Mild Pain Research Articles

Comparison of Outcome of Septoplasty with and without Intranasal Splintage in Patients Admitted to a Tertiary Care Hospital, Peshawar

Objective: To compare outcome of septoplasty with and without intranasal splints in patients admitted in Khyber Teaching Hospital, Peshawar Methodology: A Randomized controlled trial was done at department of ENT, Khyber Teaching Hospital, Peshawar from 21-01-2020 to 21-07-2020. Patients with diagnosis of symptomatic DNS, aged between 15 to 30 years, both genders and undergoing septoplasty for symptomatic Deviated Nasal Septum for primary surgery were included. Patients were randomly allocated into two groups using a coin toss method. Patients in group A were subjected to intranasal splintage packing while patients of group B were not be subjected to intranasal splintage. Patients in both groups was assessed on the first postoperative day, for degree of pain. Follow-up visits were scheduled after first and third weeks following the surgery. All the data was entered and analyzed in SPSS Version 23.0. Results: The mean age of the whole sample was 22.7 ± 4.9 years. Average age in the group A was 22.3 ± 4.9 years compared to 23.3 ± 5.0 years (p = 0.271). 60% in group A were males compared to 61.7% in group B (p = 0.852). On follow-up, out of an overall sample of 120, mild, moderate, and severe pain and bleeding were recorded in 35%, 45%, and 20% (pain) and 35%, 30%, and 35% (bleeding), respectively. In group A, 30% had mild pain compared to 40% in B group (p = 0.467), 50% in A group had mild bleeding compared to 20% in B group (p = 0.002), 30% in A group developed crusting compared to 20% in the B group (p = 0.206), and 20% in the A group had synechiae compared to 10% in the B group (p = 0.125). Conclusion: The outcome of septoplasty with splints not observed significantly differ from septoplasty without splints, except in the case of postoperative bleeding.

The Effect of Acupressure on Dysmenorhore in Adolescent Women Year 2022

Dysmenorrhea is a problem that women often experience every month and is accompanied by menstrual pain. If dysmenorrhea is not evaluated and treated, it will result in a decrease in academic achievement of 51.4%, limited activity during menstruation 40.9%, absenteeism from class 31.1%, decreased concentration 43.3%, decreased appetite and changes in sleep patterns 42. 7% and withdrawal from the community or relationships 63%. This study aims to determine the effect of acupressure therapy on dysmenorrhea in adolescents. The research method is Quasi Experimental with a group pre-post test design. Data were analyzed univariately and bivariately. The results of the study found a description of the level of dysmenorrhoea pain experienced by respondents before and after acupressure, showing that after acupressure the majority of respondents only felt mild pain (scale 1-3), namely 61.2% of respondents and the rest no longer felt pain (scale 0), namely as many as 35.8% of respondents.

ОСОБЛИВОСТІ ФІЗИЧНОЇ ТЕРАПІЇ У ПРОЦЕСІ РЕАБІЛІТАЦІЇ ОСІБ ПОХИЛОГО ВІКУ З ПОРУШЕННЯМ ФУНЦІЙ ХРЕБТА

According to literary sources, osteochondrosis of the cervical and thoracic spine is one of the most common diseases. This disease affects 22% of the world's population and ranks first in the group of diseases of the musculoskeletal system. The main goal of restorative treatment of elderly patients with cervical and thoracic osteochondrosis is to reduce muscle spasticity, decrease the level of heart rate, arterial systolic and diastolic pressure, reduce pain, facilitate the performance of household tasks, etc. In the program of physical therapy, we included therapeutic physical culture, therapeutic massage, and physiotherapeutic means. Therefore, the purpose of the study was to study of the peculiarities of physical therapy in the rehabilitation process of elderly people with osteochondrosis. Research methods. 28 people (12 men and 16 women) with osteochondrosis of the cervical-thoracic spine took part in the study. The average age of the patients was 64.5 years. The pedagogical experiment was aimed at determining the effectiveness of the program of physical therapy developed by us for elderly people with osteochondrosis on indicators of mobility in the cervical spine, intensity of pain sensations. Results and conclusions. The results of the conducted research indicate the positive impact of classes in the complex program of physical therapy for the elderly with cervicothoracic osteochondrosis. Thus, after the completion of the formative study, we established an improvement in the functional state of the cervical spine in elderly persons with cervical-thoracic osteochondrosis. The average group value of the pain intensity index in patients at the end of the study corresponded to the assessment of «very mild pain», while at the beginning of the study it corresponded to the assessment of «pain above average».

Narative Review The Effect of Endorphin Massage and Counter Pressure During Labor On Endorphin Hormone Release

Background: Labor pain is a subjective experience associated with uterine contractions, stretching of the cervix, and descent of the fetal head. According to the World Health Organization (WHO), every year, 210 million pregnancies occur in the world, and 20 million women experience pain due to childbirth. Of the 2700 mothers giving birth, 30% experienced severe pain, 20% of labor was accompanied by very severe pain, and 15% experienced mild pain. Non-pharmacological therapy continues to be developed in the world of obstetrics, which aims to provide comfort during the birthing process. Endorphin massage and counter pressure are non-pharmacological therapies that can stimulate the release of endorphins and reduce pain and anxiety during childbirth. Objective: This study aims to determine the effect of endorphin massage and counter pressure during labor on the release of endorphin hormones and their benefits. Methods: This research method was a literature review study. Journal searches were carried out by applying online databases such as PubMed, Garuda Portal, ScienceDirect, and Google Scholar. Articles were selected based on inclusion and exclusion criteria. Results: The analysis was carried out on 32 research articles. It was found that endorphin massage and counter pressure are non-pharmacological techniques to overcome and reduce labor pain and anxiety through the help of endorphin hormones which are useful for a smooth delivery process. Conclusion: The influence of endorphin massage and counter pressure during labor on the release of endorphin hormones, which are useful for reducing labor pain, reducing anxiety, increasing comfort, and speeding up the labor process.

Exploring the thermally-controlled fentanyl transdermal therapy to provide constant drug delivery by physics-based digital twins

Transdermal drug delivery is suitable for low-molecular-weight drugs with specific lipophilicity, like fentanyl, which is widely used for cancer-induced pain management. However, fentanyl's transdermal therapy displays high intra-individual variability. Factors like skin characteristics at application sites and ambient temperature contribute to this variation. In this study, we developed a physics-based digital twin of the human body to cope with this variability and propose better adapted setups. This twin includes an in-silico skin model for drug penetration, a pharmacokinetic model, and a pharmacodynamic model. Based on the results of our simulations, applying the patch on the flank (side abdominal area) showed a 15.3 % higher maximum fentanyl concentration in the plasma than on the chest. Additionally, the time to reach this maximum concentration when delivered through the flank was 19.8 h, which was 10.3 h earlier than via the upper arm. Finally, this variation led to an 18 % lower minimum pain intensity for delivery via the flank than the chest. Moreover, the impact of seasonal changes on ambient temperature and skin temperature by considering the activity level was investigated. Based on our result, the fentanyl uptake flux by capillaries increased by up to 11.8 % from an inactive state in winter to an active state in summer. We also evaluated the effect of controlling fentanyl delivery by adjusting the temperature of the patch to alleviate the pain to reach a mild pain intensity (rated three on the VAS scale). By implementing this strategy, the average pain intensity decreased by 1.1 points, and the standard deviation for fentanyl concentration in plasma and average pain intensity reduced by 37.5 % and 33.3 %, respectively. Therefore, our digital twin demonstrated the efficacy of controlled drug release through temperature regulation, ensuring the therapy toward the intended target outcome and reducing therapy outcome variability. This holds promise as a potentially useful tool for physicians.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children’s Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

1225 Endoluminal Stenting for Sleeve Gastrectomy Leak: Case Report, Literature Review and Atlas of Endoscopic Management

Abstract Introduction One of the most serious complications of bariatric surgery is post-operative leak and it can result in significant risk on the patient. Early detection and management of postoperative leak is essential to reduce the morbidities and mortality of such complication. Endoluminal Stent placement is a less invasive alternative to surgical intervention for management of bariatric surgical leak. We are reporting a case of post sleeve gastrectomy leak that has been managed by inserting self-expandable metal stents (SEMS) via endoscopy. Case presentation A 55-year-old woman presented with gradual onset of epigastric pain and high temperature with reduced oral intake. She had had a Laparoscopic sleeve gastrectomy done in another country as a form of “medical tourism” 10 days ago. She had a CT scan revealed an irregular 4.5 cm paraoesophageal collection suggesting post-operative leakage. Discussion Endoscopic management of GI leaks provides a minimally invasive, safe, and efficient alternative for surgery in selected cases. Endoscopic management is then proven to be the least invasive method to control and repair post LSG leak. Conclusions The clinical presentation of post LSG leak can vary from mild abdominal pain to severe sepsis. Endoscopic management, with its different types, has been widely used because its less invasive yet very effective way of managing such feared complication.

P-741 Standard IV Cannula Aspiration (SIVCA): A step-by-step video demonstration of the minimally invasive testicular sperm aspiration technique with technical improvements after 4 years of experience

Abstract Study question Is there room for further technical improvements in the Standard IV Cannula Aspiration (SIVCA), for a more efficient testicular issue aspiration and sperm extraction procedure? Summary answer A more efficient SIVCA procedure can be achieved by using a higher flow-rate cannula, less negative pressure aspiration and a Luer Lock syringe. What is known already Standard IV Cannula Aspiration (SIVCA) was introduced in 2022. It showed comparable sperm retrieval rates (SRR) to mTESE (56.2 vs 57.3%; McNemar P = 1.000). But given the novelty of the technique, some technical difficulties were encountered: The 14G cannula frequently kinked during the back and forth motions of aspiration, thus having to be replaced several times during the procedure; and the aspirating syringe often detached from the catheter mid-procedure, due to the absence of a lock mechanism securing it to the flashback chamber of the cannula. Study design, size, duration 224 men were enrolled in this prospective 24 months cohort study conducted at a specialized IVF center. The men had testicular tissue aspiration performed via SIVCA, either for azoospermia or increased seminal sperm DNA fragmentation, in anticipation of their partners’ ovum pick-up for an ICSI cycle. If enough testicular tissue was aspirated, it was examined for sperm. If not more than 0.2 gm of tissue could be aspirated from either testis, the patient underwent mTESE. Participants/materials, setting, methods After general anesthesia, 5cc of Xylocaine (lidocaine HCl) 2% was instilled into each spermatic cord. A standard 14-G 310 ml/min flow-rate IV cannula was introduced into the testis. After withdrawing the needle, a 3cc Luer Lock syringe was secured to the cannula. The plunger was maximally retracted to generate −250 Torr of negative pressure and clamped. Back and forth motions were performed, mapping and aspirating tissues from different regions of each testis at a time. Main results and the role of chance Out of a total of 224 cases, an adequate testicular tissue sample of more than 0.2 gm was successfully aspirated from 218 cases, with a 0.97 probability of success. Mild hematoma and pain were encountered in 5.8% of cases (n = 13/224) and subsided within two to three weeks (Grade I on the Clavien Dindo Scale). In a previous series, 130 cases of SIVCA were performed by fully retracting the plunger of a regular 20cc syringe, generating about −520 Torr of negative pressure, while the syringe was connected - but not secured - to the flashback chamber of a 270ml/min flow-rate cannula. In that series, adequate tissue samples could successfully be aspirated in 122 cases, showing a 0.93 probability of success. By using a higher flow-rate 14G IV cannula (310 ml/min vs 270 ml/min), less negative pressure (−250 Torr vs − 520 Torr) and a Luer Lock syringe; fewer number of cannulas were lost to kinking per procedure and no inconvenient disconnections occurred mid-procedure between the cannula and the aspirating syringe owing to the Luer Lock mechanism; all while maintaining a high success rate of aspiration of sufficient testicular tissue (X2 (1, N = 354) = 2.6156, p = .10582). Limitations, reasons for caution Whenever sclerosis and/or fibrosis of testicular tissue rendered aspiration of adequate amounts of testicular tissue difficult or challenging, we reverted to surgical m-TESE. Ice packs should be applied for at least 48 to 72 hours post-procedure to forestall hematomas. Further blinded randomized control studies with larger datasets are recommended. Wider implications of the findings SIVCA is a safe, efficient and easily reproducible method of testicular sperm aspiration. Its allowance for mapping different regions of the testes in order to extract sufficient amounts of tissues, makes it an ideal initial alternative to surgical m-TESE for testicular tissue aspiration and sperm searching. Trial registration number NCT05247723

P-301 Real life experience with myolysis by radiofrequency in infertile patients with type 2 and 3 fibroids

Abstract Study question Can transvaginal radiofrequency myolysis (TVRF) be a safe alternative to reduce the fibroid volume without interfering with subsequent RA treatment? Summary answer RFTV myolysis is a safe and effective alternative for the treatment of type 2-3 uterine fibroids < 4cm that compromise the endometrial cavity. What is known already The most common benign tumors among women who are in their reproductive years are uterine fibroids. Although most of them are not symptomatic, when they compromise the endometrial cavity, they can lead to reproductive problems. Type 2 and 3 fibroids that are smaller than 4 cm in diameter can cause compromise to the endometrial cavity and are difficult to remove through laparoscopy/hysteroscopy. Study design, size, duration The fibroid volume and % of reduction after 3 months were primary variables. All fibroids were examined with 2D/3D transvaginal ultrasonography to record nº of myomas, volume (the volume of an ellipsoid in cm3 = 4/3 (distance1xdistance2xdistance3), type of fibroid according to the FIGO. The secondary variables were mean procedure time, complications, and reproductive outcome after ART (pregnancy rate (PG), miscarriage Rate (MR), Live born rate (LBR) and obstetrics complications, and type of delivery way. Participants/materials, setting, methods We evaluated thirty-four patients between 2019-2023 with type 2-3 fibroids under 4 cm evaluated by 2D/3D ultrasound, confirming that they compromised the uterine cavity and with a complex surgical approach. Myolysis was carried out by TVRF Main results and the role of chance The average age of our patients was 42 years (range 37-50). In our patients, 52% had fibroids of type 3, and 48% had fibroids of type 2. According to FIGO classification. The average TVRF time for the patients was 4.17 minutes. The average volume was initially 21 cm3, but it decreased to 10 cm3 after one month, and finally dropped to 4.6 cm3 after three months. The volume reduction was >75% when evaluated three months after the TVRF. No complications were reported during the procedure except for mild pain that was controlled with oral analgesia in 21% of patients, and minimal bleeding. In eight patients, the fibroid was extruded towards the endometrial cavity and removed by hysteroscopy. Twenty four out of 34 patients (71%) underwent ART, at least 4 months after TVRF. The reproductive outcome was comparable to what was expected, with a 63% pregnancy rate, 17% miscarriage rate, and 50% ongoing pregnancy rate. Live birth rate was 46%, with 83% reaching term pregnancy, and 16% premature births at 36 and 34 weeks. The rate of cesarean section was 66%. Among the obstetric complications, only one case or IUGR was described Limitations, reasons for caution The main limitation of these data is retrospective analysis of the date and the small sample size, as this is the earliest date on the impact of TVRF on infertile patients. Wider implications of the findings TVRF myolysis is a safe and effective alternative for the infertile women with type 2-3 uterine fibroids < 4 cm that compromise the endometrial cavity that have a complex surgical approach by hysteroscopy/laparoscopy. It appears that TVRF has no impact on reproductive outcomes. Trial registration number not applicable

232 A Comparative Study Between Stapled Hemorrhoidopexy and Harmonic Scalpel Hemorrhoidectomy in Management of Third and Fourth-Degree Piles: A Randomized Clinical Trial

Abstract Aim This study compares the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of Grade III and Grade IV piles. Method The current study is a single-blind, prospective, randomized, controlled, single-center trial at Ain Shams University Hospitals. Results There were 70 patients in our study 35 patients in each group. Group(I) underwent stapled hemorrhoidopexy (SH) and Group (II) underwent harmonic scalpel hemorrhoidectomy (HSH). The mean time of the procedure in SH was 24.42 mins ± 2.367. While in HSH was 31.48 mins ± 2.21. Post-operative pain in SH showed to be less painful during the first two weeks. However, there is persistent mild pain in most of the patients of SH postoperative during and after two weeks. However, in HSH there was significant improvement in pain after two weeks. Wound infection was detected in 3(5%) patients in group (I) and no patients in group (II) (p=0.077). Postoperative bleeding occurred in 4(11.4%) patients in group (I), While no patients were detected in group (II) (p=0.039). there were 3(15%) cases of incontinence to gases only scored by Wexner score 3/20 in group (II). Recurrence in one-year follow-up occurred in 7 (20%) patients in group (I). While in group II 1(2.9%) patient was reported with recurrence (p=0.024). Conclusions HSH was determined to be safer, easier, and associated with a lower incidence of recurrence in one-year follow-up as compared to the SH technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of hemorrhoids.

Tolerance of radiotherapy with concomitant glofitamab in diffuse large Bcell lymphoma: acase report.

Glofitamab, an anti-CD20 antibody, is approved as a third-line treatment for relapsed or refractory (r/r) diffuse large-cell B lymphoma (DLBCL), achieving a complete response in nearly 40% of patients. This humanized IgG1 bispecific monoclonal antibody binds to CD20 on malignant B lymphocytes and to CD3 on cytotoxic T cells. This dual binding forms an immunological synapse, activating T lymphocytes and leading to the lysis of tumor cells. Salvage radiotherapy is also effective for r/r DLBCL, but its combination with systemic treatments like glofitamab may increase radiation-induced toxicity. We report the first case of a patient with r/r DLBCL receiving concurrent salvage radiotherapy and glofitamab. A 68-year-old female diagnosed with stage IV DLBCL underwent initial treatment with R-CHOP, then Car-T cell therapy, followed by glofitamab for recurrence. Upon early metabolic progression detected by 18FDG-PET/CT, salvage radiotherapy was administered to the refractory site concurrently with glofitamab. The patient experienced mild para-spinal pain post-radiotherapy but no other significant toxicities. Three months post-treatment, she showed a complete metabolic response with no radiotherapy toxicity, as evidenced by PET-CT, and no signs of radiation pneumonitis. This case indicates that combining glofitamab with salvage radiotherapy is tolerable and suggests potential efficacy, warranting further investigation in prospective studies for r/r DLBCL.

Clinical presentation and imaging findings in juvenile-onset back pain: a ten-year hospital-based retrospective analysis in Douala (Cameroon).

Studies exploring the clinical and imaging characteristics of juvenile-onset back pain (JOBP) are scarce. The purpose of this study was to assess the clinical presentation, imaging findings, and factors associated with JOBP. A retrospective record-based study was conducted among all pediatric cases presenting to the Rheumatology unit of the Douala General Hospital, Cameroon, from January 2014 to December 2023. The study did not include children whose back pain began after 16 years of age. Of the 216 records of patients under 18 examined, 67 children (31 girls) were diagnosed with JOBP. The median age was 15 [13-16] years. More than two-third of the children included in this study had chronic pain (n = 46; 68.65%). Pain was mild to moderate in intensity in 48 children (71.6%). Radiculopathy was present in 10 children (14.92%). The most common location of back pain was the lumbar region (n = 64; 95.52%). Some children experienced pain in more than one location. The location of the pain was not associated with gender, duration of the pain, radiculopathy, or practice of a competitive sport (p > 0.05). Musculoskeletal abnormalities on imaging were found in 38 children (62.29%). In multivariate analysis, peripheral joint involvement [aOR = 0.253 (0.073-0.878); p = 0.030] and mild pain intensity [aOR = 0.077 (0.014-0.422); p = 0.003], were independently associated with the presence of musculoskeletal abnormalities on imaging. JOBP affects a third of children and adolescents of our clinic population. The common musculoskeletal abnormalities found on spine imaging are disc diseases and scoliosis.

Effect of Phalatrikadi ghana vati in a patient of non-alcoholic fatty liver disease: a case report

Abstract A 39-year-old male patient presented with complaints of decreased appetite, generalized weakness, nausea, gastric distension of the abdomen on and off, and mild pain in the upper abdomen. Ultrasonography of the whole abdomen revealed hepatomegaly with grade II diffuse fatty infiltration of the liver or nonalcoholic fatty liver disease (NAFLD). Such disorders of the hepatobiliary system are categorized as Yakritroga in Ayurveda. A drug, Phalatrikadi ghana vati, which is a combination of eight herbs known to pacify and normalize the functions of the three doshas, was prescribed to the patient for 12 weeks along with lifestyle modifications (pathya ahara–vihara). The individual contents of this drug are known to possess hepatoprotective activity. The patient showed significant relief in subjective parameters Udarasula (pain in the abdomen), Utklesa (feeling of nausea and vomiting), Aruchi (loss of appetite), and Klama (fatigue). The elevated liver enzymes were also reported to be in the normal range after the treatment, along with improved fatty liver grading. This single case report of NAFLD was managed satisfactorily with significant improvement with no side effects.

Arthroscopic assisted foveal repair of triangular fibrocartilage complex injuries associated with distal radioulnar joint instability

Introduction Foveal tears of tfcc are common causes of ulnar sided wrist pain. They are usually associted with druj instability. Reattachment using either arthroscopic or open techniques is considered the best treatment in acute settings. This is a retrospective study to evaluate clinical and functional results of arthroscopic assisted technique. Patients and methods 20 patients were enrolled in the study. 13 males and 7 females. Mean age was 26 years. Technique involved arthroscopic reattachment of the tfcc to its foveal foot print using direct foveal portal as described by Atzei et al. Results The mean follow-up period was 14 months ranging from 8 to 20 months No pain was recorded in 13 patients, mild pain in 4 patients, and moderate pain in 3 patients. The mean VAS score was 3.2. The mean Mayo score was 70%. Conclusion Arthroscopic assisted technique using direct foveal portal is a valuable technique with good reproducible results.

Intervening in the Premonitory Phase to Prevent Migraine: Prospects for Pharmacotherapy.

Migraine is a common brain condition characterised by disabling attacks of headache with sensory sensitivities. Despite increasing understanding of migraine neurobiology and the impacts of this on therapeutic developments, there remains a need for treatment options for patients underserved by currently available therapies. The first specific drugs developed to treat migraine acutely, the serotonin-5-hydroxytryptamine [5-HT1B/1D] receptor agonists (triptans), seem to require headache onset in order to have an effect, while early treatment during mild pain before headache escalation improves short-term and long-term outcomes. Some patients find treating in the early window once headache has started but not escalated difficult, and migraine can arise from sleep or in the early hours of the morning, making prompt treatment after pain onset challenging. Triptans may be deemed unsuitable for use in patients with vascular disease and in those of older age and may not be effective in a proportion of patients. Headache is also increasingly recognised as being just one of the many facets of the migraine attack, and for some patients it is not the most disabling symptom. In many patients, painless symptoms can start prior to headache onset and can reliably warn of impending headache. There is, therefore, a need to identify therapeutic targets and agents that may be used as early as possible in the course of the attack, to prevent headache onset before it starts, and to reduce both headache and non-headache related attack burden. Early small studies using domperidone, naratriptan and dihydroergotamine have suggested that this approach could be useful; these studies were methodologically less rigorousthan modern day treatment studies, of small sample size, and have not sincebeen replicated. The emergence of novel targeted migraine treatments more recently, specifically calcitonin gene-related peptide (CGRP) receptor antagonists (gepants), has reignited interest in this strategy, with encouraging results. This review summarises historical and emerging data in this area, supporting use of the premonitory phase as an opportunity to intervene as early as possible in migraine to prevent attack-related morbidity.

Postoperative hyperglycemia among adult non-diabetic surgical patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundPostoperative hyperglycemia is associated with morbidity and mortality in non-diabetic surgical patients. However, there is limited information on the extent and factors associated with postoperative hyperglycemia. This study assessed the magnitude and associated factors of postoperative hyperglycemia among non-diabetic adult patients who underwent elective surgery at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 412 adult patients who underwent elective surgery at University of Gondar Comprehensive Specialized Hospital from April 14 to June 30, 2022 All consecutive postoperative non-diabetic elective surgical patients who were admitted to PACU during the data collection period and who fulfilled inclusion criteria were included in the study until the intended minimum sample size was achieved. And data were collected through interviews using a pretested semi-structured questionnaire. Postoperative hyperglycemia was defined as a blood glucose level of ≥ 140 mg/dl. Multivariable logistic regression was performed to identify the association between postoperative hyperglycemia and independent variables. Variables with a p-value less than 0.05 and a 95% confidence interval (CI) were considered statistically significant.ResultsA total of 405 patients’ data were evaluated with a response rate of 98.3%. The median (IQR) age was 40 (28-52) years. The prevalence of postoperative hyperglycemia was 34.1% (95% CI: 29.4–39.0). Factors significantly associated with postoperative hyperglycemia included being overweight (AOR = 5.45, 95% CI: 2.46-12.0), American Society of Anesthesiologists (ASA) classification II and III (AOR = 2.37, 95% CI: 1.17–4.79), postoperative low body temperature (AOR = 0.18, 95% CI: 0.069–0.48), blood loss ≥ 500 ml (AOR = 2.33, 95% CI: 1.27–4.27), long duration of surgery, mild pain (AOR = 5.17, 95% CI: 1.32–20.4), and moderate pain (AOR = 7.63, 95% CI: 1.811–32.20).Conclusion and recommendationOne-third of the study participants had postoperative hyperglycemia. Weight, ASA classification, postoperative body temperature, duration of surgery, intraoperative blood loss, and postoperative pain were identified as a modifiable risk factors. Maintaining normal body temperature throughout the procedure, treating postoperative pain, and monitoring and controlling blood glucose level in patients at risk of hyperglycemia is crucial.

Pain Detect as A Tool for The Screening of Neuropathic Pain in Patients with Diabetes Mellitus

Background: Diabetic neuropathy (DN) is a prevalent long-term complication of diabetes mellitus (DM), affecting more than 50% of patients. In addition, several studies also showed that distal symmetric polyneuropathy (DSPN) accounts for 75% of all DN cases. To facilitate the treatment of DN, painDETECT questionnaire, a self-reported tool with 85% sensitivity and 80% specificity, has been recommended for detecting neuropathic component in pain. Objective: This study aimed to promptly diagnose DN using painDETECT questionnaire in DM patients. Methods: The study procedures were carried out using a descriptive, cross-sectional design with 67 DM patients from Cibabat Regional Hospital Department of Internal Medicine outpatient clinic through consecutive sampling in October–November 2022. Primary data were obtained using the adapted and validated Indonesian painDETECT questionnaire. Results: Among the 67 patients, 32.9% experienced neuropathic pain with a score of 19–38, indicating the involvement of >90% of neuropathic pain components. Sensory deficits, such as numbness, burning sensation, pins-and-needles, and allodynia, were observed in 86.3%, 90.1%, and 72.7% of patients with neuropathic pain, respectively. In addition, a total of 59.7% of participants (n=40) reported the presence of mild pain (NRS 3). Conclusion: Based on the results, the majority of patients had complaints of neuropathic or mild pain (40 subjects; 59.7%). Among the 22 patients experiencing neuropathic pain, 54.5% reported mild intensity.

Ayurveda management of Savrana Shukla (superficial punctate keratitis): a case study

Abstract Savrana Shukla is one of the Krishnagata Rogas (corneal pathologies) mentioned in Ayurvedic texts. The Lakshanas of Savrana Shukla can be correlated with the clinical features of superficial punctate keratitis. Superficial punctate corneal keratitis is characterized by multiple, spotty lesions in the outermost layer of the cornea. A 30-year-old male approached the Shalakya Tantra outpatient department with complaints of foreign body sensation, mild pricking pain, redness, and watering of the left eye for 4 days. On history taking and slit lamp examination, it was revealed that the patient had superficial punctate keratitis due to trichiasis. Seka (pouring medicine on the closed eyes) and Vidalaka (application of medicated paste on the outer part of the eyes) were given as treatment for 5 days and epilation was done considering the cause (trichiasis). The subject had significant improvement for both subjective and objective parameters. The clinical features in this subject correspond to Prathama Patala Savrana Shukla Lakshanas (epithelium and Bowman’s membrane involvement) and are Sadhya (curable) according to Acharya Vagbhata. This case report highlights the efficacy of Kriyakalpa treatments in managing Savrana Shukla.

Comparison of Piezosurgery Devices and the Use of Rotatory Devices for the Extraction of Impacted Mandibular Third Molars

ABSTRACT The present study aimed to examine the extraction of impacted mandibular third molars by using rotatory and piezosurgery equipment. Twenty-five patients of both genders who required surgery to remove their third molars were split into two groups (control group and research group). In the surgical extraction of the impacted mandibular third molar, in the study group, a piezotome was used to remove the bone, while in the control group, a bur was used. Patients’ acceptance of bone cutting, the length of the operation, discomfort and bleeding during the procedure, postoperative pain, swelling, trismus, and wound healing were evaluated. A statistically insignificant difference was observed for age and difficulty index. The intraoperative bleeding was similar in both groups. Both the groups tolerated the bone cutting well, with slightly better values for the piezo group. Based on Pederson’s difficulty index, the scores of difficulty of extraction of the impacted tooth were measured between the groups. The slight difficulty was observed in 9 (36%) each in the study group and control group. The moderate difficulty in 14 (56%) of control group and 15 (60%) of study group. Severe difficulty was found among 2 (8%) in the control group and 1 (4%) in the study group. The difference was not significant (P > 0.05). Intraoral bleeding was moderately seen in 25 in both groups. Among the study and control groups respectively no intraoperative pain was seen in 14 and 16, mild intraoperative pain in 11 and 7, and moderate intraoperative pain in 0 and 2. Among group I and II acceptance to bone cutting was comfortably seen in 24 and 23, bearable in 1 and 2 respectively. The difference was not significant (P > 0.05). Piezosurgery and bur were comparable in evaluating patient acceptance, intraoperative duration, intraoperative bleeding and pain, postoperative pain, edema, trismus, and wound healing.

Resolution of extravascular hemolysis with oral iptacopan monotherapy in apatient with treatment experienced paroxysmal nocturnal hemoglobinuria (PNH).

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hematologic disorder characterized by aloss of glycosyl-phosphatidyl-inositol-linked (GPI) proteins on various hematopoietic cells. Some GPI proteins are involved in the regulation of the complement system, and their absence renders erythrocytes susceptible to complement-mediated lysis. Current standard of care in PNH is to block the complement system at the level of C5 using ravulizumab or eculizumab; however, some patients with PNH may develop extravascular hemolysis (EVH) during treatment with C5 inhibitors. The proximal complement inhibitor iptacopan has recently been shown to be efficacious in patients with PNH. This article reports on a43-year-old female patient with PNH who was successfully treated with iptacopan. The patient had received ravulizumab for several years and developed aclinically relevant EVH. After obtaining informed consent, the patient received oral iptacopan 200 mg twice daily and ravulizumab was discontinued. Over the next few weeks hemoglobin levels and reticulocyte counts normalized. The patient reported mild flushes with erythema, chills, and mild muscle pain, all of which resolved during follow-up. No breakthrough hemolysis occurred, and no severe adverse events were recorded.