Complaints Of Pain Research Articles

Abdominal Wall Reconstruction in Abdominal Wall Endometriosis: A Case Report and Literature Review

Abdominal wall endometriosis (AWE) is a rare condition representing 1% of patients operated for endometriosis. We describe a case of a 26-year-old woman, with a history of cesarean delivery, who presented with cyclical pain and a subcutaneous mass in the lower abdomen. Where most AWE lesions may be surgically managed by a single surgeon, imaging revealed an unusually large lesion (13x4x10cm) involving the rectus abdominis muscle. Plastic, gynecologic and general surgeons combined their expertise to conduct AWE excision combined with mini-abdominoplasty in a single procedure. After resection, a retrorectus mesh (Rives-Stoppa technique) reinforced the primarily closed posterior rectus sheath and an inlay mesh bridged the defect left in the anterior rectus sheath. The patient was discharged three days postoperatively, had minimal pain complaints and was satisfied with cosmetic results at one-month follow up. One year postoperatively, she gave uncomplicated vaginal birth. We conclude that, in select cases, management of a large, symptomatic AWE may benefit from a multidisciplinary approach, where symptom relief and an aesthetically pleasing result for the patient can be achieved in a single procedure. We distinctively describe double mesh repair as a viable consideration for reconstruction in AWE and review current considerations in mesh repair of the abdominal wall. Further studies into this topic are warranted.

Using Nonpharmacological Treatments in the Emergency Department to Treat Pain Complaints: A Literature Review

Pain management in the Emergency Department (ED) is crucial for humanitarian reasons and is associated with significant morbidity. Previously, pharmacologic therapies like acetaminophen, opioids, and NSAIDs were used, but they carry risks of side effects. Non-pharmacological interventions are often used in conjunction with pharmaceutical therapies to improve pain management and reduce opioid use. This study's purpose was to describe the non-pharmacological interventions that nurses can provide in addressing pain experienced by patients in the ED. This is a literature study from several databases such as Science Direct, ProQuest, SpringerLink, and PubMed using keywords combined with Boolean. The study's selection process involved searching 769 articles using keywords, excluding 27 duplicates and 712 articles not meeting research objectives. After a full-text review of 30 selected articles, 19 were excluded, and 11 were selected for inclusion. Acupuncture therapy is the most commonly used non-pharmacological therapy, followed by warm/cold compresses, distraction, and deep breath relaxation. Non-pharmacological therapies can be given to manage pain in patients in the ED. Combining pharmacological and non-pharmacological therapies can provide more analgesia for severe pain.

Studi Komparasi Sikap Kerja dengan Kejadian Low Back Pain Pada Perajin Rebana Desa Bungah Kecamatan Bungah Kabupaten Gresik

Musculoskeletal is a system that often experiences increased loads and injuries in every job, including tambourine craftsmen. Data shows that 95% of tambourine craftsmen experience musculoskeletal complaints, of which 55% occur in the lower back area, 20% in the right shoulder area, 15% in the left shoulder area and 10% experience cramps. Objective: This research is to analyze the comparison of work attitudes with the incidence of lower back pain in tambourine craftsmen in Bungah Village, Bungah District, Gresik Regency). Method: Cross sectional survey research design with observation. The population is all tambourine craftsmen in Bungah Village, Bungah District, Gresik Regency, totaling 150 people. Meanwhile, the sample size was 110 respondents taken using simple random sampling. The independent variables are sitting work attitude and standing work attitude, while the dependent variable is the incidence of low back pain. The instrument uses a closed questionnaire. Analysis uses the Chi-Square test with alpha 0.05. Results: Research shows that almost all of the working attitudes of tambourine craftsmen (83.6%) are ergonomic sitting working attitudes, while the majority (69.1%) are standing working attitudes with low risk. Almost all complaints of low back pain among tambourine crafters (79.1%) were not low back pain. The Chi-Square test results for the sitting work attitude have a p value = 0.000 < 0.05 with OR = 18.400, and for the standing work attitude the p value = 0.000 < 0.05 with OR = 3.091. Conclusion: There is a difference in work attitude regarding the incidence of low back pain in tambourine craftsmen with a sitting work attitude having a greater risk level than standing. Monotonous work positions should be avoided and stretching should be done so that muscles do not become stiff and symptoms of lower back pain can be avoided.

A case report of a foreign body in the urethra of an 18-year-old woman

Introduction : The presence of foreign bodies in the genitourinary system can be caused by self insertion, cases of sexual assault, or following trauma. Material and Methods: In this article, we present the details of the case of an eighteen-year-old unmarried woman who referred to the urology clinic due to complaints of suprapubic pain, dysuria and hematuria. Results : In the physical examination, a remarkable finding was the observation of a pencil tip inside the urethra. On ultrasound, a posterior shadow related to a foreign body was seen in the bladder, which extended towards the urethra. The patient underwent surgery and after opening the bladder, a 10 cm long pencil was seen with a stone of about 5 cm around it. Successful removal of this foreign body relieved the patient's symptoms. Conclusions :Overall, this case highlights the importance of early detection and intervention in cases of foreign bodies in the genitourinary tract. With the early detection of foreign bodies in the bladder, it is possible to prevent further damage due to infection or the formation of stones around it.

Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine.

To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.

Цервикалгия у пациентов с мигренью – коморбидная нозология или клинический аспект центральной сенситизации?

Relevance. The phenomenon of central sensitization occurs when physiological activity in nociceptive pathways increases and leads to abnormal sensitivity; it is defined as “increased sensitivity of nociceptive neurons of the central nervous system to their normal or subthreshold afferent input,” according to the definition provided by the International Association for the Study of Pain (IASP). The excitability of spinal cord neurons significantly modifies the gain of the somatosensory system. Chronic pain syndromes, anxiety-depressive disorder, sleep disorders are currently very common in the population, significantly reducing the quality of life of the population; the pathogenesis of these nosologies lies in central sensitization. Objective. To study the clinical manifestations of central sensitization in patients with episodic migraine associated with neck pain or cervicogenic headache. Materials and methods. The longitudinal prospective study included 180 patients, divided into 3 groups: 1) patients with a combination of migraine and cervicogenic headache – 60 people (study group); 2) patients with a combination of migraine and cervicalgia diagnoses – 60 people (control group); 3) patients diagnosed with migraine without complaints of pain and limitation of movements in the cervical spine – 60 people (additional group). Results. In patients with migraine and comorbid cervical headache, more pronounced central sensitization was revealed when compared with comorbid cervicalgia. Myofascial pain syndrome involving the trapezius and temporal muscles can resolve on its own with specific migraine therapy with monoclonal antibodies, however, to relieve tension and soreness in the masseter and inferior oblique muscles, the addition of therapeutic exercises and gentle manual techniques is more effective. Taking into account the identified direct relationships of moderate strength between the number of painful points of exit of the trigeminal nerve, the muscles of the pericranial region involved, as well as the effect of treatment of migraine attacks with monoclonal antibodies, it can be concluded that central sensitization is more pronounced when the masseter and inferior oblique muscles are involved. Conclusions. During examination of patients with migraine with comorbid active cervicalgic factor or even if it is absence, it is necessary to make a thorough examination of the facial and cranioverebral region muscles, even in the absence of patient complaints of pain in the face or neck, and also prescribe specific therapeutic exercises to increase the effectiveness of treatment. In all patients with migraine, regardless of chronicity, it is necessary to assess the intensity of central sensitization for timely and more complete provision of medical care.

Clinical characteristics, effectiveness and cost of different treatment methods for invasive Klebsiella pneumoniae liver abscess syndrome.

Bacterial liver abscess is one of the common infectious diseases of the digestive system. Invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS) refers to cases where, in addition to liver abscess, there are migratory infections foci or other invasive manifestations. The clinical characteristics and risk factors of IKLAS are not fully elucidated, and there is a lack of research on the effectiveness and cost-effectiveness of different treatment methods. This study aims to compare the clinical characteristics of patients with IKLAS and non-IKLAS, and explore effective and economical treatment methods. This retrospective study collected medical records of patients with Klebsiella pneumoniae liver abscess treated at Xiangya Hospital of Central South University from January 2010 to December 2023. A total of 201 patients were included, dividing into an IKLAS group (n=37) and a non-IKLAS group (n=164). Differences in demographics, symptoms and signs, laboratory indicators, imaging characteristics, comorbidities, treatment methods, treatment outcomes, and direct treatment costs between 2 groups were analyzed. The study also compared the effectiveness and costs of different treatment methods. Compared with the non-IKLAS group, the proportion of patients with diabetes, Quick Sequential Organ Failure Assessment (qSOFA)≥2, immune deficiency, anemia, and thrombocytopenia in the IKLAS group was higher, and the level of procalcitonin at the onset in the IKLAS group was also higher (all P<0.05). In terms of symptoms and signs, the IKLAS group had a higher proportion of visual abnormalities and a lower proportion of complaints of abdominal pain (both P<0.05). In terms of complications, the incidence of combined pleural effusion, pulmonary infection, acute renal failure, respiratory failure, and multiple organ failure was higher in the IKLAS group (all P<0.05). The IKLAS group had a higher proportion of patients treated with antibiotics alone (24.32% vs 11.59%), while the non-IKLAS group had a higher proportion of patients treated with antibiotics combined with puncture and drainage (86.59% vs 64.86%, both P<0.05). The overall effective rate of the IKLAS group (83.78%) was lower than that of the non-IKLAS group (95.73%), and the treatment and drug costs were higher (all P<0.05). The treatment method of antibiotics combined with surgical resection of infectious foci showed a 100% improvement rate, antibiotics combined with abscess puncture and drainage had an 84.9% improvement rate, and in antibiotics alone had an 82.1% improvement rate, with statistical differences among the 3 treatment methods (P<0.05). In terms of treatment costs, antibiotics alone were the most expensive (P<0.05). Patients with IKLAS have poorer prognosis and higher direct medical costs. The combination of abscess puncture and drainage or surgery has a higher improvement rate and lower hospitalization costs compared to antibiotics alone, suggesting that surgical intervention may reduce antibiotic costs and save medical expenses.

Musculoskeletal Disorders and Psychosocial Stress at Work: A Comprehensive Study on Indian Nurses

Background Nurses’ physical and mental well-being is crucial for prompt patient-care service. While research has been conducted on the specific causes of musculoskeletal disorders (MSDs) and occupational stress among Indian nurses, a comprehensive picture considering all these variables is still lacking. This study investigated MSD prevalence and psychosocial stress levels among female nurses in West Bengal, India, and the connections between these factors and MSDs. Methods The study was performed in nine different hospitals and nursing homes in West Bengal, India. The modified Nordic questionnaire and Copenhagen Psychosocial Questionnaire (COPSOQ) were used. The body height, body weight, BMI, pulse rate and blood pressure of the subjects were measured using an anthropometer, a weighing machine and a digital blood pressure monitor, respectively. Results 80.9% of subjects reported that they had discomfort in the past 12 months, with the highest percentage (52.1%) of complaints of low-back pain. From COPSOQ, concerning mean values were found in the demand scales and general health. The presence of different discomforts was found to be significantly related to various scales of COPSOQ. Conclusion Increased cognitive, quantitative and sensorial demands were found to be major contributors to the high prevalence of MSDs among nurses in this study. As the well-being of nurses is pivotal for maintaining well-ordered health systems, regular follow-ups on their physical and psychological health are necessary.

Evaluation of rheological properties of soft lining materials with different composition under various temperatures

PurposeThe aim of this in vitro study was to evaluate the changes the rheological properties of some soft lining materials, to compare the rheological properties and viscoelastic behaviour at different temperatures.Materials and methodsFive soft lining materials (acrylic and silicone based) were used. the storage modulus (G’), loss modulus (G”), tan delta (tan δ) and complex viscosity (η’) were chosen and for each material, measurements were repeated at 23, 33 and 37 °C, using an oscillating rheometer. All data were statistically analyzed using the Mann Whitney U test, Kruskal Wallis test and Conover’s Multiple Comparison test at the significance level of 0.05.ResultsSoft lining materials had different viscoelastic properties and most of the materials showed different rheological behavior at 23, 33 and 37 °C. At the end of the test (t¹5), at all the temperatures, Sofreliner Tough M had the highest storage modulus values while Visco Gel had the highest loss Tan delta values.ConclusionsThere were significant changes in the rheological parameters of all the materials. Also temperature affected the initial rheological properties, and polymerization reaction of all the materials, depending on temperature increase.Clinical implicationsTemperature affected the initial rheological properties, and polymerization reaction of soft denture liner materials, and clinical inferences should be drawn from such studies conducted. It can be recommended to utilize viscoelastic acrylic-based temporary soft lining materials with lower storage modulus, higher tan delta value, and high viscosity in situations where pain complaint persists and tissue stress is extremely significant, provided that they are replaced often.

Regenerative Endodontic Treatments for Immature Devital Permanent Molar Teeth: Four Case Reports

Objective: To apply regenerative endodontic treatment to immature permanent molar teeth devitalised due to dental caries and to follow the clinical and radiographic outcomes. Cases: Four patients presented to our university with complaints of pain. Radiological evaluations revealed profound dentinal caries, apical lesions, and open root tips. Clinical examinations yielded negative results on the electric pulp test (EPT) for all four teeth. Given the presence of immature necrotic teeth, the treatment for these cases was planned as regenerative endodontic treatment. This treatment was administered under local anaesthesia, following the protocol recommended by the American Endodontic Association. Results: Over a follow-up period of 10 to 15 months, certain patients exhibited a reduction in periapical lesions and completion of root formation. However, root development persisted in other patients. Conclusion: Follow-up and observations indicate that regenerative endodontic treatment is an effective alternative for the management of immature permanent molar teeth.

Older age and risk for delayed abdominal pain care in the emergency department.

Suboptimal acute pain care has been previously reported to be associated with demographic characteristics. The aim of this study was to assess a healthcare system's multi-facility database of emergency attendances for abdominal pain, to assess for an association between demographics (age, sex, and ethnicity) and two endpoints: time delay to initial analgesia (primary endpoint) and selection of an opioid as the initial analgesic (secondary endpoint). This retrospective observational study assessed four consecutive months' visits by adults (≥18 years) with a chief complaint of abdominal pain, in a UK National Health Service Trust's emergency department (ED). Data collected included demographics, pain scores, and analgesia variables. Categorical data were described with proportions and binomial exact 95% confidence intervals (CIs). Continuous data were described using median (with 95% CIs) and interquartile range (IQR). Multivariable associations between demographics and endpoints were executed with quantile median regression (National Health Service primary endpoint) and logistic regression (secondary endpoint). In 4231 patients, 1457 (34.4%) receiving analgesia had a median time to initial analgesia of 110 min (95% CI, 104-120, IQR, 55-229). The univariate assessment identified only one demographic variable, age decade (P = 0.0001), associated with the time to initial analgesia. Association between age and time to initial analgesia persisted in multivariable analysis adjusting for initial pain score, facility type, and time of presentation; for each decade increase the time to initial analgesia was linearly prolonged by 6.9 min (95% CI, 1.9-11.9; P = 0.007). In univariable assessment, time to initial analgesia was not associated with either detailed ethnicity (14 categories, P = 0.109) or four-category ethnicity (P = 0.138); in multivariable analysis ethnicity remained non-significant as either 14-category (all ethnicities' P ≥ 0.085) or four-category (all P ≥ 0.138). No demographic or operational variables were associated with the secondary endpoint; opioid initial choice was associated only with pain score (P= 0.003). In a consecutive series of patients with abdominal pain, advancing age was the only demographic variable associated with prolonged time to initial analgesia. Older patients were found to have a linearly increasing, age-dependent risk for prolonged wait for pain care.

The usage and weight of backpacks are associated with shoulder pain complaints among elementary students

Background: In recent years, backpack use has drastically increased, especially among elementary school students. This has led to an increase in musculoskeletal complaints, such as shoulder pain, due to the duration of use and the weight of the backpacks. This study investigated the correlation between the duration of use and the weight of backpacks on shoulder pain complaints in grades IV-VI elementary school students. Methods: This study employed an analytical observational research design with a cross-sectional study design. The inclusion criteria for this study were students aged 10-12 years old, using backpacks with shoulder straps, walking to and from school. In contrast, the exclusion criteria were injuries in the shoulder region. The sampling technique employed in this study was probability sampling, specifically simple random sampling. The research was conducted at Islamic Elementary School 1 and 2 in Karangasem, Bali. The sample size was calculated using the Lameshow formula, resulting in 106 samples. Results: Based on bivariate analysis using Pearson’s Correlation Coefficient (r), the p-value obtained was 0.000 (p&lt; 0.05) for both independent variables, with correlation coefficients of r = 0.570 for the duration of use variable and r = 0.709 for the backpack weight variable. Based on multivariate analysis using Multiple Linear Regression in the F-test or simultaneous test, the p-value obtained was 0.000 (p &lt; 0.05). Conclusion: Based on the research results, it can be concluded that there was a correlation between the duration of use and the backpack's weight on shoulder pain complaints, both partially and simultaneously.

Effects of Manual Therapy in Management of Diastasis Recti - A Case Study

ABSTRACT: Background: The patient was a 32 years old postpartum female with complaint of back pain which was radiating to abdominal area, she was functional limitations and abdominal muscle weakness. Methods and Measures: patient was treated 8 sessions over a period of 4 weeks. Study: Case study Intervention: Intervention included KT for rectus abdominis muscle and PF strengthening exercises to stabilize and strengthen the weakened muscles and to reduce IRD. Results: Following treatment, the patient demonstrated in an increase in functional ability and resolution of functional limitations. Statistical analysis of the data showed significant differences from pre to post intervention from session 1 to session 8. There was clinical and statistical significance found in PFS and IRD. Conclusion: Findings suggest that KT and PF strengthening exercises are more effective in reducing IRD and improving function in patient with Diastasis Recti Key words: Inter-Recti Distance(IRD), Rectus Abdominis (RA), Rectus Diastasis (RD), Diastasis Recti Abdominis(DRA), Ultrasound (Usd), Kinesio taping (KT), Physical Function Scale (PFS),Pelvic Floor (PF), Rate of Perceived Exertion (RPE), Linea Alba (LA).

Sex and Age Differences in Atypical Chief Complaints for Acute Decompensated Heart Failure in Emergency Department Visits.

Around one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms. Characterizing ED symptom presentation of ADHF patients may improve clinical care, yet sex and age differences in ED chief complaints have not been thoroughly investigated. This paper aims to describe differences in chief complaints and comorbid conditions for ED patients with a ADHF diagnosis, stratified by sex and age. Retrospective analysis of adults presenting to North Carolina EDs in NC DETECT, a statewide syndromic surveillance system, between 2010 and 2016 with a diagnosis of ADHF. Frequencies of chief complaint categories for ED visits and comorbid conditions, stratified by sex and age, were evaluated and standardized differences computed. Top chief complaints were dyspnea (19.1%), chest pain (13.5%), and other respiratory complaints (13.4%). In the 18-44 age group, females when compared to males reported more nausea/vomiting (6.7% versus 4.1%) and headache (4.2% versus 2.0%). In those 45-64 and 65+ years old, complaints were similar by sex. When stratified by age group alone, the 18-44 and 45-64 age groups had more complaints of chest pain, whereas balance issues, weakness, and confusion were more common in the 65+ age group. Sex and age differences in atypical ADHF symptoms were seen in in ED patients with ADHF. Characterizing variation of ADHF symptoms in ED patients can inform the identification of ED patients with ADHF and the management of ADHF-related symptoms.

Physical therapy in the Emergency Department: A prospective cohort study from an Alternatives to Opioids program.

Musculoskeletal pain complaints are common in the emergency department (ED). The objective of this study was to determine the impact of physical therapy (PT) in the ED on pain and ED return. A prospective cohort study was performed with those presenting to the ED or Urgent Care at a single academic center for musculoskeletal pain between November 2020 and December 2022. All patients were referred to outpatient PT. During business hours, PT was available to begin treatment in the ED. Long-term follow-up was performed using the electronic health records. Statistical analyses included descriptive and non-parametric pairwise comparisons, Fisher's exact test, and multiple logistic regression. A total of 974 patients were included in the study with 553 completing optional surveys. Back pain was most common. Pain was reduced at ED discharge for all patients, but pain was significantly improved if patients saw PT in the ED. Patients in the ED were less likely to keep their outpatient PT appointments than others, but importantly, patients who saw PT in the ED were less likely to return to the ED for the same complaint up to 1 year later. Those who kept PT appointments were likely to establish or maintain healthcare outside emergency services later. Initiating PT in this ED reduces pain at ED discharge. However, patients who utilized PT were more likely to later utilize health care resources outside of emergency services. Those who saw PT in this ED were less likely to return to the ED for the same complaint up to 1 year later.

Quadricuspid pulmonary valve: A rare cause of pulmonary artery aneurysm.

A 17-year-old male presented to our hospital from an external center with complaints of chest pain and shortness of breath, referred with preliminary diagnoses of pulmonary stenosis and pulmonary artery dilation. Echocardiography revealed moderate pulmonary regurgitation and mild pulmonary stenosis. Coronary computed tomography (CT) angiography showed normal coronary arteries and no presence of a patent ductus arteriosus, but an aneurysmal dilation of up to 4 cm was observed in the pulmonary artery. The patient was found to have a quadricuspid (QPV) pulmonary valve, while the aortic valve appeared normal. No phenotypic anomalies or accompanying aortic or lung abnormalities were detected in this case. Our case represents the first in the pediatric age group diagnosed via CT scan. Our study contributes insights into the relationship between QPV anomaly and pulmonary artery aneurysm, aiding in the diagnosis and management of these rare conditions. Furthermore, our findings highlight the importance of evaluating the possibility of QPV in patients with pulmonary valve stenosis, regurgitation, or artery aneurysm, emphasizing the significance of coronary CT angiography in the diagnostic process.

The influence of patient sex on paramedic administration of analgesia for acute abdominal pain in an Australian ambulance service

Objective: Pain is a subjective experience that encapsulates a physical, emotional, and mental response. An individual's sex is a factor that may influence how pain is experienced. It can be assumed that if females and males present with pain differently, then pain management may also differ. This research aimed to determine the influence of patients’ sex on paramedic administration of analgesia in cases of acute abdominal pain. Methods: A retrospective analytical cohort study included patients between the ages of 16 and 65 with a complaint of abdominal pain who were seen by paramedics employed by a jurisdictional ambulance service between July 2019 and June 2020. The data extracted included sex, age, pain score, type of analgesia administered, and analgesia dosage. The data were analysed using descriptive statistics, chi-square tests, and univariate and multivariate logistic regression. Results: The study sample comprised of 26,417 patients with 61.6% (n = 16,271) females. Analgesia was administered to 65.9% (n = 17,404) of patients, of whom 38.5% (n = 10,177) received an opioid, with the most administered analgesia being morphine (n = 8456; 32%). Chi-square testing identified significant associations between sex and analgesic administration (χ2(1, n = 26,417) = 7.32, p = .01, Φ = −0.02) and opioid administration (χ2(1, n = 26,417) = 25.51, p &lt; .001, Φ = 0.03). Multivariate regression identified that sex had no influence on analgesic administration in general, however found that male sex was a statistically significant predictor of opioid administration. Adjusted for age and pain severity, females were at lower odds of opioid administration than males (adjusted odds ratio 0.86; 95% confidence interval 0.80–0.91; p &lt; .001). Conclusions: Equity in pain management was demonstrated in relation to overall analgesic administration between the sexes. However, this research suggests that while females presented more commonly with abdominal pain, females had lower odds of being administered an opioid than their male counterparts. Further research is required on gender bias in relation to abdominal pain management practices by paramedics, to promote equitable access to analgesia.

A rare case of congenital right lobar segmental hepatic hypoplasia complicated by portal hypertension: a radiologic perspective

Abstract Background Segmental hypoplasia of liver is an infrequently encountered congenital anomaly which is clinically indolent and detected incidentally on cross sectional imaging or abdominal surgery which can have a myriad of surgical and medical implications. The unique radiological manifestations and associated complications makes it a diagnostically challenging entity. Case presentation We report a case of a middle-aged female presenting with complaints of non-specific abdominal pain for two years in which we reported the presence of segmental hypoplasia of right lobe complicated by development of portal hypertension incidentally detected on ultrasound examination which was followed up and confirmed on cross sectional imaging. Conclusions In this case report, we present a unique instance of congenital segmental hypoplasia of the liver, highlighting the intricacies of its radiological presentation, potential clinical implications, and the challenges associated with its diagnosis. By examining this rare anomaly, we aim to contribute to the growing body of knowledge surrounding hepatic developmental disorders, fostering a deeper understanding of the clinical spectrum, and facilitating improved patient care through enhanced diagnostic awareness.

Catastrophic implantable cardioverter-defibrillator misclassification of ventricular tachycardia

Inappropriate therapy is a frequent adverse consequence of implantable cardioverter-defibrillator. Inappropriate therapy often occurs due to the misinterpretation of sinus tachycardia or atrial fibrillation/flutter with rapid atrioventricular conduction by the device. Current implantable cardioverter-defibrillator (ICD) mechanisms integrate various discriminators into algorithms to differentiate supraventricular tachycardia (SVT) from ventricular tachycardia (VT), to prevent such occurrences. A 40-year-old man suffered seizures and cardiac arrest abruptly, without prior complaints of chest pain. Without delay, he initiated cardiopulmonary resuscitation (CPR), resulting in the regaining of spontaneous circulation. The patient had previously received a single-chamber ICD due to recurring VT and a prior episode of cardiac arrest. The patient had a medical background of coronary artery disease with complete revascularisation and no previous occurrence of SVT. Interrogating the ICD revealed captured non-sustained ventricular tachycardia (NSVT) and SVT events but no VT episode or shock therapy. During the specified time period, the patient underwent an electrophysiological study, and no SVT was induced with the normal function of the atrioventricular and sinoatrial nodes. Various causes can lead to errors in morphology discrimination criteria in single-chamber ICDs. Extending the detection interval is highly recommended to avoid misclassification of ICDs.

Delayed Hypoparathyroidism Following Thyroidectomy

Abstract Hypoparathyroidism is the most common complication following total thyroidectomy, occurring in 7.6% following anterior neck surgeries. The majority (19%–38%) of postoperative hypoparathyroidism is transient, resolving within 6 months, and permanent hypoparathyroidism is observed in 1.5% after total thyroidectomy, increasing to 6.4% in patients undergoing total thyroidectomy with prophylactic neck dissection. A 26-year-old Indian married woman, a mother of a 6-month-old baby currently lactating, presented with complaints of multiple joint pains and fever of 3-day duration with a history of thyroidectomy 8 years back and developed symptoms of hypocalcemia during the hospital stay. Evaluation revealed hypoparathyroidism. The nonspecific nature of hypocalcemic symptoms and lack of continuous follow-up for a long time after thyroidectomy could contribute to a delay in the diagnosis of hypoparathyroidism. However, it is an important diagnosis to consider in any patient with a history of neck surgery.