Preemptive analgesia application in acute appendicitis

BACKGROUND: Preemptive analgesia with infiltration of anesthetics into surgical wounds before the incision has been shown to be effective in various elective surgeries. Although this application can decrease the postoperative pain, it is not known whether it is effective in surgery with acute pain or not. AIMS: In this study, we evaluated whether the preincisional local anesthetic application will decrease the postoperative pain in patients undergoing appendectomy for acute appendicitis. MATERIALS AND METHODS: Forty consecutive patients admitted to the Emergency Department with a tentative diagnosis of acute appendicitis were randomly divided into two groups. In Group 1, 1% prilocaine and 0.25% bupivacaine was injected to the planned incision site cutaneously, subcutaneously, and under the fascia of the external oblique muscle. The patients in Group 2 received the same volume of saline to the same anatomical sites. Initially, 1 mg/kg meperidine was administered intramuscularly to both groups for postoperative analgesia. If needed further, meperidine 0.5 mg/kg was administered intramuscularly. Postoperative pain was assed by visual analog scale during the first 24 hours. The analgesic needed and the doses required were recorded. STATISTICAL ANALYSES: All data were stored using SPSS 11.0 for Windows. Wilcoxon test and two independent samples T-test was used as the non-parametric test. RESULTS AND CONCLUSIONS: No statistically significant difference was found between the two groups' pain score, the number of patients who needed analgesic, and the amount and the number of doses administered. In conclusion, we think that preincisional local anesthetic infiltration does not help to decrease the need for postoperative analgesic use in patients with acute pain, and this may be related with previous central sensitization

It isn't over ‘till it’s over: A continuing concern of the SARS-CoV-2 variants, and miRNAs targeting the S protein as a probable absolute cure

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak which still continues to affect the general population, has mutated day by day and new variants have emerged. More than 40 variants, usually caused by mutations in the spike (S) protein, have been recorded. Observation of S protein mutations in the development of t herapeutic agents will increase success rates. As we identify the three-dimensional (3D) conformation of viruses, it is more and more possible to work on models for understanding molecular interactions. Development of agents for arrays and 3D sequencing of proteins paves the way for potential therapeutic studies against variants. MicroRNAs (miRNAs) seemingly act as a potentially important group of biomolecules in combating uncontrolled cytokine release. Besides antiviral response, miRNAs promise to be  powerful therapeutic agents against infections. Studies have shown that miRNAs are able to inhibit the genome directly by miRNA-based treatments as they are sprecific to the SARS-CoV-2 genome. In order to expose this potential, in silico studies before continuing with lab studies are helpful. In our bioinformatics analysis, we proposed to compare the S protein similarities of Delta and Omicron, two of the most common variants, and to detect miRNAs targeting the S protein. The S proteins and coding sequences were compared between the two variants, and differences were determined. Within our analysis, 105 and 109 miRNAs for the Delta and Omicron variants, respectively, were detected. We believe that our study will be a potential guide for deciding on the miRNAs that may most likely have an effect on the management of the infection caused by both variants

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

RONFC: A Novel Enabler-Independent NFC Protocol for Mobile Transactions

The use of near field communication (NFC) technology for contactless mobile transactions has become popular in the past decade with the availability of this technology in mobile devices. Today, there are millions of the NFC-enabled mobile handsets in the market, with mobile handset manufacturers and mobile network operators enabling m-wallet solutions using the secure elements (SEs) that they own, thus can remotely control, on the devices. While this approach gives full control to the SE owner to activate any mobile transaction system on a device, having a more flexible approach would increase the benefits that end users could obtain from this technology in a variety of use cases. In this paper, we introduce a novel protocol for the NFC-based mobile transaction procedure, which uses tamper-resistant SEs that are already installed at the transaction terminals, and is mobile handset manufacturer and mobile network operator-independent. We evaluate and show the feasibility of the use of our proposed model with common mobile electronic payment scenarios. The evaluation results demonstrate that the proposed solution is promising for adoption as a secure NFC transaction model, which will have applications in various security-sensitive IoT scenarios, including but not limited to, mobile identification, healthcare, payment, and access control

Longitudinal Associations Between Provision of Autonomy Support and Well-Being in Spouses of Individuals With Chronic Pain

Background Caregiving spouses of individuals with chronic pain often experience poor well-being