Manal Kassab

A double-blind randomised controlled trial of 25% oral glucose for pain relief in 2-month old infants undergoing immunisation

BACKGROUND Infant immunisation is the most commonly performed health procedure in developed countries. Associated pain may be harmful because we do not know what painful experiences the infant has already had and whether it might contribute to a cumulative pain experience. Healthy infants undergo immunisation with minimal pain relief. However, immunisation pain can be managed using oral sweet solutions. OBJECTIVE To determine the effectiveness of 25% oral glucose solution in reducing immunisation pain in 2-month old infants. TRIAL DESIGN AND METHODS: A double-blind, randomised controlled trial conducted in Jordan. A total of 120 healthy full-term infants who met the eligibility criteria and were attending immunisation clinics for routine 2-month immunisation were randomised to receive either 2 mL of 25% oral glucose solution immediately prior to their immunisation or 2 mL of oral sterile water. Researchers, nurses and parents were blind to the solution. Primary outcome was behavioural pain measured using the Modified Behavioural Pain Scale (MBPS). Secondary outcomes were crying time and duration of full-lung cry. Crying was registered from onset of the immunisation injection and for up to 120 s after completion of the injection procedure. RESULTS Infants in the intervention group experienced statistically and clinically significant reduction in behavioural pain responses (p<0.001), and spent less time crying up to 2 min after the procedure (mean difference 38 vs. 77.9s). CONCLUSION A 2 mL oral dose of 25% glucose given immediately before an immunisation procedure reduces pain in 2-month old infants.

Sucrose-induced analgesia during early life modulates adulthood learning and memory formation.

This study is aimed at examining the long-term effects of chronic pain during early life (postnatal day 0 to 8weeks), and intervention using sucrose, on cognitive functions during adulthood in rats. Pain was induced in rat pups via needle pricks of the paws. Sucrose solution or paracetamol was administered for analgesia before the paw prick. Control groups include tactile stimulation to account for handling and touching the paws, and sucrose alone was used. All treatments were started on day one of birth and continued for 8weeks. At the end of the treatments, behavioral studies were conducted to test the spatial learning and memory using radial arm water maze (RAWM), as well as pain threshold via foot-withdrawal response to a hot plate apparatus. Additionally, the hippocampus was dissected, and blood was collected. Levels of neurotrophins (BDNF, IGF-1 and NT-3) and endorphins were assessed using ELISA. The results show that chronic noxious stimulation resulted in comparable foot-withdrawal latency between noxious and tactile groups. On the other hand, pretreatment with sucrose or paracetamol increased pain threshold significantly both in naive rats and noxiously stimulated rats (P<0.05). Chronic pain during early life impaired short-term memory, and sucrose treatment prevented such impairment (P<0.05). Sucrose significantly increased serum levels of endorphin and enkephalin. Chronic pain decreased levels of BDNF in the hippocampus and this decrease was prevented by sucrose and paracetamol treatments. Hippocampal levels of NT-3 and IGF-1 were not affected by any treatment. In conclusion, chronic pain induction during early life induced short memory impairment, and pretreatment with sucrose prevented this impairment via mechanisms that seem to involve BDNF. As evident in the results, sucrose, whether alone or in the presence of pre-noxious stimulation, increases pain threshold in such circumstances; most likely via a mechanism that involves an increase in endogenous opioids.

The effectiveness of glucose in reducing needle-related procedural pain in infants

This systematic review examined the effectiveness of glucose in relieving needle-associated pain in infants. Meta-analysis was not undertaken, and there was variation in dose, administration method, concentration, and outcome measurement. Glucose was more effective than placebo in relieving infant pain as measured by behavioral outcomes, but there were mixed findings for physiological outcomes. Based on these findings, 25%-50% glucose appears effective for infant pain management.

Prevalence and factors associated with the occurrence of preterm birth in Irbid governorate of Jordan: A retrospective study

Prevention is important to reduce the prevalence of preterm births. Although prematurity has been well studied in developed countries, data from developing countries, such as Jordan, are still limited. This retrospective study analysed medical records to determine possible risk factors leading to preterm birth in the Irbid governorate of Jordan. All preterm births during the year 2011 were reviewed. Abstracted data included mothers age and gravidity. Newborn information included gender, birthweight and gestational age at birth. A total of 647 singleton births were included. There were more females than males (54.9% vs. 45.1%), with 75.6% being the second child or more. Half the mothers (50.2%) were 25-35 years of age. Factors associated with preterm birth were male gender (P = 0.008), maternal age > 35 years (P = 0.005) and first birth (P = 0.003). Nurses need to provide support and education to mothers with potential risk about reproductive health and family planning.

Postpartum evaluation of vitamin D among a sample of Jordanian women

Abstract The aims of this study were to explore the vitamin D status among a sample of Jordanian postpartum women and identify factors associated with vitamin D deficiency. A total of 171 postpartum women agreed to participate. Participants completed a questionnaire on factors related to vitamin D deficiency and provided a blood sample to assess their plasma vitamin D (25(OH)D) levels using DIA source Immuno-Assays S.A. analysis. The majority of women (76%, n = 130) had vitamin D deficiency and 24% (n = 41) of participants had vitamin D insufficiency. Factors associated with vitamin D deficiency were younger age (< 30 years), low education level, unemployment, multiparity, lactation, dress style, limited sunlight exposure, high BMI, dark skin colour and lack of multivitamin use. Vitamin D supplementation must be considered during pregnancy and lactation to prevent hypovitaminosis in both mother and baby.

Sweet Solution Analgesia

Mammals’ first tasting experience is usually sweet solution. Whether it is milk (breast or formula), sugar water as in some cultures or even dates as advocated by Prophet Mohammed to his followers. Thus, it is no wonder the soothing, calming and even pain relieving effects of oral sweet solutions. Nevertheless, using sweet solution purposely for its pain-relieving effects for infants in the clinical setting is relatively recent; however, the discussion concerning sweet solution effectiveness, mechanism of actions and adverse long-term effects are still ongoing. In this chapter, we present an account of studies on both humans and animals that explored and examined the use of several sweet solutions for analgesia.

Healthcare Providers’ Knowledge and Current Practice of Pain Assessment and Management: How Much Progress Have We Made?

Context. Despite improvement in pain management and availability of clinical treatment guidelines, patients in Jordan are still suffering from pain. Negative consequences of undertreated pain are being recognized as a reason for further illnesses and poor quality of life. Healthcare providers (HCPs) are responsible for relieving pain of their patients. Objective. To evaluate the knowledge and attitudes of HCPs toward pain management in Jordan. Methods. A 16-item questionnaire with agree or disagree options was given to 662 HCPs in seven hospitals in Jordan who volunteered to participate in the study. Following data collection, the responses were coded and entered into SPSS. Results. There was a statistically significant difference (p < 0.004) in percentage scores between physicians (36%) and pharmacists (36%) versus nurses (24%). The level of knowledge was the best among physicians, followed by pharmacists specifically in the area of cancer pain management. Nurses scored the lowest for knowledge of pain assessment and management among HCPs. However, HCPs overall scores indicated insufficient knowledge specifically in relation to pain assessment and management among children.

Breastfeeding Attitudes and Knowledge among Sixth Year Medical Students in Jordan

Background: Previous reports have demonstrated that counseling about breastfeeding can improve the rate and initiation duration of breastfeeding. However, those medical students are ill-prepared for this role. It is unclear whether medical students would provide the knowledge and skills necessary for effective breastfeeding promotion or not in Jordan. The aim of this study was to identify breastfeeding attitudes and knowledge among 6th year medical students in their final year at The Jordan University of Science and Technology (JUST). Methods: A 28-item self-administered questionnaire; containing three sections: knowledge (13 items) attitude (7 items) and demographic (3 items), were distributed randomly to medical students. The random sample consisted of 234 medical students who were in their final year. The questionnaire assessed both breastfeeding attitudes and knowledge. Results: The results were explained taking into consideration gender and being a parent. Mean attitude’s score for participants without children was 46.7 as compared to 44.0 for those with children. The results showed similar negative attitude toward breastfeeding among both male and female participants regardless of having children or not (p=0.35). This means that there were no significant difference in attitudes toward breastfeeding among male and female students whether they are having children or not. On the other hand, the mean knowledge score was 22.9 for male participants while it was 21.55 for female participants, indicating some degree of breastfeeding knowledge among participants (p=0.035). However, having personal experience with breastfeeding (self or partner) did not increased breastfeeding attitudes and knowledge (p=0.35 vs. p=0.93, respectively). Conclusions: Medical students have significant educational needs in the area of breastfeeding management and breastfeeding education. Further targeted training is needed to improve both breastfeeding attitudes and knowledge.

Persistent Hiccups After Cervical Epidural Steroid Injection

Patient: Male, 60 Final Diagnosis: Persistent hiccups Symptoms: Hiccups Medication: — Clinical Procedure: Cervical epidural steroid injection Specialty: Anesthesiology Objective: Unusual or unexpected effect of treatment Background: Hiccup is a rare complication after a cervical epidural steroid injection used in the treatment of chronic pain. A few studies have reported on the physiological and pharmacological aspects of hiccups after epidural steroid injection and there have been some case reports published. Our presented case report provides insight into the side effect of hiccups that can occur in association with cervical epidural analgesia, and will help inform anesthesiologist about this unpleasant complication. Case Report: We present a rare case of persistent hiccups after a cervical epidural steroid injection in a 60-year-old male patient with chronic pain due to disc protrusion in C3–C7. Conclusions: Persistent hiccups after epidural injection is a serious complication. As the exact mechanism of hiccups is not yet known, regardless the level of epidural or the mixture of drugs used, and the incident of hiccups after epidural injection is not well-reported, we think that the etiology and the incident rate must be further evaluated.

Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans

To assess the impact of delivery at 37 weeks of pregnancy versus 38 weeks or later on maternal and neonatal outcomes among women with multiple previous cesareans.