Headache Pain Research Articles

Evaluating analgesic medications utilized in the treatment of aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

BackgroundSpontaneous aneurysmal subarachnoid hemorrhage (aSAH) recovery may be hampered by delayed cerebral ischemia (DCI). Herein, we sought to identify whether frequently administered medications in the intensive care unit (ICU) are associated with DCI. MethodsIn this retrospective study, patients admitted to a tertiary care center neuro-ICU between 2012 and 2019 with aSAH who could verbalize pain intensity scores were included. Medication dosages and clinical characteristics were abstracted from the medical record. Both paired and unpaired analyses were utilized to measure individual DCI risk for a given patient in relation to drug dosages. Results119 patients were included; average age was 61.7 ± 15.2 (SD) years, 89 (74.7%) were female, and 32 (26.9%) experienced DCI during admission. Patients with DCI had longer length of stay (19.3 ± 7.4 vs 12.7 ± 5.3 days, p < 0.0001). The combination medication of acetaminophen 325 mg/butalbital 50 mg/caffeine 40 mg (A/B/C) was associated with decreased DCI on paired (2.3 ± 2.0 vs 3.1 ± 1.9 tabs, p = 0.034) and unpaired analysis (1.84 ± 2.4 vs 2.6 ± 2.4 tabs, p < 0.001). No associations were found between DCI and opioids, dexamethasone, levetiracetam, or acetaminophen. Max and mean daily headache pain was not associated with DCI occurrence. ConclusionWe identified an association between a commonly administered analgesic and DCI. A/B/C is associated with decreased DCI in this study, while other medications are not associated with DCI risk.

Headache in Individuals with Neurodevelopmental Disorders.

Migraine is a common condition affecting an estimated billion people across the world. The incidence in individuals with neurodevelopmental disorders or intellectual disabilities like those seen in severe autism spectrum disorder (ASD) is unknown. This is likely due to the limited capacity to communicate the specifics of pain. The expression of pain with maladaptive behaviors, such as self-injurious behavior (SIB), has been described and can alert the clinician to the presence of untreated pain. This review article serves to educate the reader about clinical and treatment considerations when managing headaches in individuals with severe or non-verbal neurodevelopmental disorders given their communication challenges. It will include some clinical experiences and the gaps in our current knowledge. A comprehensive literature review was conducted using scientific databases, including PubMed, Medline, and Google Scholar. Only 1 article addressed the consideration for headaches in this population. The search was conducted using a combination of the following keywords: headache, intellectual disabilities, autism, pain, and behavior. Headache pain is likely underestimated and represents a disservice to this population of people. The consideration for headache pain should be explored when maladaptive behaviors are otherwise unexplainable. Further studies are needed in the area.

Surveillance of Malaria Cases among Residents of Villages of Tarwa Block, Azamgarh

Malaria is a protozoal disease caused by infection with parasites of genus plasmodium and transmitted to man by certain species of infected female anopheles mosquito. This mosquito is mainly found in tropical countries. Study was conducted in villages of Tarwa block, Azamgarh Uttar Pradesh, India. It was a cross sectional study where total 50 cases were studied. It was found that maximum affected population were from 10-45 year age group. Also found that all cases were suffering from fever followed by myalgia (82%), headache (78%) and retro-orbital pain in 73% of cases. During this surveillance study it was found that main source of mosquito breeding were standing water, containers, drains and gutters, water storage tanks, bird baths, flower pot saucers, ponds and lakes, pools, septic tank and sewage and marshes and wetlands.

Lumbar punctures are safe in patients with ALS and have a risk profile similar to that in the non-ALS population.

Analysis of biofluids, especially cerebrospinal fluid (CSF), is critically important for amyotrophic lateral sclerosis (ALS) research. Collection of CSF is typically performed by lumbar puncture (LP). Previous studies have demonstrated the safety of LPs in patients with other neurodegenerative diseases, such as Alzheimer's disease, although there are no published studies of the safety of LPs in patients with ALS. We performed a retrospective analysis of complications resulting from LPs. This is a retrospective study of LPs performed between 2015 and 2021 on a total of 233 participants (healthy controls [n = 63], ALS [n = 154], and disease controls [n = 16]) as part of clinical research studies at the Washington University ALS Center. We used bivariate logistical analyses looking for associations between participant characteristics and adverse events (AEs), and likelihood ratio tests were used for significance testing. We found an overall AE rate of 21.03%. AEs included headache, back pain, vasovagal syncope, and severe headache requiring epidural blood patch. Participants with ALS were not more likely to experience post-LP AEs compared to controls (odds ratio [OR] 0.61 [0.32-1.18]). Post-LP headaches were significantly less likely in participants with ALS (OR 0.36 [0.15-0.83]). Our findings demonstrate that LP is a safe procedure for participants with ALS, with a similar or lower rate of AEs than in participants without ALS.

A single infusion of intravenous lidocaine for primary headaches and trigeminal neuralgia: a retrospective analysis.

Intravenous (IV) lidocaine has been used as a transitional treatment in headache and facial pain conditions, typically as an inpatient infusion over several days, which is costly and may increase the risk of adverse effects. Here we report on our experience using a single one-hour IV lidocaine infusion in an outpatient day-case setting for the management of refractory primary headache disorders with facial pain and trigeminal neuralgia. This is a retrospective, single-center analysis on patients with medically refractory headache with facial pain and trigeminal neuralgia who were treated with IV lidocaine between March 2018 and July 2022. Lidocaine 5 mg.kg-1 in 60 mL saline was administered over 1 h, followed by an observation period of 30 min. Patients were considered responders if they reported reduction in pain intensity and/or headache frequency of 50% or greater. Duration of response was defined as short-term (< 2 weeks), medium-term (2-4 weeks) and long-term (> 4 weeks). Forty infusions were administered to 15 patients with trigeminal autonomic cephalalgias (n = 9), chronic migraine (n = 3) and trigeminal neuralgia (n = 3). Twelve patients were considered responders (80%), eight of whom were complete responders (100% pain freedom). The average duration of the treatment effect for each participant was 9.5 weeks (range 1-22 weeks). Six out of 15 patients reported mild and self-limiting side effects (40%). A single infusion of IV lidocaine might be an effective and safe transitional treatment in refractory headache conditions with facial pain and trigeminal neuralgia. The sustained effect of repeated treatment cycles in some patients may suggest a role as long-term preventive therapy in some patients.

August 2023 Medical Image of the Month: Cannonball Metastases from Metastatic Melanoma

No abstract available. Article truncated after 150 words. A 48-year-old man with a significant smoking history presented with progressive dyspnea, a mildly productive cough with brown-tinged sputum, headache, weight loss, and progressive back pain over a period of 8 weeks. The patient had no known history of lung conditions. As part of their initial evaluation, the patient received a frontal CXR and was found to have innumerable rounded pulmonary nodules throughout the lungs, which were consistent with a “cannonball” pattern of pulmonary metastatic disease (Figure 1A). A subsequent CT confirmed innumerable pulmonary metastases (Figure 1B). An MRI of the brain and spine revealed hemorrhagic brain metastases (Figure 2), spinal metastases, and bone metastases. A biopsy of a lesion in the left iliac bone confirmed the diagnosis of metastatic melanoma. This case highlights the so-called “cannonball” pattern of pulmonary metastatic disease with innumerable round nodules throughout the lungs with a slight lower lung predilection, consistent with a hematogenous spread …

The Role of Hypothyroidism in the Etiology of Hyponatremia - Case Report and a Short Review

Abstract Hyponatremia induced by hypothyroidism is a rare phenomenon and a correlation between them can be argued only with possible mechanisms. Hyponatremia often results from the concomitant development of several overlapping pathological events. The association between hypothyroidism and hyponatremia should be considered only if explanations for any other etiological causes have been exhausted. We present the case of a female patient aged 67 years who has previously undergone surgery for a meningioma and who presented with symptoms such as nausea, biliary vomiting, headache and epigastric pain. Laboratory results indicated multiple electrolyte imbalances, including hyponatremia, but the brain imaging studies did not confirm cerebral edema or the presence of tumor development. Under electrolytic correction treatment which was supplemented with L-thyroxine, the biochemical parameters were corrected and normalized and the patient was relieved of her symptoms. This case thus raises the possibility that hyponatremia could be induced or at least precipitated by hypothyroidism. Thyroid dysfunction tests should be targeted in cases of hyponatremia with non-specific causes, even if hypothyroidism is rarely the cause.

Uptake, Safety and Attitudes Towards COVID-19 Vaccination: A Cross-Sectional Study on First and Second Doses Among the General Public.

To investigate public uptake, attitudes and the safety of the first and second doses of COVID-19 vaccination. This was a cross-sectional web-based survey study. A self-administered questionnaire was prepared from a literature search and information about COVID-19 available at various resources. The developed questionnaire was validated for readability by experts and refined in light of the feedback received from the experts and the final version was prepared. The reliability of the questionnaire was 0.7 which shows an acceptable level of scale internal consistency. The data analysis was performed using IBM SPSS software (version 25). A total of 513 participants completed the survey, including 311 (60.6%) women and 202 (39.4%) men. The mean age was (31.5±12.8) years. It was found that 493 (96.1%) took the first and second doses of COVID-19 and 376 (73.3%) suffered from side effects, of these 14% (56/376) reported the side effects to the health authorities. The most common side effects were fatigue (51.5%), fever (42.3%), headache (39.5%), and injection site pain (37.6%). Half of the participants (50.5%) had a positive attitude towards COVID-19 preventive measures. Females had higher odds of experiencing side effects than males OR (95% CI); 2.002 (1.312-3.056). Individuals living in urban areas had lower odds of experiencing side effects than those living in rural areas OR (95% CI); 0.364 (0.142-0.933). Vaccine uptake was massive and side effects due to the COVID-19 vaccine were common but minor. The majority of the participants had positive attitudes towards recommended COVID-19 preventive measures. Being female and living in rural areas were associated with experiencing side effects.

Clinical comprehensive evaluation of Xiangju Capsules in treatment of rhinosinusitis

The articles involving Xiangju Capsules were retrieved, and qualitative research and quantitative research methods were combined to evaluate the evidence of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine( &quot;6+1&quot; dimensions) of this drug. Multi-criteria decision analysis(MCDA) model and CSC v2.0 software were used to comprehensively evaluate the clinical value of Xiangju Capsules in the treatment of rhinosinusitis and clarify the precise clinical positioning. The dimensions are graded A, B, C, or D. Multi-source safety evidence showed that the main adverse reactions were gastrointestinal reactions, rash, itching, dizziness, and headache. Based on the available studies, the risk is controllable and the safety is grade A. Meta-analysis showed that Xiangju Capsules + conventional western medicine could recover the Lund-Kennedy score, Lund-Mackay score, and CT score, relieve headache, nasal congestion, olfactory disturbance, and facial pain, with the effectiveness is grade B. The incremental cost-effectiveness ratio of Xiangju Capsules + conventional western medicine compared with conventional western medicine alone in the treatment of chronic rhinosinusitis was 263.71 yuan, about 0.82% of the per capita disposable income. The results of sensitivity analysis showed that the research results were relatively robust. Based on the assumption that the per capita disposable income in 2020 will be the threshold of patients' willingness to pay, it is more economical to use Xiangju Capsules + conventional western medicine. The drug belongs to grade A of the national medical insurance, with an average daily cost of 3.06 yuan, and the economy is grade B. This formula is modified from classic formulas and characteristic empirical formulas, be capable of improving immunity and preventing repeated attacks. It can be used for acute and chronic rhinitis-rhinosinusitis. It had a wide range of applicability, especially for the patients with head and face tenderness. Service innovation was reflected in the measures to guarantee supply, capacity, scalability, and coverage of grass-roots sales channels. The industrial innovation was improved through the management of medicinal resources, pharmaceutical industry, production technology, quality control, scientific research and development, and this formula won three national invention patents. Comprehensively, the innovation of Xiangju Capsules is grade B. According to the survey of 188 medical practitioners and 196 patients in 20 provinces, municipalities, and autonomous regions of China, the drug was characterized by easy preparation and administration, individualized medication, simple technology and management, convenient use, storage, and transport, and controllable adverse reactions, with the suitability is grade B. Xiangju Capsules showed the cost of 45.9 and 275.4 yuan for treatment of acute and chronic rhinitis-rhinosinusitis, respectively, being well affordable. It was sold in 35 000 medical institutions in China. The dosage form was suitable for transportation, storage, and grass-root application. With rich, sustainable, and available medicinal resources, the accessibility of Xiangju Capsules is grade A. This drug can be used for both acute and chronic rhinitis-rhinosinusitis, clearing heat and expelling pus, and strengthening the exterior to prevent relapse. After this drug was available on the market, over 4 000 cases were studied, with rich experience in human use accumulated, and characteristics of traditional Chinese medicine is grade B. Overall, the clinical value of Xiangju Capsules is class B. It is suggested that Xiangju Capsules should be used in accordance with the relevant policies of basic clinical drug administration to play its role.

The epidemiological characteristics, clinical manifestations, and outcomes of individuals diagnosed with COVID-19 infection at Al-Salama, Al-Ameria Hospital, during the period of April to August 2022.

Background: The majority of individuals who contract COVID-19, a disease caused by a novel coronavirus, are capable of recuperating at home without requiring hospitalization. However, elderly individuals and those with pre-existing medical conditions, such as heart disease, diabetes, chronic lung disease, or cancer, are at a greater risk of developing severe illnesses and may require hospitalization. The objective of this study: is to provide a detailed account of the epidemiology, clinical manifestations, and outcomes of COVID-19 patients who were admitted to Al-Salama Hospital, Al-Ameria, Baghdad, Iraq. Method: In this study, a retrospective analysis was conducted to investigate cases of COVID-19 infection that were admitted to Al-Salama Hospital, located in Al-Ameria, of Al-Karkh Health Directorate in Baghdad. Demographic data, clinical presentation, and outcomes were extracted using a specialized form. Results: The study included 101 cases admitted to Al-Salama Hospital from April to August 2022, out of which 87 were confirmed positive for COVID-19 through PCR testing while 14 were not tested. Among those who were tested, 5 cases tested negative and were discharged, while 9 cases tested positive, resulting in a total of 96 diagnosed cases of COVID-19.The duration of hospitalization was determined based on the severity of the illness. Moderate-severe cases (85/96) were discharged improved after a hospital stay of 3-7 days, while severe-critical cases (11/96) resulted in fatalities. The primary causes of death were respiratory failure and sepsis, and the patients stayed in the hospital for 8-21 days. Of the cases studied, 35/96 had been vaccinated against COVID-19. Out of the 11 deceased patients, 9 had a history of vaccination, while 26/85 of the discharged patients had been immunized. Males accounted for 56% of the cases, and the age range of 60-69 years had the highest number of male patients. Most female patients were in the age group of 80-95 years. The distribution of hospital admissions followed a trend similar to the 3rd and 5th waves of the epidemic that hit Iraq in July 2021 and 2022, respectively. Respiratory symptoms were the most common clinical presentation (74%), followed by gastrointestinal symptoms (12%), headache (8%), and chest pain (7%). Comorbidities were prevalent, with hypertension (43%), diabetes mellitus (32%), and cardiovascular disease (15%) being the most common. Conclusions: In conclusion, the findings of this study may have implications not only for Al-Salama Hospital Al-Ameria in Iraq but also for other countries with comparable epidemiological and clinical characteristics and disease outcomes during the pandemic.

Phyto-progestins for the treatment of abnormal uterine bleeding without organic cause in women at high risk for breast cancer and breast cancer survivors: a prospective, pilot study

Objectives Some plants, such as Dioscorea Villosa (DV), Vitex Agnus Castus (VAC) and Turnera diffusa (D) have some ‘progesterone-like’ properties. We have investigated their simultaneous administration in breast cancer (BC) survivors or carriers of specific genetic mutations that can increase the risk of developing BC suffering from abnormal uterine bleeding without organic cause. Methods Women with irregular cycles in terms of length (interval between ≤ 24 or ≥ 38 days) without a uterine organic disease (polyps, adenomyosis, fibroids, hyperplasia/malignancy) were included. A daily diary of bleeding, questionnaires about health-related quality of life (Short Form 36) and menstrual psychophysical well-being (PGWB-1) and the Greene Climacteric Scale (GCS) (in women older than 40 years old) questionnaire were used. The presence of some premenstrual syndrome (PMS) symptoms was also evaluated. Results In the analyzed group of women (n = 15), all experienced a regularization of the menstrual cycles, with a mean duration in the three months of use of 27.1 ± 3.2 days, with a significant reduction of menstrual pain (p = 0.02) and flow (p = 0.02) intensity. Women with PMS (7/15) reported an impovement in depression, headache and abdominal pain scores (p < 0.05). No specific deterioration of different questionnaires evaluated during treatment were observed. General satisfaction with the treatment was 6.8 ± 0.3/10 on a 10 point. Conclusions A combination of DV, VAC and D could be a promising candidate to treat menstrual irregularities without an organic cause, with a significant reduction of menstrual pain and flow intensity and possible additional benefits in PMS symptoms treatment in women at genetic risk for BC and BC survivors.

Kinesiotherapy in chronic back pain and combined tension type headache

Kinesiotherapy is eff ective in the treatment of chronic nonspecific back pain (CNBP), but its eff ectiveness in tensiontype headache (TTH) is unclear. The effectiveness of kinesiotherapy in patients with CNBP and comorbid TTH has been little studied.The aim of the study was to evaluate the effectiveness of kinesiotherapy in patients with CNBS and comorbid TTH. Patients and methods. 52 patients (22 men and 30 women, mean age 32.4 ± 7.5 years) with CNBP and combined TTH were included in the study. All patients received standard treatment, of which 28 patients received kinesiotherapy (Group 1) and 24 patients were included in the comparison group (Group 2). All patients used pain diaries. All patients were tested by using the Beck Anxiety Inventory, the Beck’s Depression Inventory, the Pain Catastrophization Scale, the Kinesiophobia Scale, the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, the Headache Impact Test 6, numerical pain rating scale before treatment and 3, 6 months after treatment. Clinical effcacy was assessed by reducing the frequency and intensity of headache (by ≥ 50%), back pain (by ≥ 30%), and by increasing functional activity during the day (by ≥ 30%).Results. At 6 months follow-up signifiantly more patients in group 1 than in group 2 achieved a clinical effect on TTH and CNBP: 78.5% (n = 22) compared to 41.7% (n = 10); OR (95% CI) = 1.99. In 9 patients (32%) of group 1, a complete remission of TTH and CNBP was noted, in group 2 there were no such patients. At 6 months follow-up group 1 showed a significant improvement (p &lt; 0.05) in comparison with group 2 in terms of functional activity and emotional state.Conclusion. Kinesiotherapy for CNBP and combined TTH is effective both for back pain and headache. It increases functional activity and improves the emotional state of patients.

Prescription Opioid Initiation for Neuropathy, Headache, and Low Back Pain: A US Population-based Medicare Study

Neuropathy, headache, and low back pain (LBP) are common conditions requiring pain management. Yet little is known regarding whether access to specialists impacts opioid prescribing. We aimed to identify factors associated with opioid initiation among opioid-naïve older adults and evaluate how access to particular specialists impacts prescribing. This retrospective cohort study used a 20% Medicare sample from 2010 to 2017. Opioid initiation was defined as a first opioid prescription filled within 12 months after a diagnosis encounter. Disease-related opioid initiation was defined as a first opioid prescription filled within 7 days following a disease-specific claim. Logistic regression using generalized estimating equations was used to determine the association of patient demographics, provider types, and regional physician specialty density with disease-related opioid initiation, accounting for within-region correlation. We found opioid initiation steadily declined from 2010 to 2017 (neuropathy: 26–19%, headache: 31–20%, LBP: 45–32%), as did disease-related opioid initiation (4–3%, 12–7%, 29–19%) and 5 to 10% of initial disease-related prescriptions resulted in chronic opioid use within 12 months of initiation. Certain specialist visits were associated with a lower likelihood of disease-related opioid initiation compared with primary care. Residence in high neurologist density regions had a lower likelihood of disease-related opioid initiation (headache odds ratio [OR] .76 [95% CI: .63–.92]) and LBP (OR .7 [95% CI: .61–.81]) and high podiatrist density regions for neuropathy (OR .56 [95% CI: .41–.78]). We found that specialist visits and greater access to specialists were associated with a lower likelihood of disease-related opioid initiation. These data could inform strategies to perpetuate reductions in opioid use for these common pain conditions. PerspectiveThis article presents how opioid initiation for opioid-naïve patients with newly diagnosed neuropathy, headache, and LBP varies across providers. Greater access to certain specialists decreased the likelihood of opioid initiation. Future work may consider interventions to support alternative treatments and better access to specialists in low-density regions.

Social and health indicators in an academic community: enteroparasites, nutritional, allergic and clinical aspects

Objective: this study aimed to associate enteroparasitic infection with nutritional, allergic, and clinical repercussions and the sociodemographic aspects in an academic community in Santo Antônio de Jesus, Bahia, Brazil. Methods: the cross-sectional research was carried out between February 2018 and March 2020, with 121 participants. Spontaneous sedimentation and Rugai techniques were used for the parasitological diagnosis of fecal samples. Allergies and clinical issues and the sociodemographic aspects were studied via a questionnaire, and the nutritional status was obtained from the assessment of body mass index and arm and abdominal circumferences. Results: there was 38.2% positivity for intestinal parasites; 65.9% for female participants; with the majority of eutrophic, between 18-27 years old; heteronormative, and single. Besides, the Endolimax nana (78.7%) and Giardia duodenalis (21.3%) were the predominant species. Statistical significance was found between obesity rates and the presence of intestinal parasites and those with allergic aspects. Nervousness, headache, and back and abdominal pains were the most common symptoms. Conclusions: this study contributes to obtaining data on epidemiological and public health surveys in the Bahian territory, providing a reference for other researchers. The statistical association of these with nutritional and allergic aspects can support future research on this population.

Potential effect modifiers for treatment with chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years: development of and results from a secondary analysis of a randomised clinical trial

BackgroundA recent randomized controlled trial (RCT) investigating the effect of chiropractic manipulation in 199 children aged 7–14 years with recurrent headaches demonstrated a significant reduction of number of days with headache and a better global perceived effect (GPE) in the chiropractic manipulation group compared to a sham manipulation group. However, potential modifiers for the effectiveness of chiropractic manipulation of children with recurrent headaches have never been identified. The present study is a secondary analysis of data from that RCT and will investigate potential effect modifiers for the benefit of chiropractic manipulation for children with headache.MethodsSixteen potential effect modifiers were identified from the literature and a summary index was prespecified based on clinical experience. Relevant variables were extracted from baseline questionnaires, and outcomes were obtained by means of short text messages. The modifying effect of the candidate variables was assessed by fitting interaction models to the data of the RCT. In addition, an attempt to define a new summary index was made.ResultsThe prespecified index showed no modifying effect. Four single variables demonstrated a treatment effect difference of more than 1 day with headache per week between the lower and the upper end of the spectrum: intensity of headache (p = 0.122), Frequency of headache (p = 0.031), sleep duration (p = 0.243), and Socioeconomic status (p = 0.082). Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056), Sport activity (p = 0.110), Sleep duration (p = 0.080), History of neck pain (p = 0.011), and Headache in the family (0.050). A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index.ConclusionChiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.Trial registration: ClinicalTrials.gov (Albers et al in Curr Pain Headache Rep 19:3–4, 2015), identifier NCT02684916, registered 02/18/2016—retrospectively registered.

Study of the Aetiology and Clinical Manifestations of Thrombocytopenia in a Tertiary Care Centre.

Introduction Thrombocytopenia is a commonly observed condition in clinical practice, and its diagnosis is often challenging due to numerous aetiologies and variations in clinical presentation. Early identification of thrombocytopenia and its causes can help prevent life-threatening haemorrhagic manifestations. Methodology A prospective observational study was conducted at a tertiary care hospital from February 2019 to January 2020. This evaluation aimed to determine the causes and prevalence of thrombocytopenia in a tertiary care setting. Patients aged 15 or older with a platelet count of fewer than 150,000/ µL were eligible for inclusion in this evaluation. Investigations for aetiology detection were recommended. Results During the one-year study period, a total of 100 patients, including 58 males and 42 females, with thrombocytopenia were selected for the study. The most common age group affected by thrombocytopenia in this study was between 46 and 55 years old. The most common clinical manifestations observed were generalised weakness (70%), haemorrhagic manifestations (60%), fever (50%), joint pain (37%), splenomegaly (35%), headache (30%), breathlessness (23%), lymphadenopathy (22%), hepatomegaly (24%), and abdominal pain (12%). The most prevalent causes of thrombocytopenia were megaloblastic anaemia (19 cases), dengue fever (15 cases), malaria (11 cases), enteric fever (nine cases), immune thrombocytopenia (ITP) (eight cases), and leukaemia (seven cases). Bleeding was reported as a symptom of thrombocytopenia in 60% of individuals in this study. Conclusion In the study, thrombocytopenia was more common in people aged 46-55 years, and males were more commonly affected than females. Megaloblastic anaemia and infectious disease were the most common causes of thrombocytopenia. Bleeding manifestations were found in 60% of patients with thrombocytopenia.

Effectiveness of 30o Head Elevation Intervention on Head Pain Levels in Patients with Space Occupying Lesion (SOL) Intracranial Tumor Post-Op Craniotomy : Case Study

ABSTRACT Intracranial tumors are abnormal mass growths in the brain that originate from tissue that grows and divides uncontrollably. Space Occupying Lesion (SOL) is a space pressure caused by an increase in volume within the brain due to the accumulation of blood, cerebro-spinal fluid or brain tissue. A common treatment for intracranial tumors is craniotomy. According to research, about 60% of patients who undergo craniotomy experience moderate to high levels of headache pain. Non-pharmacological pain management that can be done includes deep breathing interventions with guided imagery techniques, monitoring patient hemodynamics and 30o head elevation. The purpose of this study was to present the effect of 30o head elevation nursing intervention on pain levels in patients with SOL intracranial tumors post craniotomy. The method in this study used a case study design conducted in November 2022 at Sumedang Regional General Hospital. The results showed that head elevation of 30o can reduce head pain levels because it can maximize the entry of oxygen into the intracranial and increase the return flow of blood from the brain to the heart, help activate the parasympathetic nervous system which functions to control various activities of the human body at rest and maximize relaxed conditions in patients, resulting in a stable pulse frequency, respiratory frequency, blood pressure. The intervention of elevating the head position or head elevation of 30o is one of the many nonpharmacological therapies that are useful for improving intracranial pressure so that the headache felt by the patient improves and cerebral perfusion can be resolved. Keywords: SOL, Post-op Craniotomy, Head Elevation

Plague: Symptoms, Transmission, Diagnosis, Prevention and Treatment

Plague is a contagious disease caused by the zoonotic bacteria, (Yersinia pestis) but transmitted by fleas. It is found on rodents and their fleas. The most common ways for humans to contract plague are through handling a plague-infected animal or by getting bitten by a rodent flea that is carrying the pathogen. Septicemic, pneumonic, and bubonic plague are the three most prevalent types. The bubonic plague typically takes 2 to 8 days to incubate. Patients experience weakness, one or more enlarged, painful lymph nodes, headache, chills, and fever (called buboes). The bite of an infected flea results in plague, which is the most widespread type of plague. Pneumonic plague, a more severe form of bubonic plague, can progress and disseminate to the lungs. Septicemic plague incubation period isn’t exactly known but, it most likely happens within days of exposure and is accompanied by high temperature, chills, intense exhaustion, stomach discomfort, shock, and maybe, bleeding into the skin and other organs. Pneumonic plague often only takes 1 to 3 days to incubate and is accompanied by a fever, headache, weakness, rapidly progressing pneumonia, shortness of breath, chest pain, coughing up occasionally bloody or watery mucus, and other symptoms. Generally, fever, chills, headaches, and nausea are some of the general plague symptoms. There is also the case of lymph nodes enlargement, coughing, chest pain, and hemoptysis. Plague can be transmitted through; bites by fleas, contact with contaminated fluid or tissue, and infectious droplets. The symptoms of plague are typically non-specific; hence laboratory investigation is necessary for a certain diagnosis. Y. pestis infection can be detected using a microscope and by bacteria culture. The sample (buboes) can be gotten from blood, mucus (sputum), or an aspirate taken from swollen lymph nodes. Polymerase chain reaction (PCR), can also be employed to diagnose plague (F1 capsule antigen). It is also possible to identify plague by using blood tests that look for antibodies to Y. pestis. Plague can be prevented by eliminating rodent’s habitats around living houses, workplace, and leisure locations, and elimination of bushes, rock piles, garbage, cluttered firewood, and potential rodent food sources such as pet and wild animal food. Plague vaccines are only recommended for high-risk categories such as laboratory professionals who are constantly exposed to the risk of contamination, and health care workers. All forms of plague respond to antibiotic treatment if they are diagnosed early. Those suspected to have made contact with infected patients or animals should be isolated and observed. Plague remains one of the most infectious diseases worldwide. Although as at the time of this review, there is no recent case of plague in Nigeria, or in Africa, effort is still required to create robust awareness among the population on the subject of plague. The focus of this review is to educate and create more awareness among the citizens on plague as a highly infectious disease.

Seroprevalence of Brucellosis in Patients Having Complained of Joint Pain: A Case Control.

Brucellosis is a neglected zoonotic disease affecting humans and animals. This study aimed to estimate the seroprevalence of brucellosis in patients with joint pain. A total of 200 participants aged from 7 to 86 years were involved in this study. Blood samples were collected from all the participants for two years, from September 2019 to September 2021, and screened forBrucellausing anti-brucella IgM ELISA and anti-brucella IgG ELISA antibodies. A questionnaire was used to collect data on socio-demographic characteristics and human brucellosis-related risk factors. HumanBrucellaseroprevalence was 19 (9.5%) for BrucellaIgM ELISA and 23 (11.5%) forBrucellaIgG ELISA. The sensitivity forBrucellaIgM ELISA andBrucellaIgG ELISA was 65.2% and 31.6%, respectively, while the specificity was 44.1% forBrucellaIgM ELISA and 77.9% forBrucellaIgG ELISA. All blood culture reports of all patients were negative. The principal presentation was the observable symptoms of human brucellosis: fever, headache, chills, myalgia, and Joint pain. Risk factors like consumption of raw milk or their products were found to be the most important forBrucellainfection, so the awareness or information of risk factors and the modes of transmission is much more important in control and prevention programs. General awareness about clinical symptoms should be increased, which will improve proper diagnosis and will be helpful in early treatment. An ELISA test should be considered for diagnosing brucellosis in both acute and chronic phases.

ASSOCIATION OF PHYSICIAN BURNOUT WITH HEADACHE AND LOW BACK PAIN DURING PANDEMIC COVID-19

Background: Physician burnout is a common problem seen in health workers, especially doctors and it is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment in daily work. The pandemic of Corona Virus Disease 2019 (COVID-19) causes an increase in the workload among doctors which will affect the incidence of Burnout. Burnout not only includes psychological problems, but also has a risk for physical disorders including pain disorders. Objective: To investigate the association of burnout level with headache and low back pain among physicians at Yogyakarta Islamic Hospital PDHI. Methods: This research design was a descriptive analytic study with a cross-sectional design. The subjects in this study were 46 doctors who worked at the Yogyakarta Islamic Hospital PDHI. Burnout levels were assessed using the Maslach Burnout Inventory (MBI) test. The incidence of headache and its impact on daily activities were assessed using the Headache Impact Test (HIT-6) questionnaire while Low Back Pain was assessed using Oswestry Disability Index (ODI). Results: Among burnout parameters, depersonalization was the most influential parameter which caused burnout. COVID-19 pandemic gave more impact to burnout level. The headache and low back pain incidence were 39,1% (18 subjects) and 43,4% (20 subjects) respectively. There were significant correlations between headache and every burnout parameter. Low back pain also had significant correlations to each burnout parameters. Conclusion: There was association of Burnout level with headache and low back pain incidence among physicians.