Mild Chronic Pain Research Articles

Unintentionally Retained Elevator Blade Left for 8 Years Causes Mild Chronic Pain.

Fracture of surgical instruments in dental practice is not usually reported in the literature. Management involves searching for and retrieving the fragment to avoid issues such as infection, swallowing, or aspiration. Although foreign bodies may not cause symptoms for years, some can cause chronic pain. The authors describe herein the unusual case of an unintentionally retained broken elevator blade left for 8 years before being found during an orthodontic evaluation. Panoramic radiography revealed a foreign body in the alveolar bone of the right mandibular third molar that was causing mild chronic pain. The patient was unaware whether routine radiographic examination had revealed its presence. Cone-beam computer tomography was performed to identify the position of the blade fragment, and surgery was performed to retrieve it. The mild chronic pain disappeared after removal. It is advisable to use high-quality surgical instruments and to perform routine checkups before and after surgery.

Teleyoga for Patients With Alzheimer's Disease and Chronic Musculoskeletal Pain and Their Caregivers: A Feasibility Study.

Chronic musculoskeletal pain is common in patients with Alzheimer's disease (AD), and there is growing awareness that chronic pain has an impact on the progression of dementia. Yoga has shown promise in treating chronic pain. However, attending in-person yoga can be difficult for AD patients. To assess the feasibility, acceptability and preliminary efficacy of an online yoga (teleyoga) protocol suitable for AD patients with chronic pain, and their caregivers. Patients with comorbid mild AD and chronic musculoskeletal pain (n = 15, 57-95 y/o; 73% Female) and their caregivers (n = 15, 50-75 y/o; 67% Female) received 12-week of teleyoga individually (n = 5 dyads) or in groups (n = 10 dyads). Study measures included standard feasibility metrics, and secondary outcomes included the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory-II (BDI-II), and cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Caregivers also completed measures of caregiver burden, and quality of life (Short Form Health Survey-36, SF-36). Feasibility measures showed adequate treatment adherence (85.1% in patients and 86.3% in caregivers), acceptability (mean acceptability rating = 3.0 for patients and 3.3 for caregivers, indicating positive approval), recruitment rate (n = 16 dyads within 1-year), retention rate (87%), missing data rate (.03%), and fidelity of treatment delivery (87%). Preliminary efficacy findings in the AD group showed significant reductions in pain severity (BPI-SF mean Δ = -.93, P = .045) and depression (BDI-II; mean Δ = -9.85, P = .005). %). Preliminary efficacy findings in the caregiver group showed significant reductions in depression (BDI-II mean Δ = -6.88, P = .036) and fatigue (SF-36 mean Δ = 9.81, P = .021). Results show that teleyoga is a feasible treatment for patients with comorbid mild AD and chronic musculoskeletal pain. Results also provide preliminary evidence of health benefits of teleyoga for both AD patients and their caregivers.

An Analysis of Biopsychosocial Factors Associated With Chronic Pain Severity Among Hospitalized People Living With HIV in Shenzhen, China: A Cross-Sectional Study.

Chronic pain is a primary health problem in people living with HIV (PWH). However, there is limited research regarding chronic pain among PWH in Chinese health care settings. To investigate biopsychosocial factors of chronic pain severity, we conducted a cross-sectional study in Shenzhen, China. Chronic pain was defined as pain lasting for more than three months. Pain intensity was measured using the numeric rating scale (NRS). Among 123 hospitalized PWH, 78.86% of participants had mild pain and 21.14% had moderate-severe pain. Multiple logistic regression results indicated that PWH in moderate-severe pain group were more likely to have higher levels of interleukin [IL]-6 (OR = 1.034, 95% CI: 1.003-1.066, p = .029) and anxiety (OR = 1.334, 95% CI: 1.071-1.662, p = .010) than those in the mild chronic pain group. Targeted pain management interventions should be explored in clinical practices and future studies regarding PWH with high levels of IL-6 and anxiety.

Reintegration challenges among post-9/11 veterans: The role of mental health symptoms and resilience- and avoidance-based coping strategies

Many returning service members deployed in the wars of Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom and New Dawn) face numerous challenges within post-deployment community reintegration (PDCR), including mild traumatic brain injury, chronic pain, and psychological disorders such as PTSD– a constellation of symptoms referred to as polytrauma. Within a transdiagnostic acceptance and commitment therapy (ACT) framework, optimal PDCR is hindered by excesses in maladaptive avoidance-based coping and deficits in resilience-based coping. The present cross-sectional study examined the relationship between vulnerability (psychological distress, PTSD symptomology, and experiential avoidance) and resilience (values-based living; VBL) factors with PDCR in a sample of 298 Veterans with polytrauma-related concerns (Nmale = 244, Mage = 40.6). Results indicated: 1) higher psychological distress, PTSD symptomology, and experiential avoidance, respectively, and low VBL were significantly associated with greater PDCR difficulty; and 2) Veterans high in VBL (versus low) demonstrated a strengthened association between psychological distress and PTSD symptomology, respectively, with PDCR difficulty. These slope differences revealed a lack of differentiation in PDCR at high levels of distress/PTSD: PDCR difficulty was high for all levels of VBL. Conversely, at low-to-moderate levels of distress/PTSD, differences in PDCR difficulty were observed across VBL levels: PDCR difficulty was lower for Veterans high in VBL (versus low), suggesting VBL as a potential catalyst for facilitating optimal PDCR, but only for a limited range of symptom severity. Findings support the use of transdiagnostic ACT to improve outcomes for Veterans with polytrauma-related concerns.

Laparoscopic transabdominal preperitoneal repair for female patients with groin hernias

BackgroundLaparoscopic transabdominal preperitoneal repair (TAPP) was recommended for female patients with groin hernias. Whereas, only a few studies focused on whether and how to preserve the round ligament of the uterus in TAPP.MethodsClinical data of 159 female patients with 181 groin hernias who underwent TAPP at a single institution in China from January 2016 to June 2022 were retrospectively reviewed and collected.ResultsAll the patients underwent the operation smoothly without conversion. Division of the round ligament was performed for 33 hernias. Preservation of the round ligament was adopted for 148 hernias, 51 with the “keyhole” technique, 86 with the “longitudinal incision of peritoneum” method, and 11 with total dissection of the round ligament. The mean operative time was 55.6 ± 8.7 min for unilateral TAPP and 99.1 ± 15.8 min for bilateral TAPP. The mean estimated blood loss was 7.1 ± 4.5 mL. The postoperative complications included 6 (3.3%) cases of seroma, 1 (0.5%) case of hematoma, and 3 (1.6%) cases of mild chronic pain. The incidences of chronic pelvic pain and genital prolapse seemed to be higher in the division group than in the preservation groups (6.1% vs. 0.6% and 3.0% vs. 0%, separately). However, no statistical difference was observed (p > 0.05).ConclusionsTAPP is feasible and effective for female patients with groin hernias, especially in preserving the round ligament of the uterus.

Validation of the pediatric version of the Graded Chronic Pain Scale Revised in school-aged children and adolescents.

The Graded Chronic Pain Scale (GCPS) was originally developed to grade the severity of chronic pain conditions in adults. A revised version of this instrument (ie, GCPS-R) has been developed for use with adults to account for advances in pain metrics and new operational definitions of chronic pain and high-impact chronic pain. The purpose of the current study was to adapt the GCPS-R for use with pediatric samples (P-GCPS-R) and evaluate the adapted measure's concurrent validity. One thousand five hundred sixty-four school-aged children and adolescents (55% girls; 8-18 years) completed the P-GCPS-R and provided responses to measures of physical health, anxiety and depressive symptoms, maladaptive pain coping strategies, and activity limitations. Results showed that 14% of participants had chronic pain, of which 37% (5% of the whole sample) had mild chronic pain, 45% (6% of the whole sample) bothersome chronic pain, and 18% (3% of the whole sample) high-impact chronic pain. Participants without chronic pain and those with mild chronic pain showed no significant between-group differences in any of the study measures. Participants with bothersome chronic pain and high-impact chronic pain reported worse physical health, more anxiety and depressive symptoms, pain catastrophizing, and activity limitations than those with mild chronic pain. Participants with high-impact chronic pain reported more activity limitations than those with bothersome chronic pain. The findings support the concurrent validity of the P-GCPS-R for use with pediatric samples.

Graded chronic pain scale revised: validation in a Veteran sample.

The Graded Chronic Pain Scale (GCPS) is frequently used in pain research and treatment to classify mild, bothersome, and high impact chronic pain. This study's objective was to validate the revised version of the GCPS (GCPS-R) in a US Veterans Affairs (VA) healthcare sample to support its use in this high-risk population. Data were collected from Veterans (n = 794) via self-report (GCPS-R and relevant health questionnaires) and electronic health record extraction (demographics and opioid prescriptions). Logistic regression, adjusting for age and gender, was used to test for differences in health indicators by pain grade. Adjusted odds ratio (AOR) with 95% confidence intervals (CIs) were reported with CIs not including an AOR of 1 indicating that the difference exceeded chance. In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 49.3%: 7.1% with mild chronic pain (mild pain intensity and lower interference with activities); 23.3% bothersome chronic pain (moderate to severe pain intensity with lower interference); and 21.1% high impact chronic pain (higher interference). Results of this study mirrored findings in the non-VA validation study; differences between bothersome and high impact were consistent for activity limitations and present but not fully consistent for psychological variables. Those with bothersome chronic pain or high impact chronic pain were more likely to receive long-term opioid therapy compared to those with no/mild chronic pain. Findings highlight categorical differences captured with the GCPS-R, and convergent validity supports use of the GCPS-R in US Veterans.

Pharmacokinetics of cannabidiol following single oral and oral transmucosal administration in dogs.

In the last few years, different formulations containing cannabidiol (CBD) were tested with regard to its efficacy on chronic pain, refractory epilepsy, anxiety, aggressive behavior and atopic dermatitis in dogs. CBD is generally administered orally, but its low bioavailability, probably due to a first-pass metabolism, represents a great limitation. The aim of this study was to evaluate if CBD bioavailability increases after oral transmucosal administration (OTM) compared to oral treatment. Twelve dogs diagnosed with mild chronic pain were enrolled in the study and treated once orally or OTM (6 dogs/group) with a pure CBD in oil formulation at a dosing rate of 1 mg/kg b.w. At prefixed time points, blood samples were collected to define CBD plasma concentrations vs. time profiles, and the main pharmacokinetics parameters were obtained by non-compartmental model. CBD Cmax, Tmax, terminal half-life and AUC0 - t were 206.77 ± 167 and 200.33 ± 158.33 ng/mL, 2.17 ± 0.98 and 1.92 ± 1.11 h, 2.67 ± 0.53 and 2.62 ± 0.64 h, 647.51 ± 453.17, and 536.05 ± 370.21 h*ng/mL, following oral and OTM administration, respectively. No significant difference in pharmacokinetic parameters were observed between treatments. The OTM administration did not increase cannabidiol bioavailability compared to oral treatment. The almost perfectly superimposable mean plasma concentrations of cannabidiol following the two treatments suggests that CBD is not able to be adsorbed by the oral mucosa or that its absorption is very scarce, and that CBD is swallowed and absorbed in the gastrointestinal tract.

New Perspectives on the Adverse Effects of NSAIDs in Cancer Pain: An Italian Delphi Study from the Rational Use of Analgesics (RUA) Group.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for cancer pain. We used the Delphi methodology to evaluate the opinions of clinicians on NSAIDs and paracetamol, with a specific focus on their safety profile. Consensus was reached on seven statements. A high level of consensus was reached regarding the use of NSAIDs and gastrointestinal, cardiovascular, and renal risk in patients taking low-dose aspirin and assessment of liver function during long-term treatment with paracetamol. Consensus was also reached that assessment and monitoring of eGFR are important in the elderly being administered NSAIDs. It was further agreed that NSAIDs can often play a key role in association with opioids in the treatment of cancer pain and that paracetamol is the analgesic of first choice for patients with mild chronic pain. When NSAIDs are administered in combination with steroids, it was agreed that the risk of gastrointestinal damage is increased since steroids delay the healing of ulcers and that paracetamol can be used during pregnancy and does not affect the health of the fetus. This Delphi study highlights that there is poor agreement on how these drugs are routinely prescribed. However, a consensus was reached for seven key statements and may represent a valid contribution to daily practice.

P-029 A NOVEL USE OF FULLY ABSORBABLE PHASIXTM MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR

Abstract Background An inguinal hernia is repaired usually with synthetic non-absorbable mesh resulting in collagen formation leading to chronic inflammation, and fibrosis with significant reductions in hernia recurrence. However, chronic pain may affect quality of life. The new mesh introduced to minimize complications. Poly-4-hydroxybutyrate (P4HB) mesh starts to degrade in 12–18 months. We are reporting our results of TAPP inguinal hernia repair using P4HB mesh (PhasixTM Bard in, Murray Hill, NJ). Method A pilot study is carried-out for laparoscopic TAPP repair for inguinal hernia using P4HB mesh assessing the recurrence rate and chronic pain for 30 months with IRB approval (E-19–3735). The study was conducted from 24 Jan 2016 to July 2017. The study included postoperative pain, reactions, mesh sensation, discomfort, and recurrence. Results Laparoscopic TAPP inguinal repair using P4HB mesh for 15 patients. 14 male and 1 female patient were involved, average age 55.8 years old,and an average BMI of 27.4 kg/m2. No recurrence or mesh sensation encountered except one patient has mild chronic inguinal pain for one year without affecting his usual activity. Conclusion Laparoscopic TAPP inguinal hernia repair using PhasixTM mesh is safe to use in combined direct (medial) and indirect (lateral) inguinal hernia with no recurrence. The use of P4HB absorbable mesh led to less chronic pain and discomfort. However, longer follow-up and a higher number of patients are needed to allocate the status and the place of P4HB in the world for inguinal hernia repairs.

Knee Injury-Baseball

HISTORY: A 19yo male college baseball pitcher presented for acute onset left medial knee pain after attempting to carry a couch, at which time he twisted the knee into a valgus position and felt a painful pop. He had mild difficulty with weight bearing and swelling. He questioned whether he may have dislocated the kneecap with spontaneous reduction. He denied associated bruising, instability, hip or back pain. He denied prior knee injury. He did report mild chronic groin pain during pitching which was unchanged. PHYSICAL EXAMINATION: There was mild effusion about the left knee, with tenderness at the medial joint line and near the proximal origin of the MCL. There was pain with valgus stress, without clear laxity. Varus stress was non-provocative. Anterior and posterior drawer test were limited secondary to guarding. Lachman's test was equivocal. McMurray's test was positive for pain. Patellar apprehension was positive. Patellar grind was negative. Straight leg test was negative. Distal neurovascular exam was grossly intact. DIFFERENTIAL DIAGNOSIS: Lateral patellar dislocation/subluxation. ACL or MCL sprain/tear. Traumatic medial meniscus tear. Osteochondral lesion of the medial femoral condyle. Muscle or tendon sprain/tear. TEST AND RESULTS: Left knee X-ray was negative for fracture and showed normal alignment. Left knee MRI revealed nonspecific edema throughout the deep soft tissues of the posterior distal thigh and knee, most pronounced along the posteromedial aspect of the distal femoral metaphysis near the insertion of the adductor magnus tendon. Findings were suggestive of acute on chronic partial tearing/avulsion injury of the distal adductor magnus with an adjacent focus of mineralization consistent with underlying calcific tendinosis. The cruciate and collateral ligaments were intact. There were no findings suggestive of transient lateral patellar dislocation. FINAL WORKING DIAGNOSIS: Calcific tendinosis of the adductor magnus tendon, with superimposed traumatic avulsion injury/partial tearing TREATMENT AND OUTCOMES: The patient was allowed to weight bear as tolerated but was instructed to abstain from lower body exercise for 4 weeks. NSAIDs were used for pain relief as needed. He was referred to PT at 4 weeks with a focus on pitching mechanics.

Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial.

BackgroundMild traumatic brain injury (mTBI) and chronic pain often co-occur and worsen rehabilitation outcomes. There is a need for improved multimodal nonpharmacologic treatments that could improve outcomes for both conditions. Yoga is a promising activity-based intervention for mTBI and chronic pain, and neuromodulation through transcranial magnetic stimulation is a promising noninvasive, nonpharmacological treatment for mTBI and chronic pain. Intermittent theta burst stimulation (iTBS) is a type of patterned, excitatory transcranial magnetic stimulation. iTBS can induce a window of neuroplasticity, making it ideally suited to boost the effects of treatments provided after it. Thus, iTBS may magnify the impacts of subsequently delivered interventions as compared to delivering those interventions alone and accordingly boost their impact on outcomes.ObjectiveThe aim of this study is to (1) develop a combined iTBS+yoga intervention for mTBI and chronic pain, (2) assess the intervention’s feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies.MethodsThis is a mixed methods, pilot, open-labeled, within-subject intervention study. We will enroll 20 US military veteran participants. The combined iTBS+yoga intervention will be provided in small group settings once a week for 6 weeks. The yoga intervention will follow the LoveYourBrain yoga protocol—specifically developed for individuals with TBI. iTBS will be administered immediately prior to the LoveYourBrain yoga session. We will collect preliminary quantitative outcome data before and after the intervention related to quality of life (TBI-quality of life), function (Mayo-Portland Adaptability Index), and pain (Brief Pain Inventory) to inform larger studies. We will collect qualitative data via semistructured interviews focused on intervention acceptability after completion of the intervention.ResultsThis study protocol was approved by Edward Hines Jr Veterans Administration Hospital Institutional Review Board (Hines IRB 1573116-4) and was prospectively registered on ClinicalTrials.gov (NCT04517604). This study includes a Food and Drug Administration Investigational Device Exemption (IDE: G200195). A 2-year research plan timeline was developed. As of March 2022, a total of 6 veterans have enrolled in the study. Data collection is ongoing and will be completed by November 2022. We expect the results of this study to be available by October 2024.ConclusionsWe will be able to provide preliminary evidence of safety, feasibility, and acceptability of a novel combined iTBS and yoga intervention for mTBI and chronic pain—conditions with unmet treatment needs.Trial RegistrationClinicalTrials.gov NCT04517604; https://www.clinicaltrials.gov/ct2/show/NCT04517604International Registered Report Identifier (IRRID)DERR1-10.2196/37836

Impact of Gensingen brace treatment on Lenke 5 curvatures and chronic low back pain in late adolescent and adult scoliosis patients.

BackgroundLenke 5C (lumbar and or thoracolumbar) curve patterns lead to loss of lumbar lordosis which is associated with low back pain in later adulthood. We undertook our study to investigate if brace treatment may have an effect on low back pain and on improving the cosmetic appearance in late adolescents and adults.ObjectivesTo estimate if conservative treatment may have an effect on pain in single lumbar curvatures in late adolescent and adult patients with Adolescent Idiopathic Scoliosis (AIS) using a Gensingen Brace by Weiss (GBW).MethodWe investigated AIS patients with Lenke 5C pattern who wore a GBW prospectively. The inclusion criteria of our study were age over 15 years, Cobb angle greater than 20° before treatment and Risser 4 or 5. A verbal pain rating scale was used (no pain, mild pain, moderate pain, severe pain, very severe pain).ResultsA total of 26 patients met the inclusion criteria. The average age was 17.7 years and the average Cobb angle was 41.5°. Nineteen patients (73.1%) experienced mild or moderate chronic low back pain before treatment and seven patients (26.9%) were asymptomatic but seeking treatment for cosmetic reasons. At follow-up, a 23% correction of the curve was achieved. All previously symptomatic patients reported that they no longer experienced low back pain after having worn the brace regularly.ConclusionHigh correction bracing seems to have a positive effect on the curve and on chronic low back pain in patients with a scoliosis and a Lenke 5C curve pattern.Clinical implicationsHigh correction, pattern specific bracing with a GBW may be applied aiming at reducing structural curves and chronic low back pain in late adolescent and adult patients with AIS and with a single lumbar curvature.

Lichtenstein Gerilimsiz Herniorafi Sonrası Kronik Kasik Ağrısını Önlemede Hafif, Kendinden Kavrayan Ağ Etkili Midir?

Background: Inguinal hernia repair is among the most frequent elective or emergency opera-tions performed in general surgical practice. Lichtenstein hernia repair is considered the gold standard for managing such cases. Postoperative complications especially post-surgical chronic groin pain stands still as a very disabling complication. In this study, we investigated the chronic postoperative pain on 2 different types of meshes.Materials and Methods: This is a retrospective study evaluating the results of open hernior-rhaphy with self gripping mesh or regular prolene mesh. Patients included the study that was male and aged 18-65 years, which presented with unilateral inguinal hernia and were favorable with Lichtenstein tension-free herniorrhaphy using mesh.Results: The median duration of the operation was 44.6 m ± 6.1 on Group-1 and the median duration of the operation was 24.6 m ± 5.4 on Group-2, as significantly shorter than Group-1 (p< 0.001). The median hospital stay of the patients was 1 day and no statistically significant difference has detected between groups. At follow-up on the third month, the rate of the patients with complaints of mild chronic groin pain in Group-1 was % 11.1 vs none in Group-2(p˂0.05). No recurrence has been detected in both groups after 8.4 months of follow-up.Conclusions: Our experience of lightwight self-gripping mesh demonstrates that the material is both safe and effective in matters of postoperative complications and recurrence and is very promising in prohibiting chronic groin pain.Key Words: Tension-free herniorrhaphy, mesh fixation, self-gripping mesh

Clinical, humanistic, and economic burden of severe haemophilia B in adults receiving factor IX prophylaxis: findings from the CHESS II real-world burden of illness study in Europe

BackgroundReal-world studies of the burden of severe haemophilia B in the context of recent therapeutic advances such as extended half-life (EHL) factor IX (FIX) products are limited. We analysed data from the recent CHESS II study to better understand the clinical, humanistic, and economic burden of severe haemophilia B in Europe. Data from male adults with severe haemophilia B receiving prophylaxis were analysed from the retrospective cross-sectional CHESS II study conducted in Germany, France, Italy, Spain and the United Kingdom. Inhibitors were exclusionary. Patients and physicians completed questionnaires on bleeding, joint status, quality of life, and haemophilia-related direct and indirect costs (2019–2020). All outcomes were summarised using descriptive statistics.ResultsA total of 75 CHESS II patients were eligible and included; 40 patients (53%) provided self-reported outcomes. Mean age was 36.2 years. Approximately half the patients were receiving EHL versus standard half-life (SHL) prophylaxis (44% vs 56%). Most patients reported mild or moderate chronic pain (76%) and had ≥ 2 bleeding events per year (70%), with a mean annualised bleed rate of 2.4. Mean annual total haemophilia-related direct medical cost per patient was €235,723, driven by FIX costs (€232,328 overall, n = 40; €186,528 for SHL, €290,620 for EHL). Mean annual indirect costs (€8,973) were driven by early retirement or work stoppage due to haemophilia. Mean quality of life (EQ-5D) score was 0.67.ConclusionsThese data document a substantial, persistent real-world burden of severe haemophilia B in Europe. Unmet needs persist for these patients, their caregivers, and society.

Assessment of early outcome in laparoscopic totally extraperitoneal inguinal hernia repair using lightweight mesh

Background: Laparoscopic surgery is dominating in the field of hernia. The search for the ideal prosthetic biomaterial has been a longstanding issue with debate over simple versus composite biomaterial and lightweight versus heavyweight meshes. This study was done to evaluate the early outcome of lightweight mesh in laparoscopic totally extraperitoneal (TEP) repair.Methods: This prospective observational study was done for a period of 16 months. On the basis of selection criteria patient underwent laparoscopic TEP repair using light weight mesh, early outcomes were evaluated in terms of immediate postoperative pain (analysed via visual analog scale) and chronic groin pain (analysed by visual analogue scale and graded according to Cunningham), patients were also evaluated for operation time, intraoperative bleeding, seroma, stiffness or numbness around groin, or any other complications.Results: There was no intraoperative bleeding among any of the patients. Immediate post-operative pain assessed by visual analogue scale 20% scored one in the visual analogue scale in post-operative day 1. None of the patients were having any complications (like stiffness or numbness in groin or thigh and any other complication) during post-surgery follow up. Only one patient reported mild chronic groin pain at the end of 3 months after surgery.Conclusions: The short term results of laparoscopic TEP repair for inguinal hernia using light weight mesh are quite encouraging. We can conclude that light weigh mesh is fulfilling important role in successful hernia repair as it is associated with very less morbidity.

Scalloping Spine in a Patient With Type 1 Neurofibromatosis.

A 46-year-old woman with type 1 neurofibromatosis (NF1) reported a history of mild chronic pain involving her back and limbs. She had multiple neurocutaneous stigmata of NF1 including neurofibromas (Figure, A). She exhibited myelopathic changes in her lower limbs, with increased tone and hyperreflexia noted bilaterally and symmetrically. MRI of her spine showed diffuse dural ectasia from C4–T3, causing severe scalloping of the posterior endplates (Figure, B).

755 A Novel Modularized Intervention to Improve Sleep in Older Hospitalized Veterans

IntroductionDisturbed sleep in hospitalized patient populations is a highly prevalent phenomenon, with patients commonly reporting problems with shorter sleep duration, more frequent awakenings, and overall poorer sleep quality during hospital stay compared to at home. Sleep disturbance during hospitalization is especially problematic as sleep is associated with both physical and psychological well-being. Poorer sleep has been found to impact recovery outcomes in a number of patient populations including mild traumatic brain injury, chronic pain, and most recently, in hospitalized COVID-19 patients. The current analyses examined pilot data from a novel brief modularized sleep intervention implemented with older adult Veterans living on a subacute rehabilitation unit.MethodsParticipants were screened for sleep problems upon admission to the unit. Veterans who screened positive were invited to participate in the sleep intervention. Components of the intervention were selected based on screener responses and included group sleep hygiene psychoeducation, environmental accommodations (e.g. ear plugs, eye mask, soothing music), and CPAP use education. Measures completed at pre- and post- intervention assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), global health functioning (PROMIS Global Health Scale), and depressive symptoms (Patient Health Questionnaire, PHQ-9). Pre- and post- scores were compared using paired sample t-tests. Two samples t-tests compared change scores in PHQ-9 between groups.ResultsA total of 33 Veterans were included in the analyses (Mage = 69.6, 3 female, intervention group n = 21). Participants showed a trend toward decreased PHQ-9 scores following the intervention (t(16) = 1.58, p = 0.100). There were no significant effects of the intervention on sleep quality or global health. Compared to the non-intervention group, the intervention group showed greater decrease in PHQ-9 scores at the time of post-intervention (t(25) = .828, p = .025).ConclusionPreliminary data suggests that a brief modularized sleep intervention may benefit depressive symptoms for older adults during hospitalization. Additional research is needed to better understand the impact of a brief intervention on self-reported sleep quality during the hospitalization period.Support (if any)This project was funded by a VISN 20 Seed Grant as a Whole Health promotion in alignment with the National VA Office of Patient Centered Care & Cultural Transformation.

S1618 Finding the Needle in the Haystack: PTLD Occurring in the Background of GVHD and Infection

INTRODUCTION: Post-transplant lymphoproliferative disorder (PTLD) is an uncommon complication after hematopoietic stem cell transplant and is associated with Epstein-Barr virus infection and more aggressive immunosuppressive regimens. PTLD can coincide with graft versus host disease (GVHD) and mimic other disorders making endoscopic tissue sampling central to diagnosis and treatment. CASE DESCRIPTION/METHODS: A 27-year-old male was admitted for worsening diarrhea after undergoing umbilical cord blood transplant for Blastic plasmacytoid dendritric cell neoplasm 5 months prior. His transplant course was complicated by several hospitalizations for GVHD of the gut. A colonoscopy 4 months earlier was endoscopically normal with biopsies consistent with GVHD (Figure 1). At this time, the patient presented with 10 days of non-bloody diarrhea in the setting of tapering prednisone dose, similar to prior flares of GVHD. He reported mild chronic abdominal pain but was otherwise asymptomatic. Flexible sigmoidoscopy showed deep linear ulcerations from the proximal rectum to the sigmoid colon with edema, friability, and loss of vascular pattern (Figure 2) which were biopsied. GI PCR returned positive for salmonella and C difficile. A few days later he developed massive hematochezia necessitating ICU level care and massive blood transfusion protocol. Repeat colonoscopy showed interval progression of ulcerations with diffuse bleeding. Biopsies from original flexible sigmoidoscopy showed CD20/EBV + immunoblasts with intermixed CD3+ T cells and polytypic plasma cells (Figure 3) and serum EBV viral load was elevated confirming the diagnosis of PTLD. Patient was started on rituximab and achieved negative viremia after 8 weeks though his course was complicated by recurrent hematochezia. DISCUSSION: The gastrointestinal tract is a common site for PTLD. As patients can present with nonspecific symptoms and confounding diagnoses, identification requires a high index of suspicion. Endoscopic diagnosis through biopsy is critical given the associated high mortality. The characteristic lesion of PTLD in the gastrointestinal tract has been described as a raised, rubbery and erythematous lesion with central ulceration. Although this patient did not have the classic endoscopic finding and had several competing GI diagnoses, he had several risk factors for developing PTLD and once diagnosed responded appropriately to therapy.Figure 1.: First colonoscopy after umbilical cord transplant showed normal endoscopic appearance, random colonic biopsies were consistent with GVHD.Figure 2.: Subsequent flexible sigmoidoscopy showed deep linear ulcerations with edematous mucosa, friability, and loss of vascular pattern in the sigmoid colon just four months later.Figure 3.: H&E stain; 40× field: Atypical lymphoid proliferation as exhibited by numerous large, irregular immunoblasts with prominent nucleoli (examples: black arrows).

Early Outcomes of “Extended View Total Extraperitonial (eTEP)” Procedure for Inguinal Hernia

Laparoscopic inguinal hernia repair has become popular as an alternative to open surgery. The classical TEP technique is the laparoscopic technique of hernia repair which is considered closest to ideal for inguinal hernia repair, but this technique has several drawbacks such as limited space for dissection and mesh placement, restricted port placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. Extendedview modification, the eTEP technique, which overcomes several of these drawbacks. The eTEP approach can quickly and easily create an extraperitoneal space, enlarge the surgical field, provide a flexible port setup adaptable to many situations, allow unencumbered parietalization of the cord structures , ease the management of the distal sac in cases of large inguinoscrotal hernias, and improve tolerance of pneumoperitoneum, which is a common complication. The purpose of this study was to evaluate the safety and effectiveness of eTEP procedure with placement of polypropylene mesh and fixation by tackers.
 Method : It was a observational study of 25 cases. The study was conducted in Shaheed Suhrawardy Medical College Hospital, Dhaka from July 2018 to June 2019. Sociodemographic status, operation time, peroperative blood loss, unwanted events like peritoneal tear, vessel injury, nerve injury, duration of hospital stay, postoperative pain and urinary retention were recorded. All the patients were followed up for at least 3 times at the end of 1st week, 1st month and 3rd month. Any surgical site infection, mesh infection, seroma, scrotal swelling, severity of pain according to visual analogue scale, haematoma and recurrence within this time was recorded. All the data were analyzed on SPSS.
 Result : Among the 25 patients average time of operation was 1 hour and 35 minutes, peroperative blood loss was below 20 ml in all patients, peritoneal tear occurred in 2 patients, 1 vessel injury but no nerve injury was observed during the procedure. One patient had mild chronic pain even after the end of 3rd month. One patient developed scrotal swelling which subsided by the end of 1st week. No SSI, mesh infection, seroma, wound hematoma, and recurrence found within this period.
 Conclusion : This study showed that, eTEP procedure is cost effective, has minimum complication with easier learning. In the hands of an experienced surgeon, eTEP repair can be safe and effective. New study can be done to find out it’s effectiveness in incisional hernia in lower abdomen and bilateral inguinal hernia.
 J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 96-100