Chronic Discomfort Research Articles

O-16 A CASE OF VITAMIN D-DEPENDENT RICKETS DIAGNOSED IN ADULTHOOD FOLLOWING PREGNANCY

Abstract Discussion Vitamin-D (Vit-D)-dependent rickets are the result of a deficiency in 1-alpha hydroxylase. It is a rare condition that is typically diagnosed in childhood. We present a case of Vit-D-dependent rickets that was detected in adulthood after pregnancy. Clinical Case A 25-year-old female patient has been sent from the neurosurgical clinic to the endocrinology department for evaluation of Vit-D deficiency, which is believed to be causing muscle weakness. She experienced chronic lower back discomfort that began two years ago. She experienced challenges when going down stairs and when bending her body forward. Rest alleviated the lower back pain, whereas physical activity exacerbated it, and it did not interfere with her sleep. The weakness in the legs was there with it. There was no previous fractures or other form of physical injury. The woman's issues became evident after her pregnancy. She consulted a physician nine months postpartum, following the birth of a robust infant. The patient's personal and family history was unremarkable. She had no smoking or drinking habits. During the physical examination, the patient stood 150cm tall and weighed 60kg. Except for left lower extremity muscle strength, which was 3-4/5 on the neurological assessment, everything else was normal. In her laboratory results; calcium 8 mg/dl (8.8-10.6), ionized calcium 3.61mg/dL (4.6-5.0), albumin 4.7 g/dl (3.5-5.2), phosphorus 2.1 mg/dl (2.5-4.5), parathormone 640 ng/L (12-88), creatinine kinase 50 U/L (0-145), alkaline phosphatase 345 U/L (33-98), 25-OH Vit-D 24.2 ug/L, leukocyte: 7100/uL, hemoglobin 11.6 gr/dl, thrombocyte 336000/uL, ALT: 6.6 U/L, osteocalsin: 65 ng/mL (11-48), 1,25-OH Vit-D level: 43.1 pg/mL (15-90). Computed CT revealed type H vertebrae in the thoracic vertebrae, with no disease found in the lumbar, cervical, pelvic, or femur. (Figure 1). Bone density (BD): L1-L4 Z score: -2.7 BMD: 0.858; Femoral neck Z score: -2.7 BMD: 0.644. The EMG results were consistent with moderate myopathy. After one year of complaints, she became wheelchair-dependent. At that point, a neurosurgical doctor prescribed Vit-D and calcium tablets. She was able to walk again in two months and referred to our clinic two years after the initial issue. Genetic testing revealed that CYP27b1>homozygous positive was compatible with Vit-D dependent Rickets Type 1. During the two-year diagnostic period, the patient's height dropped from 153 cm to 150 cm. Calcitriol 0.25 mcg was administered every other day. Her calcium level: 9.4 mg/dL and phosphorus level: 2.2 mg/dL following treatment. This type of rickets is caused by a lack of the 1-alpha hydroxylase enzyme, which is essential for Vit-D production in the kidney. Untreated patients may have muscular and bone abnormalities. It is a sickness that responds exceptionally well to treatment.Figure 1:Vertebral lateral X -ray revealed H shaped vertebrae

A Closed Reduction of Cervical Spine Subluxation in an Arabian Foal with an External Neck Stabilizer

Cervical spine injuries that impact young horses and foals can result in mild to severe neurological signs or even result in sudden death. There are only a few reports on conservative treatment options for this condition in the scientific literature. If the condition is left untreated, it can lead to the development of degenerative joint disease, resulting in chronic neurological symptoms and discomfort. We present the case of a two-day-old Arabian foal that showed signs of ataxia following a neck injury, being the result of cervical spine subluxation. Radiological examination revealed a dislocation between the second and third cervical vertebrae. At admission to the clinic on the seventh day of life, the foal’s clinical examination parameters were within physiological ranges. The head posture at the presentation was consistently low, the foal could not lift its head above the shoulder joint throughout the whole examination, the neck muscles were spastically tensed and clinical signs of ataxia were present. The foal underwent a closed reduction in the subluxation under general anesthesia and a fiberglass semicircular gutter was created to stabilize the neck in the desired position. The ataxia symptoms began to improve around day 12 post manipulation, and the fiberglass stabilizer was removed after 16 days post manipulation, followed by radiographs. The dislocation of C2/C3 was no longer visible on the radiographs, and the foal was able to assume a normal neck posture after the removal of the fixator.

Irritable Bowel Syndrome: Gut Microbiota Dysbiosis and Psychological Co-morbidities

Irritable Bowel Syndrome (IBS) is a prevalent Gastrointestinal (GI) disorder, affecting approximately 10-15% of the global population, with significant implications for public health. It is characterised by chronic abdominal discomfort, altered bowel habits and a spectrum of symptoms that often co-exist with psychological conditions such as anxiety and depression. Emerging evidence highlights a critical imbalance in gut microbiota among individuals with IBS, underscoring the intricate gut-brain-microbiome axis. This dysbiosis not only exacerbates GI symptoms but also contributes to mental health challenges, creating a vicious cycle that impacts overall wellbeing. The broader consequences of IBS extend beyond individual health, leading to considerable impairment in daily functioning, reduced workplace efficiency and diminished Quality of Life (QoL). The socio-economic burden is reflected in increased rates of absenteeism, presenteeism and healthcare costs. Current therapeutic interventions, including probiotics, prebiotics, Faecal Microbiota Transplantation (FMT) and targeted medications, hold promise but require further research to establish their long-term efficacy and safety. This review aims to provide a comprehensive analysis of IBS, focusing on its microbial aetiology, the interplay with psychological co-morbidities, and its profound effects on work-related activities and societal productivity. By consolidating existing evidence, it seeks to emphasise the urgent need for innovative and effective therapeutic strategies. Addressing IBS as a multifaceted public health challenge requires interdisciplinary efforts to develop tailored interventions that alleviate its wide-ranging impacts on individuals and communities.

Significant Improvement Noted in Vulvodynia when Pelvic Neurogenic Inflammation is Addressed

Synopsis/Brief Summary Vulvodynia is effectively treated by the PRM Protocol™, which improves pain, function, and quality of life in patients with chronic pelvic pain. Objective: Vulvodynia, characterized by chronic pain and/or discomfort around the opening of the vulva, is known to affect up to 16% of adult women and may present as constant or intermittent pain that negatively impacts patients’ personal and working lives, as well as mental health and relationships. This study aimed to test the effectiveness of a multimodal neuromuscular treatment protocol in treating chronic pelvic pain and vulvodynia symptoms and improving pain and function. Methods: 59 patients ages 20-79 presented to an outpatient clinic with pelvic pain and Vulvodynia symptoms. These symptoms had, on average, persisted for 6 years. All patients underwent a once-weekly, six-week treatment (the PRM Protocol) consisting of ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks. To measure the effects of this treatment, a 0-10 Visual Analogue Scale (VAS) was used to measure pelvic pain intensity, and the Functional Pelvic Pain Scale (FPPS) was used to measure function across multiple areas. These measures were taken on patients’ first visit to a clinic and three months after treatment began. Results: VAS scores improved by an average of 51%. Before treatment, the mean VAS score was 7.93 (SD=1.61) (a=0.05; CI 7.52-8.34), and the posttreatment mean VAS score was 3.9 (SD=2.19) (a=0.05; CI 3.34-4.46) (P<0.0001). Pelvic pain functionality improved by 23% after three months. Pretreatment FPPS scores averaged at 12.34 (SD=5.8) (a=0.05; CI 10.86-13.82), decreasing to 9.53 (SD=5.43) (a=0.05; CI 8.14-10.91) after treatment (P<0.0001). FPPS functions that showed the most significant improvement were Sleep, which improved by 39%; Intercourse, which improved by 28%; and Walking, which improved by 28%. Conclusions: These results indicate that a six-week treatment consisting of once-weekly ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks combined with once-weekly pelvic floor physical therapy was very effective at relieving pain and improving function for patients with Vulvodynia. Significant reductions in opiate use, ER visits, and pain interference at work were observed following treatment.

3D printing of the brachial plexus and its osseous landmarks using magnetic resonance neurography for thoracic outlet syndrome evaluation

BackgroundPatient-specific three-dimensional (3D) printed anatomic models are valuable clinical tools that facilitate enhanced visualization of pertinent anatomic structures and have demonstrated benefits of reduced surgical times, increased surgeon confidence, and improved operative results and subsequent patient outcomes. Medical image-based 3D printed anatomic models are generally created from computed tomography (CT), however magnetic resonance imaging (MRI), which offers exquisite soft tissue characterization and flexible contrast avoiding the use of ionizing radiation, is an attractive alternative. Herein, the application of 3D printing incorporating both MR neurography and zero-echo time (ZTE) MRI for visualization of the brachial plexus anatomy in a subject with thoracic outlet syndrome (TOS) is described.MethodsA 28-year-old man presented with chronic right upper limb discomfort and paresthesias extending from the shoulder region to the third and fourth digits. The subject underwent evaluation with a unilateral brachial plexus MR neurography protocol at 3.0 Tesla for suspicion of TOS. The protocol included T2-weighted, 3D fast spin echo short-tau inversion recovery (STIR-FSE) and 3D radial ZTE sequences for depiction of the nerves and bones, respectively. The first rib and its synostosis impinged upon the inferior aspect of the T1 nerve root (T1NR), with accompanying mild enlargement of the T1NR. A 3D printed anatomic model was created and included: (1) bone (spine, ribs, clavicle, scapula, and humerus), (2) brachial plexus, and (3) costal cartilage.ResultsThe 3D printed model clearly demonstrated a T1NR impingement from the synostosis, confirming the diagnosis of neurologic thoracic outlet syndrome (TOS) and guided the treatment approach in prescribing TOS-specific physical therapy, which led to significant improvements in the patient’s condition.ConclusionTo our knowledge, this is the first in-vivo human 3D printed case for TOS using MRI-only data. The 3D printed model allowed for improved visualization and understanding of the spatial relationships between the nerves of the brachial plexus and surrounding osseous structures responsible for the patient’s symptoms.Clinical trial numberNot applicable.

Comorbidity Pattern and Autonomic Nervous System Dysfunction in Patients with Chronic Vulvar Discomfort

This study examines novel concepts of comorbidity in patients with chronic vulvar discomfort using data from the DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy) study, which involved 328 participants categorized into four groups: asymptomatic individuals with normal or impaired vulvar skin and patients with chronic vulvar discomfort, classified as either vulvodynia or vulvar dermatosis. Clinical data were collected through a structured questionnaire and analyzed using statistical software, including StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study received approval from the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings reveal significantly higher comorbidity rates in patients with chronic vulvar discomfort compared to other groups (p = 0.0000). A substantial percentage of asymptomatic participants with both normal (63.4%) and impaired (70.7%) vulvar skin also reported comorbid conditions. Analysis of comorbidity curves revealed distinct patterns of symptom progression, with a gradual increase in frequency from asymptomatic individuals to patients with vulvodynia, followed by a decline in vulvar dermatosis cases. These patterns highlight the central role of autonomic nervous system (ANS) dysfunction, where sympathetic hyperactivity and parasympathetic depression contribute to separate comorbidity chains. These dysfunctions may act independently or concurrently, leading to various health issues. The elevated comorbidity rates and overlapping symptomatology suggest complex pathophysiology driven by ANS dysregulation. Further research on comorbidity clusters may unveil new therapeutic targets and guide the development of multifaceted treatment strategies.

Clinical Applications and Outcomes of the Supraclavicular Osteocutaneous Flap for Head and Neck Reconstruction.

This study evaluates the clinical applications of the supraclavicular osteocutaneous (SOC) flap in complex head and neck reconstruction and its impact on shoulder function following clavicle resection. Case series with a planned chart review. Single-institution tertiary care center. We reviewed patients with complex mandibular and maxillary defects who underwent SOC flap reconstruction from 2016 to 2020. We detailed flap harvesting techniques, patient characteristics, diagnoses, defect sites, bone dimensions, skin paddle size, vascular supply, and donor site management. Complications and outcomes were also documented. The study included 7 patients with diverse clinical conditions and diagnoses. Reconstruction techniques varied, leading to different clavicle thicknesses and skin paddle sizes. Two cases had flap necrosis due to infection, and 1 experienced chronic shoulder discomfort following partial-thickness clavicle flap surgery. Full-thickness clavicle harvesting resulted in better outcomes and simplified the procedure. Notably, there were no significant long-term complications affecting shoulder function. The SOC flap is a promising option for complex head and neck reconstruction, adaptable to specific case requirements and providing reliable vascular supply. It offers favorable clinical outcomes both functionally and aesthetically. Full-thickness clavicle harvesting, with joint preservation, effectively maintains shoulder function.

Ethogram of the Domestic Cat

The existing domestic cat literature predominantly contains lists detailing its behaviour. However, these lists are neither specific enough for domestic cats nor general enough for all behaviours on a macro level of the domestic cat. Furthermore, the majority of studies lack illustrations. Therefore, we have developed a comprehensive ethogram of the domestic cat and scalable schematic representations of the behaviour units. We evaluated observational data from free-roaming cats and cats from private households using ad libitum and focal animal sampling (video material 55.31 h, n = 170 animals). In addition, we used the leading literature and detailed anatomical studies to create systematic categories and morphologically correct drawings. A total of 117 discrete behaviours were recorded and divided into 12 categories. The description of each behaviour includes a name, a word definition, an ethological classification and a schematic illustration (excluding the category devoted to vocalisations). An ethogram is needed to better understand the behavioural repertoire of healthy domestic cats and to facilitate the design phase of further investigations. This document can help to better distinguish species-appropriate behaviours and body postures from those behaviours and poses that indicate chronic pain, stress or discomfort.

Osteopathic Approach to Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE): Case Report

Abstract Proximal Hamstring Tendinopathy (PHT) provides a challenging diagnosis for clinicians due to limited evidence-based research. Presenting as chronic pain originating at the ischial tuberosity, PHT can progress to entrap the sciatic nerve, resulting in proximal hamstring tendinopathy-related sciatic nerve entrapment (PHTrSNE). This case expands the understanding of PHT by describing the osteopathic assessment and treatment of a runner with PHTrSNE. A 24-year-old female marathoner presented to the neurology clinic with a unique running gait: a left leg circumduction, or “leg whip,” that presented only when running. She also reported constantly dull hamstring pain, which occasionally elicited a sharp, shooting pain from her lower gluteal muscles to mid-hamstrings. Activities such as prolonged sitting and intense running exacerbated the sharp pain. On examination, the patient displayed ischial tuberosity tenderness and positive tests for hamstring tendinopathy. Evaluation with EMG/NCS showed mild chronic denervation of the left tibialis anterior muscle. A treatment plan for the patient’s PHTrSNE was created based on the principles of the neurological model of osteopathic medicine. Patients presenting with chronic hamstring discomfort accompanied by sharp, shooting pain may benefit from the diagnostic and therapeutic approach outlined in this study.

Endometriosis: A Comprehensive and Concise Review of Potential Biomarkers and Treatment Therapies

Abstract: Females of reproductive age can develop endometriosis, an inflammatory gynecological illness that is hormone-dependent. The variable lesions that make up the functional endometrium outside of the uterus cavity are what set this disorder apart in terms of its clinical and pathological aspects. Around 10% of women in their reproductive years have endometriosis worldwide, which significantly lowers their quality of life overall. Infertility and chronic pelvic discomfort are the two main symptoms that significantly affect women's reproductive health and general well-being. The pathophysiological underpinnings of endometriosis remain unclear despite years of intensive research. Understanding the fundamental mechanisms that produce endometriosis is crucial, as demonstrated by the substantial public and private health consequences. This article offers an overview of recent advancements in biomarkers regarding endometriosis treatment options, based on a thorough literature study.

One- versus Two-Minute Intercostal Nerve Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity.

An inherent defect of the sternum and ribs results in the formation of a funnel-shaped anterior chest wall. The gold standard of surgical correction is the minimally invasive Nuss procedure, which might cause severe pain and carries the risk of sensory disturbances and chronic discomfort. Integrating cryoanalgesia with standard multimodal analgesia improves the outcomes of this procedure. Based on histological results, it was hypothesised that the time of cryo-application can be reduced from the current standard period of two minutes. The goal of this study was to evaluate the efficacy of a one-minute application compared with the routine two-minute method in the same patient, considering the subjective perception of pain and sensory disturbances. A total of 33 patients were included in this prospective study. The results show that the assessment of pain severity and sensory disturbances did not differ significantly in terms of the time of cryo-application during first 14 days after the surgical procedure. The one-minute cryo-application time for intraoperative intercostal nerve cryoablation prior to the Nuss procedure seems to be as safe and effective as the routinely used two-minute application time in regards to pain severity, sensory disturbances, and the risk of chronic pain development. Intercostal nerve cryoanalgesia is an essential element of multimodal analgesia.

Ayurveda management of irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a complex and challenging Gastrointestinal (GI) disorder that can cause chronic abdominal pain or discomfort and altered bowel habits. Despite being a global health concern, a definitive treatment for IBS is currently not available. It has a significant effect on health, cost, and quality of life. In Ayurveda, it can be compared with Grahani roga (~disorders of lower GI tract), characterized by Muhurbhaddha-muhurdrava mala pravritti (~formed stools at one moment and another moment loose stools) associated with Udara shoola (~colicky abdominal pain), Adhmana (~abdominal distention), and Dourbalya (~weakness). A 22-year-old male patient reported to the outpatient department with complaints of frequent loose stools with varied consistency, foul smell, gaseous distention of the abdomen, nausea, loss of appetite, generalized weakness, and other associated complaints of reduced sleep and occasional headache since 5 years. The patient was diagnosed with Grahani roga based on the presenting symptoms. Rome IV criteria were used to establish IBS, and the IBS-unclassified was the diagnosis in this case. A combination of Hingwastaka choorna, Jeerakadyarishta, Shilajatwadi louha, Bilwavaleha, Panchamrita parpati, Brahmi vati, and Saraswatarishta were administered for a total period of 4 months along with diet modification, after which, a significant response was observed in the symptoms inferring the impact Ayurveda medicines in managing the pathology.

Evaluating the Influence of Acute and Chronic Orofacial Pains on the Overall Comprehensive Quality of Life.

Background Orofacial discomfort refers to various disorders that affect the mouth, jaws, and face. These conditions may substantially influence a person's quality of life (QoL). This kind of pain may be categorised into two primary classifications: acute and chronic. Acute orofacial pain (OFP) usually occurs suddenly and lasts for a short period. It is commonly caused by specific factors such as dental treatments, traumas, or infections. Hence, this study aimed to assess the influence of acute and chronic orofacial discomfort on the overall QoL. Methodology This research used a convenience sample to gather data from the five groups. It was conducted as a cross-sectional study. Four categories of OFP syndromes were utilised: temporomandibular disorders (TMDs), atypical dental pain (ADP), trigeminal neuralgia (TN), and persistent dentoalveolar pain disorder (PDAP). In addition, a control group consisting of individuals who did not experience any discomfort was also included in the study. Participants received a standardised explanation of the questionnaires utilised, and in most instances, they completed them at the clinic under the supervision of one of the investigators. Results The correlations between each version of the Oral Health Impact Profile (OHIP) were statistically significant (p < 0.001), with correlation values ranging from 0.92 to 0.97. When comparing the occurrence of OHIP items across the four pain types, we identified 18 variations that exceeded the 35% prevalence threshold we established for identifying important items that frequently occur out of the 315 comparisons. The question "Have you had a painful aching in your mouth?" showed a low frequency in patients with TN, TMD, and ADP but a significant prevalence in patients with PDAP (90%). This difference in prevalence across pain types was the biggest seen. The question that seemed to distinguish between the pain categories most effectively was "Have you experienced a toothache?" This question had a high occurrence in PDAP (65%) and ADP (60%), perhaps allowing for differentiating these two diseases from TN and TMD. The highest prevalence differences, over 30%, were most often seen when PDAP was included as one of the disorders being compared. ADP had the fewest variances, over 30%, occurring just seven times. Conclusion Both acute and chronic OFPs have a major negative influence on QoL, but they affect it differently and to differing extents. Injury-related acute pain obviously poses rapid and severe restrictions on physical function and causes temporary psychological distress and temporary social exclusion. On the other hand, chronic pain for the patient always implies being locked in a physical world that does not allow him or her to bypass physical limitations, psychological disorders remain constant, and isolation from other people persists for life.

Investigating of Minimally Invasive Approaches in the Treatment of Temporomandibular Joint Disorders.

Minimal intrusive TMJ operations have been recommended as a substitute for conservative therapy when conservative measures fail to relieve significant acute pain, chronic discomfort, inflammation, and/or degenerative illness, specifically in TMD cases. This study was conducted to investigate minimally invasive approaches (TMJ arthrocentesis and TMJ arthroscopy) in the treatment of temporomandibular joint (TMJ) disorders. It was a prospective study which included 30 clinically and radiographically diagnosed cases of TMDs. The study participants underwent two main therapy was carried out: TMJ arthrocentesis and TMJ arthroscopy. There was assessment of pain through VAS scale and maximum mouth opening (MMO) 1 month preoperatively as well as 3 months postoperatively. There was statistically significant decrease in mean VAS score and increase in MMO in patients treated with TMJ arthrocentesis and TMJ arthroscopy. When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more reduction in pain and increase in MMO in TMJ arthroscopy; however, the difference was non-significant statistically at both preoperative and postoperative situations. Minimally invasive approaches like TMJ arthrocentesis and TMJ arthroscopy can be useful in the treatment of TMJ disorders.

A Comparative Study to Analyze the Effect of Lumbar Stabilization and Conventional Back Extension Exercises on Mechanical Pain in Patients with Chronic Low Back Pain in Greater Noida

Lumbar discomfort is a major problem due to its harmful effects on health and high frequency in the general population. Depending on where and how long the pain lasts, there are three general categorizations for Lumbar discomfort: acute less than 6 weeks, sub-acute 6 to 12 weeks, and chronic more than 12 weeks. Several theories concerning the cause of nonspecific LBP feature poor posture, low body mass, hamstring flexibility, psychological discomfort, diminished trunk extensor endurance, and faulty muscular control of trunk. Pain in the lower back is a challenging illness which can result from injuries pertaining to the muscles and ligaments providing support vertebral column or from overuse or strain. One common treatment method for Lumbar discomfort is exercise therapy. This includes diverse forms of therapies including muscular strengthening, several forms of flexibility and stretching, and cardiovascular exercise for overall physical fitness. Normally, the stabilization system's job is to give the spine enough stability to meet the demands of changing circumstances immediately due to the posture changes with static and dynamic loads. As Per traditional understanding, spinal stabilization primarily relies on spinal biomechanics, the intervertebral disc, spinal ligaments, and osseous components. The stabilization and mobility of the lumbar spine can be facilitated by any muscle that exits the lumbar region. However, according to certain research, the lumbar multifidus and transverses abdominis muscles are very crucial for the stability of the lumbar segment. There is preliminary data indicating that those with long-term Lumbar discomfort do not properly recruit their core muscles and display core weakness13. Standard Exercise for back extension and exercises for lumbar stability both are used to treat low back discomfort. Thus, an effort is undertaken to compare and investigate the benefits of traditional back extension exercises and lumbar stabilization activities in patients with chronic Lumbar discomfort.

A Narrative Review on Pain Management in Head and Neck Cancer: Integrating Multimodal Analgesia and Interventional Procedures

: Surgical interventions and radiotherapy for head and neck cancer frequently result in substantial instances of acute and chronic discomfort. Optimizing pain management techniques stands as a pivotal factor in enhancing the well-being and overall quality of life for patients. This comprehensive review discusses various pain conditions encountered after head and neck cancer and explores a multidimensional approach to pain management. The review highlights the significance of incorporating multimodal analgesia, physical therapy, psychological support, palliative care, and emerging techniques including nerve blocks to achieve efficacious pain control. Such an endeavor necessitates cooperation among head and neck surgeons, radiotherapists, and pain specialists.

Pelvic Congestion Syndrome: Etiology, Symptoms, and Epidemiology of a Chronic Pelvic Pain Disorder

Pelvic Congestion Syndrome (PCS) is a chronic condition primarily affecting premenopausal, multiparous women, characterized by persistent pelvic pain and discomfort. This syndrome arises from venous insufficiency in the pelvic region, often due to incompetency in the internal iliac or ovarian veins, leading to pelvic venous dilation and varicose veins. Although the exact cause remains unclear, hormonal influences, venous valve insufficiency, and venous obstruction are believed to contribute to the development of PCS. In affected individuals, blood stasis and vein dilation can lead to pain through chemical mediators released during venous congestion. Epidemiological data indicate that around 30% of women presenting with chronic pelvic pain may have PCS, making it a significant contributor to chronic pelvic discomfort. This article reviews the etiology, pathophysiology, and epidemiology of PCS, offering insights into its diagnosis and potential treatment approaches.

Chronic diarrhea secondary to intestinal spirochetosis, should we think about it?

Abstract Human intestinal spirochetosis (HIS) is defined as a colonization of the apical membrane of the colonic mucosa and the appendix by spirochetes. It is a very rare finding, being more common in some populations (individuals living in villages and peri-urban environments in developing countries, recent immigrants from developing countries, men who have sex with other men and HIV positive patients), but the spirochete rarely is investigated as human enteric potential microorganism. It is a slow-growing microorganism and has specialized growth requirements, which is why it is not detectable in human fecal samples using routine diagnostic methods. However, it has been histologically identified attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort. In this article we present the case of a patient with chronic diarrhea secondary to intestinal spirochetosis, highlighting the importance of considering this etiology in the differential diagnosis.

Basic Characteristics and Demographic Data in Patients with Chronic Vulvar Discomfort: A Detailed Analysis of DATRIV Study

This study aims to provide a descriptive analysis of the essential characteristics and demographic profiles, including age, weight, height, body mass index, marital status, and educational background in patients with chronic vulvar discomfort. The data were collected from the study DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy), which included 328 participants divided into four groups: normal vulva, impaired vulvar skin, primary vulvar distress/vulvodynia, and secondary discomfort caused by vulvar dermatoses. The clinical data collected from the study questionnaire were analyzed using statistical software such as StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study was conducted with the approval of the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings from the DATRIV study shed light on several important aspects of chronic vulvar discomfort. They offered valuable insights into the demographic and reproductive characteristics of patients with chronic vulvar pain, specifically vulvar dermatosis. The study revealed that patients with vulvar dermatosis tended to be older, with a peak incidence in the 45-65 age range. They also had higher weight and BMI compared to other groups. There was a significant difference in the proportion of patients of reproductive age between the vulvar dermatosis group and other groups. Additionally, the vulvar dermatosis group had higher rates of marriage, births, and abortions and lower educational levels. The study&amp;apos;s limitations included lacking patients younger than 16 years. Future research should aim to include a broader age range, including pediatric populations, to gain a more comprehensive understanding of vulvar dermatosis across different age groups. Further investigation is needed to uncover the underlying mechanisms and establish causal relationships, enhancing diagnosis, treatment, and support for individuals affected by vulvar dermatosis.

Spinal neuronal activity and neuroinflammatory component in a mouse model of CFA-induced vestibulodynia

Vestibulodynia is a complex pain disorder characterized by chronic discomfort in the vulvar region, often accompanied by tactile allodynia and spontaneous pain. In patients a depressive behaviour is also observed. In this study, we have used a model of vestibulodynia induced by complete Freund's adjuvant (CFA) focusing our investigation on the spinal cord neurons and microglia. We investigated tactile allodynia, spontaneous pain, and depressive-like behavior as key behavioral markers of vestibulodynia. In addition, we conducted in vivo electrophysiological recordings to provide, for the first time to our knowledge, the characterization of the spinal sacral neuronal activity in the L6-S1 dorsal horn of the spinal cord. Furthermore, we examined microglia activation in the L6-S1 dorsal horn using immunofluorescence, unveiling hypertrophic phenotypes indicative of neuroinflammation in the spinal cord. This represents a novel insight into the role of microglia in vestibulodynia pathology. To address the therapeutic aspect, we employed pharmacological interventions using GABApentin, amitriptyline, and PeaPol. Remarkably, all three drugs, also used in clinic, showed efficacy in alleviating tactile allodynia and depressive-like behavior. Concurrently, we also observed a normalization of the altered neuronal firing and a reduction of microglia hypertrophic phenotypes.In conclusion, our study provides a comprehensive understanding of the CFA-induced model of vestibulodynia, encompassing behavioral, neurophysiological and neuroinflammatory aspects. These data pave the way to investigate spinal cord first pain plasticity in vestibulodynia.