Neuropathic Pain In Leprosy: Deep Profiling And Stratification Of Patient Groups

Leprosy is a chronic granulomatous infectious disease, affecting the skin and nerves. Neuropathic pain (NP), which is defined as pain caused by a lesion or disease of the somatosensory nervous system, is now being recognized as an important complication of leprosy. It occurs in 10-20% of patients as a result of persisting nerve damage. Patient with NP is associated with significant suffering, morbidity and limitation of quality of life. Thus, the accurate identification of NP in patients with pain is required. The clinical aspects of NP in leprosy patients in India were investigated using highly specialised assessment tool; quantitative sensory testing (QST). A case control study was conducted in 90 patients with and without pain. Two validation studies were conducted among healthy volunteers in London (18 participants) and Mumbai (52 participants). Somatosensory profiles were compared in leprosy patients to healthy control subjects. The pattern revealed a novel profile of loss of cool and warm detection thresholds and also mechanical detection but with preservation of vibration detection. This is different to profiles seen in other NP conditions. The QST parameters were effective in detecting neuropathy, but were not able to distinguish between patients with and without NP. Patients with leprosy NP had a high rate of abnormal findings in almost all QST parameters in the maximum pain area over the ulnar nerve. Their sensory profiles were categorised into two subgroups. The majority of patients have spontaneous pain with evidence of sensory loss, but no signs of sensory gain. The second subgroup had profoundly impaired pain and temperature sensation, but light mechanical stimuli often produce pain. Patients with NP had a poor quality of life and psychological well-being compared to pain-free neuropathy

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Modeling and scheduling home appliances using nature inspired algorithms for demand response purpose

Demand response (DR) refers to programs used in endeavors to reduce overall power consumption, manage consumption peak hour shifting, and reduce demand on service providers or utilities using different methods. This paper proposes a home appliance scheduler suitable for DR applications. In the proposed method, a controller controls thermal and shiftable loads, where thermal loads are empirical models that consider different factors. They produce the load profile of the home in consideration of different input parameters, e.g., setpoints and user tolerance ranges, and various factors, e.g., the room's physical structure and the external environment. A scheduler uses the controller to implement load shifting using the whale optimization algorithm, particle swarm optimization, and gray wolf optimization (GWO) algorithms for three different occupancy and price schemes. Acceptable results were obtained by applying the models using various outer temperatures and user tolerance ranges. The results also demonstrate cost reduction of 38.59% with GWO for the first occupancy scheme

Investigation of neuropathic pain in treated leprosy patients in Ethiopia: a cross-sectional study.

Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP

RETRACTED: Neurological manifestations of COVID‐19: A potential gate to the determinants of a poor prognosis

Abstract Background Several investigations were carried out during the pandemic, demonstrating a number of neurological symptoms linked to coronavirus disease 2019 (COVID‐19) infection. Objectives The goal of this review is to discuss COVID‐19 disease's neurological signs and squeals. Methodology From December 2019 to May 2020, data were retrieved from PubMed, Scopus, and ScienceDirect, as well as a manual search using Google Scholar. COVID‐19, neurological symptoms, cranial nerves, motor system were among the key phrases utilized in the search. Results The intensity of respiratory involvement increases the likelihood of neurological symptoms and consequences. According to some research, it might range from 34% to 80%. The central and peripheral neural systems are both affected, resulting in cranial nerve palsies and limb paralysis. Conclusion COVID‐19 neurologic complications are key drivers of patient severity and mortality. Headache, convulsions, mental and psychic disorders, delirium, and insomnia are just some of the symptoms that the virus can cause. The olfactory nerve is the most commonly damaged cranial nerve, resulting in anosmia. Stroke (mostly infarction), encephalitis, meningitis, Guillain–Barre syndrome, relapse of multiple sclerosis, and transverse myelitis are all symptoms and squeals

RETRACTED: The quality of life among Sudanese patients with epilepsy, Khartoum, Sudan

Abstract Introduction This is the first study done in the National Center for Neurological Sciences, Khartoum State, to assess the quality of life among more than 100 Sudanese epileptic patients, in the period from September to December 2020. Methodology This is a descriptive cross‐sectional study; data were collected using an interview‐based semi‐structured structured questionnaire and this questionnaire was modified from the SF‐36 model. Results Most of the patients were from urban areas and origin (60.2%), most of which were housewives; the majority of the patients were single and from low socioeconomic status, history of the disease was less than 3 years for most of the cases covered in this study, most of the cases were classified as generalized tonic clonic epilepsy, and normal EEG findings and normal MRI brain were found in 75.7% and 78.6%, respectively. Most patients mentioned that they experienced no attacks during the last month. Regarding mental health, 47.6% experienced symptoms of depression, and 75.7% had memory problems. In terms of physical health, 51.5% felt energetic all of the time, 9.7% experienced remarkable sleep disturbance, most of the patients are not driving nor have established hobbies during leisure time. 63.1% of the participants do not have health problems; 32% mentioned that they would feel stigmatized if an attack takes place in public. Commonest medication prescribed was carbamazepine, out of which 73.8% are fully compliant with their medication. 95.1% are not worried about long term use of medication. Conclusion Lower levels of education and manual labor are associated with poor quality of life. Epilepsy has an adverse impact on social life. There is a global decrease in cognitive function, and most of the patients are not worried about the side effects and duration of the medication usage