Gastroenterology Cases of Cutaneous Leukocytoclastic Vasculitis

Rarely, leukocytoclastic vasculitis can result from ischemic colitis, inflammatory bowel disease, and cryoglobulinemia. There is no established standard for the treatment of leukocytoclastic vasculitis associated with gastroenterologic diseases. This paper presents three cases of leukoytoclastic vasculitis, each of which is associated with a different gastroenterologic condition: ischemic colitis, Crohn’s disease, and chronic hepatitis C. Each condition went into remission by treatment of leukocytoclastic vasculitis, regardless of the underlying disease

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

On the Generalized Ostrowski Type Integral Inequality for Double Integrals

In this paper, we establish a new generalized Ostrowski type inequality for double integrals involving functions of two independent variables by using fairly elementary analysis

Oscillation of higher-order nonlinear delay differential equations with oscillatory coefficients

A criterion is established on the bounded solutions of type higher-order nonlinear neutral differential equations of type oscillatory or tending to zero at infinit

Oscillation of a class of difference equations of second order

In this paper, we investigate asymptotic behaviour of solutions of the following secondorder difference equation

Oscillation of nonlinear neutral delay differential equations of second-order with positive and negative coefficients

Some oscillation criteria for the following second-order neutral differential equatio

Oscillation and Asymptotic Behaviour of a Higher-Order Nonlinear Neutral-Type Functional Differential Equation with Oscillating Coefficients

We will study oscillation of bounded solutions of higher-order nonlinear neutral delay differential equations of the following type: [y(t)+p(t)f(y(τ(t)))](n)+q(t)h(y(σ(t)))=0, t≥t0, t∈R, where p∈C([t0,∞),R), limt→∞p(t)=0, q∈C([t0,∞),R+), τ(t), σ(t)∈C([t0,∞),R), τ(t), σ(t)<t, lim⁡t→∞τ(t), σ(t)=∞, and f,h∈C(R,R). We obtain sufficient conditions for the oscillation of all solutions of this equation