pain

A 27-year-old man presented to our hospital for abdominal pain and a cheesy discharge from the umbilicus which lasted for a few days. He was afebrile. The physical examination revealed periumbilical tenderness and discharge from the umbilicus. There were no signs of general infection. Otherwise, he had neither specific symptoms nor a palpable abdominal mass. Pelvic computerized tomographic (CT) scanning) confirmed the presence of a cyst in the midline of the abdominal wall, with communication with the bladder and peripheral calcification. The mass was infiltrated to the perivesical fat (Figure 1). The patient was prepared for surgery. During laparotomy, a urachal cyst with the cuff of the bladder dome were removed (Figure 2). Recovery was unremarkable. The resected specimen was a partial cystectomy specimen with perivesical fat and the median umbilical ligament

In the article presented the etiology of the so-called idiopathic scoliosis (Adolescent Idiopathic Scoliosis [AIS]), new classification, there are given rules of therapy and causal prophylaxis. This knowledge is based on observations from 1984, but essentially from the years 1995 – 2007. In 2001 it was given the first description in classification – “S” scoliosis in 1st group / type and “C” and “S” scoliosis in 2nd A / B group and types, in 2004 “I” scoliosis in 3rd group / type.

The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED). We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital. This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent. Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.

Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty. Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment. Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA. Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain). Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.

Introduction: In Madagascar, plague is a highly contagious acute endemic infectious disease. The diagnosis of the most severe form of pneumonic plague remains difficult in children, hence the objectives of the present study; which is to identify the clinical signs of this clinical form in children and to describe its epidemiological and evolutionary profile. Methods: A retrospective case-control study was conducted in four pediatric wards in Antananarivo during the urban pneumonic plague outbreak from September 2017 to January 2018. Those cases were defined as children aged 0-15 years old suspected of having plague with positive RDT and PCR, and they were defined as children aged 0-15 years old with negative RDT and PCR. Results: Fifty-two cases of pneumonic plague were identified, half of which (50%) were under 24 months of age. A male predominance was noted with a sex ratio of 1.23 and 86.54% of the patients were from urban areas. Several clinical signs were found but none was specific for pneumonic plague: cough (59.62% p: 0.5), dyspnea (3.85% p: 0.16), chest pain (3.85% p: 0.26%), hemoptysis (7.69% p: 0.17), vomiting (9.62% p: 0.14), diarrhea (11.54% p: 0.45), altered general condition (38.46% p: 0.24%). Two deaths were noted (3.8%). Conclusion: No specific clinical warning signs have been identified in childhood pneumonic plague. In the event of an epidemic of urban pneumonic plague, any bacterial pneumonia should at least initially include active treatment against Yersinia pestis.

Introduction: Hypertension is a silent pathology in a way that affects all four spheres to be considered as such; magnitude, transcendence vulnerability, and feasibility. The World Health Organization estimates that 45% of deaths from heart disease and 51% of deaths from stroke globally are caused by hypertension. Material and method: A longitudinal, descriptive and quantitative observational study was carried out on the personnel of high-risk public service providers. Results: The total population sampled was 550 people where it was possible to determine the sex where the disease predominates, since 92% of the hypertensive population belong to the male sex, while 8% of the female population. 57% of the total population were classified as normotensive, while 21% were classified as High Normal, Grade I Hypertension, and Grade II Hypertension. Discussion: AHT is the result of a series of interactions between endogenous and exogenous factors in an organism that tries to adapt to the increase of the cardiac output and the peripheral resistance of the blood vessels, which is manifested by the increase in blood pressure figures. Physical activity has been shown to have a lower risk of hypertension compared to sedentary individuals. The daily stress these workers face predisposes them to suffer their manifestations as headache, muscle pain, fatigue, digestive disorders and constant elevations of blood pressure.

Lemongrass is a culinary herb with a lemony aroma.it is mostly cultivated in Southeast Asia, Sri Lanka, Indonesia and India. It is conventionally used for relieving anxiety, stress and pain. Because of the presence of limonene and citral, lemongrass extracts exhibits antimicrobial, antidandruff and anti-inflammatory effects. However Tea tree extracts are mostly employed in the treatment of dermal, inflammatory and microbial infections.

Nanocontainers of the type CuO, ZnO and CeMo were developed in the present work and incorporated into commercial paints. The nanocontainers were filled with bromosphaerol (CuO and ZnO), SeaNineTM 211 (CuO and ZnO), and 8Hydroxyquinoline (CeMo). The new resulting paints were tested in the lab and in the sea via painting a fraction of two ships. The outcome of this work is encouraging demonstrating that the new nanotechnology-based paints yield to superior commercial paints that may present a major milestone in the new generation of marine paints

The Federal and State governments have declared the presence of an opioid addiction pandemic in the United States claiming the lives of more than 55,000 in 2015 (Rudd RA, Seth P, David F and Scholl L. 2016). The pharmaceutical manufacturers of the numerous FDA-approved opioid drugs are raking in more than $5 billion per year with about 2 million chronic pain sufferers addicted. The irony of this narcotic use and abuse conundrum is the existence of evidence-based technology for drug-free pain management which is not covered for reimbursement among public and private third-party payers. Therefore, this paper is presented to propose a pilot study to demonstrate the efficacy of resolving the chronic inflammation, edema and ischemia that causes non-malignant chronic pain with PEMF therapy, a non-invasive, non-thermal radio transmission of electrical impulses, thereby invalidating the legitimacy of prescribing opioid analgesics in such cases.

Patients were left in soiled sheets or sitting on commodes for hours. Some patients needing pain relief got it late or not at all.’ These were a sample of the findings in the Francis Report which revealed severe failings in patient care in the Mid Staffordshire NHS Foundation Trust in the UK. Recommendations in the Francis Report included the need to recruit compassionate staff and having compassion training for clinicians [1].

Background: The argument on whether extracorporeal shock-wave therapy (ESWT) is beneficial in short- term intervention in adults with plantar fasciitis. It is important and necessary to conduct a meta-analysis to make a comparatively more reliable and overall assessment of the outcomes of ESWT in the less than 6 months. Methods: We conducted a systematic review and meta-analysis of randomized control trials from MEDLINE, EMBASE and CINAHL databases from 2000 to 2020. Randomized trials that evaluated extracorporeal shock wave therapy used to treat plantar heel pain were included. Trials comparing an extra corporeal shock wave therapy with control/placebo were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomized controlled trial, extracted data and assessed the methodological quality of each trial. Results: Four studies involving 645 patients were included. 3 RCTs (n = 605) permitted a pooled estimate of effectiveness based on overall success rate and composite score of visual analogue scales for pain at follow-up 1 (12 weeks). The pooled data showed no significant heterogeneity at the three-month follow-up (p - value of chi-square = 0.61, p = 0.74 and I2 = 0%). The shock wave group had a better success rate than the control group at the three-month follow-up (OR = 2.26, 95% CI = 1.62-3.15, p - < 0.00001). For reduction of pain the pooled data showed no significant heterogeneity (p - value of chi-Square 0.28 and I2 22%). There were significant differences between the ESWT and control groups for all follow-up visits (random-effect model, three trials, MD = 15.14, 95% CI = 13.86 to 16.42, < 0.00001 at three-month). Conclusion: A meta-analysis of data from three randomized-controlled trials that included a total of 605 patients was statistically significant in favor of extracorporeal shock wave therapy at follow-up 1(12 weeks).

Background: Even if pain and psychological symptoms experienced by university students are common, the prognosis of these symptoms is unknown. Objective: To examine the incidence and the outcome of frequent musculoskeletal and psychological symptoms in a 4-year follow-up of first-year university students. Methods: In 2008, a national random sample (N=2750) of Finnish university students completed a questionnaire concerning pain and psychological symptoms. Of the 416 first-year students, 123 responded to the same questionnaire also in their fourth study year in 2012. Results: Of the first-year university students with frequent pain or psychological symptoms, ­one half (47% - 65%) reported frequent symptoms also four years later. Almost all (78% – 95%) of the symptom-free first-year students were symptom-free also in their fourth study year. Conclusion: Our findings indicate that pain and psychological symptoms in university students are rather persistent during the first four study years. On the other hand, as half of those with frequent symptoms become symptomless and as the prognosis of symptom-free students is favourable, there is still need for further cohort studies on this issue.

Pain is a complex phenomenon which is unpleasant. Different cosmetic procedures are associated with varying degrees of pain. Various modalities are adopted to decrease the severity of pain. The commonly used is the administration of analgesics (opioid or non-steroidal). The pain is carried to the brain by pain fibres. There are various theories about the pain [1,2]. Many attempts have been undertaken to find the modalities which decrease the perception of pain by the brain. The famous ‘gate theory’ was proposed in 1965 by Melzack et al. [3]. It was proposed that the pain experience can be reduced by the activation of nerve fibres that conduct non-toxic stimuli. The theory suggested that the stimulation of larger diameter fibres (A-beta) can close a neural ‘gate’ to nocioceptive signals and can reduce the perception of the pain. The ‘gate’ is proposed to lie within the spinal cord/brainstem and inhibits the transmission of nocioceptive action potentials to higher centres in the central nervous system [4]. The “post-synaptic inhibitory and fascilitatory mechanism” provide a basis for explaining the pain reducing strategies such as rubbing the painful area or applying cold or vibration to decrease the perception of the pain. Various topical irritants used in a few ‘magic’ creams also work on the same principle. Every effort is made to decrease the perception of pain in cosmetic surgery procedures especially hair restoration. A surgeon who can perform a hair restoration without pain has an edge over his competitors. The potential patients undergoing hair restoration are very anxious about the pain level to be perceived during the procedure. Vibration anaesthesia is becoming increasing used in hair restoration to decrease pain perception. Various recent studies have demonstrated the effective use if vibrations to decrease the pain of local anaesthesia injections [5,7]. The pain of the injection has basically two components; the first is the actual needle prick and second is the discomfort felt due to the tissue stretch by the local anaesthetic drugs [8]. The following study was conducted to compare the pain level of ring block in the patients undergoing hair restoration with and without the use of vibration

Purpose: In an aspect of qualitative treatment, this research gathered lung cancer patients’ actual experiences to understand deeply, such as their expectation for treatment results, their difficulties during treatment, and their various requests to their family and medical teams. Methods: From May to June 2013, semi-structured interviews were conducted with 9 lung cancer patients. Data were collected through a tape-recorded in-depth interview. The analysis of the data was made through the qualitative method. Results: 124 themes regarding the experience were found. From these 35 concepts, 24 subcategories were emerged. The core category was enduring hardship of the treatment with the hope for full recovery. Six categories included ‘Wishing to be cured but concern about recurrence’, ‘Receiving radiation treatment with pleasure and difficult at the same time’. ‘Being sorry for their family’s full support and trying to stand alone‘, ‘Having confidence in their medical team’, ‘regretting for their old days’, and ‘Wanting to live a long life without illness and pain’. Conclusion: The results of this study would help oncology nurses to understand the lung cancer patients receiving concurrent chemo-radiotherapy (CCRT) and to develop a quality of life improvement program for physical, psychosocial, and spiritual aspects of nursing.

Objective: The study aimed to investigate neonatal nurses' knowledge and practices related to pain assessment and management that may contribute to improve the quality of pain management by nurses at Neonatal Intensive Care Units (NICUs) of governmental hospitals in Gaza Strip. Design: The study design was quantitative, descriptive cross sectional, conducted at the NICUs affiliated to the governmental hospitals "Al Shifa Hospital - Al Nasser Pediatric Hospital - European Gaza Hospital". Materials and Methods: The sample consisted of all nurses working in NICUs. The total number of nurses was 102. The data were collected from study participants by using a self-administered questionnaire. The response rate was 100%. The data collected were analyzed by using descriptive and inferential statistical tests with level of statistical significance at p < 0.5. Results: The results showed that nurses had very low of knowledge level with mean percentages (59.42%) and very low of practice level with mean percentages (58.33%). Conclusion: Therefore, the study recommended to developing course or educational program related to assessment and management of neonatal pain to promote their integrated pain management care for neonates.

Background: Congenital Vascular malformation relatively rare and extremely varied clinical presentations. The purpose of our study was to present our initial experience of embolization in a series of 26 patients with congenital vascular malformation to assess retrospectively the results and the complications of ethanol and coils embolization treatment of these patients. Methods: Retrospective trial, the study group consisted of 26 patients with congenital vascular malformations. Transcatheter arterial embolization by ethanol or coils were performed, Therapeutic outcomes were established by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up angiography. Results: Between November 2014 and March 2018, 26 consecutive patients (3 male, 23 female) at Alshifa Hospital - Cardiac Catheterization Center with congenital vascular malformations in the body and extremities underwent staged ethanol or coils embolization. The mean age of the patients was 25 years (age range, 6– 59 years). Ethanol embolization was administrated in 16 patients, coil embolization in 9 patients and graft stent in one patient. The side effect such as pain, pulsation, and bruit in most of the patients were obtained. The reduction of redness, swelling, and warmth was achieved in all of the patients, According to the angiographic findings, congenital vascular malformation were devascularized 100% in 12 patients, 50% to 99% in 11 patients, less than 50% in 3 patients. The most common complications were reversible skin necrosis. Conclusion: Transcatheter embolization by ethanol or coils has proved efficacious and safe in the treatment of congenital vascular malformation of the body and extremities but with acceptable risk of complications

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematologic condition which could be revealed by deep venous thrombosis. It could be fatal unless correctly treated. Case report: We report here the case of a 28 year-old male with no medical history who was admitted to the emergency room for severe abdominal pain. Computerized Tomography angiography (CT) scan revealed portal vein thrombosis. Laboratory findings showed pancytopenia with severe regenerative normocytic anemia resulting in PNH. Because of the lack of Eculizumab, treatment was first based on curative anticoagulation until bone marrow transplant, with no success. Conclusion: PNH remains a severe disease with bad prognosis unless treated with Eculizumab.

Pulmonary embolism (PE) is an age-related disorder which is potentially fatal, but frequently misdiagnosed. However, the true prevalence of pulmonary embolism is unknown. Inaccurate estimates of PE prevalence might, in part, be attributable to underrecognition of atypical presentations of this disorder. If true prevalence is unknown, the positive predictive values of both typical and atypical symptoms and signs of PE will be unreliable. The negative predictive value of those parameters will, likewise, be unreliable. The aim of this review is to make clinicians more aware of atypical manifestations of PE, thereby increasing the likelihood of correct diagnosis and, hence, ascertainment of the true prevalence of PE. The range of atypical manifestations was explored by a literature search, using MEDLINE from 1946 to February 2019, and EMBASE, from 1947 to February 2019, and Pubmed, from February 2014 to February 2019, using the search terms atypical, uncommon, unusual, pulmonary embolism, lung embolism, pulmonary thromboembolism. This search revealed atypical presenting features such as non pleuritic retrosternal pain, abdominal pain, atypical breathing patterns, pulmonary oedema, Dressler’s syndrome, atypical radiographic manifestations, atypical electrocardiographic features, manifestations associated with oxygen saturation of 95% or more, coexistence of acute myocardial infarction and pulmonary embolism, coexistence of thoracic aortic dissection and pulmonary embolism, neurological manifestations other than stroke, paradoxical embolism, acute venous thrombosis of atypical location, and pulmonary embolism with normal D-dimer levels.

Dissecting aortic aneurysm with ST segment elevation, and pulmonary embolism with ST segment elevation are two of a number of clinical entities which can simulate ST segment elevation myocardial infarction. Objective: The purpose of this review is to analyse clinical features in anecdotal reports of 138 dissecting aortic aneurysm patients with STEMI-like presentation, and 102 pulmonary embolism patients with STEMI-like presentation in order to generate insights which might help to optimise triage of patients with STEMI-like clinical presentation. Methods: Reports were culled from a literature search covering the period January 2000 to March 2020 using Googlescholar, Pubmed, EMBASE and MEDLINE. Reports were included only if there was a specification of the location of ST segment elevation and an account of the clinical signs and symptoms. Search terms were “ST segment elevation”,”aortic dissection”, “pulmonary embolism”, “myocardial infarction”, and “paradoxical embolism”. Fisher’s exact test was utilised for two-sided comparison of proportions. Proportion was calculated for each group as the number of patients with that parameter relative to the total number of patients assessed for that parameter. Findings: There were 138 patients with aortic dissection, 91 of whom were either fast-tracked to coronary angiography (81 patients) or fast-tracked to thrombolytic treatment (10 patients). There were 47 patients managed with neither of those strategies. There were 102 patients with pulmonary embolism, 71 of whom were fast tracked to coronary angiography, and 31 who did not receive that evaluation. Compared with their dissecting aortic aneurysm counterparts, those dissecting aortic aneurysm patients initially managed by percutaneous coronary intervention or by thrombolysis were significantly (p = 0.0003) more likely to have presented with chest pain, and significantly (p = 0.018) less likely to have presented with breathlessness. The preferential fast-tracking to coronary angiography prevailed in spite of comparable prevalence of back pain in fast tracked and in non-fast tracked subjects. Use of transthoracic echocardiography was also comparable in the two subgroups of dissecting aortic aneurysm patients. Pulmonary embolism patients fast tracked to percutaneous coronary intervention were significantly (p = 0.0008) more likely to have presented with chest pain than their pulmonary embolism counterparts who were not fast-tracked. The prevalence of paradoxical embolism was also significantly (p = 0.0016) higher in fast-tracked patients than in counterparts not fast-tracked. Cardiac arrest was significantly (p = 0.0177) less prevalent in fast-tracked pulmonary embolism patients than in pulmonary embolism patients who were not fast-tracked. Preferential fast-tracking to coronary angiography prevailed in spite of the fact that prevalence of documented deep vein thrombosis was comparable in fast-tracked subjects and in subjects not fast-tracked. The prevalence of use of transthoracic echocardiography was also similar in fast-tracked pulmonary embolism patients vs counterparts not fast tracked. Overall, however, transthoracic echocardiography had been utilised significantly (p = 0.007) less frequently in dissecting aneurysm patients than in pulmonary embolism patients. Conclusion: Given the high prevalence of STEMI-like presentation in aortic dissection there is a need for greater use of point-of-care transthoracic echocardiography to mitigate risk of inappropriate percutaneous coronary intervention(which might delay implementation of aortic repair surgery) and inappropriate thrombolysis(which might precipitate hemorrhagic cardiac tamponade) (75) during triage of patients presenting with ST segment elevation simulating ST segment elevation myocardial infarction (STEMI). Furthermore, during triage of patients with STEMI-like clinical presentation, the combined use of point-of -care echocardiography and evaluation for deep vein thrombosis will facilitate the differentiation between acute myocardial infarction, STEMI-like aortic dissection, and STEMI-like pulmonary embolism. Among STEMI-like patients in whom DAA has been ruled out by point of care TTE, fast tracking to PCI might generate an opportunity to identify and treat paradoxical coronary artery embolism by thrombectomy. Thereby mitigating the mortality risk associated with coronary occlusion. Concurrent awareness of PE as the underlying cause of paradoxical embolism also generates an opportunity to relieve the clot burden in the pulmonary circulation, either by pulmonary embolectomy or by thrombolysis. Above all, frontline clinicians should have a greater awareness of the syndrome of STEMI-like presentation of aortic dissection and STEMI-like pulmonary embolism so as to mitigate the risk of inappropriate thrombolysis and inappropriate percutaneous coronary angiography which seems to prevail even in the presence of red flags such as back pain (for aortic dissection) and deep vein thrombosis(for pulmonary embolism). 

A 34-year-old male patient presented with the complaint of chronic pain in the left groin following left side testicular vein ligation for varicocele. Ilio-inguinal neurectomy and cremaster muscle division was done in another hospital for the pain but with no relief of pain. Patient on examination showed point tenderness in the left groin at the pubic tubercle. Finger Invagination test in the left was painful with severe tenderness. Investigation showed fibrosed contracted left distal inguinal ligament. Percutaneous Ultrasonographic (USG) guided inguinal ligament release and Platelet-Rich Plasma (PRP) injection relieved the pain completely. Post-procedure patient showed significant improvement of pain.