Clinical Assessment Of Patients Research Articles

Assessment and examination of the respiratory system.

This article aims to outline the fundamental principles of consultations with and clinical assessments of patients with symptoms that may be indicative of respiratory system pathology. The article explores how to perform a respiratory system-focused patient history and physical examination. An evaluation of clinical 'red flags' to reduce the risk of omitting serious illness is also considered, alongside the exploration of features of respiratory pathology and evidence-based clinical decision-making tools that may be used to support clinical diagnosis.

Comparison of outcomes and recurrence rates in patients undergoing single or double burr hole surgery for the treatment of chronic subdural hematoma in Bosnia and Herzegovina

IntroductionChronic subdural hematoma (CSDH) is a prevalent condition commonly seen in elderly individuals, often requiring neurosurgical intervention. Research questionThis study investigates patient characteristics and recurrence rates in CSDH patients treated with single or double burr hole surgery in Bosnia and Herzegovina. Methods: A retrospective study was conducted on patients treated for CSDH between January 2018 and December 2022. The diagnosis of CSDH was confirmed through preoperative CT or MRI of the brain. Patients underwent either single or double burr hole surgery based on the neurosurgeon's decision. Preoperative and postoperative brain CT scans, along with clinical outcomes, were analyzed. ResultsA total of 87 patients were included in the study, with 102 burr hole surgeries performed. Among these, 49 patients received single burr hole surgery, while 53 patients underwent double burr hole surgery. Recurrence of CSDH occurred in 8.8% of cases, with no significant difference observed between the groups. Notably, single burr hole surgery demonstrated comparable efficacy to double burr hole surgery in terms of subdural reduction and occurrence of pneumocephalus, while exhibiting fewer complications and shorter hospitalization. Discussion and conclusionsburr hole surgery, whether performed as a single or double procedure, is an effective treatment option for CSDH, as it leads to positive outcomes in both radiological and clinical assessments of patients following surgery. The population of Bosnia and Herzegovina receives good neurosurgical care for CSDH.

A real-life ImmunoCAT study: impact of molecular diagnosis through ImmunoCAPTM ISAC 112 on immunotherapy prescription in pollen-polysensitized patients in Catalonia, Spain.

Molecular diagnosis in allergology helps to identify multiple allergenic molecules simultaneously. The use of purified and/or recombinant allergens increases the accuracy of individual sensitization profiles in allergic patients. To assess the impact of molecular diagnosis through the ImmunoCAPTM ISAC 112 microarray on etiological diagnosis and specific immunotherapy (SIT) prescription. This was compared to the use of conventional diagnoses in pediatric, adolescent, and young adult patients with rhinitis or rhinoconjunctivitis and/or allergic asthma, sensitized to three or more pollen allergens of different botanical species. A multicenter, prospective, observational study was conducted in patients aged 3-25 years who received care at the Allergology service of 14 hospitals in Catalonia from 2017 to 2020. Allergology diagnosis was established based on the patient's clinical assessment and the results of the skin prick test and specific immunoglobulin E assays. Subsequently, molecular diagnosis was conducted using ImmunoCAPTM ISAC® 112 to recombinant and/or purified allergen components. A total of 109 patients were included; 35 (32.1%) were pediatric patients and 74 (67.9%) were adolescents or young adults (mean age: 18 years), with 58.0% being females. A change of 51.0% was observed in SIT prescription following molecular etiological diagnosis by means of a multi-parameter microarray. Molecular diagnosis by means of multi-parameter tests increases the accuracy of etiological diagnosis and helps to define an accurate composition of SIT.

Comparative Review of the Socioeconomic Burden of Lower Back Pain in the United States and Globally.

Internationally, the United States (U.S.) cites the highest cost burden of low back pain (LBP). The cost continues to rise, faster than the rate of inflation and overall growth of health expenditures. We performed a comprehensive literature review of peer-reviewed and non- peer-reviewed literature from PubMed, Scopus, and Google Scholar for contemporary data on prevalence, cost, and projected future costs. Policymakers in the U.S. have long attempted to address the high-cost burden of LBP through limiting low-value services and early imaging. Despite these efforts, costs (~$40 billion; ~$2,000/patient/yr) continue to rise with increasing rates of unindicated imaging, high rates of surgery, and subsequent revision surgery without proper trial of non-pharmacologic measures and no corresponding reduction in LBP prevalence. Globally, the overall prevalence of LBP continues to rise largely secondary to a growing aging population. Cost containment methods should focus on careful and comprehensive clinical assessment of patients to better understand when more resource-intensive interventions are indicated.

CAUSES OF CHRONIC PAIN UNRELATED TO SURGICAL TRAUMA AFTER GROIN HERNIA REPAIR: A PROSPECTIVE COHORT STUDY

Abstract Background Chronic inguinal pain (CIP) can be caused by several factors including musculoskeletal or neurological pathologies as well as by surgical trauma following groin hernia repair. The principal aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair. Method During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were physically evaluated by surgeons and filled out an Inguinal Pain Questionnaire and a Numerical Rating Scale pain-questionnaire. For patients undergoing groin hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on postoperative questionnaires were reevaluated by phone consultation and physical examination. Results 289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies. Conclusion This cohort study found CIP unrelated to surgical trauma in 4.8 % of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring groin pain on pain-questionnaires did not have chronic post-operative pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to surgical trauma.

Demethylzeylasteral exerts potent efficacy against non-small-cell lung cancer via the P53 signaling pathway

Lung cancer has one of the highest mortality rates worldwide, with non-small-cell lung cancer (NSCLC) constituting approximately 85% of all cases. Demethylzeylasteral (DEM), extracted from Tripterygium wilfordii Hook F, exhibits notable anti-tumor properties. In this study, we revealed that DEM could effectively induce NSCLC cell apoptosis. Specifically, DEM can dose-dependently suppress the viability and migration of human NSCLC cells. RNA-seq analysis revealed that DEM regulates the P53-signaling pathway, which was further validated by assessing crucial proteins involved in this pathway. Biacore analysis indicated that DEM has high affinity with the P53 protein. The CDX model demonstrated DEM's anti-tumor actions. This work provided evidence that DEM-P53 interaction stabilizes P53 protein and triggers downstream anti-tumor activities. These findings indicate that DEM treatment holds promise as a potential therapeutic approach for NSCLC, which warrants further clinical assessment in patients with NSCLC.

Nursing students’ experiences with the “DiagNurse” mobile app to support clinical patient assessment – a pilot study

Nursing students’ experiences with the “DiagNurse” mobile app to support clinical patient assessment – a pilot study

Clinical Profile and Risk Factors of Cerebral Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) is a rare but serious neurovascular disorder that can lead to life-threatening complications such as hemorrhage and cerebral edema. This condition presents with a wide array of symptoms due to the formation of blood clots in the cerebral venous sinuses, impairing the drainage of deoxygenated blood and cerebrospinal fluid from the brain. Objective: The aim of this study was to elucidate the clinical profile and risk factors associated with CVST, enhancing the understanding of its epidemiology and facilitating better diagnostic and therapeutic strategies. Methods: This prospective cross-sectional study was conducted at the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. A total of 135 participants diagnosed with CVST were enrolled through non-probability consecutive sampling. Participants underwent comprehensive physical and neurological examinations using a structured Clinical Patient Assessment Form. Diagnostic imaging included MRI, MRV, CT, and CT venography, although the principal diagnostic tools were CT and MRV. Data collection focused on demographics, clinical manifestations, and risk factors, with all information analyzed using SPSS version 25. Results: The study population predominantly consisted of females (74.8%) with the age group of 31-40 years being the most common (31.1%). Headache was the most frequently reported symptom (90.4%), followed by hemiparesis (53.3%) and seizures (40%). Significant risk factors included postpartum status (50.4%), iron deficiency anemia (25.9%), and genetic prothrombotic conditions (9.6%). Imaging studies revealed that the transverse sinus was the most affected site (74.1%). Conclusion: CVST exhibits a diverse range of clinical presentations and is associated with multiple demographic and physiological risk factors. Early diagnosis and management are crucial to prevent severe outcomes. This study highlights the importance of considering a detailed clinical and risk factor profile in patients presenting with neurological symptoms to aid in timely and accurate diagnosis of CVST.

The impact of mandated use early warning system tools on the development of nurses' higher-order thinking: A systematic review.

Ascertain the impact of mandated use of early warning systems (EWSs) on the development of registered nurses' higher-order thinking. A systematic literature review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist (Page etal., 2021). CINAHL, Medline, Embase, PyscInfo. Eligible articles were quality appraised using the MMAT tool. Data extraction was conducted independently by four reviewers. Three investigators thematically analysed the data. Our review found that EWSs can support or suppress the development of nurses' higher-order thinking. EWS supports the development of higher-order thinking in two ways; by confirming nurses' subjective clinical assessment of patients and/or by providing a rationale for the escalation of care. Of note, more experienced nurses expressed their view that junior nurses are inhibited from developing effective higher-order thinking due to reliance on the tool. EWSs facilitate early identification of clinical deterioration in hospitalised patients. The impact of EWSs on the development of nurses' higher-order thinking is under-explored. We found that EWSs can support and suppress nurses' higher-order thinking. EWS as a supportive factor reinforces the development of nurses' heuristics, the mental shortcuts experienced clinicians call on when interpreting their subjective clinical assessment of patients. Conversely, EWS as a suppressive factor inhibits the development of nurses' higher-order thinking and heuristics, restricting the development of muscle memory regarding similar presentations they may encounter in the future. Clinicians' ability to refine and expand on their catalogue of heuristics is important as it endorses the future provision of safe and effective care for patients who present with similar physiological signs and symptoms. This research impacts health services and education providers as EWS and nurses' development of higher-order thinking skills are essential aspects of delivering safe, quality care. This is a systematic review, and therefore, comprises no contribution from patients or the public.

Bedside clinical assessment of patients with common upper limb tremor and algorithmic approach.

The diagnostic approach for patients with tremor is challenging due to the complex and overlapping phenotypes among tremor syndromes. The first step in the evaluation of tremor is to identify the tremulous movement and exclude the tremor mimics. The second step is to classify the tremor syndrome based on the characteristics of tremor from historical clues and focused examination (Axis 1). Comprehensive tremor examinations involve the assessment of tremor in different conditions (rest, action or mixed, position or task-specific), distribution of tremor (upper limb, lower limb, head, jaw), positive signs for functional tremor (FT) if suspected (distractibility, entrainment, co-contraction), and associated neurological signs including parkinsonism, dystonic posture, cerebellar/brainstem signs, neuropathy, and cognitive impairment. A pivotal feature in this step is to determine any distinct feature of a specific isolated or combined tremor syndrome. In this review, we propose an algorithm to assess upper limb tremors. Ancillary testing should be performed if clinical evaluation is unclear. The choice of investigation depends on the types of tremors considered to narrow down the spectrum of etiology (Axis 2). Laboratory blood tests are considered for acute onset and acute worsening of tremors, while structural neuroimaging is indicated in unilateral tremors with acute onset, nonclassical presentations, and a combination of neurological symptoms. Neurophysiological study is an important tool that aids in distinguishing between tremor and myoclonus, etiology of tremor and document specific signs of FT. Treatment is mainly symptomatic based depending on the etiology of the tremor and the patient's disabilities.

Nadifit, data-driven diagnosis: a clinical study for evaluating the significance of traditional Chinese medicine organ patterns through pulse diagnosis (nadi pariksha) for accurate pathology predictions

Background: Pulse diagnosis or nadipariksha, is a traditional diagnostic technique utilized in ayurveda and traditional Chinese medicine, analyzing various pulse characteristics such as force, patterns, rate, and rhythm to discern underlying health conditions. This method integrates TCM's five-element energy levels and Ayurveda's Tridosha levels to accurately identify the root cause of diseases, enabling practitioners to tailor treatments accordingly. In today's fast-paced world, the need for efficient health monitoring is imperative. However, finding expert practitioners proficient in pulse diagnosis is becoming increasingly challenging, necessitating the development of systems capable of providing personalized health insights based on accurate root-cause analysis. Methods: In this study, we compared predicted symptoms derived from objective TCM organ pattern analysis using the Nadifit pulse diagnosis system with subjective clinical assessments of patients' symptoms. TCM organ patterns were determined based on the combination of five elements and their Yin/Yang energy levels. Pulse signals were collected from 105 individuals and compared with clinical evaluations of patients' symptoms. Results: The analysis revealed a high level of agreement between the clinical assessment of symptoms and the predicted organ patterns, with a Kappa coefficient of 0.82. This suggests that objective pulse analysis effectively identifies root causes, aligning with subjective assessments. Conclusions: The findings of this study underscore the validity and reliability of objective pulse analysis in diagnosing health conditions. By demonstrating significant agreement with subjective clinical assessments, this method provides a promising avenue for enhancing diagnostic accuracy and facilitating personalized treatment strategies based on individual health profiles.

Linguistic changes in neurodegenerative diseases relate to clinical symptoms.

The detection and characterization of speech changes may help in the identification and monitoring of neurodegenerative diseases. However, there is limited research validating the relationship between speech changes and clinical symptoms across a wide range of neurodegenerative diseases. We analyzed speech recordings from 109 patients who were diagnosed with various neurodegenerative diseases, including Alzheimer's disease, Frontotemporal Dementia, and Vascular Cognitive Impairment, in a cognitive neurology memory clinic. Speech recordings of an open-ended picture description task were processed using the Winterlight speech analysis platform which generates >500 speech features, including the acoustics of speech and linguistic properties of spoken language. We investigated the relationship between the speech features and clinical assessments including the Mini Mental State Examination (MMSE), Mattis Dementia Rating Scale (DRS), Western Aphasia Battery (WAB), and Boston Naming Task (BNT) in a heterogeneous patient population. Linguistic features including lexical and syntactic features were significantly correlated with clinical assessments in patients, across diagnoses. Lower MMSE and DRS scores were associated with the use of shorter words and fewer prepositional phrases. Increased impairment on WAB and BNT was correlated with the use of fewer nouns but more pronouns. Patients also differed from healthy adults as their speech duration was significantly shorter with more pauses. Linguistic changes such as the use of simpler vocabularies and syntax were detectable in patients with different neurodegenerative diseases and correlated with cognitive decline. Speech has the potential to be a sensitive measure for detecting cognitive impairments across various neurodegenerative diseases.

Skeletal abnormalities in mice with Dnmt3a missense mutations

Overgrowth and intellectual disability disorders in humans are typified by length/height and/or head circumference ≥ 2 standard deviations above the mean as well as intellectual disability and behavioral comorbidities, including autism and anxiety. Tatton-Brown-Rahman Syndrome is one type of overgrowth and intellectual disability disorder caused by heterozygous missense mutations in the DNA methyltransferase 3A (DNMT3A) gene. Numerous DNMT3A mutations have been identified in Tatton-Brown-Rahman Syndrome patients and may be associated with varying phenotype severities of clinical presentation. Two such mutations are the R882H and P904L mutations which result in severe and mild phenotypes, respectively. Mice with paralogous mutations (Dnmt3aP900L/+ and Dnmt3aR878H/+) exhibit overgrowth in their long bones (e.g., femur, humerus), but the mechanisms responsible for their skeletal overgrowth remain unknown. The goal of this study is to characterize skeletal phenotypes in mouse models of Tatton-Brown-Rahman Syndrome and identify potential cellular mechanisms involved in the skeletal overgrowth phenotype. We report that mature mice with the Dnmt3aP900L/+ or Dnmt3aR878H/+ mutation exhibit tibial overgrowth, cortical bone thinning, and weakened bone mechanical properties. Dnmt3aR878H/+ mutants also contain larger bone marrow adipocytes while Dnmt3aP900L/+ mutants show no adipocyte phenotype compared to control animals. To understand the potential cellular mechanisms regulating these phenotypes, growth plate chondrocytes, osteoblasts, and osteoclasts were assessed in juvenile mutant mice using quantitative static histomorphometry and dynamic histomorphometry. Tibial growth plates appeared thicker in mutant juvenile mice, but no changes were observed in osteoblast activity or osteoclast number in the femoral mid-diaphysis. These studies reveal new skeletal phenotypes associated with Tatton-Brown-Rahman Syndrome in mice and provide a rationale to extend clinical assessments of patients with this condition to include bone density and quality testing. These findings may be also informative for skeletal characterization of other mouse models presenting with overgrowth and intellectual disability phenotypes.

Evaluation of vital signs through a mobile application in patients with heart failure: a opportunity for remote titration?

Virtual consultations have increased exponentially, but a limitation is the inability to assess vital signs (VS). This is particularly useful in patients with heart failure (HF) for titrating prognosis-modifying medication. This issue could potentially be addressed by a tool capable of measuring blood pressure (BP) and heart rate (HR) accurately, remotely, and conveniently. Mobile phones equipped with transdermal optical imaging technology could meet these requirements. To evaluate the accuracy of a transdermal optical imaging-based app for estimating VS compared to clinical assessment in patients with HF. A prospective cohort study included patients evaluated in an HF outpatient unit between February and April 2022. BP and HR were simultaneously assessed using the app and clinical examination (BP with an automated sphygmomanometer and HR by brachial palpation). Three measurements were taken by both the app and clinic for each patient, by two independent blinded physicians. Thirty patients were included, with 540 measurements of BP and HR. The mean age was 66 (± 13) years, 53.3% were male. The mean left ventricular ejection fraction was 37 ± 15, with 63.3% having previous hospitalizations for HF, and 63.4% in NYHA class II-III. The mean difference between the app measurement and its clinical reference measurement was 3.6 ± 0.5 mmHg for systolic BP (SBP), 0.9 ± -0.2 mmHg for diastolic BP (DBP), and 0.2 ± 0.4 bpm for HR. When averaging the paired mean differences for each patient, the mean across the 30 patients was 2 ± 6 mmHg for SBP, -0.14 ± 4.6 mmHg for DBP, and 0.23 ± 4 bpm for HR. The estimation of BP and HR by an app with transdermal optical imaging technology was comparable to non-invasive measurement in patients with HF and met the precision criteria for BP measurement in this preliminary study. The use of this new transdermal optical imaging technology provides promising data, which should be corroborated in larger cohorts.

Sarcopenia in systemic sclerosis: prevalence and impact—a systematic review and meta-analysis

ObjectiveThis review aims to provide an estimate of sarcopenia prevalence and its impact on clinical characteristics in patients with systemic sclerosis (SSc).DesignSystematic review and meta-analysis.Data sourcesEmbase, Medline, Web of Science...

Mid-term Results Following Reverse Shoulder Arthroplasty and the Role of Navigation in the Management of Glenoid Bone Loss.

Background Inaccurate positioning of the glenoid component has been well described as the most common cause of early failure following a reverse shoulder arthroplasty (RSA). Among the latest developments in operative technique, three-dimensional preoperative planning and navigation intraoperative systems have been developed to improve the accuracy of the baseplate positioning during RSA. The primary purpose of this retrospective analysis was to investigate the mid-term results of patients who underwent an elective RSA or for acute highly comminuted proximal humerus fractures. The secondary goal was to investigate the role of navigation in the execution of preoperative planning, especially in the management of glenoid bone loss. Methodology In total, 101 cases were included in this study. Patients were divided into the following two groups: 88 cases of RSA performed without the use of navigation (conventional RSA) and 13 cases performed using intraoperative navigation (navigated RSA). For all patients included in the study, preoperative planning software was employed. Patient demographics, gender, past medical history, indication of procedure, operated site, type of glenoid component used, length of baseplate screws, and clinical assessment scores (Oxford Shoulder Score, OSS) were reported for all patients. Cases of revision shoulder arthroplasty were excluded from this study. Results The postoperative clinical assessment of patients revealed that following RSA, all patients improved significantly with a consistently upward trend of the OSS noted for both groups (conventional and navigated RSA) throughout the postoperative assessment. Despite no statistically significant difference detected, the clinical scores of the navigated RSA group outperformed those of the conventional RSA group in the postoperative period. A higher incidence of augmented baseplate use was noted in the navigated RSA group than in the conventional group (23.07% vs. 5.68%, p < 0.001). Conclusions Our results indicate that the use of intraoperative navigation appears to be a valuable tool in preoperative planning, providing accurate positioning of the baseplate, a better understanding of the glenoid anatomy, and real-time monitoring of the length and direction of the baseplate screws. It is difficult to conclude if the use of navigation leads to superior clinical outcomes, and the cost-effectiveness of its use needs to be further analyzed. Prospective randomized trials are required to assess the cost-effectiveness of routine use of navigation in RSA.

Clinical and Instrumental Swallowing Assessments for Dysphagia

What Is the Issue?&#x0D; &#x0D; Dysphagia, or swallowing impairment, is a common complication of many health conditions. To assess patients for dysphagia, speech-language pathologists may use instrumental swallowing assessments or clinical assessments.&#x0D; Instrumental swallowing assessments are more accurate and comprehensive, but they also require more time and resources.&#x0D; To help inform decisions about whether it is appropriate to increase use of clinical assessments and limit the use of instrumental swallowing assessments, it is important to understand current best practices as well as the comparative clinical utility and diagnostic accuracy.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; We searched for literature evaluating the clinical utility and diagnostic accuracy of instrumental swallowing assessments versus clinical assessments for patients with suspected dysphagia. We also searched for evidence-based guidelines that provide recommendations about the use of instrumental and clinical assessments for suspected dysphagia.&#x0D; An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2019, and November 30, 2023.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; Four diagnostic test accuracy studies compared various clinical evaluations to instrumental swallowing exams. The tests ranged in their sensitivity, specificity, positive predictive values, and negative predictive values. Three of the 4 studies concluded that the clinical assessments they examined could be used to identify dysphagia. One of these 3 studies examined multiple clinical evaluations and noted the varying degrees of accuracy among the tests and indicated which of these is most accurate. The fourth study found that further evidence is needed to determine if a clinical feeding evaluation can predict aspiration. We did not find any studies directly evaluating the clinical utility of instrumental swallowing assessments versus clinical evaluation for patients with suspected dysphagia that met the inclusion criteria for this review.&#x0D; Six evidence-based guidelines made recommendations related to instrumental and clinical swallowing assessments for dysphagia. These recommendations generally indicated that instrumental assessments should be used when resources allow, or that they should take place in addition to clinical swallowing assessments.&#x0D; &#x0D; What Does This Mean?&#x0D; &#x0D; Health care practitioners may wish to conduct an instrumental swallowing assessment, such as a fibreoptic endoscopic evaluation of swallowing or a videofluoroscopic swallowing study for patients for whom there are sufficient resources to do so.&#x0D; Clinical assessments for dysphagia have the potential to help clinicians diagnose patients with dysphagia without the use of instrumental swallowing assessments, particularly in settings with limited resources. However, this is not the case for all clinical assessments and needs to be determined on a case-by-case basis.&#x0D;

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.&#x0D; Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&amp;3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&amp;6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.&#x0D; Discussion : Age older than 60 years old, female gender, short axial length (&lt;23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.&#x0D; Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.&#x0D; Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&amp;3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&amp;6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.&#x0D; Discussion : Age older than 60 years old, female gender, short axial length (&lt;23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.&#x0D; Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

Association Between Pain and Radiological Changes in Patients with Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is a leading cause of disability worldwide, characterized by joint degeneration, pain, and functional limitations. Despite the prevalence of knee OA, the relationship between radiographic changes and the severity of pain remains complex. Previous studies have offered conflicting views on the association between structural joint alterations and clinical symptoms. Objective: The aim of this study was to investigate the association between radiographic degenerative changes in the knee, as classified by the Kellgren and Lawrence grading system, and the severity of resting pain measured using the Numeric Pain Rating Scale (NPRS). Methods: This cross-sectional study was conducted on 70 patients diagnosed with knee OA at multiple healthcare facilities in Lahore, Pakistan, from July 2022 to January 2023. Participants aged between 40 and 80 years, both males and females, were included. The severity of knee OA was determined using the Kellgren-Lawrence grading system through X-ray evaluations. Pain severity was assessed using the NPRS. Data were analyzed using SPSS version 25.0, with chi-square tests applied to explore the association between radiographic grades of knee OA and pain severity. Results: The distribution of knee OA severity among participants was as follows: Grade I (22.9%), Grade II (25.7%), Grade III (32.9%), and Grade IV (18.6%). Pain severity reported by participants was predominantly mild (55.7%), followed by moderate (37.1%) and severe (7.1%). Statistical analysis revealed a significant association between the grade of knee OA and the severity of resting pain (Chi-square = 30.06, p &lt; 0.0001), indicating that higher grades of knee OA were correlated with increased pain severity. Conclusion: The study confirmed a significant association between radiographic degenerative changes in knee OA and the severity of resting pain. These findings suggest the need for comprehensive clinical assessments in patients with knee OA, incorporating both radiographic evaluations and pain severity measures to guide management and treatment strategies.