OBJECTIVES: This study aimed to (i) assess the reliability and validity of the Arabic version of HIT-6 in Arabic-speaking patients experiencing migraine, and (ii) evaluate the responsiveness of HIT-6 following migraine preventive therapy.
METHODS: In this prospective study, patients with migraine (n = 145) were requested to fill out a headache diary, the Arabic version of HIT-6, and Migraine Disability Assessment Scale (MIDAS) at two time points (baseline and 3 months after initiation of prophylactic treatment). Some respondents (n = 73) were requested to fill out HIT-6 again 1 week from the baseline for test-retest reliability. The intensity of migraine headache attacks was evaluated using the Visual Analogue Scale (VAS). An anchor-based method was used to establish the minimal important change (MIC) value and responsiveness of HIT-6.
RESULTS: The total scores of HIT-6 were significantly correlated to a fair degree with MIDAS (r = 0.41), as well as VAS (r = 0.53), and monthly migraine days (r = 0.38) at the baseline while at the follow-up (after 3 months), the correlations were of moderate degree with MIDAS scores (r = 0.62) and monthly migraine days (r = 0.60; convergent validity). Reliability estimates of the Arabic HIT-6 were excellent (Cronbach's α = 0.91 at baseline and 0.89 at follow-up). The average measure interclass correlation coefficient (ICC) value for the test-retest reliability was 0.96 (95% confidence interval = 0.94-0.98, p
OBJECTIVE: To compare pain scores at 6 and 24 h postoperatively between laser closure and ligation of the intersphincteric tract for anal fistula.
DESIGN: Prospective, double-blinded randomized controlled trial.
SETTINGS: A quaternary hospital in Malaysia.
PATIENTS: Patients aged 18-75 years with high transsphincteric fistulas.
INTERVENTION: Fistula laser closure versus ligation of the fistula tract (LIFT) treatment.
MAIN OUTCOME MEASURES: Pain scores, continence, quality of life (QOL), operative time, and treatment failure were compared using chi-square, Fisher's exact test, student t-test, or Mann-Whitney with p pain scores for laser versus LIFT at 6 h postoperatively were 1.0 versus 2.0 (Rest, p = 0.213) and 3.0 versus 4.0 (Movement, p = 0.448), respectively. At 24 h, this reduced to 2.5 in both arms at rest (p = 0.842) but increased to 4.8 versus 3.5 on movement (p = 0.383). Median operative time for laser was significantly shorter (32.5 min) than LIFT (p 0.05).
LIMITATIONS: Patients with prior fistula surgery (approximately 20%) led to heterogeneity. The total laser energy delivered varied depending on fistula anatomy.
CONCLUSION: Laser fistula closure is an alternative to LIFT, with similar postoperative pain and shorter operative time despite more complex fistula anatomy in the laser arm, with a greater improvement in QOL.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT06212739.
METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020) guidance and was registered in International Prospective Register of Systematic Reviews (CRD42023482529). Eight databases were searched for randomized controlled trials published between January 2000 and September 2025. Eligible studies included adult ICU patients receiving immersive or non-immersive VR interventions. Primary outcomes were anxiety, depression, and post-traumatic stress disorder (PTSD); secondary outcomes included pain, sleep quality, lower-limb function, and bedside balance. Risk of bias was assessed using the Cochrane RoB tool, and certainty of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation.
RESULTS: Twenty randomized controlled trials were identified, involving a total of 1551 patients. This meta-analysis showed that VR intervention helped improve anxiety (standardized mean difference [SMD] = -0.67, 95% confidence interval [CI: -1.00 to -0.35], P pain score (SMD = -0.57, 95% CI [-1.49 to 0.36], P = .23) and bedside balance score (SMD = 0.61, 95% CI [-0.44 to 1.66], P = .25). Most studies were assessed as having varying degrees of risk of bias. All evidence was rated from very low to moderate.
CONCLUSION: VR interventions may confer meaningful benefits for anxiety, depression, PTSD, and sleep quality in adult ICU patients, and may improve lower-limb function in selected populations. However, evidence for analgesic effects and bedside balance remains inconclusive. Standardized VR protocols, objective outcome assessment, and adequately powered multicenter trials are needed to clarify the clinical value of VR in ICU care.
AIMS AND OBJECTIVES: To evaluate the feasibility of using an intraoperative lesser palatine nerve block (LPNB) to manage postoperative pain in adult patients undergoing multilevel sleep surgery for obstructive sleep apnea.
MATERIALS AND METHODS: Retrospective cohort of 62 adults receiving standardised multimodal analgesia with (n = 35) or without (n = 27) bilateral LPNB (0.5% bupivacaine with epinephrine). Primary outcome: visual analog scale (VAS) pain scores at 6 h and Day 1.
RESULTS: LPNB was feasible and safe with no adverse events across all 35 administrations. A clinically meaningful pain reduction trend at 6 h (3.14 ± 1.33 vs 3.85 ± 1.63; 18% reduction; p = 0.076) and a statistically significant reduction at Day 1 (3.00 ± 1.50 vs 3.89 ± 1.58; 23% reduction; p = 0.027). In the pre specified high risk subgroup of severe OSA patients, exploratory analysis showed significantly lower pain at 6 h (3.00 ± 1.38 vs 4.21 ± 1.42; p = 0.023). On multivariable adjustment, LPNB was associated with reduced odds of moderate to severe pain (adjusted OR 0.38; 95% CI 0.13-1.13; p = 0.082).
CONCLUSIONS AND SIGNIFICANCE: LPNB is feasible, safe, and associated with a clinically meaningful analgesic signal.
OBJECTIVES: This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancer patients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT).
METHODS: The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient's current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, education and counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4 weeks.
RESULTS: Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest (n = 11) and communication barriers (n = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4 weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other's attitudes, ensuring effective isolation of interventions The PharmaCAP intervention showed significant improvement in QoL (P pain intensity decreased in both groups, the difference was not statistically significant. Satisfaction with the PharmaCAP intervention was high, with 93.0% of participants expressing satisfaction and 88.3% acknowledging that the clinical pharmacists effectively addressed their drug-related queries.
CONCLUSION: Findings of this RCT demonstrate that integrating clinical pharmacists into the MDT team in low low-resource setting is feasible and shows promise in improving QoL, reducing anxiety and depression, and enhancing medication adherence among cancer patients. These findings support the feasibility of conducting a full-scale RCT. Enabling clinical pharmacists to assist with cancer pain management in low-resource settings can benefit patients, healthcare teams, and health systems.
TRIAL REGISTRATION: ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.
Methods: In a prospective study, colonoscopy was performed on 2,469 consecutive patients. Biopsies were taken from the terminal ileum and ascending, transverse, descending and sigmoid colon in all patients.
Results: Sixty-four of the 2,469 patients (2.6%) had eosinophilic gastroenteritis. Only five of the 64 patients (7.8%) with eosinophilic gastroenteritis had endoscopic mucosal abnormalities during colonoscopy. Six of these 64 patients (9.4%) had severe disease at presentation, and seven of these 64 patients (10.9%) required systemic steroid treatment. An elevated absolute peripheral eosinophil count was independently associated with severe disease at presentation (4/6 [66.7%] vs 3/58 [5.2%], p=0.005; odds ratio [OR], 25.320; 95% confidence interval [CI], 2.628 to 243.910), and severe disease at the time of presentation was independently associated with the use of systemic steroid treatment (6/7 [85.7%] vs 0/57 [0%], p=0.008; OR, 18.021; 95% CI, 2.163 to 150.152).
Conclusions: The prevalence of eosinophilic gastroenteritis is common, and patients usually present normal-appearing mucosa on colonoscopy. Those with severe disease at presentation usually have a raised absolute peripheral eosinophil count and should be commenced on systemic steroids as an initial therapy.