To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH).
Systematic review and meta-analysis of randomized controlled trials.
...Not applicable.
Patients undergoing diagnostic OH received tramadol versus those who were administered placebo.
Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic).
Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure.
One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n = 209; placebo: n = 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference WMD = -1.33; 95% confidence interval CI -1.78 to -0.88, I
= 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = -1.05; 95% CI -1.49 to -0.61, I
= 0, P = .84) and 30 minutes after (WMD = -0.98; 95% CI -1.30 to -0.65, I
= 0, P = .88).
This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.
The study sought to identify parental trends in children's self-medication, health-seeking behavior, knowledge of self-medication, antibiotic use, and antimicrobial resistance in Asir, Saudi Arabia.
...A web-based cross-sectional study was carried out by a survey questionnaire. Snow Ball sampling technique was used to select the Eight hundred and sixteen parents with children in the Asir region by WhatsApp and email, and 650 participants who met the inclusion criteria consented to participate in the study.
There were 1809 episodes of childhood illnesses reported during the study period. The mean scores are on knowledge at 8.11 ± 2.43, favorable attitude at 17.60 ± 1.17, and practice was 7.72 ± 1.72, and a significant correlation was found between knowledge, attitude, and practice (KAP) at p = 0.01. Out of 624, the majority of parents showed strong knowledge and proficiency in antibiotics. However, the attitude scores of over 50% towards the usage of antibiotics were subpar. Around 54% of parents were self-medicating their children and 43% were unaware that skipping doses contributes to anti-microbial resistance (AMR). The facilitators for self-medication were male gender (aOR: 2.13; 95% CI: 1.26–3.98,p < 0.05), having more children (aOR: 2.78; 95% CI: 1.27–4.12p < 0.01), professional qualification (aOR:3.07; 95% CI 1.57– 4.68; p < 0.01), residing in urban area (aOR: 3.17; 95% CI: 2.13–5.61,p < 0.05), working in health care (aOR: 5.99; 95% CI: 1.78–18.2,p < 0.01) and high income (aOR: 3.57; 95% CI: 2.08–6.34,p < 0.05).
The findings indicated that the majority of parents had unfavorable views and improper practices of antibiotic usage. Strategic education programs to the targeted population, especially to the parents about side effects of antibiotics, dangerous consequences of self-medication, and crucial AMR concerns must be addressed immediately.
This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context.
This is a prospective hospital-based ...study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019.
The total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG).
Improvement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome ...its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.
64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.
Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.
Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.
Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.
Cutaneous leishmaniasis (CL) is a parasitic disease transmitted through the bite of infected sandflies, causing disfiguring skin lesions and a range of physical symptoms. However, the psychological ...impact of CL is often overlooked despite the significant burden it imposes on the affected individuals and communities. This is especially true in Saudi Arabia, where limited research exists on the psychological consequences of CL, particularly among females. This study aimed to address this knowledge gap by investigating the perceived psychological problems associated with CL among females living in the Hubuna area of Saudi Arabia.
This cross-sectional study recruited 213 females with CL in the Hubuna area of Saudi Arabia using purposive sampling. Data was collected using a self-administered electronic questionnaire that included socio-demographic characteristics and measures of depression and anxiety using the BDI and GAD-7 tools. Descriptive analysis was used to determine the psychological impact of CL, including means and standard deviations for the BDI and GAD-7 scores, as well as frequencies and percentages for other variables of interest. Logistic regression was performed to identify independent predictors of anxiety and depression, including variables such as age, marital status, education, occupation, number and location of lesions. The significance level for all statistical tests was set at
< 0.05. The study was carried out between September and December of 2022.
The study found that the mean Beck Depression Inventory (BDI) and Generalized Anxiety Disorder-7 (GAD-7) scores among the participants were 8.67 ± 4.82 out of 63 and 8.20 ± 7.08 out of 21, respectively. Furthermore, the prevalence of depression and anxiety was 55.9% and 68.1%, respectively, indicating a significant psychological burden associated with CL in the study population. The results of the logistic regression analysis showed that anxiety and depression were significantly associated with age, marital status, number of lesions, and location of the lesions on the body, highlighting the importance of considering these factors when designing interventions aimed at improving the mental health of CL patients.
In conclusion, this study highlights the significant psychological impact of CL among females in the Hubuna area of Saudi Arabia, calling for urgent action to address this neglected aspect of the disease. By integrating mental health considerations into CL prevention and management efforts, healthcare providers can improve the overall well-being of affected individuals and contribute to the broader goal of eliminating CL as a public health concern.
Transesophageal Doppler (TED) is a minimally invasive monitor that allows continuous hemodynamic variables monitoring. Non-invasive electrical cardiometry (EC) and TED methods added an additional ...facility to monitor cardiac output (CO) continuously and guide fluid management. The aim of this study was to correlate hemodynamic monitoring between non-invasive EC and Esophageal Doppler (ED) in cases undergoing major abdominal surgery.
This prospective observational study was carried out on 35 adult cases, American Society of Anesthesiologists (ASA) physical status II or III, undergoing major abdominal surgery. Esophageal Doppler and EC were attached to the same patient. Parameters measured were hemodynamic parameters.
Comparison of CO with ICON and ED showed that the ICON mean value ranged from 5.6 to 6.2 l/min, and the ED mean value always ranged from 5.7 to 7.6 l/min with the non-significant difference between the two methods. The precision for the ICON ranged from 15.19 to 17.99% and the precision for ED ranged from 13.39 to 17.08%. At a 15% change in ICON, the ED values' sensitivity was 72.6% and specificity was 30.9% with AUC 0.505.
The agreement between CO measured by EC and ED is acceptable. Both monitored trend changes and guided fluid administration in the operation theater. The EC is as accurate as ED in measuring hemodynamics during major abdominal surgery.
Controversy exists regarding the use of NPWT for wound healing.
This study assessed the effectiveness of NPWT compared with conventional treatment in the management of different wound types, ...including acute and chronic wounds.
PubMed, Cochrane Central Register of Controlled Trials, Scopus, EMBASE, EBSCO, Ovid, and Web of Science were searched, from database inception up to October 2021, for relevant studies comparing NPWT with conventional treatment for wound healing. Primary outcomes included time to healing, wound healing rate, and duration of treatment. Secondary outcomes included adverse events, length of hospital stay, and 30-day mortality rate. Pooled analysis of the outcomes data is presented as SMD (95% CI) for continuous data and OR (95% CI) for dichotomous data.
Twenty-four studies (3064 patients) were included in the meta-analysis. NPWT was associated with shorter time to healing (SMD, -0.79; 95% CI, -1.22 to -0.37), shorter duration of treatment (SMD, -1.24; 95% CI, -1.92 to -0.56), and higher rate of wound healing (OR, 2.05; 95% CI, 1.49-2.83) compared with control. NPWT was also associated with a lower incidence of adverse events (OR, 0.42; 95% CI, 0.23-0.77) and a lower 30-day mortality rate (OR, 0.25; 95% CI, 0.12-0.56). There were no significant differences between NPWT and control regarding hospital stay (SMD, -0.52; 95% CI, -1.06 to 0.03).
NPWT is seemingly associated with better wound healing outcomes compared with conventional therapy. However, the data should be interpreted with substantial caution given limitations such as high heterogeneity between studies and the small sample size of the included studies.
This study investigated the cone-beam computed tomography (CBCT)-based features of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina with respect to age and sex. A ...total of 306 CBCT mandibular images were included in this retrospective study to measure the mandibular canal location and extension, the mental foramen position, the presence of the anterior loop, and the accessory mental foramina. The measurements were obtained in sagittal, coronal, and axial views. Descriptive statistics are presented. Sex-related differences, correlations, and comparisons were calculated using SPSS at 5% significance level. The mandibular canal was located more coronal and medial in male patients. The majority of cases had the mental foramen located just apical to the mandibular second premolar with a mean height of 2.94 mm and a mean length of 3.28 mm. Age affected the size of the mental foramen. The mental canal in all cases tended to show a coronal direction. Mesial extension of the anterior loop was found in 66.01% of the images while accessory mental foramina were detected in 2.6%. The complexity of the mandibular canal, mental foramen, anterior loop, and accessory mental foramina among Sudanese patients with respect to age and sex was confirmed.
ABSTRACTBackground Supraglottic Airway Devices (SGAs) are designed to counteract the drawbacks of endotracheal intubation. They have proven to be easy to use, robust, versatile, and usable in many ...difficult situations. This work aims to investigate the use of the Baska Mask (BM) airway and ProSeal™ Laryngeal Mask Airway (PLMA) as SGAs for ventilation.Methods This randomized controlled trial was carried out on 74 cases aged 21–65 years old for elective surgery of a planned duration of up to 2 h during general anaesthesia with intermittent positive pressure ventilation. Cases were divided into two equal groups. Ventilation was done either by BM® Airway (group BM) or PLMA (group PLMA).Results BM had a shorter insertion time and lower leak fraction versus PLMA, while seal pressure elevated significantly with BM versus PLMA (P < 0.001). PLMA had significantly more cases than the BM mask group complaining of a sore throat at 2 h (P = 0.042). Complication after gastric tube insertion was parallel between both groups.Conclusions BM can be used successfully during anesthesia as it displays a shorter insertion time, lower leak fraction, higher seal pressure, and lower incidence of sore throat and gastric tube insertion complications than PLMA.
In this study, we have opened a great route to fabricate a high-performance nanocomposite for various functional applications based on the composite of a natural stone. A clay sample (black shale ...(B.Sh)) was collected from the Abu-Tartur area in Egypt. The black shale was organically modified with organic materials in our laboratory, which is called organo-black shale (O-B.Sh). The samples were characterized by XRD, FTIR, SEM, and XRF. These techniques confirmed that the samples have multi-oxide phases with approximately SiO2 at 54.1%, Al2O3 at 24.73%, Fe2O3 at 6.02%, K2O at 1.12%, MgO at 1.09%, and Na2O of 0.09%, as calculated by XRF. The two samples were applied to the adsorption processes of the radioactive technetium materials, which have been used for the medical treatment of the cancer institute of Upper Egypt. The adsorption processes were performed at various concentrations of the radioactive material and various amounts of clay samples. The as-collected B.Sh sample showed an adsorption activity of 65%, however, the organically modified materials showed a high adsorption rate toward technetium reaches to 100% in a very short time and without any further process. The present collected materials are very promising to withdraw the radioactive materials from the saline solution to save human and environmental health. We believe these multi-compound composites may open a new approach for creating new fabric composites with high performance for various applications.
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