction in anxiety during treatment with exercise and duloxetine is related to improvement of low back pain-related disability in patients with non-specific chronic low back pain

Background: Non-invasive treatment is generally recommended for patients with non-specific chronic low back pain (CLBP). However, the impact of combination therapy with physical exercise and a serotonin-norepinephrine reuptake inhibitor has not been clarified in patients with non-specific CLBP. This study assessed the efficacy of combination treatment with exercise and duloxetine on non-specific CLBP and aimed to identify factors that contributed to improvement of LBP-induced disability.Methods: This prospective study was conducted on consecutive outpatients with non-specific CLBP. Patients received a supervised home-based exercise program and duloxetine administration for 15 weeks. The Roland-Morris Disability Questionnaire (RDQ), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS) were assessed at baseline and 15 weeks. Multiple logistic regression modeling was used to identify factors associated with an improvement in RDQ. Results: Forty-two patients were enrolled. Overall, scores on the RDQ, NRS, and PCS (total score, magnification, helplessness) were significantly reduced at 15 weeks (p < 0.01 for all). An improvement of disability was confirmed in 22 patients (52%). A higher HADS depression score before and after the intervention was significantly associated with a lack of improvement in disability (p < 0.01). Further, a reduction in HADS anxiety score over 15 weeks was a significant factor associated with an improvement in disability (odds ratio: 1.99;95% CI: 1.26-3.65). Conclusions: Supervised exercise plus duloxetine resulted in favorable outcomes and an improvement of LBP-related disability in approximately 50% of patients. A reduction in anxiety over treatment was associated with the improved disability.     

Efficacy of bupivacaine injection after pulsed radiofrequency ablation in the management of trigeminal facial pain: A prospective,randomized, and double-blind study

Objectives:To assess the effect of bupivacaine application following pulsed radiofrequency (PRF) ablation on trigeminal facial pain.Methods:A total of 73 patients with trigeminal facial pain refractory to conservative therapy were randomized into 2 groups. Group I subjects underwent PRF ablation procedure, followed by the injection of 1 ml of bupivacaine. Whereas, Group II underwent the same procedure followed by the injection of 1 ml of normal saline. Pain relief duration, the time of onset of pain relief, and analgesic effect evaluated by numerical pain rating scale were considered as outcomes.Results:Thirty-nine patients in Group I and 34 in Group II. The duration of pain relief in the 2 groups was comparable (5 months in Group I vs. 6 months in Group II, p=0.53). The onset of pain relief in the patients of Group I was shorter than Group II (0 days vs. 4.5 days, p<0.001). The binary logistic regression analysis revealed that the application of bupivacaine alone had a significant effect on the reduction of the intake of medications (p<0.05).Conclusion:In situations involving patients who require rapid pain relief, bupivacaine injection following PRF ablation can be employed to provide immediate relief without subjecting the patients to the risks associated with major complications.     

Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial

CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain. DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002. SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland. PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension. CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.     

The correlation between fear of falling and upper extremity muscle strength

Objectives:To determine the relationship between fear of falling (FOF) and upper extremity muscle strength.Methods:This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests.Results:The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively).Conclusion:The measurement of upper extremity strength could be a predicting parameter of FOF.     

Emotional responses and coping strategies of medical students during the COVID-19 pandemic

Objectives:To assess the emotional responses and coping strategies of medical students during the lockdown and social distancing measures implemented during the coronavirus disease -19 (COVID-19) pandemic.Methods:This cross‑sectional study is based on data collected from undergraduate medical students at the College of Medicine, Alfaisal University Riyadh, Saudi Arabia, during the fall semester of academic year 2020-2021. All the participants completed a self-administered online questionnaire consisting of 3 parts: demographic information, emotional response scale, and 14-item, adapted brief coping orientation to problems experienced inventory to determine the use of avoidant or approach coping strategies. Coping and emotional response scores were compared using t-test. Linear regression analysis was also performed.Results:A total of 261 students from all years were included. Overall scores were higher for avoidant coping strategies. The use of avoidant coping strategies was significantly higher in females (p=0.03) and in preclinical students (p<0.001). Preclinical students had a higher mean score for anger (p=0.002). Conversely, students in the clinical phase had higher scores for anxiety (p=0.005) and sadness (p=0.027). The regression analysis of emotional responses and coping strategies suggests that avoidant coping is a predictor of anger (p=0.003) and sadness (p=0.005).Conclusion:Interventions to train medical students in the use of more productive and effective coping strategies may reduce negative emotional responses linked to the present COVID-19 pandemic and in the future.     

Does injury claim status and benefit status predict low back pain outcomes?

Background

In New Zealand the Accident Compensation Corporation (ACC) is a state-funded insurance agency that accepts claims for accidental injuries, including lumbar spine injuries. It is unknown whether ACC claim status (accepted, not accepted) affects low back pain (LBP) outcomes, or whether benefit status (e.g., sickness, disability) further affects outcomes in patients without ACC cover

Aims

This study aimed to determine whether ACC claim and benefit status are likely to influence a range of outcomes for people with LBP in New Zealand.

Methods

A prospective survey of low back pain patients was performed (April 2008–October 2010). ACC claim status was recorded, and individuals without accepted claims indicated benefit status. Surveys were sent at multiple time points; pain, functional limitation, psychological factors, and general health were assessed. Statistical analysis was undertaken using ANCOVA and ANOVA (p<0.05).

Results

In total, 168 patients completed the study. Six-month measures showed individuals with no ACC claim for LBP to overall have poorer outcomes (mental health, p=0.039; pain, p=0.045; functional limitation, p=0.049); sub-group analysis (no ACC claim) between those with or without a benefit showed those on benefits to have significantly higher functional limitation (p<0.001), poorer physical health (p=0.002), greater pain (p=0.027), and stronger fear avoidance behaviours for both work (p=0.047) and physical activity (p=0.35).

Conclusion

Findings indicate individuals with accepted ACC claims for LBP have significantly better outcomes than those without, and patients on benefits with no accepted ACC claim for LBP have even poorer outcomes.     

Normative data of olfactory abilities using cultural adaption Sniffin’ sticks smell test in different age groups

Objectives:To assess olfactory abilities using a culturally adapted Sniffin’ Sticks smell test in different age groups.Methods:This was a cross-sectional study, conducted at Otorhinolaryngology outpatient clinic of Universiti Kebangsaan Malaysia Medical Centre, Secondary Science School, and Children Learning Centre in Kuala Lumpur, Malaysia, from August 2019 until December 2021.Results:In 450 healthy participants, the cut-off points of the threshold discrimination identification (TDI) scores at the 10th percentile for olfactory abilities were 19 in children, 30.1 in adolescents, 32.1 in young adults, 31.1 in middle-aged adults, and 28.6 in older adults. The children had significantly lower olfactory abilities, with the Bonferroni post-hoc tests of p<0.001. The young adults had higher olfactory abilities than older adults (p<0.05). The results showed that the identification score was highest in middle-aged adults (p<0.001). The discrimination score was the highest in young adults (p<0.001). The best odor threshold performance was observed in adolescents (p<0.001). The TDI score showed a significant difference in olfactory abilities between men and women (p=0.001).Conclusion:Using a culturally adapted smell test, our population was able to identify, discriminate, and perceive odorants better than the European population. This data will help clinicians and researchers with a tool to reliably establish the correct results of olfactory function in our population. Women had better olfactory abilities than men.     

Efficacy,safety, and predictors of response to botulinum toxin type A in refractory chronic migraine: A retrospective study

BackgroundDue to its persistent and debilitating nature, refractory chronic migraine (RCM) can cause significant socioeconomic burden. This study retrospectively reviewed the efficacy and safety of botulinum toxin type A (BoNT-A) in the treatment of RCM. Predictors of treatment response were also investigated.MethodsWe enrolled 94 patients in this study after reviewing the records of those patients who received BoNT-A injections ≥75 U in our headache clinic, and who fulfilled the criteria for RCM established by Schulman et al. The outcome variables included headache frequency, migraine disability assessment score, and adverse events recorded in headache diaries. Treatment response was defined as ≥30% reduction in headache frequency from baseline at 12 weeks. Potential predictors of treatment response were evaluated, including patient demographics, headache directionality, ocular-type headache, medication overuse, BoNT-A dosage, body mass index, and Beck depression inventory score.ResultsFor the 94 patients with RCM who were enrolled, their mean baseline headache frequency was 23.9 days/28 days. At 12 weeks after BoNT-A injection, the mean reduction in headache frequency was 6.5 days/28 days (p < 0.001), and the median migraine disability assessment score decreased from 60.0 to 30.0 (p < 0.001). Thirty-seven (39.4%) patients responded to treatment, and only ocular-type headache was associated with a higher response rate (ocular vs. nonocular, 54.8% vs. 31.7%; p = 0.031). The most common adverse event was lateral eyebrow elevation (19.1%), followed by neck soreness (5.3%).ConclusionAbout 40% of patients with RCM obtained ≥30% reduction in headache frequency at 12 weeks after BoNT-A injection, and treatment-related adverse events were transient and acceptable. Ocular-type headache may predict treatment response.     

Burnout and imposter syndrome among Saudi young adults: The strings in the puppet show of psychological morbidity

Objectives:To determine the prevalence of imposter syndrome (IS) among Saudi adults and its association with burnout.Methods:Using non-probability convenience sampling, we carried out a cross-sectional analytical study among adults in Northern Saudi Arabia. Data collection toll was a self-administered questionnaire containing young imposter scale (YIS), Maslach burnout inventory (MBI) and depression, anxiety, and stress scale 21 (DASS 21). These 3 scales are valid and reliable measurement tools for measuring IS, burnout, and psychological morbidity.Results:In the study sample (n=384), imposterism was present among 222 adults (57.8%). Moderate and severe symptoms of depression were present in 217 (56.5%), symptoms of stress in 210 (54.7%), and symptoms of anxiety in 126 (32.8%). Burnout was measured in 3 domains of depersonalization, emotion exhaustion, and personal accomplishments. High degree of depersonalization was found in 221 (57.6%), higher emotional exhaustion in 246 (64.1%) while lower personal accomplishment was present in 126 (32.8%). We found statistical association between IS and gender (p<0.01), depression (p<0.001) stress (p<0.001) and all 3 domains of burnout (p<0.01). Imposter syndrome was not found associated with anxiety (p=0.97). Young imposter scale score was associated with all the 3 domains of burnout even after controlling for depression, anxiety, and stress.Conclusion:Imposter syndrome is frequent among Saudi adults and associated with all 3 burnout domains. Mental health domains like burnout, depression, stress, and anxiety were found associated with IS.     

Body mass index,pain and function in individuals with knee osteoarthritis

Background:

Obesity is a risk factor for progression of knee osteoarthritis (OA), and high body mass index (BMI) may interfere with treatment effectiveness on pain and function in individuals with knee OA. This study investigated the effects of BMI on pain and function during a four-week exercise programme in patients with knee OA.

Materials and Methods:

Forty-six (31 women and 15 men) participants with knee OA of different BMI categories (15 normal weight participants, 13 over weight participants and 18 obese participants), received standardised exercise therapy programme twice a week for 4 weeks. Outcome included a 10-point pain rating scale for pain-intensity and the western Ontario and McMaster university osteoarthritis index (WOMAC) for physical function.

Results:

Two-way repeated measure analysis of variance (ANOVA) on pain assessment score revealed a significant effect of time (F = 1049.401, P < 0.001) and group (F = 9.393, P < 0.001) on pain. Similar significant effect of time (F = 595.744, P < 0.001) and group (F = 5.431, P = 0.008) was obtained for WOMAC score on function. Post hoc analysis revealed significant difference between the normal weight and overweight group (t = 2.472, P = 0.016) and between normal weight and obese group (t = 3.893, P = 0.005) on pain outcome at the 4^th week post treatment. No significant difference was found at 4^th week post treatment on WOMAC scores (F = 2.010, P = 0.146).

Conclusion:

Exercise improved pain and function scores in OA patients across the BMI groups. Overweight independent of obesity may interfere with effectiveness of pain control during the symptomatic treatment of knee OA patients.     

三位一体牵伸技术联合Mulligan关节松动术治疗原发性冻结肩的疗效观察

目的 探讨三位一体牵伸技术联合Mulligan关节松动术对原发性冻结肩功能恢复的影响。方法 选取2018年1月—2020年3月在丽水市第二人民医院诊治的原发性冻结肩患者96例。将患者随机分为治疗组和对照组，每组48例。对照组行Mulligan关节松动术治疗，治疗组行三位一体牵伸联合Mulligan关节松动术治疗，持续4周。比较两组疗效、疼痛［视觉模拟评分法（VAS）评分］、关节活动度（ROM）、功能［日本骨科学会（JOA）肩关节功能评分（以下简称JOA评分）］、日常生活活动能力［（ADL）评分］、安全性。结果 治疗组脱落2例，对照组脱落1例，最终治疗组46例，对照组47例完成治疗；治疗组总有效率（95.65%）高于对照组（78.72%）（P <0.05）；治疗组治疗前后ROM（外展、后伸、内旋、前屈、外旋）、JOA评分（疼痛、功能、活动度、X线评定、关节稳定性、总分）、VAS评分和ADL评分的差值均大于对照组（P <0.05）；治疗过程中所有患者未发生皮下出血、肌肉拉伤、关节脱位等不良事件。结论 三位一体牵伸技术联合Mulligan关节松动术治疗原发性冻结肩效果显著，可明显缓解疼痛，增加关节活动度，改善肩关节功能，提高患者活动能力，且安全可靠。     

Anxiety and depression affect pain drawings in cervical degenerative disc disease

Introduction: Pain drawings have been frequently used in the preoperative evaluation of spine patients. Until now most investigations have focused on low back pain patients, even though pain drawings are used in neck pain patients as well. The aims of this study were to investigate the pain drawing and its association to preoperative demographics, psychological impairment, and pain intensity.

Methods: We carried out a post hoc analysis of a randomized controlled trial, comparing cervical disc replacement to fusion for radiculopathy related to degenerative disc disease. Preoperatively the patients completed a pain drawing, the Hospital Anxiety and Depression Scale (HADS), and a visual analogue scale (VAS). The pain drawing was evaluated according to four established methods, now modified for cervical conditions. Comparisons were made between the pain drawing and age, sex, smoking, and employment status as well as HADS and VAS.

Results: Included were 151 patients, mean age of 47 years, female/male: 78/73. Pain drawing results were not affected by age, sex, smoking, and employment status. Patients with non-neurogenic pain drawings according to the modified method by Ransford had higher points on HADS-anxiety, HADS-depression, and HADS-total. Patients with markings in the head region had higher score on HADS-depression. Markings in the neck and lower arm region were associated with high values of VAS-neck and VAS-arm.

Conclusions: Pain drawings were affected by both pain intensity and anxiety/depression in cervical spine patients. Therefore, the pain drawing can be a useful tool when interpreting the patients’ pain in correlation to psychological impairment and pain location.     

Post-vaccination survey for monitoring the side effects associated with COVID-19 vaccines among healthcare professionals of Jazan province,Saudi Arabia

Objectives:To identify the self-reported vaccine-related side effects among healthcare professionals (HCPs) in the Jazan province, Saudi Arabia, and determine the associated socio-demographic factors. With the recent second and third waves of coronavirus disease -19 (COVID-19) infections worldwide, the race is not only to encourage but also to achieve mass vaccination.Methods:A total of 397 HCPs from across Jazan province participated in an anonymous online cross-sectional survey conducted for a period of 45 days (March 30, 2021 to May 13, 2021) in Jazan province, Saudi Arabia. Data was collected using a validated 22-items self-report survey.Results:For both COVID-19 vaccines, majority of reports were related to flu-like symptoms including fever, chills, headache, fatigue, tiredness, and myalgia. Statistically significant associations were observed between the severity of side effects and gender (χ²=73.32; p<0.001), type of vaccine (χ²=112.08; p<0.001), and presence of known allergies (χ²=99.69; p<0.001). Female HCPs were more likely to report any side effects compared with male HCPs (adjusted odds ratio [AOR]: 3.72; p<0.001). Furthermore, HCPs with known allergies were more likely to report any side effects than their counterparts with unknown allergies (AOR: 16.29; p<0.001).Conclusion:The findings of the present study would help in designing educational programs aimed at combating the misconstrued fear of vaccination and highlighting the urgent need of getting vaccinated. This study also helps in the identification of factors affecting the presence and severity of side effects.     

伤口病人操作性疼痛程度与疼痛恐惧、心理弹性的相关性研究

目的了解伤口病人操作性疼痛程度现状,分析伤口操作性疼痛的影响因素以及疼痛程度与疼痛恐惧、心理弹性之间的相互关系。方法采用方便抽样法,应用自设的一般资料调查表、数字疼痛模拟量表（NRS）、疼痛恐惧问卷（FPQ）和心理弹性量表（CD-RISC）评估病人疼痛程度、疼痛恐惧和心理弹性情况。结果伤口病人操作性疼痛程度得分为（4.53±1.98）分。病人年龄与疼痛程度均呈正相关（P＜0.01）,文化程度、伤口持续时间、距上次换药时间与疼痛程度均呈负相关（P＜0.01）,病人疼痛恐惧与疼痛程度呈正相关,心理弹性与疼痛程度呈负相关（P＜0.01）。是否首次换药、疼痛恐惧、心理弹性是疼痛程度的独立影响因素（P＜0.01）。结论伤口病人操作性疼痛程度与疼痛恐惧和心理弹性有着密切的联系,医护人员在对伤口病人进行治疗的同时,还应充分重视其疼痛程度与疼痛恐惧和心理弹性的相互影响。     

Impact of preprocedural anxiety levels on pain perception in patients undergoing office hysteroscopy

BackgroundWe aimed to determine if preprocedural anxiety levels had a significant association with procedure-related pain in women undergoing office hysteroscopy (OH) and also to assess the effect of various clinical factors on pain perception in these women.MethodsThere were 148 women undergoing OH enrolled in this observational study. Before examination, patients were asked to complete two forms, the STAI-T (State–Trait Anxiety Inventory, Trait) and STAI-S (State-Trait Anxiety Inventory, State) anxiety scales, to evaluate their usual anxiety state and state of anxiety during the examination. Patients were asked to quantify on a visual analog scale the pain felt during and 60 minutes after the procedure. Associations between STAI and visual analog scale scores were assessed using correlation analysis. The effects of various contributing factors on pain perception were investigated with linear regression analysis. A p value < 0.05 was considered statistically significant.ResultsThe preprocedural mean trait and state anxiety scores were 38.4 ± 9.2 and 44.8 ± 10.0, respectively, and the mean patient age was 43.6 ± 3.3 years. During OH, there were significant positive correlations between in-hospital waiting time, procedure time, preprocedural trait or state anxiety scores, and pain. Sixty minutes after OH, significant positive correlations between in-hospital waiting time, procedure time, preprocedural state or trait anxiety scores, and pain were observed. There was also a significant negative correlation between parity and procedure-related pain 60 minutes after procedure. OH-related pain scores during the procedure were significantly affected by in-hospital waiting time (p < 0.001), state anxiety level (p = 0.001), and trait anxiety level (p = 0.01). However, 60 minutes after the procedure, pain was affected by patient parity (p = 0.02), procedure time (p = 0.002), and preprocedural state anxiety level (p < 0.001).ConclusionThe pain that study participants felt during and soon after OH was negatively affected by preprocedural anxiety levels. Some factors, such as reducing the waiting time before the procedure, might be useful in reducing anxiety levels.     

Association between sex hormones and migraine in young Saudi females

Objectives:To assess the sex hormone levels in young Saudi female migraineurs during a migraine attack and during pain-free periods and compare them with control subjects.Methods:A case-control study involving 14 Saudi female migraineurs and 21 control subjects was conducted between December 2019 and March 2020. Demographic and disease history data were collected through participant interviews. Blood samples were drawn during the migraine attack and pain-free periods.Results:Follicular (30.00±19.60; p<0.001) and luteal (39.79±11.45; p=0.037) estrogen levels were significantly higher in patients with non-menstrual related migraine (NMM), while luteal testosterone levels (1.10±0.31; p=0.023) were significantly higher in patients with menstrually related migraine (MM). Body mass index (BMI) was higher in patients with NMM (25.77±6.53; p=0.013), and it was found to be associated with follicular estrogen (p=0.016), progesterone (p=0.018), and pain intensity (p=0.042). Luteal estrogen level was significantly lower (13.96±7.88; p=0.036) in patients with luteal onset of attack.Conclusion:High estrogen levels were found to mediate NMM, their effect being more pronounced with increase in BMI; whereas low luteal estrogen levels mediated MM. Young females with MM might have high luteal testosterone levels, and a compensatory protective role could be surmised accordingly.     

Quality of life in vitiligo patients in central Saudi Arabia

Objectives:To assess the quality of life (QoL) in patients with vitiligo in central Saudi Arabia using the dermatology life quality index (DLQI).Methods:A cross-sectional study spanning over 6 months was conducted on 253 adult patients with vitiligo at the outpatient dermatology clinics of the National Center of Vitiligo (Light Clinics) and King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were asked to complete a self-administered questionnaire using an Arabic version of the DLQI to measure the impact of vitiligo on their QoL. The association between the demographic and diseases characteristic to the median DLQI scores was investigated using binary logistic regression.Results:The median DLQI score was 4, the range 25, min 0 - max 25 and percentiles 2-8. The unadjusted odds ratio (95%CI) showed the median DLQI score was significantly higher in married subjects 2.29 (1.33-3.94) (p<0.01), non-segmental vitiligo 2.10 (1.16-3.79) (p<0.01), and the progressive vitiligo 1.87 (1.09-3.18) (p<0.02) than their counterparts. However, after adjustment only married status predicted the high DLQI score 2.08 (1.11-3.61) (p<0.01).Conclusion:The QoL in vitiligo patients in Saudi Arabia is adverse than those with lighter skin, in other countries. Therefore, in Saudi Arabia, better management modalities to improve patients’ QoL and prevent subsequent mental distress are needed.     

Could flank pain be an indicator of COVID-19 infection?

BackgroundWe describe the incidental detection of patients infiltrates due to COVID-19 in lung basal sections in patients undergoing abdominal computed tomography (CT) with flank pain attending the urology outpatient clinic during the current pandemic.MethodsWe retrospectively analysed 276 patients admitted to the Siirt Training and Research Hospital Urology outpatients clinic between 15 March 2020 and 9 August 2020 with a complaint of flank pain and undergoing non-contrast abdominal CT. A total of 10 patients with COVID-19 compatible findings in CT were defined as the study group. A control group was formed from 10 patients with only urological pathologies (kidney stones, ureteral stones, and hydronephrosis) without a COVID-19 compatible appearance on CT.ResultsTen (3.6 %) patients were identified with COVID-19 and pneumonic infiltrations in the basal regions of the lungs; diagnosis was made by cross-sectional abdominal CT. The visual analog scale (VAS) score of flank pain was significantly higher in the control group (p<0.001); these subjects had urological pathology and no evidence of COVID-19 in the basal regions of the lungs on abdominal CT. There were no signs of COVID-19 disease detected during the admissions procedure in the urology outpatient clinic, including fever, cough, and shortness of breath.ConclusionDuring the COVID-19 pandemic, it is important to consider a diagnosis of COVID_19 in patients reporting non-severe flank pain if no urological pathology is evident on abdominal CT scans.     

Effectiveness of using tranexamic acid in total hip and total knee arthroplasty: Single tertiary center experience

Objectives:To measure the effectiveness of tranexamic acid (TXA); in total joint arthroplastyin terms of reducing post-operative blood loss.Methods:A retrospective cohort study in which patients who had underwent total hip arthroplasty (THA) and TKA between 2010-2018 in a single tertiary center. Those had received TXA (group 1) and those who had received no-TXA (group 2) were evaluated. Unpaired student’s t-test was used to compare TXA and no-TXA groups for continuous variables and Chi-square test was used for categorical variables. A p-value<0.05 was considered significant.Results:A total of 385 patients were included, 180 patients received TXA, and 205 patients received no-TXA. Post-operative blood loss was significantly less in TXA group (13.41±9.51, p<0.001). Total drainage output was significantly lower in TXA group compared to no-TXA (373.98±246.12 vs. 487.11±307.13 mL, p<0.001). Blood transfusion units were significantly less in TXA group than in the control group (20 units; 11.1% vs. 50 units; 24.4%, p<0.001).Conclusion:Tranexamic acid use in TKA and THA is effective in reducing post-operative blood loss in terms of drop in Hg level, total drainage output and blood transfusion rate.