Topical analgesia following excisional haemorrhoidectomy: a systematic review and meta-analysis of randomised controlled trials

International Journal of Colorectal Disease - Post-operative pain following excisional haemorrhoidectomy poses a particular challenge for patient recovery, as well as a burden on hospital...     

Stereological evaluation of fibronectin in the periurethral region of the transitional zone from normal human prostates compared with benign prostatic hyperplasia

The aim of this study was to assess the volumetric density (Vv) of the fibronectin in the periurethral region of patients with benign prostatic hyperplasia (BPH) and compare with a control group. Prostatic periurethral tissue samples were obtained from ten patients (age range 65 to 79 years, mean 66) with clinical symptoms of bladder outlet obstruction who had undergone open prostatectomy. The control group samples (periurethral tissue samples from the transitional zone) were collected from prostates obtained during autopsy of accidental death adults of less than 25 years. The volumetric density (Vv) of the fibronectin was determined with stereological methods from 25 random fields per sample using the point-count method with an M-42 grid test system. The quantitative data were analyzed using the Kolmogorov-Smirnov and Mann-Whitney U tests. The Vv in the control and BPH groups was 21.9% ± 1.5% and 29.1 % ± 1.2% in the fibronectin, respectively. BPH tissues presented a significant increase of fibronectin in prostatic periurethral region in the transitional zone that may cause lengthening of the prostatic urethra.     

Organization of the fibrous connective tissue of the fallopian tubes in fertile and climacteric periods: a scanning electron microscopic and stereologic study

The extracellular matrix (ECM) of the fallopian tubes is subject to several changes due to hormonal influences and aging. However, there is a lack of studies regarding its arrangement in older women. We aimed to analyze the organization of ECMcomponents, including collagen and elastic fibers, in the fallopian tube’s ampulla from young and old women by means of scanning electron microscopical and stereological methods. Twenty-one samples were analyzed: 12 from female cadavers in a fertile age (G1) and 9 from the climacteric period (G2). Masson’s trichrome stain was used to observe collagen and smooth muscle, while Weigert’s Fuchsin-Resorcin was employed to observe elastic fibers. Statistical analysis was performed by the Wilcoxon-Mann-Whitney test with the aid ofthe R^© software. The tissue was also fixed for scanning electron microscopic analysis in a modified Karnovsky solution and the three-dimensional organization of fibrous connective tissue was observed and compared. Statistically significant differences (P < 0.01) were found in all stereologic comparisons of the extracellular matrix between the groups, which revealed a higher volumetric density of the fibrous tissue in the climacteric group. Scanning electron microscopy showed degenerative alterations of extracellular matrix. According to our results, aging caused significant changes to the elements of the extracellular matrix and the smooth muscle of the fallopian tubes.     

Intravenous Local Anaesthetic Compared with Intraperitoneal Local Anaesthetic in Abdominal Surgery: A Systematic Review

Introduction

Modern perioperative care strategies aim to optimise perioperative care by reducing the body’s stress response to surgery. A major facet of optimising an abdominal surgery analgesia programme is using a multimodal opioid sparing approach. Local anaesthetics have shown promise and there has been considerable research into the most effective route for their administration. This review aims to determine if there is a difference in analgesic efficacy between intraperitoneal local anaesthetic (IPLA) and intravenous local anaesthetic (IVLA).

Materials and Methodology

In concordance with the PRISMA statement, a literature search was conducted to identify randomised control trials that compared IVLA with IPLA in abdominal surgery. The primary outcomes of interest were opioid analgesia requirements and pain score assessed by visual analogue score. Data were extracted and entered into pre-designed electronic spreadsheets.

Results

This review has identified six papers that compared intravenous lignocaine to intraperitoneal lignocaine. This review showed significantly lower morphine consumption at 4 and 24 h in the intraperitoneal group. There was no significant difference in pain scores.

Conclusion

From the analysis of these studies, intraperitoneal local anaesthetic had an analgesic benefit over intravenous lignocaine with regard to decreased opioid consumption for abdominal surgery. Further research investigating IVL combined with intraperitoneal local anaesthetic is warranted.

     

Key Indicators of the Transition from Social to Problem Gambling

At the International Gambling Conference: Policy, Practice and Research in 2004 (Clarke, eCommunity-International Journal of Mental Health and Addiction, 3:29–40, 2005), a paper was presented which proposed key indicators of the transition from social to problem gambling and to recovery, based on a review of literature on factors leading to substance abuse. They included availability of gambling activities, lack of social and cultural empowerment, low socioeconomic status, and personal loss of control. Subsequently, a multidisciplinary team collected data on why people gamble. Four New Zealand ethnic groups (Päkehä/New Zealand European, Mäori, Pacific peoples and Asians) in South Auckland were targeted for both phases of the study. Phase 1 involved qualitative analysis of data from individual interviews and focus groups. Phase 2 surveyed 345 adults using a questionnaire developed from the first phase. From both phases, key indicators for problem gambling were similar to the indicators for substance abuse. Public health interventions such as reducing access to electronic gaming machines and empowerment of cultural groups, and a longitudinal study of the development of gambling in the community are suggested.     

Antibiotic resistance in wastewater: origins,fate, and risks

Antimicrobial resistance is increasing worldwide and threatens our capacity to treat infectious diseases. Recently, special attention has been given to the environment in the cycling of antibiotic resistance from and to humans. In urban areas, wastewater treatment plants represent a critical point of resistance propagation, since the discharge of domestic, hospital, and industrial effluents into municipal collectors mixes together human commensal, pathogenic, and environmental bacteria and high loads of antibiotic residues. Today we observe that wastewater bacteria have a high prevalence of resistance to antibiotics used in the last few decades. In parallel, resistance determinants recently detected in clinical settings are regularly observed in wastewater, suggesting a rapid propagation to the environment. The residues of antimicrobial compounds and some heavy metals play an important role in the propagation of resistance, not only during wastewater treatment but also after the discharge into the environment. Currently, it is not possible to estimate the probability of resistant bacteria or genes reaching humans, but direct transmission seems highly unlikely. However, the contamination of surface water and soil may represent a source of transmission to humans, via the food chain, drinking water, or leisure activities.     

Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.