Methods of pain assessment in adult intensive care unit patients - Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale)

Many patients treated in the intensive care unit (ICU) experience pain that is a source of suffering and leaves a longterm imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, while the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission. As daily nursing procedures and interventions performed in the ICU may be a potential source of pain, it is crucial to use simple pain monitoring tools. The assessment of pain intensity in ICU patients remains an everyday challenge for clinicians, especially in sedated, intubated and mechanically ventilated patients. Regular assessment of pain intensity leads to improved outcome and better quality of life of patients in the ICU and after discharge from ICU. The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). Although international guidelines recommend the use of validated tools for pain evaluation, they underline the need for translation into a given language. The authors of this publication obtained an official agreement from the authors of the two behavioral scales - CPOT and BPS - for translation into Polish. Validation of these tools in the Polish population will aid their wider use in pain assessment in ICUs in Poland.

Relationship between toll-like receptor 2 R753Q and T16934A polymorphisms and Staphylococcus aureus nasal carriage

BACKGROUND

The association among specific single-nucleotide polymorphisms (SNPs) in TLR2 R753Q (rs5743708) and T16934A (rs4696480) and the nasal carriage of Staphylococcus aureus was studied in adults before CABG.

METHODS

The TLR2 polymorphisms were genotyped in 299 consecutive patients prepared for a CABG operation. Genotyping was performed using restriction fragment length polymorphism (RFLP) analysis of PCR-amplified fragments. Two nasal swab cultures were taken within 2 weeks before the operation. Subjects were classified as Staphylococcus aureus carriers if at least one culture was positive while those patients with both cultures found to be negative were classified as non-carriers.

RESULTS

The prevalence of nasal S. aureus carriage in the final cohort was 22.1% (66/299), while no MRSA was detected in our study group. No significant differences in the TLR2 polymorphisms were observed between the study and the control groups. No associations were found between TLR2 haplotypes and the covariates of age, sex, NYHA, weight, height, BMI, CAD, smoking status and ESlog score. No differences were found between carriers and noncarriers regarding the allelic distribution of the TLR2 T-16934A SNP. Almost 93% of the patients who were screened for the presence of the TLR2 Arg753Gln (rs5743708) were GG wild type homozygous. Twenty one subjects from the study group (7.1%) were GA heterozygous, while no patient in either group was homozygous for the TLR2 Arg753Gln (rs5743708) mutation. TLR2 Arg753Gln genotyping showed that GA heterozygous patients were detected more frequently in the group of Staphylococcus aureus nasal carriers than in non-carrier adults.

CONCLUSION

Our results suggest that the carrier status for the GA variant of the TLR2 Arg753Gln (rs5743708) polymorphism may be a risk factor for Staphylococcus aureus carriage.

[The issue of expert opinions in underage pornography materials involving underage persons below 15 years of age]

The number of cases in which the estimation of age of the persons pictured in pornography materials is mandatory has been increasing for the last few years. The aim of the publication was to indicate the possibilities which are currently available for the forensic experts in this matter. The ones published heretofore mainly had focused on the difficulties which are inseparable elements of such expertise. Current publication has a demonstrative character and has been based upon the experience of two Forensic Medicine Departments. Such expertise have been constantly prepared in both of them for the last few years and none of them had to be changed till now. The currently available methods which allow for age estimation of the persons upon their photographical and movie images are far from perfection. Still authors remain skeptic about the possibility that significant progress in that matter can be achieved in predictable future. In such situation the most effective application of existing techniques becomes essential to minimize the risk of false-positive and false-negative results from appearing. Some of the difficulties pointed out by other authors are not important in practice.

[Application of thermovision in forensic medicine on the basis of the research carried out in Forensic Medicine Department, Pomeranian Medical University in Szczecin]

All solid bodies in the temperature above absolute zero emit electromagnetic radiation whose spectrum depends, among others, on temperature. Thermovision is the method which uses infrared cameras for recording infrared radiation emitted by human skin. The method is widely applied in medicine. In this study we want to present possible applications of the thermovision camera in forensic medicine (to investigate the decrease in the temperature of mortal remains; to study temperature distribution in the material simulating human body tissue exposed to the action of a bullet shot from firearms) as well as emphasize the necessity of establishing thermal norms as a potential source for comparative research.