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Using cryotherapy, <scp>EMLA</scp> (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial
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Abstract<sec><title>Introduction

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre‐puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture.

Methods

This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel‐group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale.

Findings

A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively).

Discussion

Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.

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Forced Displacement during the Syrian Forced Displacement during the Syrian Crisis, and its Impact on Jaramana’s Children's Education: A Field Study , and its Impact on Jaramana’s Children's Education: A Field Study: نهال ريحاوي جلب , قاسم الربداوي
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Video steganography has become a popular option for protecting secret data from hacking attempts and common attacks on the internet. However, when the whole video frame(s) are used to embed secret data, this may lead to visual distortion. This work is an attempt to hide sensitive secret image inside the moving objects in a video based on separating the object from the background of the frame, selecting and arranging them according to object's size for embedding secret image. The XOR technique is used with reverse bits between the secret image bits and the detected moving object bits for embedding. The proposed method provides more security and imperceptibility as the moving objects are used for embedding, so it is difficult to notice the

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