Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia - a prospective, observational study

Background Pain relief in the prehospital setting is often insufficient, as the administration of potent intravenous analgesic drugs is mostly reserved to physicians. In Australia, inhaled methoxyflurane has been in routine use by paramedics for decades, but experience in Central European countries is lacking. Thus, we aimed to assess whether user friendliness and effectiveness of inhaled methoxyflurane as sole analgesic match the specific capabilities of local ground and air-based EMS systems in Austria. Methods Observational study in adult trauma patients (e.g. dislocations, fracture or low back pain following minor trauma) with moderate to severe pain (numeric rating scale [NRS] ≥4). Included patients received a Penthrop® inhaler containing 3 mL of methoxyflurane (maximum use 30 min). When pain relief was considered insufficient (NRS reduction < 3 after 10 min), intravenous analgesics were administered by an emergency physician. The primary endpoint was effectiveness of methoxyflurane as sole analgesic for transport of patients. Secondary endpoints were user friendliness (EMS personell), time to pain relief, vital parameters, side effects, and satisfaction of patients. Results Median numeric pain rating was 8.0 (7.0–8.0) in 109 patients. Sufficient analgesia (reduction of NRS ≥3) was achieved by inhaled methoxyflurane alone in 67 patients (61%). The analgesic effect was progressively better with increasing age. Side effects were frequent (n = 58, 53%) but mild. User satisfaction was scored as very good when pain relief was sufficient, but fair in patients without benefit. Technical problems were observed in 16 cases (14.7%), mainly related to filling of the inhaler. In every fifth use, the fruity smell of methoxyflurane was experienced as unpleasant. No negative effects on vital signs were observed. Conclusion In prehospital use, inhaled methoxyflurane as sole analgesic is effective for transport of trauma patients (62%) with moderate to severe pain. Older patients benefit especially from inhaled methoxyflurane. Side effects are mild and vital parameters unaffected. Thus, inhaled methoxyflurane could be a valuable device for non-physician EMS personnel rescue services also in the central Europe region.

Complications after Stapled Hemorrhoidectomy: A Single Center Experience

Background: A circumferential strip of mucosa about 1.5 to 2 centimetres above the dentate line is removed in stapled hemorrhoidectomy, a new technique for haemorrhoids treatments. Objective: The aim of the study was to evaluate complications after stapled hemorrhoidectomy.Methods:A total of 101 patients between the age group 20 to 70 years were diagnosed with grade 3 and grade 4 haemorrhoids. Patients are included in stapled haemorrhoidectomy. The questionnaire focused on stapled hemorrhoidectomy procedures performed in the period July 2018 to June 2020. Descriptive analysis was done based on the student’s T-test using SPSS 24 software version. The level of significance was set at 5% (p < 0.05).Results:In the 2-years timeframe, out of 101 patients in the Immediate (within 1 week) complications of stapled hemorrhoidectomy, 84.16% were in None, 5.94% were severe pain, 3.96% were bleeding, 1.98% were Thrombosis, 0.99% were urinary retention, 1.98% were Anastomotic dehiscence 0.99% were Fissure, 0.99% were perineal intramural hematoma and 0.99% were submucosal abscess. Out of 90.09% were in none, 1.98% were Recurrent hemorrhoids, 0.99% were Severe pain, Stenosis, Fissure, Skin tag, Thrombosis, Staples problems, Intramural abscess and Intussusception.Conclusion:Although stapled hemorrhoidectomy appears to be promising, we believe that a multicenter randomized controlled trial with a long-term follow-up comparing stapled hemorrhoidectomy and banding is required before the treatment can be recommended. The majority of difficulties can be avoided by following the rectal wall anatomy during the surgery.

HIPERTENSÃO OCULAR SECUNDÁRIA À LUXAÇÃO DE CRISTALINO PARA CÂMARA ANTERIOR NA SÍNDROME DE MARFAN

Marfan syndrome (MFS) is a rare autosomal dominant metabolic disorder, caused by mutations in the gene responsible for coding the fibrillin-1 protein. It is characterized by cardiovascular, musculoskeletal and ocular manifestations. The purpose of this report was to present a rare ophthalmologic complication in a patient with MFS. Female, 51 years old, attended the emergency room complaining of severe pain, low visual acuity and hyperemia in the right eye, started two days before. Biomicroscopy: ectopia lentis (luxated) for anterior chamber; Tonometry: 56 mmHg. Hypotensive drugs were prescribed which reduced intraocular pressure (IOP) to 8 mmHg. Referred for emergency surgery (facectomy without IOL implantation) in order to avoid further damage to the cornea and optic nerve. In the post operative period, presented IOP control and improved VA to 20/50. Multidisciplinary follow-up is necessary in patients with MFS, enabling early diagnosis, which can prevent and minimize any complications.

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Background The aim of this prospective study was to assess the incidence of complex regional pain syndrome type I (CRPS I) in patients with scaphoid waist fracture and to explore associated factors. Methods This was a multicenter, prospective observational study. Demographic, imaging indicators and clinical data were collected before the conservative treatment of scaphoid waist fracture patients. The occurrence of CRPS I and pain condition were the main outcomes. To explore the factors associated with CRPS I, multivariate logistic regression model was used. Results A total of 493 scaphoid waist fracture participants undergoing conservative treatment were recruited for this study. The incidence of CRPS I was 20% (n = 87). The average time between injury and the onset of CRPS I was 6.7 ± 2.1 weeks. Multivariable logistic regression analysis revealed that female sex (odds ratio (OR): 1.669; 95% confidence interval (CI): 1.189–2.338), diabetes mellitus (OR: 3.206; 95% CI: 2.284–4.492), and severe pain condition before treatment (visual analog scale (VAS) score more than 4 cm) (OR: 27.966; 95% CI: 19.924–39.187) were independently associated with CRPS I. Conclusions Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. Early screening and regular follow up evaluation are recommended in these patients.

النظام الجنائي الإسلامي و طرق الحماية من جرائم إشانة السمعة : دراسة مقارنة بما عليه العمل من القوانين الجنائية المعاصرة

النظام الجنائي الإسلامي و طرق الحماية من جرائم إشانة السمعة : دراسة مقارنة بما عليه العمل من القوانين الجنائية المعاصرة slam aims of protecting people honour and keeping their fame and dignity and for this reasin it silences ill mannered people and those who seek shme for innocent people . It prtvents these ill mannered people from injuring people feelings and staining their honour. and it seriously prohibilty propagate indecent among the belivers so that life could be vilrluos and free of this evil for this, Islam prohibits compelty and considers it as one are of the greatest sins and indecent and the person doing this is deemed to curse . dissolute and banishment from Allah's mercy and he deserves severe pain in this world and the hereafter. The subject is tackled in to themes : 1. Definition of defaming crime and explaining its elements in Islam and its legal punishment. 2. Definition of disgrace and its punishment in the criminal legislations. It concludes with the important findings and recommendations

Development and assessment of a knitted shape memory alloy-based multifunctional elbow brace

Osteoarthritis is a chronic disease that affects joint cartilage and can cause severe pain and disability. Minor neglected injuries may also result in other diseases that affect daily life. Various attempts have been made to develop wearable auxiliary devices using functional fabrics, but few have simultaneously provided both heat and pressure. Using knitted shape memory alloy (SMA) fabric, a module was manufactured that achieved bending and contraction during operation. An elbow brace that simultaneously provided heat and pressure was developed using this module. Subjective evaluation and measurements of the range of motion (ROM), changes in skin temperature ( T sk ), clothing pressure ( P c), and blood flow ( F b) were conducted on the elbow brace while being worn by 10 participants. The multifunctional elbow brace (MFEB) developed in this study generated pressure and heat that increased T sk and P c, ultimately increasing F b. In addition, the ROM of the elbow joint was increased after actuating the elbow brace. Subjective evaluation of the heat and pressure sensation demonstrated its applicability to the human body. We confirmed that the elbow brace had a positive effect on F b and increased the ROM of the joint. These results show the applicability of smart textiles to the development of various wearable devices.

Trial Assay for Safe First-Aid Protocol for the Stinging Sea Anemone Anemonia viridis (Cnidaria: Anthozoa) and a Severe Toxic Reaction

Anemonia viridis is an abundant and widely distributed temperate sea anemone that can form dense congregations of individuals. Despite the potential severity of its sting, few detailed cases have been reported. We report a case of a severe toxic reaction following an A. viridis sting in a 35-year-old oceanographer. She developed severe pain, itching, redness, and burning sensation, which worsened one week after treatment with anti-inflammatories, antihistamines and corticosteroids. Prompted by this event, and due to the insufficient risk prevention, lack of training for marine-environment users, and lack of research into sting-specific first-aid protocols, we evaluated the cnidocyst response to five different compounds commonly recommended as rinse solutions in first-aid protocols (seawater, vinegar, ammonia, baking soda, and freshwater) by means of the Tentacle Solution Assay. Vinegar and ammonia triggered an immediate and massive cnidocyst discharge after their application and were classified as activator solutions. Baking soda and freshwater were also classified as activator solutions, although with a lower intensity of discharge. Only seawater was classified as a neutral solution and therefore recommended as a rinse solution after A. viridis sting, at least until an inhibitory solution is discovered.

Prime Editor-mediated Correction of a Pathogenic Mutation in Purebred Dogs

Canine hip dysplasia (HD) is a multifactorial disease caused by interactions between genetic and environmental factors. HD, which mainly occurs in medium- to large-sized dogs, is a disease that causes severe pain and requires surgical intervention. However, the procedure is not straight-forward, and the only way to ameliorate the situation is to exclude individual dogs with HD from breeding programs. Recently, prime editing (PE), a novel genome editing tool based on the CRISPR-Cas9 system, has been developed and validated in plants and mice. In this study, we successfully corrected a mutation related to HD in Labrador retriever dogs for the first time. We collected cells from a dog diagnosed with HD, corrected the mutation using PE, and generated mutation-corrected dogs by somatic cell nuclear transfer. The results indicate that PE technology can potentially be used as a platform to correct genetic defects in dogs.

Literature Review : Gambaran Tingkat Nyeri Pada Remaja yang Menstruasi

The period of growth in adolescents is characterized by physical and psychological changes. Girls will experience menstruation and the impact that often occurs is dysmenorrhea (menstrual pain). Dysmenorrhea causes mood disorders in adolescents which will reduce learning motivation. In early adolescents who need adaption, their mental is needed to be ready for the changes which physically and psychologically related to dysmenorrhea. His study aimed to determine the level of pain in adolescents who menstruate. He method used in this research was descriptive with a litetarute review approach. The articles were published in 2011-2021 on Garba Garuda or PubMed. The result obtained according to the inclusion and exclusion criteria were then analyzed using the JBI (Joanna Briggs Institute) instrument. The result of study of the 5 articles with a total of 1,807 respondents showed that the level of menstrual pain was 27,6% mild pain, 37,2% moderate pain, and 35,2% severe pain. The number of adolescents who have moderate pain levels is more that those with mild and severe pain levelsKeywords: adolescents, dysmenorrhea, menstrual pain AbstrakMasa pertumbuhan pada anak remaja ditandai dengan perubahan fisik dan psikologis. Pada anak perempuan akan mengalami menstruasi dan dampak yang sering terjadi yaitu dismenorea (nyeri haid). Dismenorea menyebabkan gangguan mood pada remaja yang akan menurunkan motivasi belajar. Pada remaja awal yang membutuhkan adaptasi sehingga perlu kesiapan mental mengenai perubahan yang dialami secara fisik dan psikologis terkait dismenorea. Penelitian bertujuan untuk mengetahui gambaran tingkat nyeri pada remaja yang menstruasi. Metode yang digunakan pada penelitian ini adalah deskriptif dengan pendekatan literature review, pencarian artikel pada rentang waktu 10 tahun yaitu dari 2011-2021 melalui penelusuran didapatkan 4 artikel melalui Garba Garuda dan 1 artikel melalui PubMed. Hasil pencarian sesuai dengan kriteria inklusi dan eksklusi kemudian dianalisa menggunakan instrument JBI (Joanna Briggs Institute), kemudian diolah menggunakan uji Chi-Square dan tidak memenuhi syarat sehingga dilanjutkan menggunakan uji Mann-Whitney. Hasil penelitian dari ke-5 artikel dengan total responden 1.807 menunjukkan bahwa tingkat nyeri haid yaitu 27,6% nyeri ringan, 37,2% nyeri sedang, dan 35,2% nyeri berat. Dari ke-5 artikel yang telah dianalisa menunjukkan bahwa remaja putri yang berada pada tingkat nyeri sedang lebih banyak dibanding dengan tingkat nyeri ringan dan beratKata kunci: dismenore, nyeri menstruasi, remaja