Main Complaint Research Articles

Maxillofacial Abscess et Causa Odontogenic Infection: A Case Report

Background: Odontogenic infection is an infection that occurs in the oral cavity caused by carious teeth and periodontal disease where the disease can spread to surrounding tissues to the face, jaw and neck. Maxillofacial abscess is a manifestation of periapical or periodontal infection. incicus, canicus or molar teeth, where periapical infection is the most frequent source of odontogenic infection compared to periodontal. Inflammation or damage to chronic dental problems can cause complications of abscesses in the surrounding area. The main complaint that causes sufferers to come to the hospital is pain in the abscess area. These complaints can also be accompanied by trismus, dysphagia, stridor caused by compression of the trachea, and even respiratory tract obstruction. Objective: To determine the progression of maxillofacial abscess so that medical management can be provided up to surgical incision and drainage. Case report: We report 2 cases of maxillofacial abscess due to odontogenic infection with management according to the progression of each case. Conclusion: The most common cause or etiology that can cause maxillofacial abscess is toothache. Management of maxillofacial abscesses begins with empirical antibiotics, which is the first step to reduce bacterial infections that produce beta lactamase. In maxillofacial abscesses, medical therapy can be given in the form of antibiotics combined with ceftriaxone with metronidazole, or meropenem with metronidazole and termination measures in the form of incision and drainage. Treatment can be chosen based on the presence or absence of warning signs and signs of complications. Incision and drainage is performed when complaints do not improve after administration of antibiotics, multiple abscesses and airway obstruction threaten the patient's life.

Dialysis disequilibrium syndrome: A case report

Dialysis disequilibrium syndrome (DDS) is a rare syndrome that can occur in patients with severe azotemia undergoing an initial hemodialysis (HD) session. DDS is associated with a more rapid decrease in urea concentration in the blood than in the brain during dialysis. Although severe DDS is less common, the milder forms of DDS may be missed by doctors. A 53-year-old male patient had the main complaint of severe dizziness in the last 10 months accompanied by a sensation of a wobbling head and tinnitus in his right ear. The patient had previously been diagnosed with polycystic kidney disease in 2018 and underwent regular hemodialysis two times a week since June 2019. In the patient's neurological status, cerebellar examination was positive for left dysmetria, left positive past pointing, Romberg test (open eye) fell to the right, and Romberg test (closed eye) fell to the right. There was no nystagmus on the patient's neuro-ophthalmological examination. Patients with kidney failure are at risk of developing DDS, so that appropriate precautions are needed. Due to the variability of symptoms, DDS often goes undiagnosed. Thus, it is important to be aware of the risk factors for DDS so that preventive steps can be taken appropriately. Continuous case reporting will raise awareness and the opportunity for further research to improve outcome in severe cases of DDS. Keywords: Dialysis; Disequilibrium; Dizziness; Polycystic Kidney. Citation: Yahya, Hidayati HB, Sugondo AT, Puspamaniar VA, Firdausa FS. Dialysis disequilibrium syndrome: A case report. Anaesth. pain intensive care 2024;28(1):191−195; DOI: 10.35975/apic.v28i1.2388 Received: October 10, 2023; Reviewed: December 20, 2023; Accepted: January 02, 2024

Analysis of clinical characteristic of children with progressive familial intrahepatic cholestasis type 3

Objective: To analyze the clinical manifestations, pathology, and gene variant characteristics in children with progressive familial intrahepatic cholestasis type 3 (PFIC3). Methods: This retrospective study assessed the clinical manifestations, pathological features, gene variants, and prognosis data of 11 children with PFIC3 hospitalized in the Department of Hepatology, Fifth Medical Center, PLA General Hospital, from January 2015 to December 2022. Panel or whole exome sequencing was performed on the probands, followed by Sanger sequencing for verification within the family. Detected pathogenic variants were compared with known disease databases. Additionally, the new variants were predicted the deleteriousness and protein structure using relevant software to evaluate their pathogenicity. Results: Among the 11 PFIC3 children, 8 were boys and 3 were girls. The age of onset was 3.1 (0.2, 15.6) years. The main complaint of onset was different in the 11 patients;5 of them were abnormal liver function, 3 of them were liver and spleen enlargement, 2 of them were abdominal distension, and 1 of them was jaundice. Alanine aminotransferase, asparate aminotransferase and γ-glutamyltransferase increased in all the patients, which were(113±40), (150±44) and (270±156) U/L respectively. Moreover, direct bilirubin increased in 9 patients, and cholestasis was showed in 8 patients. All patients showed liver fibrosis on imaging, and 8 patients had cirrhosis. The pathological features of 8 cases by liver biopsy were as follows: 8 cases of fibrosis in the portal area, 7 cases of small bile duct hyperplasia, 4 cases of positive copper staining, and 5 cases of cirrhosis. A total of 17 ABCB4 gene variants were detected, including 9 new variants: c.589C>T(p.Q197X), c.1230+1G>A(Splicing), c.2914G>A(P.D972N), c.1058G>A(p.C353Y), c.956G>T(p.G319V), c.473T>A(p.L158Q), c.164T>C(p.L55S), c.2493G>C(p.R831S), and c.1150G>C(p.G384R). All 11 patients were treated with ursodeoxycholic acid and followed up for 5.1(0.6, 7.4) years. Among them, 4 cases of cirrhosis progressed continuously, 3 cases had liver transplantations, and the remaining 4 cases were stable after medical treatment. Conclusions: Children with PFIC3 have early onset, diverse clinical manifestations, rapid progression of fibrotic and cholestasis, as well as poor prognosis. Genetic testing helps to confirm the diagnosis.

Eye involvement in patients with rheumatoid arthritis: a cross-sectional study

Background: Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA. Methods: Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed. Results: Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%). Discussion: The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis. Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs. Conclusion: Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.

Acute fibrinosis and organized pneumonia

Acute fibrinous and organizing pneumonia (AFOP), first described histologically by Beasley et al.1 in 2002. AFOP occurs in a wide age range (38-78 age) and in a non-sexist spectrum of patients. Although idiopathic cases have been reported, case series in which the underlying etiology is known. The histologically specific pattern is the presence of organized intra-alveolar fibrin and is the essential parameter for diagnosis. There is no significant difference in the radiological pattern except for the halo finding in the comparison of AFOP and COP. In patients presenting with an acute and more fulminant picture, the clinic presents with rapidly worsening respiratory failure. The main complaints were fever, cough and chest pain respectively. Since AFOP is a diagnosis of exclusion, most patients are diagnosed with pneumonia that does not respond to treatment or has delayed resolution during follow up. Although the clinical presentations of the fulminant and subacute forms of AFOP are different, a clear distinction cannot be made for treatment due to the high mortality of the fulminant form. The prognosis is poor in acute fulminant cases.

느린 학습자의 자존감 향상을 위한 인문치료 사례연구

The purpose of this study was to investigate the effectiveness of humanistic therapy to improve the self-esteem of slow learners. The subjects of this study were slow learner adolescents in the first year of a specialized high school, who were experiencing problems such as academic sluggishness, psychological atrophy, peer relationship inadequacy, and school life inadequacy. The study explored the process of change through the application of a humanistic therapy program over 30 sessions. The results of this study were as follows First, she showed positive changes in expressing their feelings and thoughts through emotional writing and therapeutic writing. Second, she showed academic changes, such as improving their presentation skills in class through activities such as reading literary short texts such as poems and essays and non-literary texts from textbooks slowly and repeatedly out loud. Third, she was attitudinal changes in life, such as recognizing the extent of school progress and saying no to friends. Humanistic therapy had a positive effect on the student's emotional changes, self-disclosure, and relationship improvement, and served as a medium to help improve the main complaints of the subject.

Tense Ascites in a Young Man Aged 24 Years Due to TB Peritonitis: Case Report

Tuberculous peritonitis is parietal or visceral peritoneal inflammation caused by Mycobacterium tuberculosis bacteria. Pathogenesis Tuberculous peritonitis is preceded by M. tuberculosis infection followed by spread to the peritoneum. This is a report from a young male patient with the main complaint of an increasingly enlarged stomach in 2 weeks and weight loss accompanied by other symptoms such as fever, nausea, vomiting, difficulty breathing. Investigation showed anemia, the results of Adenosine deaminase (ADA) ascitic fluid: 36.3 U/L. Radiological examination. Thorax photo showed Sinistra pleural effusion. Abdominal ultrasound found ascites. Then an ascitic puncture of approximately 2600 cc of greenish fluid was carried out. The diagnosis of tuberculous peritonitis is based on the Adenosine deaminase (ADA) test. Next, the patient received Fixed Drug Combination (FDC) therapy consisting of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol for 2 months, followed by a combination of Rifampicin and Isoniazid for 7-10 months. The prognosis of tuberculous peritonitis is fair if diagnosis is prompt and the patient is treated adequately.

Complaints and Advices of Alternative Medicine among Pilgrimages Visitors in Vivahpanchami at Janakpurdham, Nepal

Background & Objectives: Potential health related risks and spread of communicable disease is one of the challenges of religious mass gatherings. With the rise of globalization, parts of Ayurveda are now popularized as a form of alternative medicine. In Nepal, Ayurveda medicine faces lots of challenges, and is under threat due to inadequate funding, ignorance of modern diagnostic technologies, and insufficient quality research. It is vitally important to continually monitor and promote Ayurveda in the modern era of allopathic medicine. Thus, this study aimed to identify the main complaints and advices on Ayurvedic medicine among pilgrims visiting Vivahpanchmi in Janakpurdham, Madhesh Province, Nepal. Materials and Methods: The information was gathered from the registration book of pilgrims who attended an Ayurveda health camp at Rangbhumi Maidan (Barahbigha) in December 2023, organized by the Ayurveda and Alternative Medicine center, Janakpurdham Sub Metropolitan office, Dhanusha, Madhesh Province. The extracted data were imported into MS Excel and SPSS 20 was used for analysis. Data were expressed in frequencies and percentage. Results: Of the 707 pilgrims, 97.7% were from India and 2.3% were from Nepal; 68.9% of the visitors were women and 31.1% were men. Out of all visitors, less than 10% were over 60, and more than half were between the ages of 41 and 60. Gastritis accounted for the highest percentage (45.9%), followed by joint pain, weakness, back pain (31.3%), and coughing (17.1%). Only 4.4% of people reported being constipated. Conclusion: The most common complaints from Pilgrims were related to gastritis (Amlapitta), which was followed by joint discomfort, weakness, and back pain (Vata). The possible ayurvedic advices and medications were provided and distributed among the pilgrims during Vivahpanchmi.

P133 Anti-synthetase syndrome: an experience from a tertiary referral center

Abstract Background/Aims Anti-synthetase syndrome (ASS) is a subset of Idiopathic inflammatory myositis (IIMs). It is a syndromic diagnosis classified by Connors et al. and Solomon et al. criteria. Raynaud’s phenomenon (RP), fever, arthritis, mechanics hands, ILD and myositis constitute this syndrome along with the classical Anti-aminoacyl tRNA synthetase antibodies (ARS). About 25% of IIMs patients are classified as ASS. This study was planned to evaluate the prevalence of ASS; their phenotype, antibody subtypes, treatment responsiveness and outcomes. Methods All consecutive ASS patients were enrolled in the study fulfilling Connors et al. criteria during January, 2016 to August2023. Their demographic details, clinical features, laboratory and imaging features, treatment were analyzed. ARS were considered positive on a Line Immunoassay with cutoff >6U/ML using BlueDriverQuantrix-ANA25 Screen IgG kit (includes Jo1, Pl-7, Pl-12) from D-tek, Belgium including three ASS antibodies (Jo-1, PL-12, PL-7). Anti EJ, OJ antibodies were not present in the kit. Descriptive analysis were used to describe disease characteristics. Results Among 139 total IIM patients, 21(15%) patients were diagnosed with ASS. All patients fulfilled Connors et al. criteria while 66.6% patients fulfilled stricter criteria by Solomon et al. Mean(±SD) age group was 43(±16.4) years. 71.4% were Females. Anti Jo-1 was the predominant antibody seen in 66.6% while Anti PL-12 and Anti Pl-7 antibodies were present in 19% and 14.3% respectively. 66.6% had ANA positivity and MAA antibodies were seen in 52.3%. Rash was seen in 61.9%, mechanics hands in 38%, RP in 52.3% fever in 38% ,arthritis in 57%, myositis 62% and ILD in 80.9%. NSIP (66.6%) was the predominant type, followed by OP (9.5%) and UIP (4.7%). Median (IQR) CPK level was 736 (210-4556)U/L. Anti Jo-1 patients had higher prevalence of mechanics hands and rash whereas ILD was observed in all cases of Anti PL-7 and Anti PL-12 antibodies. Malignancy was seen in two patients (Malignant fibrous histiocytoma, Metastatic Pancreatic carcinoma). Mean (SD) MMT8 score was 62.8(±22.2) at presentation . Treatment is with steroids in all cases followed by maintenance with azathioprine in 57.1%, Methotrexate in 14.2%. Rituximab was used in 14.2%, cyclophosphamide in 9.5% and mycophenolate mofetil in 23.8%. Mortality was seen in one patient with respiratory failure. Lung involvement was severe in patients with both MSA and MAA positivity. 62% patients were in remission. Conclusion ILD and Arthritis were the main presenting complaints in our cohort. Myositis is relatively less prevalent in ASS. NSIP was the predominant ILD subtype. Non Jo-1 group had high MAA positivity. Jo-1 was associated with mechanic’s hands and rash. Malignancy was less prevalent in ASS. All patients with PL-7 and PL-12 antibodies had lung involvement. Biologics were required in few refractory cases. Disclosure P. Khatri: None. J.R. Yadavalli: None. S. Dhuria: None. N. Negalur: None. K. Shivam: None. R. Gupta: None.

Collecting Duct Carcinoma in the Kidneys: A Rare Case Report

Background: Collecting duct carcinoma (CDC) is one of the rare pathological subtypes of renal cell carcinoma, with high malignancy and poor prognosis. Pathological examination is the gold standard in confirming the diagnosis of CDC. CDC is described as a tumor that has a tubulopapillary architecture and forms a hobnail pattern along the glandular tube. Case presentation: A 56-year-old woman with the main complaint of a lump in the right abdomen for 1.5 months before entering the hospital. The lump in the stomach is getting bigger, complaints are accompanied by intermittent pain, nausea, vomiting, body feeling weak, and decreased appetite. The patient then underwent a CT-Scan examination of the abdomen and concluded that fluid/water was found next to the right kidney, and a hypodense lesion appeared in segment 6 of the right lobe of the liver. Histopathological examination of large tissue shows pieces of kidney tissue with a connective tissue capsule on the outside containing glomeruli and tubules lined by cuboidal epithelium as well as a proliferation of tumor cells that grow infiltratively in the connective tissue stroma which is partly desmoplastic and fatty tissue between the glomeruli and tubules. Tumor cells are arranged to form tubulopapillary and tubulocystic structures. These cells with pleomorphic nuclei, some hyperchromatic, some vesicular, coarse chromatin, clear nuclei, and atypical mitoses can be found and tumor cell embolism in the blood vessels and perineural invasion can be seen. There were spots and clusters of lymphocytes and plasma cells as well as areas of bleeding and necrosis. Conclusion: The patient was diagnosed with collecting duct carcinoma (CDC).

Hepatic Cirrhosis with Esophageal Varices: A Case Report

Background: In adults, portal hypertension is generally caused by hepatic cirrhosis, whereas in children it is more commonly caused by extrahepatic abnormalities with normal liver function. Portal hypertension causes hemodynamic abnormalities. Gastrointestinal bleeding is the most severe clinical manifestation of portal hypertension in both children and adults. Pathogenetically, increased pressure in the portal vein can be caused by increased vascular resistance and increased portal blood flow. The site of obstruction can be prehepatic (portal vein obstruction), intrahepatic (presinusoidal: eg congenital hepatic fibrosis; para sinusoidal: cirrhosis, hepatotoxic drug therapy, vitamin A hepatotoxicity; post sinusoidal: venocclusive disease) and/or post hepatic (Budd-Chiari syndrome, constrictive pericarditis). Case presentation: The study reports the results of observations of a case of a boy, FAA, aged 12 years and 2 months who came to the emergency room at Dr. M. Djamil General Hospital Padang with the main complaint of hematemesis and splenomegaly from physical examination. Non cirrhotic portal fibrosis is a cause that is not uncommon in the population in the early second decade of life. Some children with non-cirrhotic portal fibrosis as adults can end up with end stage liver disease. Conclusion: Patients with noncirrhotic or cirrhotic portal hypertension can be assessed using the Child Pugh instrument as an instrument that is still used to determine the survival rate if patients with portal hypertension.

Aggressive Thoracic Spine Hemangioma Treated by Total En Bloc Spondylectomy: A Case Report

Introduction: Vertebral hemangioma (VH) is the most widely faced tumor in the vertebral column. It is generally asymptomatic and slowly growing. Moreover, the appearance of extraosseous extensions in vertebral hemangiomas is locally aggressive, causing neurological deficits, and should be distinguished from other vertebral hemangiomas based on its prognosis and treatment. Here we present a rare case of vertebral hemangioma caused by thoracic cord compression and healed by total en block spondylectomy.Objectives: We present a case of VH with extraskeletal expansion that caused the progressive neurologic deficit and was medicated by resection of the entire tumor.Methods: A 33-year-old female came to the Soetomo General Hospital outpatient clinic with the main complaints of back pain and being unable to move her legs since September 2021. In July 2021, the patient felt tingling in her lower extremities. The patient was still able to walk, but she felt the weakness develop. She still can urinate, but she has a defecation problem. There is no history of a palpable mass in some places. The patient is a housewife and she has no previous history of any disease.Results: The patient felt tingling in her lower limbs. She didn’t lose her to walk, but she felt the weakness develop. On the physical examination, there was a neurological deficit at the lower extremity. According to radiographic and histopathologic examination, the patient was diagnosed with VH at the T5 level. We then performed total en-block spondylectomy and posterior stabilization. As a result, the motoric part improved but sensory deficits still occurred. Neurological improvement happened during the follow-up in three months. An inevitable challenge awaits in terms of the medication of VH with extraskeletal expansion that causes neurologic deficits. Pre-operative diagnosis including radiologic and pathologic findings is essential for the strategy and decision for combative hemangioma. An unjustified diagnosis may lead to an inappropriate surgical strategy or the emergence of various complications.Conclusions: Vertebral hemangiomas with extraosseous extension causing spinal cord compression should be considered an aggressive benign tumor, and total excision that includes a tumor margin is indicated.

Serial case report: Radiological images of congenital sensorineural hearing loss patients with and without hypoplasia of the vestibulocochlear nerve

Background: Congenital Sensorineural Hearing Loss (SNHL) is a hearing loss caused by damage to the inner ear (cochlea), vestibulocochlear cranial nerve (N.VIII), or the innervation pathway from the inner ear to the brain that is acquired from birth. If hearing loss occurs from birth or before the period of speech development is not detected. Thus, this case report compares two patients with congenital sensorineural hearing loss with and without vestibulocochlear nerve hypoplasia. Case Description: The first case was a 4-year-old girl with the main complaint of not hearing and responding to calls since the age of 1.5 years. Temporal CT scan and MRI results did not show existing organ and structural abnormalities, so suspected retro-cochlear auditory neuropathy. Patients undergo the installation of a cochlear implant in the left ear with good results. Case second, a 3-year-old girl with Down Syndrome who has not been able to speak since birth. CT scan results showed left and right basal cochlea 1.5 turns and bilateral jugular notch dehiscence, while MRI results showed vestibulocochlear nerve hypoplasia, narrowing of the IAC opening width 1.5 turns cochlea. If this happens, a cochlear implant cannot be done because abnormality finding is a contraindication operation. Conclusion: CT-scan and MRI examination are necessary to evaluate the structures and organs in the outer, middle and inner ear because the presence or absence of structural abnormalities found in the patient will significantly impact further management.

Efficacy of endoscopic sinus surgery in management of odontogenic maxillary sinusitis after control of dental pathology

BackgroundOdontogenic sinusitis (ODS) has clinical features like rhinogenic sinusitis. Although it is usually unilateral, diagnostic overlap could happen. However, ODS necessitates different management which includes dental intervention to eliminate the dental infection source. In some patients, ODS may persist even after management of dental pathology. The aim of this study was to assess the clinical features, and diagnostic criteria of ODS that is persistent after management of dental pathology, and to evaluate the efficacy of endoscopic sinus surgery (ESS) as a therapeutic option of the disease.MethodsTwenty patients were included in this study. All patients were presented with ODS refractory to medical treatment after management of their dental problems. Clinical features of the patients were analyzed. Also, endoscopic nasal examination and computed tomography of paranasal sinuses (CT) were performed for all patients. ESS were used, with widening of the maxillary ostium for drainage. Follow-up was carried out for at least 6 months.ResultsAll patients had unilateral disease, with 3 main complaints: malodourous nasal discharge (90%), facial pain (75%), and nasal obstruction (45%). Endoscopic nasal examination showed either middle meatal purulence (70%) or polypoid mucosa (30%). CT showed either thickened maxillary sinus mucosa (50%), or complete maxillary opacity (50%) with retained foreign body in 2 patients (10%). After ESS, all patients reported relieve of their sinonasal symptoms, and nasal endoscopy showed patent middle meatus, with one patient demonstrated adhesions between the middle turbinate and lateral nasal wall which was asymptomatic.ConclusionPrior dental intervention is a suspicious diagnostic landmark for ODS, and unilateral foul nasal discharge is the main prevalent complaint. Nasal endoscopy usually shows purulence or polypoid mucosa in the middle meatus, and CT is a good diagnostic tool for ODS. ESS with good widening of the maxillary ostium is an effective therapeutic option for those patients.

Breastfeeding-Related Adverse Drug Reactions of Triptans: A Descriptive Analysis Using Four Pharmacovigilance Databases.

Objective: Migraine attacks are common in women of reproductive age. Although attacks are often less severe and less frequent during pregnancy, they regularly reoccur shortly after delivery. When first-line analgesic treatment is insufficient, triptans may be used for acute treatment of migraine attacks. Milk levels of occasional triptan use have shown to be low, and no adverse effects in breastfed infants have been reported. However, the available knowledge on the safety of triptans during breastfeeding is still limited. Methods: Four (inter)national pharmacovigilance databases were searched for breastfeeding related adverse drug reactions of triptans. These included the Dutch Pregnancy Drug Register and three databases of spontaneous reports (Netherlands Pharmacovigilance Centre Lareb, the European Medicines Agency [EudraVigilance], and the World Health Organization [VigiBase]). Results: A total of 26 reports on 27 breastfeeding related adverse drug reactions were identified (one report involved two separate adverse drug reactions). These involve three main complaints: painful breasts and/or nipples, painful milk ejection reflex, and a decrease in milk production. Discussion and Conclusion: The hypothesized pharmacological mechanism relates to the serotonin-receptor agonistic properties of triptans. These may lead to vasoconstriction in the breasts and nipples, including the vasculature surrounding the milk ducts and alveoli, and may also influence the hormonal function and levels of prolactin. The reported adverse drug reactions do not negatively impact the overall compatibility of triptans with breastfeeding. However, breastfeeding women may experience them as unsettling. Awareness of these potential adverse drug reactions is essential and should be weighed against the potential adverse effects of (untreated) symptoms of migraine attacks.

The Characteristics of Chronic Rhinosinusitis at Wangaya Regional Hospital Denpasar Period January-December 2022

ABSTRACT Chronic rhinosinusitis is inflammation that affects the nose and paranasal sinuses accompanied by two or more symptoms, one of which is blockage or obstruction in the nose and nasal mucus that flows posteriorly or anteriorly which can be accompanied by additional symptoms in the form of pain or pressure on the face and reduced olfactory sensitivity or loss of smell when symptoms more than 12 weeks. Chronic rhinosinusitis has a greater impact on reducing quality of life and huge burden of health costs than acute rhinosinusitis. This research was retrospective descriptive uses secondary data from medical records January-December 2022 Otorhinolaryngology Department of Wangaya Regional Hospital Denpasar. The sampling technique used was total sampling. Data collected included gender, age, occupation, main complaint, comorbidities, number of sinus involvement, location of sinuses, therapy. The data obtained were analyzed univariately using SPSS software version 23.0 and presented in the form of tables and narratives. From the research, it was obtained that the gender was mostly female 51.2%, average age of 38.05 ± 14.26 years with the highest age group is 46-60 years old, mostly private employees 48.8%. The most common main complaint was a blocked nose 48.8%. The highest comorbid was septum deviation 14%. The majority of sinuses involved were single rhinosinusitis 67%. The highest location in the maxillary sinus 69.8%. The majority of therapy was medication 58.1%. Most cases were found in female gender, average age 38.05 ± 14.26 year age group is 46-60 years old, private employees, main complaint was blocked nose, comorbidities with deviated septum, single rhinosinusitis, the highest location in the maxillary sinus, medicamentosa therapy. Keywords: Characteristics, Patients, Chronic Rhinosinusitis

Evaluation of Electromagnetic Therapy in the Treatment of Severe Dysmenorrhea in Young Women of Basrah.

Primary dysmenorrhea (PD) is a public disease of young female worldwide, it affects their daily performances. Severe recurrent uterine cramps are the main complaints in 90% of adolescents and 50% of reproductive-age females. This study aimed to evaluate the use of magnetic field therapy in the treatment of severe dysmenorrhea grade 3 and provide an encouraging goal to continue daily work without pain. Two hundred and fifty female patients were recruited in this study from gynecological clinics in Basrah, southern Iraq. All had severe dysmenorrhea, patients were subjected to a questionnaire form, Visual Analog Scale, and verbal multidimensional scoring system to determine the pain intensity and grade of dysmenorrhea. Only 38 young females had severe dysmenorrhea grade 3 with ages ranging from 16 to 28 years with a mean age of 22.04 ± 1.43 years and body mass index 23.81 ± 1.94, patients subjected to electromagnetic field therapy (EMFT), two sessions per week for 20 min each for 6 weeks. Three categories were assessed, working ability, associated symptoms, and drugs used. Data were collected and statistically analyzed using SPSS version 22. The present study showed statistically significant progress (P < 0.05) in reducing pain, rare physical and mental complaints, and improved working ability with no need for drugs in majority of patients. EMFT has better results than other methods in relieving pain and symptoms of dysmenorrhea with a settled lifestyle.

Zoster-associated Limb Paralysis: Clinical and Electrophysiological Data of 15 Cases with Segmental Zoster Paresis with the Literature Review

ABSTRACT Background: Herpes zoster (HZ) is a viral disease characterized by skin eruptions and pain in specific dermatomes. Focal motor weakness that appears in the segment of skin eruptions is a rare complication of this infection. Because of the difficulty in clinically diagnosing thoracic or upper cervical motor weakness and due to the pain that causes overlooking of weakness, the true incidence of this complication is not known. In this study, we want to review the clinical presentation of segmental zoster paresis and also discuss electrophysiological findings with the involvement of nerve, plexus parts, or spinal roots. Methods: Electromyography records were examined retrospectively from 2010 to 2023 for patients who had HZ-associated limb paresis. Clinical data were reviewed and abstracted, and patients whose clinical limb weakness and sensory deficits conformed to the distribution of peripheral nerve (s) or spinal root and whose electrodiagnostic evaluation corroborated the localization, were included in the series. Results: Fifteen patients were included in our study. Ten of them were men and five of them were women. Paresis and neuropathic pain are the main complaints. In all patients, the distribution of paresis was consistent with the area of skin eruptions. C8–T1 in the upper extremity and L5–S1 in the lower extremity are the most commonly involved segments. Electrophysiological findings showed radicular involvement in three cases, brachial plexus in six cases, ulnar nerve in one case, sciatic nerve in two cases, and fibular nerve in three cases. Axonopathy is the main detected pathology in all cases. Conclusion: Segmental zoster paresis is a rare complication of cutaneous zona zoster and it affects different nerve segments. Clinicians should be aware of clinical and electrophysiological findings of this disease for the appropriate management of the patients.

Epidemiology of Knee Injuries in Baseball Players from the State of São Paulo.

Objective This study aimed to identify the main knee complaints and injuries associated with baseball and their prevalence in the state of São Paulo, Brazil. Methods This epidemiological study analyzed data from an online questionnaire sent to baseball athletes from the state of São Paulo, Brazil, from 2019 to 2022. Results Ninety-eight athletes participated in the study. Their average age was 24.3 years, and 85.72% of the subjects were men. The most prevalent ethnicities were yellow (50%) and white (42.86%). Most athletes had incomplete or complete higher education (75.5%). Most (88.77%) have been training for over 1 year, and 40.82% played in more than 1 position. More than half also practiced another sport. Most (66.32%) athletes present knee complaints or symptoms, and 37.75% had suffered a knee injury playing baseball, with several mechanisms (contact with the ground, contact with another player, or no contact). More than half (59.45%) of the athletes required time away from baseball due to complaints, symptoms, or injuries. Conclusion Among the athletes interviewed, 66.32% had a knee complaint, and 37.75% had already had a knee injury, especially meniscal and ligament injuries. The injury rate was highest in the first year of practice.

Single visit indirect pulp capping with Biodentine: clinical case report

Introduction. Dental caries is the most widespread dental disease worldwide; it affects population of different ages. If not treated promptly or addressed improperly, dental caries progresses in a deep cavity, with potential signs of pulp inflammation. The minimal invasive principles of treatment of deep carious lesions provide guidelines for the preservation of the dental pulp, techniques known as vital pulp therapies. Among these techniques, indirect pulp capping is a method that has shown high clinical rates of success over time, if performed properly. The applied bioactive dental material plays an important role. The aim of this clinical case report is to describe a clinical case of single-visit indirect pulp capping with Biodentine, along with the algorithm of diagnosis of the pulp health status and treatment used in deep caries lesion in a permanent tooth. Materials and methods. Description of a clinical case of a permanent upper molar with a deep carious lesion, treated by single-visit indirect pulp capping with Biodentine. Clinical and radiological methods of investigations were used; the patient was assessed after 3 and 6 months after the applied treatment. Results. The main complaint of sensitivity to sweet stimuli presented by the patient attenuated shortly after receiving the treatment. After 3 and 6 months, the tooth is asymptomatic; the clinical and radiological findings show no evidence of pulp inflammation. Conclusions. Biodentine showed successful results when used as a bioactive dental material for indirect pulp capping.