Early Complaints Research Articles

Dysphagia, dyspnoea, dizziness, and ‘inverted D’: Abnormal LV eccentricity secondary to extrinsic compression by oesophageal achalasia

AbstractExtrinsic compression of the left atrium (LA) due to oesophageal achalasia though uncommon has been reported in literature. This case report describes a middle‐aged man who presented with sudden onset dyspnoea and atrial fibrillation, but was later diagnosed to have achalasia cardia and megaoesophagus, resulting in extrinsic compression of the LA as well as posterobasal wall of the left ventricle (LV). The patient's early complaints of dysphagia and weight loss prompted a thorough study, with echocardiography helping to identify extrinsic compression of heart chambers caused by the dilated oesophagus. The left ventricular eccentricity index was increased secondary to compression by volume‐loaded megaoesophagus, which was one of the most notable findings. Through this case, we describe probably the first case of LV compression by achalasia cardia, in addition to LA and we want to highlight the fact that D‐shaped LV can also occur secondary to extrinsic etiologies particularly compression from posterior mediastinal structures.

Early predictors of prolonged grief among bereaved trauma survivors 8.5 years after a terrorist attack.

A better understanding of the development of prolonged grief disorder can help professionals identify bereaved in need of intervention efforts and improve the efficiency of services. We aimed to examine the prevalence of and risk factors for prolonged grief disorder in a sample of young, bereaved terrorist attack survivors almost a decade postloss. In total, 165 bereaved survivors (Mage = 27.75, SD = 4.27; 45.5% females) of the 2011 terror attack on Utøya island, Norway, participated in face-to-face, semistructured interviews. At 4-5 months after the attack, early posttraumatic reactions were measured using the Brief Grief Questionnaire, University of California at Los Angeles PTSD Reaction Index, the Hopkins Symptom Checklist-8, and the eight-item Children's Somatic Symptoms Inventory. At 8.5 years postloss, the Traumatic Grief Inventory-Self Report Plus was used to assess prolonged grief disorder. To explore the association between participants' sociodemographic characteristics, early postloss clinical characteristics, and later prolonged grief reactions, we used multiple linear regression analyses. We found that 4.8% of the participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision diagnostic criteria for prolonged grief disorder 8.5 years after their traumatic loss. Lower age and high levels of early somatic complaints predicted higher prolonged grief reactions almost a decade postloss. Young, bereaved survivors may be at particularly high risk of experiencing persistent grief reactions following the traumatic loss of a peer. Pending replication of our findings, professionals should focus on identifying bereaved who experience intense somatic symptoms early after a traumatic loss. Targeting these symptoms may alleviate the exacerbation of persistent grief reactions several years after a traumatic loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effectivity of a School-Based Early Intervention Targeting Psychological Complaints and Non-Suicidal Self-Injury in Adolescents.

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11-14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention.

Significance of Prescribing Astigmatic Correction in Young Patients having Low Astigmatism with Near Vision Complaints

Astigmatism causes increased difficulty in reading performance like book reading, mobile usage and computer work. Objective: The primary objective was to find out the significance of prescribing astigmatic correction in young patients having low astigmatism with near vision complaints and secondary objective was to find out the most common type of astigmatism affecting near vision. Methods: This was a multicentered, prospective cohort study conducted from April 2022 to Sep 2022. A total of 64 subjects of both genders were selected through non-probability convenient sampling technique. Patients with age between 15-30 years having low astigmatism (0.25-0.75D) with near vision complaints were included. Any amount of astigmatism was corrected with appropriate glasses and subjects were asked for a follow up fortnightly. Follow up improvement in symptoms were recorded and compared with earlier complaints by applying chi square test using SPSS version 23.0. Results: A total of 64 subjects were enrolled in the study. The mean age of patients was 22.44 years including 27 (42%) males and 37 (58%) females. The most common symptom was Eye Strain found in 53 (83%) of the patients. Most common type of astigmatism was Against the Rule astigmatism. 62 (96%) patients improved to 6/6 in both eyes. On follow up, improvement in symptoms was noted and compared with symptoms before the usage of glasses. Conclusions: The study concluded that the treatment for near vision complaints in young patients is prescribing them with proper cylindrical / astigmatic correction in the form of eye glasses.

MRI imaging pattern of metastasis and tuberculous spondylitis in the spine: serial case report

Background: Tuberculous spondylitis and spinal metastasis manifestations have a similar clinical manifestation. Spinal metastasis prevalence is high in malignant process while tuberculosis is frequent in endemic areas. Back pain, paresthesia, and paralysis are commonly caused by vertebral fractures, soft tissue mass, and spinal canal involvement. The magnetic resonance imaging (MRI) is a useful modality in the pattern differentiation of these diseases. This case series aimed to provide a differentiation between those two diseases using MRI. Case report: In the first case, we presented a 24-year-old female complained of hip pain without history of tuberculosis infection or malignancy. Whole spine MRI showed kyphotic deformity, compression of T9 vertebral body, erosion of anterior aspect T8 and T10 vertebral body, and subligamentous abscess at T7-T12 vertebrae level. Tuberculous infection was proven. The second case was a 39-year-old female complained of leg weakness without complaint of cough or breathing difficulty. Whole spine MRI showed kyphotic thoracic vertebrae, compression T10 vertebral body, destruction of inferior endplate T9 vertebrae, bone marrow changes on thoracic vertebral body, and paravertebral soft tissue mass on anterior T6 to T11 vertebral body. Tuberculosis etiology was proven. The third case was a 51-year-old female that came to the hospital due to waist pain with no history of tuberculosis infection or malignancy. Whole spine MRI revealed T8 and T9 vertebral body compression and bone marrow replacement on cervical, thoracic, and lumbar vertebrae, spinous process of thoracic and lumbar, bilateral posterior rib T4-T5, and soft tissue mass at the posterior T9 vertebrae. In the last case, we presented a 58-year-old male that complianed pain in the back and both legs. Lumbosacral MRI showed compression fracture with signal intensity change on L3 vertebral body, bone marrow replacement on thoracic, lumbar, and sacral vertebrae, expanding to epidural and cause spinal canal stenosis. CT-scan thorax showed lung malignancy proven to be non-small cell lung carcinoma. A spinal biopsy revealed malignant infiltration. Conclusion: Tuberculous spondylitis and metastasis differentiation can be a challenge. Early complaints mostly are back pain, paresthesia, and paralysis. Spine MRI can differentiate the pattern of both diseases and identify the possible etiology.

Relationship between telomere shortening and early subjective depressive symptoms and cognitive complaints in older adults

AbstractBackgroundTelomere length (TL) has been reported to be associated with depression and cognitive impairment in elderly. Early detection of depression and cognitive impairment is important to delay disease progression. Therefore, we aimed to identify whether TL is associated with early subjective depressive symptoms and cognitive complaints among healthy elderly subjects.MethodThis study was a multicenter, outcome assessor‐blinded, 24‐week, randomized controlled trial (RCT). Measurement of questionnaire and physical activity scores and blood sample analyses were performed at baseline and after six months of follow‐up in all study participants. Linear regression analyses were performed to identify whether early subjective depressive symptoms, cognitive complaints, and several blood biomarkers are associated with TL.ResultAltogether, 137 relatively healthy elderly individuals (60‐79 years old) were enrolled in this prospective RCT. We observed an approximate decrease of 0.06 and 0.11−0.14 kbps of TL per one point increase in the geriatric depression scale and cognitive complaint interview scores, respectively, at baseline and after six months of follow‐up. We also found an approximate decrease of 0.08−0.09 kbps of TL per one point increase in interleukin (IL)‐6 levels at baseline and after six months of follow‐up.ConclusionOur study showed that both early subjective depressive symptoms and cognitive complaints were associated with a relatively shorter TL in relatively healthy elderly individuals. In addition, based on our findings, we believe that IL‐6 plays an important role in the relationship between shortening TL and early subjective depressive symptoms and cognitive complaints.

Validation of trail making test part A for cognitive screening in multiple sclerosis

Cognitive impairment is a crucial early and late complaint in multiple sclerosis (MS). The exact onset of cognitive impairment in MS and its pathophysiology remain elusive. A simple, easy, and time saving method is crucial for detecting early cognitive complaints, specifically information processing speed, which is important for the functionality of higher cognitive processes. Here, the authors compare the sensitivity and specificity of trail making test part A as a short and free valid test with the symbol digit modality test (SDMT) for assessment of information processing speed in a sample of Egyptian people with MS.

Assessment of three different radioiodine doses for ablation therapy of thyroid remnants: Efficiency, complications and patient comfort.

I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ± 0.3, 2.6 ± 0.6, and 2.9 ± 0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.

Clinical efficacy and nocebo effect following non-medical biosimilar switch in patients with inflammatory bowel disease: A prospective observational study

BackgroundWe aimed to evaluate clinical efficacy, biomarker activity, therapeutic drug monitoring (TDM), adverse events (AEs), and nocebo effect in inflammatory bowel disease (IBD) patients who underwent non-medical biosimilar switching. MethodsA prospective observational study of consecutive IBD patients who underwent biosimilar switch. Disease activity, biomarkers, TDM, and AEs, including the nocebo effect were captured 8 weeks before switch, at the time of switch (baseline),12 and 24 weeks after the switch. Results210 patients were included [81.4% had Crohn's disease (CD), the median age at inclusion: 42 years (IQR 29–61)]. There was no significant difference in the rates of clinical remission at week 8 before switch, baseline, week12, and 24 after switch: 89.0%,93.4%,86.3%,and 90.8%,p = 0.129. The biomarker remission rates were not significantly different; CRP:81.3%,74.7%,81.2%,73.0%,p = 0.343; fecal calprotectin: 78.3%,74.5%,71.7%,76.3%,p = 0.829. The rates of maintaining therapeutic levels (84.7%,83.9%,83.0%,85.3%,p = 0.597) and prevalence of positive anti-drug antibodies remained unchanged. Drug persistence at 12 week of switch was 97.1%, regardless of disease phenotype and originator. The nocebo effect was observed in 13.3%. The discontinuation rate was 4.8%. ConclusionDespite a significant number of early nocebo complaints within the first 6 months after the biosimilar switch, no significant changes were found in clinical efficacy, biomarkers, therapeutic drug level, or anti-drug antibodies.

From Pariah to Baboon: Ludwig Robert’s Parody of Michael Beer’s Paria

Abstract Michael Beer’s successful 1823 play Der Paria is famous as an early complaint against the status of Jews as second-rate citizens. As such, it is fundamental to the conception of Jews as pariahs, best known through the writings of Hannah Arendt. Its long reception history has overlooked an important source, that is now uncovered for the first time in a hundred years. Beer’s play was parodied by Ludwig Robert with Der Pavian. Both authors were scions of Berlin’s Jewish elite, and among the first authors of Jewish descent to write in German. Robert’s parody shows why he did not share in the general enthusiasm about Der Paria, how the choice of the parodic genre was a self-referential critique, and how form and content of the parody together intervened in Beer’s use of the genre of Trauerspiel. Thus, it contributes to our understanding of the diverse strategies and self-perceptions of upper-class Berlin Jews, confronted with the limits of their pioneering the Jewish integration into non-Jewish society, showing the role of theater as a means of negotiating contemporary social problems both in private and publicly, stressing the difficult presence of Jews in the German public sphere.

The Utility of Transvaginal Ultrasound After Intrauterine Pregnancy Identification on Transabdominal Ultrasound in Emergency Department Patients.

Ultrasonography has an important role in the evaluation of Emergency Department (ED) patients presenting with early pregnancy complaints. Both transabdominal (TAUS) and transvaginal ultrasound (TVUS) can be utilized. While TVUS generally allows for greater detail, it is unclear how much added benefit exists in performing TVUS once an intrauterine pregnancy (IUP) has been identified on TAUS. This was a retrospective study utilizing Radiology Department ultrasound examinations obtained in first trimester pregnancy ED patients during a consecutive four month period in 2019. Studies wherein both TAUS and TVUS were both performed were included. Two ED physicians with specialized training in point of care ultrasound reviewed only the TAUS images from these studies. Their findings were compared to the Radiologist interpretation, which was inclusive of both TAUS and TVUS components of the study. 108 studies met inclusion criteria. Amongst these, 82 had IUP's identified on the radiologist report. 69 studies had an IUP identified by ED physician review of the TAUS images, with 1 false positive. Each case of intrauterine fetal demise (IUFD) was identified on ED physician review of TAUS. Two ectopic pregnancies were present, neither of which was mistaken for IUP on ED physician TAUS review. There were 15 studies with subchorionic hemorrhage and 3 studies with an ovarian cyst noted on the radiologist report. Following the identification of an IUP on TAUS, the added diagnostic value of TVUS amongst this cohort of ED patients was low. Given the added time and cost of TVUS, selective instead of routine usage should be encouraged.

AHRC Efforts Action to Reduce Racial Discrimination Cases Occur in Australia

This article discusses the efforts of the Australian Human Rights Commission (AHRC) to reduce cases of racial discrimination in Australia 2015-2018. The AHRC's efforts are defined in five rules and procedures for resolving complaints of racial discrimination. Among them are socialization or early warning, complaints and investigations, compliance, continuation of legal action, and public hearings. The moment Australia ratified the United Nations Human Rights Commission (UNHRC) rules, namely the CERD rules on the International Convention on the Elimination of All Forms of Racial Discrimination which sparked the 1975 Racial Discrimination Act that could form the formation of the AHRC in 1986. In principle UNHRC is an organization known as the regime adopted in Australia in the form of the AHRC. This journal aims to discuss, describe, and find out the efforts of the Australian Commission on Human Rights in reducing cases of racial discrimination in Australia 2015-2018. Describes the rules and procedures for resolving racial discrimination complaints received by the AHRC through the five stages of resolution. After that it analyzes whether the five rules and procedures applied by the AHRC are implemented optimally to reduce cases of racial discrimination that occurred in Australia in 2015-2018.

Extension of the Clinicoradiologic Spectrum of Newly Described End-Truncating LAMB1 Variations.

To refine the clinical spectrum of a very recently identified phenotype associated with LAMB1 end-truncating pathogenic variations. Detailed clinical, neuropsychological, and MRI investigation of 6 patients from 2 unrelated families segregating end-truncating LAMB1 variations. All patients harbored a LAMB1 end-truncating pathogenic variation. The specific association of a hippocampal type episodic memory dysfunction and a diffuse leukoencephalopathy was observed in all 4 patients aged older than 50 years, slightly worsening over time in 2 patients with several years of follow-up. Additional unspecific neurologic symptoms are reported, such as episodes of numbness, language troubles, or faintness in these 4 patients and the 2 younger ones. The association of an extensive leukoencephalopathy with an episodic memory dysfunction of the hippocampal type is strongly suggestive of a LAMB1 end-truncating variation in adults older than 50 years. Early cognitive complaints and imaging abnormalities might exist decades before. Additional transient manifestations can be observed, and this association should lead to LAMB1 screening to avoid unnecessary invasive investigations.

Case Report Of Transverse Myelitis: Rare Neurological Complications Of Herpes Zoster Virus

Introduction: Transverse myelitis is a rare disease that accured by incident 0,3%-1% Though it rare happened transverse myelitis deserve to diccus because the variant presentation that make clinical challenge to dianosis to pre-observation for upgrade’s prognosis.
 Case Report: we reported case of transverse myelitis that was neurology complication to rare herpes zoster virus. Woman 27 years old came by early complaint of tingling fever, pain, shiver continue on foot and the right hand. After got well, patient cameback to her disease bacause of the worst condition that cold not mover her left foot. Diagnosis transverse myelitis could stand through clinical sympton and magnetic resonance imaging (MRI) patient that came by her skin of hipopigment have to always considere the happening of transverse myelitis and lost control of defecate on neurologi observation being got paraplegi, monoparese extremitas superior, and hipoanesthesia dermatom C5 on low grade. We got observation of MRI to the level cervicothoracal that show long segment hipeintensity introdural intra medullary to the level craniovertebral junction so C5 and T2 so on that involved 2/3 spinal cord that strength described transverse myelitis.
 
 Discussion: Varicella zoster virus cou caused neurologis complication, the of transverse myelitis, of it is sign and sympton like pain, sencoric trouble, weakness on arm and foot, and the problem bladder and intestines. This symptom often occured unilaterally , Ipsilateral toward rash then become bilaterally. Intervention should the customize with pattient complaint: The implement combination asiklovir and high close steroid’s inject significantly relieve the pattient complaining but still occured paraplegi.
 Keywords: Transverse myelitis, HZV, neurological complication

P417 Frequent Early Nocebo Complaints but Maintained Clinical Efficacy, Biomarker and Therapeutic drug levels following mandatory Biosimilar Switch in Patients with Inflammatory Bowel disease: Preliminary data from a Prospective Observational Cohort Study

Abstract Background Current evidence suggests that biosimilar is safe and effective for patients with IBD. There is limited data on and nocebo effect after switching from originator to biosimilar. We aimed to report clinical efficacy, therapeutic drug monitoring, adverse events (AEs), and frequency of nocebo in IBD patients with biosimilar switches. Methods We performed a prospective observational study of 257 consecutive IBD patients who underwent biosimilar switch at McGill University Health Centre, Montreal, Canada, between November 2021 and October 2022. We excluded 74 patients due to missing follow-up data/delay in the switch. Patients underwent a mandatory switch from the originator (Remicade or Humira) to biosimilars due to a change of the reimbursement policy in Quebec. Clinical and biochemical data were captured at 8 weeks before switch, baseline (time of the switch), and 12 and 24 weeks after the switch. Clinical remission was defined as an HBI<5 for Crohn’s disease (CD) or a partial Mayo<3 points for ulcerative colitis (UC). Biomarkers remission was defined as C-reactive protein (CRP<5mg/mL) and fecal calprotectin (FCAL)<250 mcg/g. Drug trough levels and anti-drug antibodies were measured at baseline and week 24 (therapeutic level was defined as infliximab level≥3mcg/mL, adalimumab≥5mcg/mL). AEs and nocebo effects were assessed. Results A total of 183 patients were included [79.2% were CD, male 57.4%, median age at inclusion 46 years (IQR 30-52), and median duration of disease 13 years (IQR8-22)]. There was no significant difference in the proportion of patients in clinical remission at week 8 before the switch(88.5%), baseline(93.8%), week 12(85.7%) and week 24(88.7%), p=0.835. Similarly, the proportion of patients remaining in biomarkers remission was not significantly different at week 8 before the switch, baseline, week 12 and week 24; CRP (82.4%/75.0%/80.0%/77.3%), p=0.760; FCAL (76.7%/77.8%/71.2/77.3%), p=0.932, as well as there was no significant difference in the proportion of patients maintaining the therapeutic level, (85.5%/82.2%/79.6%, p=0.853) and prevalence of positive anti-drug antibody at (10.5%/4.4%/11.8%, p=0.190) at 8 weeks before switch, baseline, and week 24, respectively. 14.5% of patients had subtherapeutic drug levels, 6% underwent dose optimization, and 4.4% had a loss of response/relapse. Nocebo was reported in 12% of patients (9.3% within the first 12 weeks and 2.7% within the first 24 weeks after the switch), 5.5% had drug AEs,and 3.8% discontinued biosimilars due to AEs. Conclusion Despite a significant number of early nocebo complaints within the first 3 months after the biosimilar switch, no significant changes were found in clinical efficacy, therapeutic drug trough level, and anti-drug antibodies.

Isolated A1 pulley release surgery for trigger finger leads to significant increase in tip-to-tip pinch strength

BackgroundEven in the first application of patients with early complaints of trigger finger, pinch strength of the hand may be affected. Therefore, it is difficult to assess the change of strength as a result of treatment in this problem. In this study, we aimed to evaluate the change of strength taking into account both measured and expected pinch strengths before and after A1 pulley release surgery. MethodsThirty fingers (9 thumbs, 12 middle, 8 ring and 1 index fingers) of 26 patients (17 women, 9 men) who underwent A1 pulley release were included into this study. The mean age of the patients was 53 (16–71). Tip-to-tip finger pinch strengths were measured pre-operatively and at 3 months postoperatively. The expected strengths were calculated using the values obtained from the healthy side and taking into account the dominance effect. In the analysis, pre-operative and postoperative measured strength/expected strength ratios were compared. ResultsThe mean of measured pinch strength/expected pinch strength ratio was 0.91 ± 0.3 pre-operatively and 1.14 ± 0.3 postoperatively (p < 0.05). ConclusionWith the calculation method used in this study, it was found that there was a significant increase in the tip-to-tip pinch strength after surgical A1 pulley release for the trigger finger. Level of EvidenceIII (Retrospective cohort study).

Early physical maturation and subjective health complaints in adolescent girls: a pooled cross-sectional analysis

BackgroundAlthough adolescents are generally healthy, subjective health complaints (SHC) are common in this age group, especially in adolescent girls. We explored the association between early menarche and the frequency of...

A young soldier with Susac syndrome: a case report

BackgroundSusac syndrome is a rare disease with multisystem manifestations. While the exact pathogenesis is not known, it has been proposed to be an autoimmune endotheliopathy affecting the microvasculature of the brain, retina, and inner ear. The disease is characterized by a triad of encephalopathy, vision loss, and hearing loss. However, patients may not have the triad at initial presentation and present with only a single finding.Case presentationA 25-year-old male resident of Panu Akil presented to Combined Military Hospital Lahore with complaints of dizziness and vertigo associated with severe migraine like headaches. He experienced sudden painless loss of vision in his right eye and was admitted to the medical intensive care unit. On examination, he had right-beating nystagmus and diplopia along with scintillating scotoma. After his admission, contrast-enhanced magnetic resonance imaging (MRI) was done which showed numerous enhancing bilateral white matter internal capsule micro-infarcts indicating typical “string of pearls” sign and a snowball lesion on the corpus callosum. His fundus fluorescein angiography (FFA) did not exhibit any branched retinal artery occlusions (BRAO). Fundoscopy showed the presence of drusen spots. His pure tone audiometry was unremarkable. Based on the highly characteristic findings present on the MRI, a diagnosis of Susac syndrome was made. He was started on injection methylprednisolone 1 gm IV in 500 ml normal saline over 1 h once a day for 5 days and then once a week for 8 weeks. He was also started on tablet mycophenolate mofetil 500 mg once daily for 7 days. Patient showed marked clinical improvement afterwards.ConclusionsSusac syndrome is a rare multisystem illness with an often insidious presentation. Patients can be misdiagnosed due to the nonspecific nature of the early complaints present in the disease. High index of suspicion is required for timely diagnosis and adequate management. Although no specific guidelines exist, management consists mainly of immunosuppressants.

Does Saline Irrigation at Different Temperatures Affect Pain, Edema, and Trismus After Impacted Third Molar Surgery: A Clinical Trial

Lower impacted third molar surgery is a very common oral-maxillofacial surgical procedure, which has complications such as facial swelling, pain, and trismus. This clinical trial aimed to compare the intensity of postoperative morbidity (pain, facial swelling, and trismus) following the third molar surgery performed using saline irrigation at different temperatures (4°C, 10°C, or 25°C). This double-blind, single-center, split-mouth, randomized prospective clinical trial was conducted among 48 systemically and periodontally healthy patients who had bilaterally asymptomatic mandibular third molars. Patients were randomly allocated into 2 groups (n=24) according to the temperature of the saline used. In each patient, one impacted third molar was determined as the test group (4°C or 10°C saline irrigation) and the other impacted third molar as the control group (25°C saline irrigation). Trismus and swelling were evaluated on the 1st, 3rd, and 7th days postoperatively. Pain perception by visual analog scale (VAS) and the total number of analgesics taken during the 7postoperative days were recorded. Data were analyzed using the Shapiro-Wilk test, the chi-square test, one-way analysis of variance, Duncan test, the Kruskal-Wallis test, the Dunn test, and the Friedman test (P<.05). Forty-eight patients (28 females, 20 males) with a mean age of 24.6±3.8years were included in the study. The duration of operations was similar. VAS values of test groups [test group 1 (4°C): 4.0, test group 1 (10°C): 8.0] and the number of analgesics taken [test group 1 (4°C): 0, test group 1 (10°) C): 3] were significantly lower (P<.001) than control groups (VAS, control group 1: 13.0, control group 2: 15.5, number of analgesic taken, control group 1: 5.5, control group 2: 4.0). Significant differences were found between the test groups in VAS values and the number of analgesics taken (P<.001). Also, the lowest trismus and facial swelling values were detected in the 4°C test group at all time points (P<.001). In the impacted third molar surgery, the use of cooled saline irrigation during bone removal may be a simple, inexpensive, and effective method for reducing early postoperative complaints.

Feasibility of quantitative sensory testing in juvenile idiopathic arthritis

ObjectiveJuvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10–17% pain remains a major symptom. Very few data exist on sensory threshold changes at the knee in JIA, a location in which inflammation often manifests. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children.MethodsSixteen patients with JIA aged 9–18 years with one affected knee and a patient-reported pain by Visual Analog Scale (VAS) > 10 on a 0–100 scale, and 16 healthy controls completed the study and were included for the analysis. QST was assessed in compliance with the German Research Network on Neuropathic Pain (DFNS) standard. Disease severity was determined using Juvenile Disease Activity Score (JADAS. Perceived pain was assessed with a visual analogue scale(0–100). Feasibility of QST was tested in patients aged 6–9.ResultsUnder the age of 9, QST testing showed not to be feasible in 3 out of 5 JIA patients. Patients with JIA aged 9 and older reported an average VAS pain score of 54.3. QST identified a significant reduction in pressure pain threshold (PPT) and increase in cold detection threshold (CDT) compared to healthy controls. PPT is reduced in both the affected and the unaffected knee, CDT is reduced in the unaffected knee, not the affected knee.ConclusionIn a Dutch cohort of Patients with JIA, QST is only feasible from 9 years and up. Also, sensory threshold changes at the knee are restricted to pressure pain and cold detection thresholds in Patients with JIA.PerspectiveThis article shows that in a Dutch population, the extensive QST protocol is only feasible in the age group from 9 years and older, and a reduced set of QST tests containing at least pressure pain thresholds and cold detection thresholds could prove to be better suited to the pediatric setting with arthritis.