The use of topical anaesthesia at children's minor lacerations: an experimental study

BACKGROUND: In a great many situations within health care and treatment, children are subjected to unnecessary pain and suffering. When local anaesthetics is to be administered the child can experience this as incomprehensible especially when the nursing staff assures the child that no pain would be felt, only to discover soon after, that it actually did hurt at the moment of anaesthetic infiltration. The soothing of pain during the suturing of wounds in emergency wards can be reduced, ensuring that unnecessary pain in the cafe-and-treatment process is mot meted out to children. In order to prevent this (subjection to unnecessary pain), and by improving accepted practice, it was interesting to investigate whether children felt pain at the time of infiltration anaesthesia following the initial topical anaesthesia. AIM: The aim of the present study was to investigate the effects of introductory topical anaesthesia using Xylocain solution dropped in the wound prior to a definitive infiltration-anaesthesia. An experimental, prospective design was used where children were included in either an experimental group or a control group. The experimental group (n=10) were given a Xylocain solution while the control group (n=10) received physiological Sodium solution. Data collection for the study was made by making VAS estimates and by interviews. RESULT: The study shows that a certain alleviation of pain does occur when using Xylocain but no statistically significant difference exists between the two groups. Irrespective of whether the children received an introductory topical anaesthesia with Xylocain or Sodium solution at the time of infiltration anaesthesia, they expressed pain in connection with infiltration. The study also shows that many children express fear and anxiety. CONCLUSION: Current research highlights the difficulties involved in offering children a really satisfactory form of pain relief in connection with infiltration anaesthesia and suturing of wounds. It is urgent to throw more light on children's pain, both from a nursing and from a medical point of view. No statistically significant difference was found in children's reported pain, after treatment with Xylocain but the solution can have a positive effect at the time of the infiltration jab, but a larger study needs to be done in order to establish this firmly.     

The osteoporotic pain experience

Osteoporosis, a disease characterized by skeletal fragility, represents a major health problem, especially for postmenopausal women. This project is a pilot study exploring the female osteoporotic patient's understanding of her individual pain condition and investigating the potential of a structured nursing program, called the Osteoporotic Pain Program (OPP), to increase the patient's insight, skills and motivation to self help, and possibly reduce pain. Findings in other studies and the expertise of experienced clinical nurses formed the basis for the OPP, which consists of three elements: conversations between nurse and patient, pain curves, and body charts. Qualitative interviews, using a semi-structured guide, were conducted to explore the meaning of the program as seen from the perspective of the patients. Participating in the OPP proved meaningful to patients in two major ways, actively exploring one's pain and feeling empowered. The analysis lead to forming a main category, "Exploring the chronic pain situation", and five subcategories were identified: expressing one's pain, understanding one's pain, justifying one's pain, accepting medication, and entering a ready-to-act mode. Findings indicate that the OPP contributes to challenging the patients. Their self-efficacy increases, their actions change, and pain intensity appears to decrease.     

Rye,lignans and human health

Rye bran contains a high content not only of dietary fibre, but also of plant lignans and other bioactive compounds in the so-called dietary fibre complex. Blood concentrations of lignans such as enterolactone have been used as biomarkers of intake of lignan-rich plant food. At present,evidence from studies in human subjects does not warrant the conclusion that rye, whole grains orphyto-oestrogens protect against cancer. Some studies, however, have pointed in that direction,especially in relation to cancers of the upper digestive tract. A number of prospective epidemiological studies have clearly shown a protective effect of wholegrain cereals against myocardial infarctions. A corresponding protective effect against diabetes and ischaemic stroke(brain infarct) has also been demonstrated. It seems reasonable to assume that these protective effects are associated with one or more factors in the dietary fibre complex.     

Postantibiotic and sub-MIC effects of benzylpenicillin against Streptococcus pneumoniae with different susceptibilities for penicillin

BACKGROUND: The purpose of the study was to examine whether penicillin-susceptible and nonsusceptible strains of Streptococcus pneumoniae exhibited different pharmacodynamic responses to benzylpenicillin. METHODS: The postantibiotic effects (PAEs) and the postantibiotic sub-MIC effects (PA SMEs) were investigated by optical density against strains of S. pneumoniae with different susceptibilities to benzylpenicillin. To validate the data, the PAE and PA SME of one susceptible and one resistant strain were also tested with the viable count method. The post-MIC effects (PMEs) were studied in an in vitro kinetic model, simulating human pharmacokinetics with a half-life of 1 h and a time above MIC of approximately 20% of 24 h. RESULTS: There were no differences with respect to the PAEs, PA SMEs and PMEs of benzylpenicillin for the various strains of S. pneumoniae, irrespective of their susceptibility to penicillin. For both some of the susceptible and resistant strains investigated, longer PA SMEs at 0.2 and 0.3 x MIC were noted, indicating that these parameters might be more dependent on the type of strain rather than on the susceptibility status. CONCLUSION: No differences in the pharmacodynamic response after similar drug exposure were seen for S. pneumoniae strains with different penicillin susceptibility.     

Ecological-level associations between highly processed food intakes and plasma phospholipid elaidic acid concentrations: results from a cross-sectional study within the European prospective investigation into cancer and nutrition (EPIC)

Elaidic acid is the main unnatural trans fatty acid isomer occurring during partial hydrogenation of vegetable oils used as ingredients for the formulation of processed foods. The main objective is to assess associations between processed food intakes and plasma phospholipid elaidic acid concentrations within the European Prospective Investigation into Cancer and Nutrition study. A cross-sectional study was used to determine fatty acid profiles in 3,003 subjects from 16 centers. Single 24-h dietary recalls (24-HDR) were collected using a standardized computerized interview program. Food intakes were computed according to their degree of processing (moderately/nonprocessed foods, processed staple foods, highly processed foods). Adjusted ecological and individual correlations were calculated between processed food intakes and plasma elaidic acid levels. At the population level, mean intakes of highly processed foods were strongly correlated with mean levels of plasma elaidic acid in men (P = 0.0016) and in women (P = 0.0012). At the individual level, these associations remained but at a much lower level in men (r = 0.08, P = 0.006) and in women (r = 0.09, P = 0.0001). The use of an averaged 24-HDR measure of highly processed food intakes is adequate for predicting mean levels of plasma elaidic acid among European populations.     

Prostate cancer: 1.5 T endo-coil dynamic contrast-enhanced MRI and MR spectroscopy—correlation with prostate biopsy and prostatectomy histopathological data

Purpose

To investigate diagnostic accuracy of detection of prostate cancer by magnetic resonance: to evaluate the performance of T2WI, DCEMRI and CSI and to correlate the results with biopsy and radical prostatectomy histopathological data.

Materials and methods

43 patients, scheduled for radical prostatectomy, underwent prostate MR examination. Prostate cancer was identified by transrectal ultrasonographically (TRUS) guided sextant biopsy. MR examination was performed at 1.5T with an endorectal MR coil. Cancer localisation was performed on sextant-basis - for comparison between TRUS biopsy, MR techniques and histopathological findings on prostatectomy specimens.

Results

Prostate cancer was identified in all 43 patients by combination of the three MR techniques. The detection of prostate cancer on sextant-basis showed sensitivity and specificity: 50% and 91% for TRUS, 72% and 55% for T2WI, 49% and 69% for DCEMRI, and 46% and 78% for CSI.

Conclusion

T2WI, DCEMRI and CSI in combination can identify prostate cancer. Further development of MR technologies for these MR methods is necessary to improve the detection of the prostate cancer.     

Polymorphisms at the osteoprotegerin and interleukin-6 genes in relation to first-ever stroke

BACKGROUND: Arterial calcification and osteoporosis often coexist, especially in postmenopausal women. Osteoporosis associates with a substantially increased risk of stroke in elderly women, suggesting that impaired estrogen signaling may link stroke and osteoporosis. Osteoprotegerin (OPG, TNFRSF11B) and interleukin-6 (IL-6, IL6) are putative target genes for estrogen signaling and have been implicated in both cardiovascular diseases and osteoporosis. We hypothesized that specific polymorphisms in these genes may be associated with increased risk of ischemic stroke or intracerebral hemorrhage (ICH). METHODS: We performed a population-based prospective nested case-control study, in which the relationships between polymorphisms (OPG-1181G/C, OPG-950T/C and IL6-174G/C) and ischemic stroke and ICH were examined. Definitive first-ever stroke events (n = 388), i.e. ischemic stroke (n = 320), ICH (n = 61) and unspecified stroke (n = 7) cases, and controls without cardiovascular disease (n = 773), matched for age, sex and geographical region were studied. Univariate and multivariate models using conditional logistic regression, which included traditional risk factors, were used to test for association. RESULTS: Carriers of the OPG-1181C/C genotype had a significantly (p = 0.018) increased risk of ICH (OR, 2.69; 95% CI, 1.19-6.12) in the univariate analysis. After adjustments (hypertension, diabetes, BMI and triglycerides), this genotype remained significantly (p = 0.005) associated with ICH (OR, 6.04; 95% CI, 1.71-21.29). By contrast, no correlations were found between this genotype and ischemic stroke, nor between the OPG-950T/C or IL6-174G/C polymorphisms and stroke subtypes. CONCLUSIONS: In this population, the OPG-1181C/C genotype associates with first-ever ICH, implying that alterations in OPG-mediated signaling in the vasculature may be involved in the pathophysiology of this disease.     

Early prognosis of stroke outcome by means of Katz Index of activities of daily living.

The predictive validity of Katz' Index of ADL (Activities of Daily Living) regarding length of hospital stay, discharge to own home or death within one month, and its reproducibility in clinical practice was studied prospectively in S?dert?lje and in Enk?ping, Sweden. The S?dert?lje study included 124 consecutive patients, who were all assessed on days 5-7 after stroke by an occupational therapist. The Enk?ping study included 106 consecutive patients, who were assessed similarly by trained nurses. Ninety-six and 94%, respectively, of patients in grades A-C on days 5-7 after stroke were discharged to their own homes within one month. Ninety-six and 92%, respectively, of patients in grades D-G stayed in hospital longer than one month or died. Sixty-two and 68%, respectively, of patients in grade G died within one month. The instrument is now used as a valid tool for early prognosis of stroke outcome in order to facilitate the planning of care and rehabilitation in clinical practice.