The Effect of Premedication with Curcumin on Post-Operative Pain in Single Visit Endodontic Treatment of Acute Pulpitis in Mandibular Molars: A Randomized Controlled Trial

Objective: The purpose of this randomized double-blind clinical trial was to compare the effect of a single pretreatment dose of Curcumin and placebo on post-operative pain for patients diagnosed with symptomatic irreversible pulpitis in mandibular molars treated in single visit. Methods: Forty-four patients with severe to moderate pain randomly received either Curcumin (400mg +20 mg pepper) or placebo (420 mg Starch) one hour before starting root canal treatment (n = 22 per group). Participants rated their pain using visual analogue pain scale (VAS): preoperatively and at 5 time points: immediately post-operative, 8, 12, 24 and 48 hours postoperative. Patients also stated emergency analgesic intake. The need for supplemental anesthesia during treatment was recorded. Mann-Whitney U-test compared the two groups at each time point, while Repeated-Measure ANOVA and Wilcoxon Signed Rank test compared time points within each group. A p-value <0.05 was considered statistically significant. Results: Baseline characteristics of both groups showed non-significant differences (P > 05). Curcumin group at 8, 12 and 24 hours revealed statistically significantly less VAS values (44.2, 26.7, 19.1) than the placebo (58.5, 43.3, 30.3), respectively, (P > 05). All patients in Curcumin group did not need emergency analgesics. Curcumin group revealed statistically significantly lower percentages for the need of supplemental anesthesia (27.3%) compared to placebo (68.2%), (P < 05). Conclusion: Single preoperative oral dose of Curcumin proved to be an effective premedication that reduced post-operative pain as well as the need of supplemental anesthesia for patients diagnosed with symptomatic irreversible pulpitis of mandibular molars.

Evaluation of the clinical-radiographic results of patients undergoing arthroscopic metatarsal-phalangeal arthrodesis of the hallux

Introduction: Hallux rigidus (HR) is a frequent pathological condition of the foot, responsible for marked functional impairment. Metatarsal-phalangeal arthrodesis is an excellent treatment alternative for advanced stages of the disease, usually performed as an open surgery. Forefoot arthroscopy had its greatest development in the last decade, with a progressive expansion of indications, yielding encouraging results. Objective: To present the clinical and radiographic results of patients undergoing arthroscopic metatarsal-phalangeal arthrodesis of the hallux, depicting the technique and reporting complications. Methods: This study involves a series of cases, we operated 9 patients (10 feet), all with advanced HR (grades 3 and 4 - Coughlin-Shurnas). The patients underwent an arthroscopic procedure through two dorsal portals, small joints instruments. We assessed the results using the AOFAS functional score and the visual analogue pain scale. The radiographic parameters we used to analyze were the metatarsal-phalangeal angulation in the anteroposterior (pre- and postoperative) and lateral (post-operative) views, and we measured the radius shortening. Conclusion: Arthroscopic metatarsal-phalangeal arthrodesis is an excellent treatment option in advanced stages of hallux rigidus, with minimal disruption and providing excellent results, in addition to a low incidence of complications. Level of Evidence IV; Therapeutic Studies; Case Series

ADHESIVE CAPSULITIS; MANAGEMENT BY PHYSIOTHERAPY VERSUS INTRA-ARTICULAR CORTICOSTEROID INJECTION

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale. Study Design: Comparative prospective study. Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021. Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale. Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p<0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p>0.05). Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.

EndoTech® minimally invasive trigger thumb release

We describe a novel minimally invasive technique for the treatment of trigger thumb. 37 patients with a total of 41 thumbs were included in the study. A visual analogue pain scale was used before surgery and also at 2 week and 6 month follow up visits. The pain was significantly improved from a pre op of 7.92 (+/- 1.6) to .65 (+/- .8) at the 2 week follow up and finally .29 (+/- 1.8) at the 6 month follow up. All of the patients had relief of triggering and only 1 patient required any therapy. This endoscopic technique for trigger thumb allows the surgeon to perform a trigger release with a minimal incision and provides excellent relief without any complications.

Management of Pain with Morphine in cancer patients in a Tertiary Care Centre of Nepal

Pain is one of the most afflicting symptoms reported by cancer patients, mainly those with metastatic disease. The prevalence of cancer has increased, with an estimated projection of 17 million new cases in 2020. This means that there will be an increase in individuals with pain caused by the disease and by treatment. Morphine has been used to relieve pain in cancer patients for centuries. WHO, created a global health policy document for management of cancer pain entitled “Cancer Pain Relive,1 in which morphine was central. In a retrospective study of 1229 patients with cancer pain, the author reported that the analgesic ladder was effective in 71%. Many patients do not get adequate pain relief. Rationale of this study was to assess cancer related pain by using visual analogue pain scale and to prescribe optimal dose of morphine through dose titration to relieve pain and to improve quality of life. An interventional hospital-based study was done in fifty-two different types of cancer patients from 1st Jan, 2020 to 31st Dec, 2020 at Department of Oncology, Nepal Medical college and Teaching Hospital (NMCTH), Kathmandu. Among them 31 were male and 21 were female with mean age 63.87 and 58.19 respectively and SD +/- 12.10 in male and 16.07 in female with p value 0.152 significant. These patients were assessed for severity of pain through visual pain analogue. Improvement in daily activities after administration of morphine according to ECOG performance scale was done. Constipation was the most common complication induced by morphine 38.5%, sedation 32.7% and nausea in 25%. By understanding the context and social meaning surrounding the use of morphine to treat cancer pain, health care professionals can begin to anticipate, acknowledge and address some of the barrier to its use, thereby enhancing the pain control.

Effects of silodosin, darifenacin, and combination therapy for the treatment of ureteral stent related discomforts

Background: To evaluate the effect of silodosin, darifenacin and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents.Methods: A total of 150 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (4 Fr and length 26 cm), which were removed at a mean of around 14 days postoperatively. A total of 40 patients were given no medication (group 1), 39 patients were given silodosin 4 mg once daily (group 2), 40 patients were given darifenacin 7.5 mg once daily (group 3), and 31 patients were given a combination of two agents postoperatively (group 4). International prostate symptom score (IPSS) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1st day postoperatively and on the day of stent removal.Results: In the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the quality of life (QoL) score.Conclusions: Combination therapy with silodosin and darifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.

Catastrophization is related to the patient and not to the severity of migraine

ABSTRACT Background: Catastrophization is a psychological aspect of pain that alters its perception and expression. Objective: To investigate the feature of catastrophization in migraine. Methods: An online survey of individuals suffering from migraine attacks at least twice a month, for at least one year was carried out. Confidentiality was assured and participants gave details of their headache (including a visual analogue pain scale) and answered the Hospital Anxiety and Depression Scale and the Catastrophization Scale questionnaires. Results: The survey included 242 individuals with migraine attacks at least twice a month. The median scores observed in this group of individuals were 7 for pain, 11 for anxiety, 7 for depression, and 2 for catastrophization. Catastrophization had no correlation with the duration (p=0.78) or intensity (p=0.79) of the migraine. There was no correlation between catastrophization and headache frequency (p=0.91) or the monthly amount of headache medication taken (p=0.85). High scores for catastrophization (≥3.0) were identified in one third of the participants. These high scores were not associated with age, headache duration, pain severity, frequency of attacks, or traits of depression or anxiety. There was a moderate association between both depression and anxiety traits with catastrophization. Conclusions: Catastrophization seems to be a trait of the individual and appears to be unrelated to the characteristics of the migraine.

Late follow-up of peripheral neural decompression in leprosy: functional and clinical outcomes

ABSTRACT Background: Peripheral neural surgical decompression (PNSD) is used as a complementary therapy to the clinical treatment of neuritis to preserve neural function. Objective: To evaluate the long-term (≥ 1 year) clinical and functional results for PNSD in leprosy neuritis. Methods: This cross-sectional study included leprosy patients who were in late postoperative period (LPO) of surgical decompression of ulnar, median, tibial, and fibular nerves. Socioeconomic, epidemiological, and clinical data were collected. The following instruments were used in this evaluation: visual analogue pain scale (VAS), Douleur Neuropathique en 4 Questions (DN4), SALSA scale, and simplified neurological assessment protocol. The preoperative (PrO) and 180-day postoperative (PO180) results were compared. Results: We evaluated 246 nerves from 90 patients: 56.6% were on multidrug therapy (MDT) and 43.3% discharged from MDT. Motor scores and pain intensity showed statistically significant improvement (p<0.01). There was an increase in sensory scores only for bilateral ulnar nerves (p<0.05). Of the operated cases, 26.0% of patients were referred for surgery of ulnar neuritis and 23.6% of tibial neuritis. Neuropathic pain was reported in 41% of cases. Daily dose of prednisone reduced from 39.6 mg (±3.0) in PrO, 16.3 mg (±5.2) in PO180, to 1.7 mg (±0.8) in LPO. The SALSA scale results showed mild activity limitation in 51% and moderate in 34% of patients. Eighty percent of individuals reported that the results reached their expectations. Conclusions: PNSD in leprosy was effective in the long term to decrease the prevalence and intensity of pain, improve motor function, and reduce the dose of corticosteroids, which is reflected in the patients’ satisfaction.

The role of herbal preparations in lithokinetic therapy and metaphylaxis of urolithiasis

Relevance. Urolithiasis is still one of the most widespread and actively progressing diseases. The high incidence of complications from taking chemical drugs has become the main reason for the change in attitudes towards herbal medicines, and now the treatment with herbal medicines is returning again, revealing its benefits based on evidence-based medicine. Phytochemicals have a positive effect on the gut microbiome and are widely used to prevent and treat obesity, liver, intestinal and inflammatory diseases. Materials and methods. The study involved 100 patients with a verified diagnosis of urolithiasis aged 25 to 78 years. The first group included 30 patients who underwent 1-2 sessions of extracorporeal lithotripsy (EBL) or percutaneous nephrolithotripsy (PCNL) for kidney stones up to 20 mm in size. The second group included 70 patients who were diagnosed with calculus during outpatient examination based on ultrasound and X-ray examinations. Each patient group was randomly divided into 2 subgroups. Patients of the subgroup A - A1 and A2 received standard lithokinetic therapy - α-blockers, antispasmodics, adherence to daily urine output of at least 2 liters per day, if necessary, analgesic therapy with non-steroidal anti-inflammatory drugs. Patients of the subgroup B - B1 and B2 received a similar therapy with the addition of dietary supplements Nereus . During the observation period, an assessment of daily diuresis, fluctuations in the pH level of urine, clinical and laboratory studies of biochemical parameters of blood and daily urine, general clinical blood and urine tests, urine culture for flora and the degree of bacteriuria were carried out. To assess the severity of the pain symptom, a 10-point visual analogue pain scale (VAS) was used. Re-examination was performed after 1 and 3 months of treatment. Results. The use of the combined herbal preparation Nereus in lithokinetic therapy and metaphylaxis of urolithiasis reduces the need for analgesic and antispasmodic therapy, promotes an increase in urine output by 37%, maintains urine pH at physiological values, effectively reduces the level of leukocyturia and bacteriuria, accelerates the passage of stones and their fragments from various parts of the urinary tract. In all patients who took the herbal preparation Nereus , there were no undesirable or side effects affecting the quality of life of patients. Conclusions. The study of the efficacy and safety of the drug Nereus in lithokinetic therapy and metaphylaxis of urolithiasis showed a significant effect of the phytocomplex on increasing urine output, eliminating the infectious-inflammatory process and passing stones from the urinary tract, good tolerance and absence of side effects.

Effect of Posterior Bite Raiser on Periodontium of Lower Molars in Orthodontic Patients

BACKGROUND Temporary bite opening with occlusal composite is performed routinely during orthodontic treatment of patients with deep bite and cross bite. There have been no studies yet to assess its effect on periodontium. This study was done to assess the effect of temporary bite-raising on periodontium when placed on the mandibular molars. METHODS A prospective clinical trial which was a pilot study conducted on fifteen subjects attending the Department of Orthodontics, Saveetha Dental College and Hospitals, (SIMATS), Chennai. Probing depth and pain score on percussion were recorded bilaterally on subjects with class 1 malocclusion, before and after placing bite blocks in the posterior teeth. The bite-raising was done using light cured orthodontic composite Blu BiteTM on both mandibular first molars. Probing depth was measured using a Williams probe at mesiobuccal, mid-buccal and distobuccal sites on molars and pain score on percussion was recorded using visual analogue scale. The pocket probing, before (T0) and after one month of temporary bite-raising (T1) was recorded and statistically analysed using paired t test and Wilcoxon sign rank test based on normality of variables. RESULTS There was a significant increase in the mean probing depth after bite raising with a mean difference of 1.07 ± 0.04 (P = 0.000). The mean pain score also significantly increased after temporary bite-raising (P = 0.002). CONCLUSIONS There were minor yet significant changes in the periodontium that occurred after temporary bite rising with Blu BiteTM. KEY WORDS Composite Resin, Periodontium, Occlusal Force, Orthodontic Adhesive, Visual Analogue Pain Scale