Chief Complaint Of Pain Research Articles

A case report of fungal keratitis due to Fusarium oxysporum after an injury by fingernails

Fusarium keratomycosis is a disastrous fungal infection of the eye, can affect healthy individuals, is cumbersome to treat, and has a poor prognosis. Herein, we present a case of a healthy 40-year-old female patient, who presented with chief complaints of pain, redness, and watering of the left eye since 15 days along with the diminution of vision. She had a history of trauma to the left eye by fingernails, followed by the development of symptoms. KOH wet preparation of corneal scrapings revealed fungal elements with the growth of culture on Sabouraud's dextrose agar confirming the etiological agent as Fusarium oxysporum. This case is reported for its rarity.

下口唇に生じた粘表皮癌例

Minor salivary gland tumors are rarely encountered head and neck tumors. These tumors are more often malignant than neoplasms of the major salivary glands. In this article, we report a patient with mucoepidermoid carcinoma of the lower lip. The patient was a 50-year-old woman who presented with the chief complaint of pain in the lower lip. On examination, a small nodule was palpable on the right side of the lower lip, with tenderness. MRI did not reveal any lesion. Therefore, we performed surgery under local anesthesia for diagnosis and treatment. The nodule was confirmed by palpation and removed with the surrounding tissue. Histopathology revealed the diagnosis of low-grade mucoepidermoid carcinoma, and the resection margins were negative. Although the incidence of minor salivary gland tumors is low, they must be included in the differential diagnosis of nodular lesions of the lower lip, as the incidence of malignant transformation of these tumors is relatively high.

Coexistence of Fusion and Birooted Primary Canine in a Child

Bilateral birooted primary canine presentation is an exceptionally rare dental oddity, and its occurrence with primary double teeth is even rarer. In Indian literature, fused primary anteriors are the most common dental morphological anomalies, whereas only one case of bilateral birooted primary canines has been published. This article describes the case of a 3-year-old male with a chief complaint of pain and intraoral swelling associated with fused primary anterior teeth, wherein supernumerary roots in primary canines found bilaterally were an incidental radiographic finding. This case thus emphasizes the importance of a thorough and comprehensive intraoral and radiographic examination using numerous angulations for facilitating early diagnosis, favorable treatment outcome, and reduced need for complex orthodontic interceptions for similar dental anomalies.

Rehabilitation with Table-Top Restoration Post Bicuspidisation: An Interdisicplinary Case Report

The first teeth to erupt in the oral cavity are the mandibular molars which are more prone to endodontic and periodontal involvement. This may lead to significant issues like an increase in pocket depth, furcation involvement, loss of clinical attachment and mobility of teeth ultimately resulting in tooth loss. Thus, it necessitates cautious oral hygiene measures. Advances in dentistry have led to treatment modalities for preserving teeth which were earlier indicated for extraction. Hence, periodontally compromised tooth with severe furcation involvement, which may not be amenable for regeneration, may be retained by bicuspidisation. Bicuspidisation is a surgical technique which involves separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually, followed by rehabilitation with fixed prosthesis of the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. In the present case report, a 50-yearold male patient reported with the chief complaint of pain, sensitivity and food lodgement in left mandibular first molar. Clinical and radiographic examination revealed grade III furcation involvement, significant pocket depths, delayed electric pulp test response and bone loss in furcation area. Bicuspidisation was opted as the suitable treatment modality. Root canal treatment was done, followed by bicuspidisation and subsequent rehabilitation with novel prosthetic technique. The bicuspids were restored using combination of deep margin elevation, and non splinted Lithium Disilicate table-top restorations. Six month follow-up showed good healing of hard and soft tissues around the bicuspidized sections, which was indicative of a successful treatment outcome, and can be attributed to a careful case selection, choice of restorative materials and techniques as well as good oral hygiene compliance.

THE COMBINATION OF SIDDHA PURIFICATION THERAPIES ALONG WITH SIDDHAR YOGAM IN THE MANAGEMENT OF THANDAGAVATHAM (LUMBAR SPONDYLOSIS) - A CASE REPORT

Lumbar spondylosis is a degenerative disorder of the lumbar spine characterized clinically by an insidious onset of pain and stiffness and radiologically by osteophyte formation. Vathaa disease is classified into 80 types. Thandagavatham is one of them. It may be correlated with Lumbar Spondylosis in modern science. Siddha is a comprehensive system of medicine that emphasizes the body, mind and spirit to restore the innate harmony of the individual. It contains various therapies like varmam, yogam, purification therapies and external therapies. Purification therapies are fasting, purgation, enema, nasiyam and etc. It helps us to detoxify the body and retain energy and restore it. Yogam is one of the parts of the Siddha system of medicine. Yoga helps in increasing flexibility, muscle strength and body tone. A male patient at the age of 42 reported at the National Institute of Siddha, Chennai with chief complaints of pain in the lumbar region, radiating to both lower limbs, numbness in both legs, and difficulty walking and standing for 3 months. While pain aggravates during prolonged walking and standing. After the treatment of purification therapies along with Siddhar yogam therapy for 48 days, the symptoms were reduced. This study demonstrates that the improvement is seen in the Numeric Pain Rating Scale (NPRS). This result shows that a combination of purification therapies along with Siddhar yogam therapy is very effective in the management of Thandagavatham.

Hemisection and porcelain fused to metal crown splinters on the first molar: A case report

Objective: The aim of this treatment was to preserve the remaining tooth structure and to restore the function of the tooth
 Methods: A 37-year-old female patient with a chief complaint of pain in the lower right molar tooth after root canal treated one week ago. Clinical examination revealed a cavity on the disto-occlusal side achieve half the crown of the tooth with a dentin depth. Percussion: (+), palpation: (-), mobility: (-), vitality: (-). Radiograph examination revealed radiolucent area mesial root and ± 1.5mm radiopaque images that are thought to be file fractures in the apical foramen. Vertical radiolucent lines on dental bifurcation were detected vertical bone loss was evident on mesial root of the lower right molar with furcation involvement. Management of the patient is hemi section and Porcelain fused to metal crown splinter.
 Results: After one month of hemi section, no pain detected, the gingiva shows good healing, no Intra and extraoral swelling, trismus was absent, and objective examination percussion test was (-) and mobility (-).
 Conclusion: Hemi section is a conservative and effective treatment of choice overcome vertical radiolucent lines on dental bifurcation and broken file in the apical foramen.

Current concepts of Drug Therapy in Dentistry: A Review

Knowledge and awareness about current concept of drug therapy in dentistry is very important for clinicians to deliver a high quality of care to their patients. Most of the patients report to dental setup with the chief complaint of pain and swelling. Efficient utilization of latest regimen of analgesics and antibiotics not only helps in reducing pain and swelling but also build up good trust with the dentist. In the present time numerous newer analgesics like ketorolac and tramadol are available in the market. This review article gives an overview of newer analgesics, antibiotics, local anesthetic agents, and delivery devices which will enable the dentist to provide Painless Dentistry.

Swyer-James-Macleod Syndrome: A Rare Entity

Swyer-James-MacLeod syndrome is a radiological entity characterised by hyperlucency of one or more lobes or of the entire lung associated with decreased number and diameter of ipsilateral peripheral pulmonary vessels resulting in difficult visibility of the arterial network, and unobstructed bronchial system. We report the case of a 12-year-old girl who presented with chief complaint of pain in the chest. Chest radiograph (postero-anterior view) showed hyperlucent left lung field with increased lung volume and shift of the mediastinum to the right side. Contrast-enhanced computed tomography (CECT) of the chest showed hyperlucency and diminished vascularity in the upper lobe and lingula of left lung with hyperinflation of the pulmonary parenchyma. On the basis of clinical and radiological findings, the patient was diagnosed to have Swyer-James-MacLeod syndrome.

Dental calculus contributing to impaired speech and deglutition: A rare case

A 21 year female patient reported with the chief complaint of pain and difficulty while eating and swallowing food from past 15-20 days. Her mother complained about her silent mode most of the time. Patient revealed that she is having pain while speaking, therefore she avoid speaking from past few days. Patient was systemically healthy. Intraoral examination revealed plaque, heavy calculus deposits and bleeding on probing. In mandibular anterior teeth, calculus deposits extended till the lingual vestibule with respect to right mandibular central incisor (Figure 1a). Severe gingival inflammation was there. Calculus was irritating the lingual floor mucosa leading to pain while swallowing and speaking. Calculus contributes indirectly to gingival inflammation by providing fixed nidus to the microbial plaque, primary etiologic agent, for its retention near the periodontal tissues [1]. Mean GI [2], PPD and CAL were 3, 1.9 and 2.5 respectively for mandibular anteriors.

Dental calculus contributing to impaired speech and deglutition: A rare case

A 21 year female patient reported with the chief complaint of pain and difficulty while eating and swallowing food from past 15-20 days. Her mother complained about her silent mode most of the time. Patient revealed that she is having pain while speaking, therefore she avoid speaking from past few days. Patient was systemically healthy. Intraoral examination revealed plaque, heavy calculus deposits and bleeding on probing. In mandibular anterior teeth, calculus deposits extended till the lingual vestibule with respect to right mandibular central incisor (Figure 1a). Severe gingival inflammation was there. Calculus was irritating the lingual floor mucosa leading to pain while swallowing and speaking. Calculus contributes indirectly to gingival inflammation by providing fixed nidus to the microbial plaque, primary etiologic agent, for its retention near the periodontal tissues [1]. Mean GI [2], PPD and CAL were 3, 1.9 and 2.5 respectively for mandibular anteriors.

High quality interventions that reduced the overall number of frequent emergency department visitors for pain-related complaints

Background: Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. Summary: Generation and dissemination of care plans led to a decrease in emergency room visits and hospital admissions. The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient's quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints

BackgroundPain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program.ResultsThere were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care.Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test’s p-value of less than 0.001.ConclusionThe authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient’s quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy

Background: Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that potentially attacks all parts of the human body. Despite the use of disease-modifying anti-rheumatic drugs (DMARDs), the rate of total knee arthroplasty (TKA) remains high. Critical complications such as infection, dislocation, and readmission following TKA are also reportedly high and therefore, appropriate management during perioperative period is critical. We reported the perioperative management of a patient with late RA and genu contracture underwent tenotomy. Case Presentation: A 22-year-old male was referred to Dr. Soetomo General Hospital with a chief complaint of pain in the right and left groin. He also complained of immobilization and stiffness in both knees. He had been diagnosed with bone tuberculosis in 2014 and underwent a total knee replacement of both knees in 2015 due to stiffness and inability to walk. Radiography examination indicated erosion and loss of joint spaces in the joints of the hip, fingers, and toes. Laboratory investigation showed positive anti-mutated citrullinated vimentin (anti-MCV), confirming RA. The patient underwent tenotomy surgery and was treated with methylprednisolone 4 mg peroral daily, chloroquine 250 mg peroral daily, and natrium diclofenac peroral to reduce pain. Tenotomy was performed. Considering the disease activity, conventional DMARDs (chloroquine 250 mg peroral and low dose steroid, methylprednisolone 1x4mg peroral) were prescribed. Conclusion: The case highlights the complexity of perioperative management of late RA and genu contracture underwent tenotomy that required multiple disciplines. Therefore, interdisciplinary collaborative team is critical to be able to achieve optimal results of the patient.

Evaluating Cancer Pain Characteristics and Treatment Factors in the Emergency Department: A Retrospective Cohort Study.

Objectives: To identify patient characteristics and treatment factors of patients presenting to the emergency department (ED) with cancer-related pain that may affect patient outcomes. Methods: We conducted a retrospective cohort study to evaluate adult patients with active cancer, who presented to the ED with a chief complaint of pain between June first, 2012 and January first, 2016. We utilized multivariable logistic regression to evaluate the association of several exposure variables, including disease and demographic characteristics, primary pain site, and treatment methods, on ED disposition and revisit rate. Results: We included 483 patients with active cancer with a chief complaint of pain. Patients with severe pain on arrival tended to be younger than those who did not present with severe pain (median: 58 vs 62 respectively, OR 8.0 p < 0.01). Patients with high ECOG scores (3-4) with severe pain on arrival (≥7 out of 10) had less improvement in their pain than the rest of our cohort (OR 8.4, p < 0.01). Also, those with musculoskeletal pain had significantly less improvement in reported pain than all other pain types (delta pain −2.1 vs −3.4, OR 2.3, p = 0.025) Long delays in initial analgesic administration were associated with increased rates of subsequent admission (OR 3.4) [p = 0.014]. Although opioid analgesics led to greater decreases in pain than non-opioid analgesics, patients treated with opioids were more likely to be admitted (43% vs 34.5% AOR 1.51, p = 0.048). Conclusion: Our study showed that delays in analgesic administration, poor functional status, and the presence of musculoskeletal (MSK) pain significantly influenced outcomes for this patient cohort. These findings suggest the development of specific protocols and tools to address cancer-related pain in the ED may be necessary.

AMELOBLASTOMA OF THE MAXILLARY SINUS: A CASE REPORT

A 64-year-old female patient presented with the chief complaint of pain in the right sinus region and history of previous traumatic extraction, but no swelling was observed. Imaging exams revealed a well-defined homogeneous expansive lesion, occupying the entire sinus and partially invading the right side of the nasal fossa, in addition to erosion of the alveolar process of the maxilla, resulting in buccosinusal communication. Incisional biopsy was performed, and the histopathologic diagnosis was ameloblastoma. The patient is currently under preoperative preparation for further definitive surgery. Ameloblastoma is an aggressive odontogenic tumor, with less than 20% of cases occurring in the maxilla, where the proximity to the orbit, skull base, and intracranial contents contributes to increase the morbidity rates of the tumor. In addition, due to its rarity in maxilla, the clinical diagnosis of ameloblastoma is challenging and commonly leads to a delay in proper management of the tumor. A 64-year-old female patient presented with the chief complaint of pain in the right sinus region and history of previous traumatic extraction, but no swelling was observed. Imaging exams revealed a well-defined homogeneous expansive lesion, occupying the entire sinus and partially invading the right side of the nasal fossa, in addition to erosion of the alveolar process of the maxilla, resulting in buccosinusal communication. Incisional biopsy was performed, and the histopathologic diagnosis was ameloblastoma. The patient is currently under preoperative preparation for further definitive surgery. Ameloblastoma is an aggressive odontogenic tumor, with less than 20% of cases occurring in the maxilla, where the proximity to the orbit, skull base, and intracranial contents contributes to increase the morbidity rates of the tumor. In addition, due to its rarity in maxilla, the clinical diagnosis of ameloblastoma is challenging and commonly leads to a delay in proper management of the tumor.

ORAL REHABILITATION WITH DENTAL IMPLANTS IN A PATIENT WITH HADJU-CHENEY SYNDROME: CASE REPORT

Hadju-Cheney syndrome (HCS) is a rare disease of the connective tissue and bone metabolism. This osteolytic disorder follows an autosomal-dominant inheritance pattern, and some manifestations are acro-osteolysis, osteoporosis, short stature, craniofacial changes, progressive periodontitis, premature tooth loss, and dental abnormalities. The proband was a 21-year-old male patient with HCS with the chief complaint of pain and chewing difficulty due to teeth mobility. Clinical examination showed generalized advanced periodontitis. However, computed tomography showed satisfactory basal bone height. For oral rehabilitation, total teeth extraction and dental implant was proposed. First, total extraction of the maxillary teeth and 6 dental implants were performed. In the second surgery, total extraction of the mandibular teeth and 4 dental implants were performed. Six months after the first surgery and successful osseointegration of the dental implants, an implant-supported dental prosthesis was placed. The oral rehabilitation provided a more aesthetic appearance, with better masticatory performance and quality of life. Hadju-Cheney syndrome (HCS) is a rare disease of the connective tissue and bone metabolism. This osteolytic disorder follows an autosomal-dominant inheritance pattern, and some manifestations are acro-osteolysis, osteoporosis, short stature, craniofacial changes, progressive periodontitis, premature tooth loss, and dental abnormalities. The proband was a 21-year-old male patient with HCS with the chief complaint of pain and chewing difficulty due to teeth mobility. Clinical examination showed generalized advanced periodontitis. However, computed tomography showed satisfactory basal bone height. For oral rehabilitation, total teeth extraction and dental implant was proposed. First, total extraction of the maxillary teeth and 6 dental implants were performed. In the second surgery, total extraction of the mandibular teeth and 4 dental implants were performed. Six months after the first surgery and successful osseointegration of the dental implants, an implant-supported dental prosthesis was placed. The oral rehabilitation provided a more aesthetic appearance, with better masticatory performance and quality of life.

OSTEOBLASTOMA OF THE MANDIBLE: A CASE REPORT

A 19-year-old White female patient presented with the chief complaint of pain in the left region of the mandible, without extra- or intraoral clinical alteration. Radiographic exams and cone beam computed tomography revealed a mixed-density lesion, with poorly defined borders, promoting dental displacement, and cortical expansion by lingual. Teeth 31 to 35 showed thickening of the periodontal ligament. The provisional diagnosis was osteoblastoma. An incisional biopsy revealed the presence of thin, anastomosed irregular bone trabeculae, lined by a rim of osteoblasts and occasional osteoclast-like multinucleated giant cells, permeated by fibrovascular stroma, confirming the clinical hypothesis of osteoblastoma. The lesion was surgically removed, and the final diagnosis was osteoblastoma. Osteoblastoma is a rare benign neoplasm in the jaw, and diagnosis is based on the correlation between clinicopathologic findings. Because of its varied clinical behavior, early diagnosis is an important strategy for the establishment of an effective treatment.

NON-HODGKIN'S LYMPHOMA OF PALATE: A CASE REPORT OF A HIGHLY DESTRUCTIVE LESION

A 54-year-old female patient presented to a dental office with a chief complaint of pain in her palate. Intraoral physical examination revealed a 2-cm local swelling with a small, centered ulceration and dilated superficial capillaries in the left posterior palatal area. Cone beam computed tomography did not show bone destruction. An incisional biopsy was performed and the histopathologic exam was inconclusive. Immunohistochemistry was positive for Ki-67 marker; co-expression of CD45, CD20, BCL-2, and BCL-6 associated with a high proliferative index of Ki-67 established a diagnosis of diffuse large B-cell lymphoma. Positron emission tomography revealed the involvement of the hard and soft palate, palatine tonsil, cervical and axillary lymph nodes, and inguinal area. The palatal lesion showed very rapid growth, affecting the underlying bone, causing extensive destruction and leading to a buccosinusal communication in a short period of time. An acrylic palatal obturator was installed to improve the patient's quality of life during oncological treatment.

Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report

BackgroundVibrio vulnificus infections develop rapidly and are associated with a high mortality rate. The rates of diagnosis and treatment are directly associated with mortality.Case presentationWe describe an unusual case of a 61-year-old male patient with chronic liver disease and diabetes who presented with a chief complaint of pain in both lower legs due to V. vulnificus infection in winter. Within 12 h of arrival, typical skin lesions appeared, and the patient rapidly developed primary sepsis. Despite prompt appropriate antibiotic and surgical treatment, the patient died 16 days after admission.ConclusionOur case findings suggest that V. vulnificus infection should be suspected in patients with an unclear infection status experiencing pain of unknown origin in the lower legs, particularly in patients with liver disease or diabetes, immunocompromised status, and alcoholism.

Subscapular elastofibrolipoma treated with marginal resection: two case reports

BackgroundElastofibroma dorsi is a rare benign tumor of soft tissue, typically under the lower angle of the scapula. Its specific location and distinctive clinical symptoms can provide enough information for diagnosis. Nevertheless, pathological confirmation by biopsy may be needed to rule out other malignancies.Case presentationHere, we present two cases of 63-year-old and 49-year-old female Asian patients who came to us with the chief complaint of pain and bulging in their shoulders. Both patients had rubbery and mobile masses. Also, shoulder movements were not restricted in the examination; however, the patients expressed pain during movements. Computed tomography scans were compatible with the diagnosis of elastofibroma dorsi. Surgical excision was performed for both cases owing to the symptomatic nature of the masses, and histopathological findings confirmed the diagnosis.ConclusionElastofibroma dorsi is a benign pseudotumor presenting with an uncomfortable feeling in the shoulder with movement in older females. In typical symptom-free cases of elastofibroma dorsi, observation is sufficient, while in symptomatic patients or if there is suspicion of malignancy, complete resection with marginal resection is the treatment of choice.