Complaints Of Pain Research Articles

Spontaneous hemoperitoneum in a 29‐week pregnancy with a history of endometriosis: A case report and review of the literature

AbstractSpontaneous hemoperitoneum in pregnancy (SHIP) is defined as sudden, nontraumatic intraperitoneal bleeding that occurs during pregnancy or up to 42 days postpartum. The incidence ranges between 4 and 4.9 per 100 000 births. Although seen rarely, it is associated with perinatal morbidity and mortality due to maternal hemodynamic instability. Endometriosis was shown to be present in 71% of SHIP cases. A 30‐year‐old primigravid woman with a spontaneous conception, at 29 weeks of gestation, presented to our obstetrics and gynecology emergency department with complaints of abdominal and back pain. In terms of her medical history, a laparoscopic cystectomy was performed in August 2022 due to a 90 mm × 50 mm endometrioma in the right ovary. However, deep endometriosis and adenomyosis were not observed. After decelerations appeared on the non‐stress test, the repeat hemoglobin values dropped to 7.2 g/dL, with blood pressure at 70/50 mm Hg and a pulse rate of 95/min. The decision was made for laparotomy and emergency delivery of the baby. It is crucial to consider SHIP, especially in pregnant patients with a history of endometriosis surgery. Managing such high‐risk cases in specialized centers and easily identifying predisposing factors for SHIP can lead to improved outcomes, despite its rarity and poor prognosis.

Paralabral cyst in cricketers – A case series

Objectives: Paralabral cysts of the shoulder are rare, and it is usually associated with labral tears. Repetitive stress on the labrum due to increased training history in cricketers can cause micro-tear of the labrum. These tears commonly occur during the early cocking phase in cricketers. These longstanding micro-tears usually form paralabral cysts where the tear operates as a one-way valve. It is fairly common in cricketers who had a longer duration of training and playing history. These cysts are commonly seen in posterior-superior labral tears and SLAP tears. Materials and Methods: Data were obtained from a total of 12 cricketers between the period of March 2022 and July 2023. All these athletes mostly came with complaints of chronic shoulder pain, and the diagnosis was confirmed with magnetic resonance imaging. All these patients were treated by arthroscopic cyst decompression with labral repair. A rehabilitation regimen was administered postoperatively to improve the functional ability of the shoulder and help the athlete to return-to-play. QuickDASH score was performed 12 months postoperatively to assess the effectiveness of the surgical outcome. Results: All the patients reported remission of pain and showed improvement in their QuickDASH scores compared to the pre-operative period. A properly supervised rehabilitation regimen helped the athlete to return to sport. Conclusion: Early diagnosis of paralabral cysts helps in preventing neurological compromise and quicker return-to-play in cricketers. Arthroscopic cyst decompression with labral repair, along with a criteria-based rehabilitation program helps in improving the functional outcome of the athlete.

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

Interventional Pain Management in Degenerative Spine Disorders: A Case Report

Low back pain (LBP) is a common health issue affecting a significant portion of the population, particularly adults aged 35-55 years. Nearly 70-80% of individuals in developed countries experience LBP at some point in their lives. We reported a 54-year-old female presenting with LBP persisting for one year. Her pain predominantly occurs during walking, is limited to 100 meters, and is characterized by gripping sensations in the thigh and calf, exacerbated by positional changes but relieved with rest. Imaging revealed anterior listhesis of the L4 vertebral body relative to L5 (<25%) and multiple bulging discs at various lumbar levels, most notably severe at L4-5 with moderate central and severe bilateral neural foraminal stenosis. The patient underwent Selective Nerve Root Block (SNRB) and facet joint blocks with local anesthetic and steroid medication, resulting in a reduction of pain complaints and decreased leg numbness post-intervention. Understanding and addressing specific spinal pathologies in this case was expected to guide effective treatment strategies to alleviate symptoms and improve patient function.

Giant Cell Tumor of Capitate with Secondary Aneurysmal Bone Cyst: A Case Report

Abstract Background Giant cell tumors (GCTs) of the carpal bones are rare. GCTs of the hand tend to be aggressive, could result in multifocal presentation, and have a high rate of recurrence. Case Description We report a rare case of GCT of the capitate with secondary aneurysmal bone cyst (ABC) in a 40-year-old man. The patient presented with complaints of pain and swelling over his right wrist since 6 months. Radiographs showed the presence of a lytic lesion in the capitate. Magnetic resonance imaging scanning revealed a well-defined, lobulated, multiseptate lytic lesion involving the entire capitate, extending into its subarticular regions. Fine-needle aspiration revealed findings suggestive of a GCT. He underwent en-bloc excision of the capitate, bone grafting of the defect using an appropriately sized bicortical iliac crest autograft, and third carpometacarpal and midcarpal fusion. Histopathological examination of the lesion confirmed the presence of a GCT, with a secondary ABC. At 3 years following surgery, he was asymptomatic with no signs of tumor recurrence, radiocarpal arthritis, or instability. He was able to perform 45 and 60 degrees of wrist extension and flexion, respectively. Literature Review To our knowledge, there are no prior reported cases of GCT of the capitate with a secondary ABC. Clinical Relevance GCTs of the hand in general have a high rate of recurrence. The presence of a super-added ABC could further increase this risk. In the authors' opinion, en-bloc excision of the affected bone, reconstruction of the defect, and appropriate fusion is the optimal mode of management of these cases.

Dengue Fever in Pregnant Women with a Favorable Outcome

Dengue fever is a viral infectious disease, it manifests itself from mild to severe severity, in some cases to fatal outcomes. The number of cases of dengue fever has been increasing in recent years. The results of many studies have also shown adverse effects on pregnant infected women. This article describes the clinical course of Dengue fever in pregnant women, which occurred in moderate severity and without complications. Dengue fever in a pregnant woman manifested itself in the form of complaints of pain in the epigastric region, bleeding gums and petechial hemorrhages within 1 day. She had a high fever for 5 days before going to the hospital. Upon admission, her body temperature was 37 °C, blood pressure was 110/80 mmHg, pulse rate was 80 beats per minute, respiratory rate was 20 beats per minute. She had mild dehydration, normal breathing and heartbeat. The height of the bottom corresponds to the gestation period of 31 weeks, and the fetal heart rate was 144 beats per minute. Petechiae measuring at least 1-2 m in diameter were found around her face, forearms and both basal areas. In a laboratory study, the results showed changes in the number of platelets in the form of thrombocytopenia, leukocytopenia and in the biochemical analysis of blood by increasing the concentration of C-reactive protein and the detection of antibodies in serum during serological analysis. Although many studies have shown that Dengue during pregnancy increases the risk of preeclampsia, hemorrhagic dengue fever (HLD), fetal distress, premature birth, cesarean section and maternal mortality and intrauterine development delay and stillbirth consequences. This clinical case concludes with favorable outcomes. But the physiological effects of dengue fever during pregnancy (for both mother and child), depending on the trimester, as well as research and treatment methods require further study, especially in the region of endemic zones and India.

A National Study on the Association of Abdominal Ultrasound with CT Utilization and Disposition in the Emergency Department

Background Ultrasound and CT imaging have distinct and overlapping roles in the assessment of undifferentiated abdominal pain in the emergency department (ED). CT imaging is the gold standard for many pathologies, ranging from bowel obstruction to aortic pathology whereas ultrasound benefits from less radiation exposure and the ability to employ at bedside. In this pilot study, we utilize nationally representative data to identify associations between ultrasound use in ED patients with a primary complaint of abdominal pain with abdominal CT imaging use and disposition. Methods We analyzed retrospective, cross-sectional data on ED patient visits obtained from the National Hospital Ambulatory Medical Care Survey from 2016-2020. This dataset utilizes a weighed multistage, probability sample of ED patient visits involving a four-stage sampling design, including data at county-level geographic regions, hospitals within these regions, emergency service areas in these hospitals, and patient visit records. The study population includes adult patient ED visits with an age of 18 and up presenting with a primary complaint of atraumatic abdominal pain. Descriptive statistics was utilized to describe the sample population. Survey-weighted multivariate logistic regression analysis with calculated odds ratios evaluated for differences between the binary dependent variable of abdominal pain visits with versus without ultrasound use with independent variables of disposition and abdominal CT imaging use while controlling for visit acuity and adjusting for demographic information. Results A total of 7563 patient visits met inclusion criteria, representing approximately 60 million patient visits from 2016-2020. In this study population, 18.5% of visits involved ultrasound, whereas 39.8% of visits involved CT imaging use. 14.6% of visits resulted in hospital admission. On weight-adjusted regression analysis, visits involving ultrasound were less likely to require CT imaging and more likely to be admitted, with ORs of 0.49 (95% CI: 0.37, 0.64) and 1.97 (95% CI: 1.44, 2.68), respectively. Visits involving ultrasound were more likely to be associated with an emergency medicine residency program and an emergent acuity level, with ORs of 1.40 (95% CI: 1.01, 1.94) and 1.53 (95% CI: 1.01, 2.31), respectively. Conclusion In this national pilot study, abdominal pain visits involving ultrasound were associated with a lower likelihood of CT imaging use and a highly likelihood admission and an emergent acuity level.

K wire migration into spinal canal: An infrequent cause of neurological morbidity: A case report

Introduction: K wire is one of the most common implants used for fixation of acromioclavicular joint dislocation. The migration of K wire from the AC joint to the spinal canal is a rare occurrence. In this report, we present a case of a young adult who presented with weakness of left upper limb secondary to migration of K wire from the AC joint to the spinal canal. Case presentation: A 46-year-old male farmer presented with complaints of pain in the neck, tingling sensation in the left upper limb, and a tender palpable swelling on the left side of his neck with weakness of finger flexors and abductors. He had had an open reduction and fixation with K wire for Acromioclavicular dislocation three months back. CT confirmed the K wire passing through neural foramen between C5 and C6 vertebra and extending across the entire diameter of spinal canal. Under intravenous anesthesia, a transverse skin incision was made over the prominent swelling on the neck and the wire was gently removed. Minimal seepage of spinal fluid was observed which stopped on its own after few days. Discussion: Although AC joint stabilization by K wire fixation provides a safe and easy fixation with low morbidity, complications such as a loss of fixation or loosening can occur. Migration of K wire into a spinal canal is a well-known but infrequent complication. Resorption of bone, muscle action, and negative intrathoracic pressures associated with respiration and heat necrosis causes progressive loosening and dislodgement. Spinal migration is very dangerous because it can cause serious damage to the dura mater, spinal cord, and vertebral artery. Conclusion: Early identification and removal of the K wire, once it has migrated from the site of use, is mandatory to prevent its grievous complications.

A Rare Presentation of Acute Suppurative Thyroiditis.

A previously healthy 17-year-old female patient initially presented with symptoms of anterior neck pain. After multiple emergency department visits, she was found to have unilateral enlargement of her thyroid gland. Laboratory studies were consistent with hyperthyroidism. Symptoms were initially attributed to subacute thyroiditis, and she was discharged with steroids and propranolol. She presented again 1 week later with complaints of nausea, vomiting, abdominal pain, and shortness of breath. She was readmitted and developed sepsis with multiorgan system infection and Lemierre syndrome. Further imaging revealed acute suppurative thyroiditis as the likely source. Direct laryngoscopy and bronchoscopy revealed ulceration of the anterior esophageal wall, a fistulous tract to the thyroid, and copious purulent drainage. Esophageal biopsies with immunostaining established a diagnosis of herpes simplex virus esophagitis as the likely cause of esophageal perforation, fistula development, and acute suppurative thyroiditis.

065. Ileoileal Small Bowel Intussusception in Adult

Background: Intestinal Intussusception is invagination of a proximal segment of the gastrointestinal tract into the distal. In adults, ileoileal intussusception is a rare case and diagnostically challenging. We present four cases of ileoileal small bowel intussusception in adults. Case: a 19-year-old man with complaint of abdominal pain. An exploratory laparotomy was performed, an ileoileal invagination was found. Second case : a 29-year-old woman with complaint of not being able to defecate or flatus. An ileal dilatation up to 240 cm from the ligament of treitz and ileoileal invagination with an ileal tumor was found in exploratory laparotomy. Third case : a 51-year-old man with complaint of difficulty defecating since 1 day before admission. A 30 cm long ileoileal invagination and tumor in the invaginated ileum was found. Fourth case : a 77-year-old man with a difficulty in defecating. A dilatation of the bowel starting from jejunum-ileum and a 20 cm long invagination was found. Conclusion: Clinical presentation of bowel obstruction is helpful to diagnose adult ileoileal small bowel intussusception. The mainstay of treatment is surgical intervention.

Musculoskeletal disorders and quality of life of artisanal fishermen from riverside localities in the Brazilian Amazon.

Artisanal fishing is widely practiced in the Amazon region. However, the exhaustive labor demand impacts on the health of fishermen. Thus, this study aimed to evaluate the prevalence of musculoskeletal disorders (MSDs) and the relationship with the quality of life (QoL) of artisanal fishermen. A cross-sectional study was carried out, evaluating male fishermen from two rural communities bordering Janauacá lake, Amazonas. Data were collected through interviews, using REDCap installed on smartphones. The Nordic Musculoskeletal Questionnaire was utilized to identify the body regions with the greatest pain complaints, and QoL was assessed using the mental and physical components of the SF-12. After the descriptive analysis, linear regression analysis was performed to evaluate the association between the occurrence of MSDs and the components of QoL. The analyses were performed using Stata SE software, version 17. In total, 115 fishermen were evaluated. MSDs were reported in all of the body regions assessed, with a higher prevalence in the lower (80.0%) and upper (43.5%) back, and knee (40.9%). Lower QoL scores were observed in emotional performance (20.7 ± 4.0), physical performance (25.1 ± 4.3), and mental health (29.0 ± 13.6). It was observed that individuals with any MSD presented worse QoL in the physical component (βadj=-5.0; 95%CI=-9.7; -0.3). The findings showed a high prevalence of MSDs in the study population, as well as its impact on the QoL of artisanal fishermen. This highlights the need to reorganize health services to prevent the occurrence of MSDs, as well as for their treatment and rehabilitation.

Clinical Improvement of Patients With Complications of Exfoliativa Dermatitis: A Case Report

Exfoliative dermatitis or erythroderma is a severe skin inflammatory syndrome, characterized by erythema and desquamation more than 90% of the body surface area. Previous study shown erythroderma incidence was 83 people in 2011 to 2014. Incidence of erythroderma in Portugal 9.4 cases per year, with the predominance age of 41 to 61 years. The most common etiology of erythroderma is psoriasis and dermatitis. A woman Mrs. T, 55 years old, came to emergency room Rajawali Citra General Hospital Bantul on 5 September 2023 with complaints of abdominal pain, frequent vomit, cough and itchy and dry skin on the face, upper limbs and lower limbs. Patient has erythroderma medical history since a year ago. On dermatological examination, the facial showed patch erythema with scales on left suprasilia and nasales, the upper and lower limbs showed xerotic. This patient was diagnosed with erythroderma with improvements. Patient was treated with Loratadine 10 mg tablets once a day orally and Desoximethasone oint twice a day. Erythroderma treatment depends on its underlying disease. The main therapy is using petrolatum, emollient or low-potency topical steroid to maintaince skin barrier function and reduce inflammatory. Antihistamines can be used to relieve pruritus and as antianxiety agent. A well combination drugs therapy shows clinical improvement on erythroderma performance.

The effectiveness of intramuscular dry needling stimulation in treating trigger points: A case series

Myofascial trigger points are a common presentation in clients with chronic spinal pain. Various techniques are used to manage trigger points and are considered a vital part of chronic spinal pain management. Reducing pain caused by trigger points may be effective in improving function. Case series can provide preliminary evidence and assist in feasibility assessment. The objective of this case series is to document the feasibility of intramuscular dry needling stimulation in managing trigger-point-induced chronic pain. Three individuals aged 35, 33, and 28 years presented to a private clinic with chief complaints of scapular region muscular pain, and their management is reported in this case series. Initial physical examination revealed tenderness over D6 and D8. There was a palpable para spinal muscle hypertonicity and reduced thoracic spine mobility to both sides in all the three clients. The presence of multiple trigger points bilateral to the spine indicated postural dysfunction, which altered pain on changing thoracic posture. Clients were treated with dry needling with intramuscular stimulation over trigger points, paraspinal muscle and inferior to scapula by a therapist trained in the technique. The frequency was kept at 1.5 Hz and intensity was as tolerated by the patient. Outcome measures were taken using VAS, RMDQ and digital inclinometer for thoracic spine rotation. Subject one reported a change of 22 mm in VAS after the first week and 40 mm in the fourth week. It also reported an improvement in mobility to both side rotations by 20 degrees in the first week and full towards the fourth week. Subject two and three improved VAS by 10 mm in week one and 35 mm towards the fourth week. Full mobility was achieved in the fourth week in both cases. RMDQ scores improved significantly in the three cases. The three cases demonstrate significant improvement in both symptoms and function based on outcome measures. This indicates the efficacy of treating thoracic spine myofascial trigger points with dry needling and intramuscular stimulation, but a large-scale study is recommended.

Suppurative Flexor Tenosynovitis: A Case Report

Background: Suppurative flexor tenosynovitis is an infection of the flexor tendon sheath. This case report presents the clinical course and management of a patient diagnosed with suppurative flexor tenosynovitis. The diagnosis is based on history taking, physical examination, and supporting examination findings. Case Report: A 42-year-old man presented with chief complaints of pain, swelling, and immobility of the index finger of his right hand after being pierced by a fish spine 3 days prior. Physical examination revealed the second digit in a slightly flexed and swollen position, with pain elicited on palpation and passive extension, limiting the patient's range of motion. The patient was diagnosed with suppurative flexor tenosynovitis and treated with antibiotics, debridement, and drainage. Postoperative results were good, with no signs of complications such as spread of infection, tendon necrosis, osteomyelitis, or indications for amputation.Discussion: The treatment for suppurative flexor tenosynovitis involves a combination of antibiotics and surgery. Surgical interventions typically include open drainage and debridement or closed catheter irrigation. Additionally, postoperative rehabilitation is a crucial aspect that requires careful consideration, as it has been shown to accelerate the healing process.Conclusion: Suppurative flexor tenosynovitis is a rare but serious condition that demands early detection and a multidisciplinary approach. Timely surgical debridement and targeted antibiotics, guided by the identification of the causative organism, are essential for positive patient outcomes.

Tuberculous meningitis in an intravenous drug user: A case report

Tubercle bacilli can cause tuberculous meningitis by hematogenous spread from a primary focus. A 49-year-old foreign national male patient was admitted to the emergency department with complaints of joint pains, fever, cough and malaise. He was diagnosed with a viral upper respiratory tract infection and discharged after treatment was organised. The patient was admitted again the next day with the complaint of inability to urinate, and suprapubic tenderness was also present on physical examination. The patient's laboratory values, different from the previous day, were determined as WBC:16000/µL CRP:115 mg/L, and he was discharged again after oral treatment. On his 3rd admission to the emergency department, he had complaints of weakness and numbness in the legs and spasm in the neck. It was learned that the patient had a history of intravenous substance use. Following the tests, the patient was initially diagnosed with atypical meningitis and was taken to the intensive care unit. As a result of advanced examinations performed here, the patient was diagnosed with tuberculous meningitis and treated. Patients who experience repeated hospitalisations and exhibit abnormal neurological symptoms should have a thorough physical examination, deeper anamnesis, and considered in the diagnosis that takes uncommon illnesses like atypical meningitis into account.

017. Etiology of Acute Appendicitis in Paediatric Patients: A Literature Review

Background: Appendicitis is a disease that can occur at any age. The incidence of appendicitis is 1.66 per 1000 children annually. 1-8% of patients who enter the paediatric emergency room with complaints of acute abdominal pain were acute appendicitis patients, and often requires surgery. The etiology and pathogenesis of appendicitis remains unclear despite the treatment of acute appendicitis is patent, some literature says that the etiology of appendicitis was multifactorial. Methods: A literature search was conducted using online database sites namely Cochrane, PubMed, EMBASE, and Proquest. Results: Literature searches on Cochrane, PubMed, EMBASE, and ProQuest database sites obtained 2,719 articles, 30 articles met the criteria. Among them, the etiology of acute appendicitis in paediatric patients was caused by obstruction of the appendiceal lumen because of appendiceal intraluminal fecalith, lymphoid hyperplasia, viral or bacterial infection, parasites, foreign bodies and tumors. Conclusion: The etiology of acute appendicitis in paediatric patients was caused by obstruction of the appendiceal lumen, most of the obstruction was caused by lymphoid hyperplasia whether accompanied by the presence of appendiceal intraluminal fecalith or not. Other etiologies such as obstruction due to parasites, foreign bodies and tumors.

Perforated Meckel’s Diverticulum: A Case Report

Meckel’s diverticulum is a true diverticulum that consists of all layers of bowel normally found in a normal small bowel wall. The three most common presentations in children are intestinal bleeding (30–56%), intestinal obstruction (14–42%), and diverticular inflammation (6–14%). Complications result in more severe symptoms, such as acute abdomen and signs of peritonitis. These presentations are not specific to Meckel’s diverticulum and can be found in many other conditions, making the diagnosis difficult. A five-year-old child came to the emergency department with complaint of acute abdominal pain, especially in the right lower quadrant. The pain was accompanied by vomiting. On physical examination, patient was febrile and signs of peritonitis were found. Abdominal plain film revealed the probability of focal inflammation in the right lower region of the abdomen, with partial intestinal obstruction. Ultrasonography showed a presence of a mass in right iliac region with the size of 24x20x23 mm, with normal appendix. During exploratory laparotomy, a necrotic and perforated Meckel’s diverticulum was found, with associated purulent matter. Diverticulectomy with segmental resection of ileum followed by end-to-end anastomosis were done. Diagnosis of Meckel’s diverticulum requires a high index of suspicion, especially in the pediatric population. It is important for clinicians to be aware of unusual presentations of Meckel’s diverticulum.

Coping Mechanisms among Women Who Experience Dysmenorrhea in Baleasri Village, Magetan, Indonesia

Background: Dysmenorrhea (menstrual pain) is often experienced by women of childbearing age. The main complaint is abdominal pain that spreads from the lower back to the thighs. The pain complaint results in disruption of daily activities. The purpose of the study was to identify the description of type of coping, and coping mechanisms in women who experience dysmenorrhea. Methods: The type of research used was descriptive exploratory with a population of 252 women of childbearing age who experienced dysmenorrhea. The sample size of this study was 152 women (Krejci & Morgan table). The independent variable is dysmenorrhea, and the dependent variable is the type and coping mechanisms. The instrument for identifying the type, and coping mechanisms used a questionnaire. Data on women of childbearing age who experienced dysmenorrhea were obtained from secondary data from the Village Midwife's records. Data collection techniques used questionnaires and secondary data observations. Data analysis was carried out descriptively, in the form of frequency distribution percentages and prevalence ratios. Results: The results showed that women who experienced dysmenorrhea tended to use adaptive coping. The most frequently used coping mechanism was problem-focused coping. Women who work and are active in sports are risk factors that can reduce dysmenorrhea. Adolescent age, secondary education, age of menarche less than 12 years, and menstrual periods more than 7 days are triggers for dysmenorrhea. Conclusion: regular exercise and work are positive coping mechanisms that can reduce dysmenorrhea.

The Relationship Between Age, Gender, Workload, and Complaints of Low Back Pain (LBP) among Emergency Room Nurses

Low Back Pain (LBP) is Pain felt in the lower back area, can be local pain or radicular pain or both. Risk factors for low back pain (LBP) include age, gender and workload. This study aims to determine the relationship between age, gender and workload with complaints of Low Back Pain (LBP) in nurses in the emergency department of RSUD Banten in 2022. This type of correlation research uses a cross-sectional study approach. The population in this study were all ER nurses at Banten Regional Hospital as many as 65 nurses. The number of samples was determined by a total sampling technique of 65 respondents. The results showed 33 (50.8%) nurses had mild LBP complaints, 35 (53.8%) nurses aged < 30 years, 40 (61.5%) female nurses and 38 (58.5%) nurses had a light workload. The results of the analysis showed that there was a relationship between age and complaints of LBP (P value 0.004), gender with complaints of LBP (P value 0.002) and workload with complaints of LBP (P value 0.000). It is expected that the Banten Regional Hospital will observe and treat nurses who have LBP complaints.

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.