Search Results (11)

Background Chronic low-back pain (LBP) is the largest contributor to disability worldwide, yet many assessments still reduce a complex, spatially distributed condition to a single 0–10 score. Body-map drawings capture location and extent of pain, but manual digitization is too slow and inconsistent for large studies or real-time telehealth. Methods Paper pain drawings from 332 adults in the multicenter COMEBACK study (four University of California sites, March 2021–June 2023) were scanned to PDFs. A Python pipeline automatically (i) rasterized PDF pages with pdf2image v1.17.0; (ii) resized each scan and delineated anterior/posterior regions of interest; (iii) registered patient silhouettes to a canonical high-resolution template using ORB key-points, Brute-Force Hamming matching, RANSAC inlier selection, and 3 × 3 projective homography implemented in OpenCV; (iv) removed template outlines via adaptive Gaussian thresholding, Canny edge detection, and 3 × 3 dilation, leaving only patient-drawn strokes; (v) produced binary masks for pain, numbness, and pins-and-needles, then stacked these across subjects to create pixel-frequency matrices; and (vi) normalized matrices with min–max scaling and rendered heat maps. RGB composites assigned distinct channels to each sensation, enabling intuitive visualization of overlapping symptom distributions and for future data analyses. Results Cohort-level maps replicated classic low-back pain hotspots over lumbar paraspinals, gluteal fold, and posterior thighs, while exposing less-recognized clusters along the lateral hip and lower abdomen. Neuropathic-leaning drawings displayed broader leg involvement than purely nociceptive patterns. Conclusions Our automated workflow converts pen-on-paper pain drawings into machine-readable digitized images and heat maps at the population scale, laying practical groundwork for spatially informed, precision management of chronic LBP. Full article

The clinical case presented demonstrates how a person living with type 2 diabetes and treated with insulin reuses the same pen needle several times to save money and performs an incorrect maneuver while screwing the needle, which breaks, remains stuck at the end of the pen, and causes loss of insulin during subsequent use. The findings in this case study are observed in many others in clinical practice but have only been sporadically published. Who is responsible for incorrect injections? Indeed, health workers, diabetic patients, and all the other actors involved in diabetes care and insulin utilization share responsibility. Recommendations and guidelines are not enough to fill this gap. Moreover, not all healthcare providers (HCPs) know or adhere to them. It is observed daily that more than half of insulin users make mistakes that affect glycemic control, increase the risk of complications, and reduce the quality of life of people living with diabetes, who, by a rough estimate, make up a population of over 100 million in the world. This case study offers us the opportunity to briefly review the literature on the most common errors made during insulin injection technique and, therefore, consider how necessary it is to promote structured and coordinated actions among various actors to promote the culture of therapeutic education. Full article

Diabetes is one of the most common diseases worldwide, with an increasing number of people affected. Insulin therapy is still the major treatment for both Type 1 and Type 2 diabetes and has evolved from bulky syringes to modern insulin pens introduced in 1985. An insulin pen consists of three major parts: a cartridge, a single-use pen needle (PN), and a precision dosing mechanism. Initially, PNs were long and thick, causing great discomfort and concern. Thanks to advances in design, shorter and thinner needles have appeared on the market, improving patient acceptability and pain perception. Studies highlight the influence of PN geometry and other characteristics on injection-related pain, including length, diameter, bevel design, and hub. Despite a lack of specific international regulations for PN geometry, scientific publications have focused on exploring different PNs’ characteristics to optimize patient comfort and reduce pain. To guide the selection of suitable PNs, this review provides a round-up of literature research findings on the impact of PN geometry on pain perception and patient acceptability. Specifically, it provides an overview of the PN manufacturing process, current international regulations, and the state-of-the-art research on PN geometry affecting pain perception. Full article

A correct injection technique is essential in order to ensure the effectiveness of insulin and to achieve good metabolic control, and the use of suitable needles is fundamental. Today, technological evolution has transformed insulin needles into innovative tools able to guarantee an effective and safe administration of insulin, to reduce local complications, such as lipodystrophies that are an obstacle to the effectiveness of the treatment itself, and to minimize the pain of the injection, a crucial factor in the acceptance of therapy and for compliance. The steering committee of the scientific society SIMDO has commissioned the scientific committee and some members of the board to draw up an official SIMDO point of view/consensus on the use of insulin needles. In this way, a group that has combined the experience gained in their field of expertise—diabetologists operating in the public and private sectors, nurses, psychologists, and patients—was set up. The aim is to give indications regarding insulin injection techniques, combining themes such as technology innovation, education in self-management, and psychological support for the patient into a unified approach based on the priority area of patient quality of life. The document will provide operational recommendations that integrate the directions regarding the standards of care for diabetes resulting from the most recent scientific acquisitions with the concept of quality at 360°, as it emerged from the point of view of all the operators involved, but with the patient’s interests as a central focal point. Full article

Patients affected with type 1 diabetes and a non-negligible number of patients with type 2 diabetes are insulin dependent. Both the injection technique and the choice of the most suitable needle are fundamental for allowing them to have a good injection experience. The needles may differ in several parameters, from the length and diameter, up to the forces required to perform the injection and to some geometrical parameters of the needle tip (e.g., number of facets or bevels). The aim of the research is to investigate whether an increased number of bevels could decrease forces and energy involved in the insertion–extraction cycle, thus potentially allowing patients to experience lower pain. Two needle variants, namely, 31 G × 5 mm and 32 G × 4 mm, are considered, and experimental tests are carried out to compare 3-bevels with 5-bevels needles for both the variants. The analysis of the forces and energy for both variants show that the needles with 5 bevels require a statistically significant lower drag or sliding force (p-value = 0.040 for the 31 G × 5 mm needle and p-value < 0.001 for 32 G × 4 mm), extraction force (p-value < 0.001 for both variants), and energy (p-value < 0.001 for both variants) during the insertion–extraction cycle. As a result, 3-bevels needles do not have the same functionality of 5-bevels needles, show lower capacity of drag and extraction, and can potentially be related to more painful injection experience for patients. Full article

Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles. Full article

The aim of this study was to analyse the behavioral aspects of suckling piglets after an intradermal vaccination method in comparison to an intramuscular vaccination applied on the seventh day of life. Possible effects on piglet welfare should be evaluated. Under field conditions, 135 suckling piglets from 12 litters were vaccinated against Mycoplasma hyopneumoniae—64 of those intradermally and 71 intramuscularly, from six litters each. For behavioral analyses, videos were recorded per pen, starting three days before the vaccination and ending three days after the vaccination. In the video analyses, the observation periods 6.00–10.00, 13.00–17.00, and 19.00–21.00 were analysed via scan sampling for the behaviors lying, standing, walking, suckling, and social contact. In the behavioral observations, in all piglets, the most frequent behavior was lying, followed by suckling at the sow’s teats. After vaccination, less lying behavior and more suckling behavior were assessed in intradermally vaccinated piglets compared to intramuscularly vaccinated piglets, which indicates that the piglets were not impaired by stress following vaccination. The results of this study showed that intradermal needle-free vaccination has clear advantages, as it caused fewer vaccination-associated behavior changes in suckling piglets than the intramuscular vaccination method with a needle. Full article

Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term in subjects with mechanical neck pain. This was an evaluator-blinded randomized controlled trial. Subjects were recruited through announcements and randomly allocated into DN or PENS groups. Pain intensity, disability, pressure pain threshold (PPT), range of motion (ROM), and side-bending strength were measured. The analyses included mixed-model analyses of variance and pairwise comparisons with Bonferroni correction. The final sample was composed of 44 subjects (22 per group). Both groups showed improvements in pain intensity (η_p² = 0.62; p < 0.01), disability (η_p² = 0.74; p < 0.01), PPT (η_p² = 0.79; p < 0.01), and strength (η_p² = 0.37; p < 0.01). The PENS group showed greater improvements in disability (mean difference, 3.27; 95% CI, 0.27–6.27) and PPT (mean difference, 0.88–1.35; p < 0.01). Mixed results were obtained for ROM. PENS seems to produce greater improvements in PPT and disability in the short term. Full article

Although used widely in cosmetic formulations, topical delivery of niacinamide (LogP = −0.35) is unfavorable by conventional means. Poly(lactide-co-glycolide) (PLGA) formulations, can undergo a sol-gel transition triggered by solvent exchange, entrapping molecules and sustaining their release. The current study aims to exploit the ability of PLGA to gel in situ and enhance the topical delivery of niacinamide in microporated skin. In vitro drug permeation studies were performed using vertical Franz diffusion cells. Microporation was performed using Dr. Pen^TM Ultima A6, where pre-treatment with a 1 mm needle-length for 10 s and a 0.5 mm needle-length for 5 s, both at 13,000 insertions/min were compared. The effect of different grades of PLGA, EXPANSORB^® DLG 50-2A (“low” molecular weight), and EXPANSORB^® DLG 50-8A (“high” molecular weight) on topical delivery was also determined. Formulations containing PLGA resulted in successful gelation in situ on application over microporated skin. A significantly higher amount of drug was found in the skin with the 0.5 mm treatment for 5 s (892 ± 36 µg/cm²) than with 1 mm for 10 s (167 ± 16 µg/cm²). Hence, the different grades of PLGA were evaluated with 0.5 mm, 5 s treatment, and a significantly larger amount was seen in skin with the higher rather than the lower molecular weight polymer (172 ± 53 µg/cm²). Full article

Epinephrine is a life-saving treatment in anaphylaxis. In community settings, a first-aid dose of epinephrine is injected from an auto-injector (EAI). Needle phobia highly contributes to EAI underuse, leading to fatalities—especially in children. A novel rapidly-disintegrating sublingual tablet (RDST) of epinephrine was developed in our laboratory as a potential alternative dosage form. The aim of this study was to evaluate the sublingual bioavailability of epinephrine 30 mg as a potential pediatric dose incorporated in our novel taste-masked RDST in comparison with intramuscular (IM) epinephrine 0.15 mg from EAI, the recommended and only available dosage form for children in community settings. We studied the rate and extent of epinephrine absorption in our validated rabbit model (n = 5) using a cross-over design. The positive control was IM epinephrine 0.15 mg from an EpiPen Jr^®. The negative control was a placebo RDST. Tablets were placed under the tongue for 2 min. Blood samples were collected at frequent intervals and epinephrine concentrations were measured using HPLC with electrochemical detection. The mean ± SEM maximum plasma concentration (C_max) of 16.7 ± 1.9 ng/mL at peak time (T_max) of 21 min after sublingual epinephrine 30 mg did not differ significantly (p > 0.05) from the C_max of 18.8 ± 1.9 ng/mL at a T_max of 36 min after IM epinephrine 0.15 mg. The C_max of both doses was significantly higher than the C_max of 7.5 ± 1.7 ng/mL of endogenous epinephrine after placebo. These taste-masked RDSTs containing a 30 mg dose of epinephrine have the potential to be used as an easy-to-carry, palatable, non-invasive treatment for anaphylactic episodes for children in community settings. Full article

Burning incense indoors is a common behavior in Southeast Asia. In this investigation, needle trap samplers (NTS), a novel, green analytical technology is used for sampling gaseous combustion by-products from sandalwood incense coils. To extract indoor volatile organic compounds (VOCs), two NTS are prepared, one using 60–80 mesh and the other using 100–120 mesh divinylbenzene (DVB) particles packed in 22-gauge stainless steel needles. This work compares extraction efficiency of an NTS and that of a commercially available 100 μm polydimethylsiloxane solid phase microextration (PDMS-SPME) fiber sampler. Experimental results indicated that the 100–120 mesh DVB-NTS performed best among all samplers during a 1 h sampling period. The main extracted compounds were toluene, ethylbenzene, propane, chloromethane, 1,3-butadiene, methanol and dichloromethane. The potential use of small badge-sized or pen-sized NTS for the indoor atmosphere and occupational hygiene applications is addressed. Full article