Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) at either an acupoint or dermatome corresponding to the surgical incision produces comparable decreases in postoperative opioid requirements and opioid-related side effects. However, the effect of the frequency of the electrical stimulus on the postoperative analgesic response to TENS therapy has not been studied. METHODS: One hundred women undergoing major gynecological procedures with a standardized general anesthetic technique were enrolled in the study. Patients were randomly assigned to four groups: group I, patient-controlled analgesia (PCA) plus sham TENS (no stimulation); group II, PCA plus low-frequency (2-Hz) TENS; group m, PCA plus high-frequency (100-Hz) TENS; group IV, PCA plus mixed-frequency (2- and 100-Hz) TENS. The PCA device was programmed to deliver 2-3 mg intravenous boluses of morphine with a lockout interval of 10 min. The TENS device was used every 2 h during the day. Standard 100-mm visual analog scales were used to assess pain, sedation, fatigue, and nausea at specific intervals after surgery. RESULTS: Mixed frequency (2 and 100 Hz) of stimulation decreased morphine requirements by 53% compared with the sham group; low (2-Hz) and high (100-Hz) frequencies produced 32% and 35% decreases, respectively. All three "active" TENS groups reduced the duration of PCA therapy, as well as the incidence of nausea, dizziness, and itching. CONCLUSIONS: TENS decreased postoperative opioid analgesic requirements and opioid-related side effects when utilized as an adjunct to PCA after lower abdominal surgery. Use of TENS at mixed (2- and 100-Hz) frequencies of stimulation produced a slightly greater opioid-sparing effect than either low (2-Hz) or high (100 Hz) frequencies alone.     

Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia

The improvement of the conditions of care and quality of life of people living with drepanocytosis now constitutes a major concern of health authorities and voluntary groups (associations of sick people and their parents). In order to examine the conditions and methods of care for children living with drepanocytosis in the Bizerte region of Northern Tunisia and to understand the problems and difficulties experienced by them and their families in their daily lives, an anthropological study was carried out in the region between January 16 and February 12, 1997. Thirty-three interviews were carried out with families of infected children. The interviews were semi-directive using a pre-established protocol (interview guide). Thirty interviews were then analysed. A multitude of information concerning various medical and psycho-social aspects of drepanocytosis in the region were revealed. The data were regrouped into the following categories: circumstances of discovering the illness; explicative model of the illness as perceived by the people interviewed; conditions and methods of care of the sick child; degree of satisfaction with the health care system; psychological profile of the children interviewed; educational level of the children interviewed; repercussions the illness has on the family; impact of the illness on household budget; suggestions and comments of the people interviewed. In light of the information collected, various actions have been proposed with the goal of improving the conditions of care and quality of life of people living with drepanocytosis in the region.     

Treatment with danaparoid during pregnancy for a woman with a cutenous allergy to low-molecular-weight heparin]

The authors describe a case of heparin-induced skin reaction due to two preparations of low molecular weight heparin in a pregnant woman. The main characteristics of heparin-related cutaneous allergy are reported. The use of an heparinoid, usually indicated for patients with heparin-induced thrombocytopenia, appeared to be efficient and safe for the mother and her fetus. An epidural analgesia was performed for labor analgesia, 24 hours after the last injection of danaparid of sodium.     

Prediction of Ecofriendly Concrete Compressive Strength Using Gradient Boosting Regression Tree Combined with GridSearchCV Hyperparameter-Optimization Techniques

A crucial factor in the efficient design of concrete sustainable buildings is the compressive strength (Cs) of eco-friendly concrete. In this work, a hybrid model of Gradient Boosting Regression Tree (GBRT) with grid search cross-validation (GridSearchCV) optimization technique was used to predict the compressive strength, which allowed us to increase the precision of the prediction models. In addition, to build the proposed models, 164 experiments on eco-friendly concrete compressive strength were gathered for previous researches. The dataset included the water/binder ratio (W/B), curing time (age), the recycled aggregate percentage from the total aggregate in the mixture (RA%), ground granulated blast-furnace slag (GGBFS) material percentage from the total binder used in the mixture (GGBFS%), and superplasticizer (kg). The root mean square error (RMSE) and coefficient of determination (R²) between the observed and forecast strengths were used to evaluate the accuracy of the predictive models. The obtained results indicated that—when compared to the default GBRT model—the GridSearchCV approach can capture more hyperparameters for the GBRT prediction model. Furthermore, the robustness and generalization of the GSC-GBRT model produced notable results, with RMSE and R² values (for the testing phase) of 2.3214 and 0.9612, respectively. The outcomes proved that the suggested GSC-GBRT model is advantageous. Additionally, the significance and contribution of the input factors that affect the compressive strength were explained using the Shapley additive explanation (SHAP) approach.     

Association of dry eye disease with smoking: A systematic review and meta-analysis

There is conflicting evidence for the association between smoking and dry eye disease (DED). We conducted a meta-analysis to determine the true relationship between smoking and DED. A systematic literature search was performed using electronic databases, including PubMed, Embase and Cochrane Library, till August 2021 to identify observational studies with data on smoking as risk factor of DED. Quality assessment of the included studies was conducted using Joanna Briggs Institute (JBI) critical appraisal checklists. The random-effects model was used to calculate the pooled odds ratio (OR). Heterogeneity was evaluated by Cochrane Q and I² index; in addition, subgroup, sensitivity, and meta-regression analyses were performed. Publication bias was assessed using funnel plot and Egger’s regression test. A total of 22 studies (4 cohort and 18 cross-sectional studies) with 160,217 subjects met the inclusion criteria and were included in this meta-analysis. There is no statistically significant relationship between current smokers (OR_adjusted = 1.14; 95% CI: 0.95–1.36; P = 0.15; I² = 84%) and former smokers (OR_adjusted = 1.06; 95% CI: 0.93–1.20; P = 0.38; I² = 26.7%) for the risk of DED. The results remained consistent across various subgroups. No risk of publication bias was detected by funnel plot and Eggers’s test (P > 0.05). No source of heterogeneity was observed in the meta-regression analysis. Our meta-analysis suggest current or former smoking may not be involved in the risk of dry eye disease. Further studies to understand the mechanism of interaction between current smokers and formers smokers with DED are recommended.     

Prevalence,pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir

The aim of this study was to determine specific pattern of port site microbial colonisation, sensitivity and resistance to different antibiotics of bacteria isolated from port site infection (PSI) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir. This is a prospective study. The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory. The positive swab cultures were subjected to antibiotic susceptibility test. The data obtained was analysed by using appropriate statistical analytical tests. The incidence of PSI after elective laparoscopic cholecystectomy is 6·7%. The commonest organism responsible for PSI is pseudomonas, 19 (42·2%) cases. Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital,pseudomonas was found 100% resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem, amikacin and vancomycin in 89·47,57 and 52·63% of cases respectively. Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopiccholecystectomy and will have a great impact on morbidity and mortality in them because of PSI.     

A multi-resolution textural approach to diagnostic neuropathology reporting

Journal of Neuro-Oncology - We present a computer aided diagnostic workflow focusing on two diagnostic branch points in neuropathology (intraoperative consultation and p53 status in tumor biopsy...     

Fracture-avulsion de la tuberosité calcanéenne : à propos d’un cas

An avulsion fracture of the tuberosity of the calcaneus is a very rare, but recognized, occurrence. In the majority of cases, it is accompanied by displacement of the torn fragment, and usually surgery is required to treat the displaced fracture. Basic surgical fixation using foam-type screws is commonly used.We are reporting on a case of an avulsion fracture of the tuberosity of the calcaneus in a male, aged 70. Through this case and a review of the literature discussing its etiology, we are proposing mechanisms and treatment methods for this type of lesion.     

Evolution of drug-resistance genes in Plasmodium falciparum in an area of seasonal malaria transmission in Eastern Sudan

We investigated the evolution of drug-resistant Plasmodium falciparum in a village in eastern Sudan. The frequencies of alleles of 4 genes thought to be determinants of drug resistance were monitored from 1990 through 2001. Changes in frequencies of drug-resistance genes between wet and dry seasons were monitored from 1998 through 2000. Parasites were also typed for 3 putatively neutral microsatellite loci. No significant variation in frequencies was observed for the microsatellite loci over the whole study period or between seasons. However, genes involved in resistance to chloroquine showed consistent, significant increases in frequencies over time (rate of annual increase, 0.027/year for pfcrt and 0.018/year for pfmdr1). Genes involved in resistance to the second-line drug used in the area (Fansidar) remained at low frequencies between 1990 and 1993 but increased dramatically between 1998 and 2000, which is consistent with the advent of Fansidar usage during this period. For mutant alleles of the primary drug-resistance targets for chloroquine and pyrimethamine, higher frequencies were seen during the dry season than during the wet season. This cyclical fluctuation in drug-resistance genes most likely reflects seasonal variation in drug pressure and differences in the fitness of resistant and sensitive parasites.