Аcute paracetamol intoxication

Paracetamol is non-narcotic analgesic and antipyretic of the central action from group of anilides, widely used in clinical practice. This drug has pronounced hepatotoxic effect which amplifies with alcohol. Paracetamol intoxication most frequently happens as a result of deliberate peroral intake of excessive doses of drug with a suicidal purpose. Undeliberate medicine poisoning is possible as a result of self-treatment.

Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high-grade hydronephrosis

Percutaneous nephrostomy (PCNL) and retrograde intrarenal surgery (RIRS) are the two main treatments for upper urinary tract stones. The aim of our study was to compare the effectiveness and safety of standard PCNL (S-PCNL) and RIRS for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. The study included 118 patients who underwent surgery for stones at ureteropelvic junction. S-PCNL and RIRS were performed on 66 and 52 patients, respectively. Patient age, sex, body mass index (BMI), stone side, history of urinary tract infection (UTI), history of diabetes, history of ESWL, stone size, Hounsfield unit (HU) values of stones, grade of hydronephrosis, operating time, postoperative hemoglobin loss, narcotic analgesic use, postoperative transfusion rates, stone-free rates (SFRs), length of hospital stay, complication rates and number of secondary interventions were recorded. The comparison of the operative data between the two groups revealed no statistically significant differences in the operative time, SFRs, narcotic analgesic use, postoperative transfusion rate or other postoperative complications defined according to the Clavien system (P > 0.05). The postoperative urinary sepsis rate in the RIRS group was as high as 15.4%, which was much higher than the 1.5% rate observed in the S-PCNL group, and the difference was statistically significant (P < 0.05). A total of 13.5% of the patients in the RIRS group required a second operation due to failure of the placement of the ureteral access sheath. Additionally, S-PCNL had an advantage in operation time, while RIRS in duration of hospital stay and postoperative hemoglobin loss. RIRS and S-PCNL were safe and effective methods for the treatment of stones at ureteropelvic junction with high-grade hydronephrosis. Importantly, S-PCNL had more advantages in terms of the postoperative urinary sepsis rate and secondary surgery rate.

Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair

Background: Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes. Purpose: To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use. Study Design: Case-control study; Level of evidence, 3. Methods: We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores. Results: Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration ( P = .007), smoking status ( P = .001), degree of fatty degeneration ( P = .009), preoperative narcotic analgesic use ( P < .001), preoperative DN4 and ASES scores, 30-day VAS score ( P < .001), duration of opioid and nonopioid analgesic use ( P < .001), tear size ( P = .026), and retraction stage ( P = .032). Tear size ( P = .009), retraction amount ( P = .005), preoperative narcotic analgesic use ( P < .001), degree of fatty degeneration ( P < .001), and preoperative DN4 score ( P = .024) were factors independently associated with prolonged postoperative pain and analgesic use. Conclusion: Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.

Uji Aktivitas Analgetik Ekstrak Etanol Daun Inggu (Ruta angustifolia [l.] Pers) Pada Tikus Putih Jantan

Pain is an uncomfortable feeling caused by strong or destructive stimulation, if unchecked can affect daily routine. This study aims to determine the analgesic effect and dosage of the leaf extract ethanol, as well as to determine the effectiveness of the leaf extract ethanol as a narcotic analgesic by the Tail Flick method or as a non-narcotic analgesic by the Paw Pressure Test Randall Selitto method. Extraction was done by maceration of leaf powder with a solvent 96% ethanol. 25 male Wistar white rats were divided into 5 groups, positive group mefenamic acid 9 mg /200 g BW for the Paw Pressure Test Randall Selitto Method and tramadol 0.9 mg /200 g BW for the Tail Flick Method, negative control CMC Na 0,5%, ethanol extract leaves inggu leaves a dose of 10 mg /200 g BW, 20 mg /200 g BW and 40 mg /200 g BW. The data obtained were analyzed by ANOVA test, then LSD test was used to determine differences between groups. The results showed extract dosage of 10 mg /200 g BW, 20 mg /200 g BW, 40 mg /200 g BW had analgesic effect. Extract dosage of 20 mg /200 g BW and 40 mg /200 g BW in the Randall selitto Paw Pressure Test method is equivalent to mefenamic acid, extract dose 10 mg /200 g BW, 20 mg /200 g BW, and 40 mg /200 g BW the Tail Flick method is equivalent to Tramadol. Ethanol leaf extract is more effective as a narcotic analgesic by the Tail Flick method.

PERIOPERATIVE ANESTHESIA: TO DO OR NOT TO DO?

Introduction. In patients with chronic loco-motor system diseases the pain often persists after arthroplasty and does not respond to symptomatic therapy.Purpose of study: to evaluate the efficacy of perioperative use of Meloxicam in patients after hip arthroplasty. Patients and methods. The follow-up covered 120 patients (mean age 64.4±5.23 years) after hip arthroplasty. In the main group (n=60) Meloxicam was given 7 days prior to and 3 weeks after surgery; after intervention narcotic analgesic was used on the request. In control group (n=60) the patients were only on narcotic analgesic on request after operation. Treatment results were assessed by 100-millimeter visual analog scale (VAS) and D’Aubigné-Postel Score.Results. Seven days before the surgery the pain severity in the main and control groups was comparable: 85±2.3 and 84±2.1, respectively. In 2 days after operation the pain relief was more pronounced in the main group — 69±2.1 mm versus 82±3.4 mm in the control group (p0.05). In 3 months those indices made up 10±2.1 and 35±12.6 mm (p0.001), respectively. In the main group the result was assessed as the excellent and good in 22 patients, in the rest of patients as satisfactory by d’Aubigné-Postel Score. In the control group the good result was recorded in 9, satisfactory — in 47 and poor — in 4 cases.Conclusion. Meloxicam may be considered as an effective perioperative analgesic in large joints arthroplasty.