Complete Relief Of Symptoms Research Articles

Akram’s lifestyle: An effective remedy for the management of gastroesophageal reflux disease

Abstract: INTRODUCTION: The prevalence of gastroesophageal reflux disease (GERD) has generally increased worldwide. Irregular pattern of intake of meals are known to be the most prevalent cause of GERD. The intake of food on top of another meal may cause gastroesophageal reflux either by generating transient lower-esophageal sphincter relaxations (TLESRs) subsequent to distention of the upper part of the stomach or/and delayed gastric emptying due to inhibition of migrating motor complexes (MMCs) in the distal part of the stomach. Present study evaluated the effect of authors suggested regimen “Akram’s lifestyle”, taking meals twice-a-day with the liberty to consume only liquids in the intervening periods on the outcome of patients presenting with mild to moderate GERD. MATERIALS AND METHODS: Study included 60 patients with symptoms of GERD who agreed to follow “Akram’s lifestyle”, took two meals a day about 10-12 hours apart, consuming liquids in between meals for a period of two weeks. Typical GERD symptoms of heartburn, acid reflux, nausea, vomiting and dyspepsia as reported by the patients were scored on visual analog scale (VAS). Gastrointestinal and associated complaints were also evaluated by “Yes/No” response. Data obtained before and after two weeks of intervention was analyzed using SPSS version 28.0. RESULTS: Final data after 2 weeks were available for 45 patients. There was a highly significant improvement in GERD symptoms (heartburn, reflux, nausea, vomiting, and dyspepsia) within 2 weeks of dietary intervention (P < 0.000). Improvement was also reflected in the significant reduction (>69%) in the gastrointestinal complaints as evaluated by “Yes/No” responses after the dietary intervention. CONCLUSIONS: Adherence to “Akram’s lifestyle” for GERD for 2 weeks resulted in a significant improvement or complete relief of symptoms of patients with GERD. Reduced gastric acid secretion, TLESRs and enhanced gastric emptying could be the potential contributing factors in causing this improvement. Further investigations with larger samples are needed to confirm the findings.

EXPERIENCE OF TREATING OF SHOULDER JOINT ADHESIVE CAPSULITIS TREATMENT

This paper summarizes the experience of treating 59 patients with adhesive capsulitis of the shoulder joint. The observation period was 2 years. Rationale of choosing a method of treatment and a methodology of conservative treatment of adhesive capsulitis of the shoulder joint by intra-articular injection of corticosteroids in the projection of the anteriorupper arthroscopic access and subsequent exercise therapy and physical rehabilitation are described. As a result of the study, it was found that in 94% of patients treated for adhesive capsulitis there was a complete relief of adhesive capsulitis symptoms after 3 months from the start of the treatment, a full range of motion was achieved.

Complete bicorporeal uterus, double cervix, longitudinal obstructing vaginal septum: an integrated approach for one-stop diagnosis and ultrasound-guided endoscopic hymen-sparing treatment

Background: Complete bicorporeal uterus, double cervix and obstructive longitudinal vaginal septum (classified as U3bC2V2 according to ESHRE/ESGE classification) is a rare congenital anomaly of the genital tract. This condition is typically associated with ipsilateral renal agenesis and is known as Herlyn-Werner-Wunderlich syndrome or OHVIRA (Obstructed HemiVagina and Ipsilateral Renal Anomaly) syndrome. The primary symptoms include dysmenorrhea and pelvic pain, which usually manifest after menarche due to haematocolpos in the obstructed hemivagina. Diagnosis is often challenging and frequently delayed. Early detection and surgical drainage of the haematocolpos are essential for symptom relief and prevention of complications. Various surgical approaches have been described, with vaginoplasty and septal resection being the recommended treatment. Objective: To propose a step-by-step demonstration with narrated video footage of an integrated approach for one-stop diagnosis and ultrasound-guided endoscopic hymen-sparing treatment in a patient with OHVIRA syndrome. Materials and Methods: We present the case of a 17-year-old virgo-intacta female who was referred to our institution due to dysmenorrhea, abnormal uterine bleeding and a right presumed ovarian endometrioma. A preoperative evaluation, including pelvic ultrasound and MRI, suspected a U3bC2V2 malformation, associated to a right haematocolpos and ipsilateral renal agenesis. The patient underwent a complete minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum under transabdominal ultrasound guidance, using a 15Fr bipolar mini-resectoscope. The procedure successfully drained the haematocolpos and allowed visualisation of the right cervix, confirming the preoperative diagnosis. Results: The procedure was performed in our Digital Hysteroscopic Clinic (DHC) - CLASS Hysteroscopy -under general anaesthesia (with laryngeal mask), according to an ambulatory model of care. No complications occurred and the patient was discharged three hours after the procedure. Main outcomes: After 40 days, hysteroscopic office control revealed a normal vagina with double cervix and complete bicorporeal uterus (classified as U3bC2V0 according to ESHRE/ESGE classification), and the patient had complete relief of symptoms. Conclusion: The combined approach of one-stop diagnosis and ultrasound-guided minimally invasive vaginoscopic resection of the obstructive longitudinal vaginal septum, using a 15Fr bipolar mini-resectoscope, has proven to be an effective strategy. This approach leads to optimal surgical results without complications.

Symptom assessment in the dying: family members versus healthcare professionals

ObjectivesSymptom management and support of the family members (FMs) are considered essential aspects of palliative care. During end of life, patients are often not able to self-report symptoms. There is...

An ayurvedic approach to the management of Fissure-in-ano: A case Study

Background: In today's sedentary lifestyle, coupled with unhealthy dietary habits and stress, digestive disorders such as Fissure-in-ano have become prevalent. Fissure-in-ano is a longitudinal tear in the anal canal, most commonly occurring in the posterior midline, characterized by severe pain, burning sensation, and occasional bleeding. In Ayurveda, this condition aligns with Parikartika, often caused by improper administration of therapies like Basti (enema) or Virechana (purgative). Case Study: It explores the efficacy of per rectal Administration of Kaseesadi Taila for the management of Parikartika in a 35-year-old female patient presenting with anal pain, burning, and rectal bleeding post-defecation. Materials & Methods: It involved daily rectal Administration of Kaseesadi Taila (10ml) for 7 days. Results: It showed significant improvement by day 3, with complete relief of symptoms and healing of the fissure by day 7. The therapeutic benefits of Kaseesadi Taila are attributed to its Lekhana (scraping), Shodhana (cleansing), and Ropana (healing) properties, which promote wound healing, reduce inflammation, and facilitate easier bowel movements. Conclusion: Kaseesadi Taila is an effective, cost-efficient treatment for fissure-in-ano, providing significant symptom relief without the drawbacks of conventional surgical interventions.

Megaformer as a Rehabilitation Modality for Hamstring Strain Injury in Division I American Football: A Case Study

BACKGROUND: With athletes striving for peak performance, noncontact muscle strain injuries are increasingly common. Hamstring strain injuries (HSIs) make up the largest portion of noncontact injuries and provide further difficulty because of the high reinjury rate. This case study explores the Megaformer as a modality to treat HSIs with the potential to reduce the return to play timetable and recurrence rate. CASE PRESENTATION: A 23-year-old male American football player with a history of hamstring injuries presented with pain in the right proximal hamstring and deficits in strength and mobility testing as a result of sustained hyperflexion of the right hip with full knee extension. Magnetic resonance imaging (MRI) confirmed a recurrent proximal hamstring strain. OUTCOME AND FOLLOW-UP: Subsequent strength and range of motion testing revealed no impactful tenderness or pain during active participation or palpation after 9 days, and complete alleviation of symptoms at 6 weeks. No reinjury occurred during the remaining football season. DISCUSSION: This case study highlights possible advantageous features of the Megaformer as a recovery modality for HSIs. The Megaformer aims to improve flexibility, strengthen primary and secondary muscles, and enhance neuromuscular coordination to attempt to decrease the return to play timetable and reduce injury recurrence.

Hypertrophy of the Annular Ligament as a Cause of Painful Elbow Snapping: Case Report and Literature Review.

Snapping annular ligament is an uncommon cause of lateral elbow pain. Due to the limited literature, snapping annular ligament is often misdiagnosed as lateral epicondylitis. Recognition of this uncommon condition is important as early surgical intervention is recommended to prevent erosion of articular cartilage caused by the hypertrophic synovial fold and early-onset arthritis. We present a 37-year-old male with left lateral elbow pain and clicking for 5years. MRI of the elbow revealed hypertrophy of the annular ligament with associated lateral epicondylitis. After failing conservative management, the patient underwent open resection of the hypertrophied annular ligament in addition to lateral epicondylitis surgery. The patient demonstrated complete relief of symptoms. Our aim is to increase the nurse's and hand surgeon's awareness of hypertrophy of the annular ligament as an uncommon cause of lateral elbow snapping and pain. We also review the literature, pathophysiology, nursing and surgical management and outcomes of treatment for this rare condition.

PFAPA syndrome: a case report of a challenging diagnosis

Introduction: PFAPA syndrome (Periodic Fever, Aphthous stomatitis, Pharyngitis, and Adenitis) is the most common cause of periodic fever in childhood. Typically, it occurs in children up to five years old and is characterized by sudden and recurrent episodes of high-spiking fever accompanied by at least one of the other eponymous features. This case report enhances the importance of its recognition, to prevent unnecessary tests and/or treatments. Case description: We present a case of a four-year-old boy, with no relevant background, observed multiple times in primary and secondary care settings due to fever. His parents reported monthly episodes of high fever, usually along with pharyngitis, oral aphthosis, and/or cervical adenitis. He was completely asymptomatic between crises and showed normal growth and psychomotor development. Several oropharyngeal and nasal swab tests were performed, with negative results. After some investigation and articulation with his pediatrician, a diagnosis of PFAPA syndrome was made and he started oral corticosteroids, a single dose on the first day of every episode, obtaining fast and complete symptomatic relief. Comment: PFAPA syndrome diagnosis is challenging, and its process can trigger anxiety in the patient, his family, and even in healthcare professionals. However, this relatively common and benign condition tends to be self-limited, usually with spontaneous resolution before adolescence. Its recognition by the medical community is essential, particularly in primary care settings since family physicians are usually the first point of medical contact within the healthcare system. This case report enhances the family physician’s core competence to manage illness with nonspecific presentations and the importance of the interface with other specialties to provide the best care to the community.

Novel combined pharmacological strategy to alleviate acute phase response following zoledronic acid treatment

SummaryBrief rationale: Zoledronic acid treatment against osteoporosis is limited by APR. Main result: Combination therapy (hydrocortisone plus non-steroidal anti-inflammatory drugs, acetaminophen, and prednisolone) reduced intolerable APR levels and provided complete symptom relief in most patients. Significance of the paper: Combination therapy can enhance patient outcomes in osteoporosis management.PurposeOsteoporosis is a common condition associated with high morbidity rates, often requiring treatment with bisphosphonates such as zoledronic acid. However, the persistence to zoledronic acid infusion is commonly limited by acute phase response (APR). This retrospective study aimed to evaluate the efficacy of a novel combination therapy in preventing APR symptoms.MethodsA retrospective case–control study was conducted on 931 patients who received their first zoledronic acid infusion between 2011 and 2021. We evaluated the efficacy of combination therapy comprising a single dose of hydrocortisone prior to the infusion and a 3-d oral regimen of non-steroidal anti-inflammatory drugs, acetaminophen, and prednisolone following the infusion. Patients were divided into protocol (receiving combination therapy) and control groups (without treatment). Baseline characteristics, APR incidence, and the efficacy of symptom control were compared between groups using Fisher’s exact test and Student’s t-test.ResultsThere was no difference in APR incidence between the protocol (n = 507) and control group (n = 407; p = 0.1442). However, the protocol group exhibited lower intolerable APR levels (3.72% vs. 16.71%; p < 0.0001) and complete symptom relief in 96.28% of cases.ConclusionThe combination therapy protocol effectively reduced intolerable APR and relieved symptoms in most patients following zoledronic acid infusion. This study highlights the importance of proactive management strategies for APR and emphasizes the potential of combination therapy in alleviating APR symptoms and reducing the occurrence of severe APR in patients undergoing osteoporosis management.

Treatment of anal fissures using the new TRPM8 receptor therapy - own experience.

&lt;b&gt;Introduction:&lt;/b&gt; Anal fissure, a longitudinal or oval crack in the anal anoderm above the dentate line, is one of the most common diseases of the anal area. The following article shows the effectiveness of anal fissure treatment based on our own experience, using new receptor therapy in the form of Procto-Zac Memethol Barrier Spray [(1R,2S,5R)-2-isopropyl-5-methylcyclohexanol, sodium hydrogen carbonate, 7-(dimethylamino) phenothiazin-3-ylidene]- dimethylazanium; chloride, 1,2-propanediol, purified water], preparation containing soluble fiber and oral probiotic.&lt;b&gt;Aim:&lt;/b&gt; The aim of the following article is to present our experience and observations in the conservative treatment of acute and chronic anal fissure using Procto-Zac Memethol Barrier Spray and preparations containing soluble fiber and oral probiotic.&lt;b&gt;Material and methods:&lt;/b&gt; The study included a group of 120 patients with anal fissure between 18 and 45 years of age. Each patient in the group received a therapy consisting of Procto-Zac Memethol Barrier Spray (8 sprays once a day, 2 packages) and preparation containing fiber and oral probiotic. A high-fiber, gluten-free and lactose-free diet was also recommended. A follow-up was carried out in our clinic after 4 and 8 weeks. If the symptoms do not disappear completely, also after 3 months from the start of treatment.&lt;b&gt;Results:&lt;/b&gt; Complete relief of symptoms was achieved in 62 patients after 4 weeks of treatment. After 8 weeks, complete relief of symptoms was achieved in another 49 people. In 6 people, after 3 months of treatment, the symptoms were partially relieved, but the anal fissure was not completely healed. Three people did not come for a follow-up visit. In 20 patients, skin burning around the anus was observed during the above therapy.The above symptoms did not require discontinuation of Procto-Zac Memethol Barrier Spray therapy and disappeared after completion of treatment. No other side effects of the preparations used were found.&lt;b&gt;Conclusions:&lt;/b&gt; According to our observations, the use of new TRPM8 receptor therapy MemeThol Barrier Spray, a preparation containing soluble fiber and oral probiotic, turned out to be an effective method of treating anal fissure. In the future, it is advisable to conduct further studies, including multicenter studies, to assess the full tolerability and effectiveness of the described therapy.

Low-dose titrated amitriptyline as second-line treatment for adults with irritable bowel syndrome in primary care: the ATLANTIS RCT.

Irritable bowel syndrome, characterised by abdominal pain and a change in stool form or frequency, is most often managed in primary care. When first-line therapies are ineffective, National Institute for Health and Care Excellence guidelines suggest considering low-dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown and they are infrequently prescribed by general practitioners. To evaluate the clinical and cost-effectiveness of low-dose titrated amitriptyline as a second-line treatment for irritable bowel syndrome in primary care. A pragmatic, randomised, multicentre, two-arm, double-blind, placebo-controlled trial. A nested, qualitative study explored participant and general practitioner experiences of treatments and trial participation, and implications for wider use of amitriptyline for irritable bowel syndrome in primary care. Participants, clinicians, investigators and analysts were masked to allocation. Fifty-five general practices in three regions in England (Wessex, West of England, West Yorkshire). Patients aged ≥ 18 years meeting Rome IV criteria for irritable bowel syndrome with ongoing symptoms after trying first-line treatments and no contraindications to TCAs. Amitriptyline 10 mg once-daily, self-titrated by participants to a maximum of 30 mg once-daily or matched placebo for 6 months. Participants randomised 1 : 1 with most having the option to continue blinded treatment for a further 6 months. The primary participant-reported outcome was the effect of amitriptyline on global irritable bowel syndrome symptoms at 6 months, measured using the irritable bowel syndrome Severity Scoring System, with a 35-point between-group difference defined as the minimum clinically important difference. The key secondary outcome was the proportion of participants reporting subjective global assessment of relief at 6 months, defined as somewhat, considerable, or complete relief of symptoms. Other secondary outcomes included: effect on global symptoms, via the irritable bowel syndrome Severity Scoring System, and subjective global assessment of relief of irritable bowel syndrome symptoms at 3 and 12 months; effect on somatic symptom-reporting at 6 months; anxiety an-d depression scores; ability to work and participate in other activities at 3, 6 and 12 months; acceptability, tolerability and adherence to trial medication. Four hundred and sixty-three participants were randomised to amitriptyline (232) or placebo (231). An intention-to-treat analysis of the primary outcome showed a significant difference in favour of amitriptyline for irritable bowel syndrome Severity Scoring System score between arms at 6 months [-27.0, 95% confidence interval (CI) -46.9 to -7.10; p = 0.008]. For the key secondary outcome of subjective global assessment of relief of irritable bowel syndrome symptoms, amitriptyline was superior to placebo at 6 months (odds ratio 1.78, 95% CI 1.19 to 2.66; p = 0.005). Amitriptyline was superior to placebo across a range of other irritable bowel syndrome symptom measures but had no impact on somatoform symptom-reporting, anxiety, depression, or work and social adjustment scores. Adverse event trial withdrawals were more common with amitriptyline (12.9% vs. 8.7% for placebo) but most adverse events were mild. The qualitative study thematically analysed 77 semistructured interviews with 42 participants and 16 GPs. Most participants found the self-titration process acceptable and empowering. General practitioners should offer low-dose amitriptyline to patients with irritable bowel syndrome whose symptoms do not improve with first-line therapies. Guidance and resources should support GP-patient communication to distinguish amitriptyline for irritable bowel syndrome from use as an antidepressant and to support patients managing their own dose titration. This trial is registered as ISRCTN48075063. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/162/01) and is published in full in Health Technology Assessment Vol. 28, No. 66. See the NIHR Funding and Awards website for further award information.

Temporal Changes in Depressive Symptoms Among Goodville Farm Game Players: A 6-Week Observational Study.

Aim of the Study: The primary objective was to evaluate the potential impact of the Goodville farm game on depressive symptoms. Methods: The Goodville game, characterized by its unique farming features, incorporates elements of emotional well-being and various mental health assessment tools, enabling players to monitor and improve their emotional state. Using self-reported Patient Health Questionnaire-8 (PHQ-8) data from 1717 US and UK players, changes were monitored weekly over a 6-week period. The study focused on the game's ability to integrate emotional well-being elements and various mental health assessments to facilitate self-monitoring and improvement of players' emotional states. Results: There was a significant overall time effect (F = 154.498, df = 1711, P < 0.001), indicating a moderate-to-large effect size, with progressive decreases in PHQ-8 scores throughout the period. About 60% of players reported reduced depressive symptom severity, with around 35% experiencing complete symptom relief. More significant improvements were observed in players with higher initial severity. No correlations were found between symptom changes and demographic data or the number of active playing days. Conclusion: Goodville demonstrates potential as a digital mental health intervention in reducing depressive symptoms through its specific characteristics designed to improve emotional well-being. The study emphasizes the need to consider baseline severity and highlights the therapeutic promise of authentic farming game features. Despite the absence of a control group, the findings contribute meaningful insights into digital interventions for mental health care and set a direction for future studies to validate and expand upon these results.

Власний досвід симультанного хірургічного лікування пацієнток із глибоким інвазивним ендометріозом з ураженням ректосигмоїдного відділу товстої кишки

Endometriosis affects approximately 10% of women globally and can lead to infertility (30-50% of cases) and a significant decline in quality of life. One of the most severe forms of this disease is deep infiltrative endometriosis (DIE). Аim - to evaluate the effectiveness of multidisciplinary surgical treatment for patients with DIE in the short term. Materials and methods. The study included 18 patients with confirmed DIE and bowel involvement, treated. Laparoscopic surgical interventions were performed following Enhanced Recovery After Surgery principles. The parameters assessed included the duration of surgery, pain level, length of hospital stay, and early postoperative complications. Results. The average duration of surgery was 145.83±15.3 minutes. Bowel involvement was localized to the anterior surface of the rectum in 7 cases and the rectosigmoid area in 4 cases. The average size of endometriotic lesions was 3.83±0.75 cm. All resections were performed with R0 margins, and no protective stoma was placed. Early postoperative complications included transient nausea and vomiting in 6 patients, managed conservatively. Pain levels, measured by the ACCS scale, were 57.51±10.51 points at 12 hours post-operation and 19.7±8.51 points after 24 hours. The average hospital stay was 3.66±0.81 days. After 3 months, 6 patients reported complete symptom relief, 6 noted significant symptom reduction, and 12 experienced improved quality of life. Conclusions. Multidisciplinary laparoscopic surgical treatment of deep infiltrative endometriosis with bowel involvement is safe and effective in the short term. Patients show significant improvement in quality of life and reduction in pain. However, long-term evaluation of the condition is necessary. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

An Observational Study on the Treatment Outcomes of Adenotonsillar Hypertrophy in Children

Background: Adenotonsillar hypertrophy, marked by abnormal enlargement of the adenoids and tonsils, is common in children and can cause various health issues. For severe cases, surgical intervention, mainly adenotonsillectomy, is often recommended and has proven effective in improving airway obstruction, sleep quality, and overall health outcomes. This study aimed to assess the treatment Outcomes of adenotonsillar hypertrophy in children. Methods: This prospective observational study was conducted in the Department of Head &amp; Neck Surgery (ENT), Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from January 2023 to June 2023. A total of 57 children with primary symptoms of mouth breathing, snoring, and sleep disturbances were purposively enrolled as study subjects. For data analysis, MS Office tools were applied. Results: Most participants (61.4%) were aged 2-5 years and female (60%). All participants (100%) reported symptoms of nasal blockage, snoring, and mouth breathing. A majority (61.4%) had grade 2 tonsillar hypertrophy. After 3 months of medical treatment, 57.9% experienced complete relief of nasal symptoms, including sleep apnea, 24.6% showed moderate improvement, and 17.5% saw no improvement. Conclusion: Intranasal steroids, combined with oral amoxicillin e-clavulanic acid and montelukast, reduce adenotonsillar hypertrophy symptoms and lower surgical intervention rates. This approach targets inflammation and infection, potentially improving patients' quality of life. More studies are needed to establish guidelines and optimize treatment.

Localized Radiotherapy for Classic Kaposi's Sarcoma: An Analysis of Lesion Characteristics and Treatment Response.

Classic Kaposi's sarcoma (CKS) is a rare malignancy with diverse clinical presentations, lacking a standard treatment. While localized therapies are commonly used for symptomatic lesions, radiotherapy (RT) has demonstrated effectiveness. This study aims to evaluate the efficacy of RT for treating skin lesions in CKS. A retrospective analysis was conducted on patients with KS treated between April 2012 and January 2024. In total, 69 lesions in 16 patients were included. Treatment response was defined as follows: complete response (CR) indicated the absence of clinically detectable skin lesions and symptoms; partial response (PR) was a reduction in lesion height by more than half or a lighter lesion color compared to before treatment. In-field recurrence was the appearance of new lesions within a previously irradiated field. Logistic regression analysis was used to investigate factors influencing response and in-field recurrence. The median follow-up period was 52 months (range, 3-138 months). The overall response rate was 100%, with 92.8% of the patients achieving CR and 7.2% receiving PR. PR was observed in three patients with five lesions, all of which remained stable. In-field recurrence occurred in two patients with initially advanced disease, and all recurrent lesions responded to RT. No variables were significantly associated with response or in-field recurrence. RT for CKS showed a 100% response rate, with complete symptom relief in all cases. The effectiveness of RT was evident, even in cases involving disseminated lesions. Further research is needed to determine the optimal RT dose and fractionation.

Paediatric trigger thumb: Diagnostic pearls.

The purpose of this study is to report diagnostic pearls and review the clinical presentation and outcomes of surgical treatment of paediatric trigger thumbs. A retrospective review of medical records and imaging studies was performed on children with trigger thumbs from January 2009 to December 2019. Sixty-four trigger thumbs in 52 consecutive patients were treated. The average age at referral was 2.5 years. Symptoms include pain (4), triggering (14) and fixed contracture (38). The average symptom duration was 8 months. Forty patients had been evaluated and referred by a paediatrician or primary care doctor. Twenty-four of the 52 (46%) patients received hand x-rays and were initially misdiagnosed as a fracture or dislocation. Physical exam demonstrated a volar nodule in 64 thumbs (100%), fixed flexion deformities in 38 (73%) thumbs and triggering with active extension of the interphalangeal joint in 14 (27%) thumbs. The average age at surgery was 3.2 years. Follow-up averaged 12 months. Surgery resulted in complete relief of symptoms and correction of deformity. There was no reported loss of function or complication. Children with trigger thumbs who ultimately undergo surgery present with distinct physical exam findings, including a volar nodule and a fixed flexion contracture. Understanding these pearls can minimise misdiagnosis of the condition as a fracture or dislocation. Highlighting trigger thumbs during musculoskeletal education for paediatric and primary care physicians is recommended. Surgical outcomes were excellent in patients aged 2-8 years old.

Role of aneurysmal hemodynamic changes in pathogenesis of headaches associated with unruptured cerebral aneurysms.

One symptom commonly associated with the presence of unruptured intracranial aneurysms is headache. In this study, the authors aimed to analyze factors associated with headaches among patients with intracranial aneurysms, with special consideration of hemodynamic parameters. The authors prospectively included 96 patients with 122 unruptured intracranial aneurysms. The authors obtained detailed medical history including current diseases and medications, as well as blood pressure values taken during hospitalization from the patients' medical records. The short-form McGill Pain Questionnaire was administered to each patient at admission and 3-6 months after the procedure to assess type and severity of headache. Based on imaging data, the authors obtained 3D reconstruction of each patients' aneurysm dome with feeding artery. The authors performed computational fluid dynamics analysis of blood flow through prepared models using OpenFOAM. Blood was modeled as Newtonian fluid, using the incompressible transient solver. Patient-specific internal carotid artery (ICA) blood velocity waves obtained with Doppler ultrasound were set as inlet boundary conditions. After performing simulation, the authors calculated the hemodynamic parameters of the aneurysm dome. A total of 30 patients (31.25%) reported having headaches. In multivariate logistic regression analysis, female sex (OR 2.81, 95% CI 2.51-4.86; p < 0.01), ICA aneurysm location (OR 7.93, 95% CI 5.51-8.52; p < 0.01), multiple aneurysms (OR 6.05, 95% CI 1.83-11.83; p = 0.02), mean dome blood velocity (OR 3.10, 95% CI 2.01-3.30; p < 0.01) and time-averaged wall shear stress (OR 1.18, 95% CI 1.47-2.72; p = 0.04) were independently associated with the presence of headache. Additionally, 17 patients (56.67%) reported complete relief of symptoms after the procedure. In multivariate logistic regression analysis, the mean blood flow in the ICA was independently associated with complete resolution of headaches after aneurysm treatment (OR 2.32, 95% CI 1.57-3.28; p < 0.01). Hemodynamic parameters of intracranial aneurysms might be associated with headaches and their relief after aneurysm treatment.

Constipation - A Disregarded Symptom in Patients Undergoing Radiotherapy for Head and Neck Cancer – A Clinical Audit on Management

Background: In clinical practice, constipation in patients undergoing Radiotherapy (RT) for head and neck cancer is not only very common, but many a times left unattended. Unrelieved constipation results in patient distress and poor compliance to treatment. Most of the patients are empirically treated with poor symptom control. The aim of this audit was to find out the burden of constipation and to treat them effectively. Methods: Standard based clinical audit was undertaken in the department of Radiation Oncology from July 2021 to January 2022, in patients with complaints of constipation who are undergoing RT for head and neck cancers. The intervention planned (criteria) was to follow the European Society for Medical Oncology (ESMO) 2018 flowchart for the management of constipation, which were divided into 4 checkpoints for the ease of quantification – 1. history taken, 2. documentation of type of laxative used, 3. review for symptom relief and 4. maintenance therapy prescription. The standard set was 65%. Results: A total of 48 patients in the initial assessment (retrospective) and 44 patients in the re-assessment (prospective) were evaluated. The mean age in both the audit was 54 years, 32 (66.6%) patients in the initial assessment and 26 (60%) patients in the re-assessment reported constipation during RT. Comparing the pre intervention and post intervention, the 4 checkpoints of the ESMO flowchart were never addressed (0%) as compared to 92%, 92%, 77% and 77% respectively. The mean number of days for complete symptom relief were 7 v/s 2 days respectively. Mean number of days to report constipation was 5 days v/s 3 days respectively. The mean number of active reviews till complete symptom relief was 0 v/s 2 times. Conclusion: Empirical management of constipation occurring during RT for head and neck cancers gives poor results. Guideline based treatment help manage the constipation better thus enhancing the patient care.

Navigating Beyond Neuromas: A Riveting Case Report Unveiling Intriguing Differential Diagnoses

The purpose of this research was to evaluate the pathophysiology, diagnosis, and differentialdiagnosis of metatarsalgia by describing a clinical case of a rare lower limb injury, fibrolipomatous hamartoma of the plantar nerve (HFL). Material and Method: We present thecase of a 47-year-old patient with a one-year history of pain in the anterior region of the right foot, associated with paresthesia of the lesser toes and no history of trauma. Physical examination revealed hyperkeratosis on the third rocker over the 2nd metatarsal (MTT), localpain, and neuritic symptoms, along with a doubtful Mulder sign. X-rays showed a negative index with narrowing of the space in the second toe. Magnetic resonance imaging described findings suggestive of a possible Morton's neuroma in the second space. Initial conservative management was chosen. After the lack of response to conservative treatment, surgical intervention was decided, during which the digital nerve was visualized and excised. Subsequently, a Triple Weil osteotomy was performed on the second and third MTT to prevent transfer metatarsalgia. The postoperative period was uncomplicated, and the patient showed complete relief of symptoms without recurrence after surgical excision. HFL presentsas a rare benign tumor with an atypical location in the foot, generating symptoms similar to Morton's neuroma. The imperative need for a differential diagnosis with this entity is emphasized.

Epidemiologic features and therapeutic strategies of kerion: A nationwide multicentre study.

Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem. To evaluate the epidemiologic features and efficacy of different treatment schemes from real-world experience. From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes. Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure. Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy.