Search Results (24,818)

Large bowel evisceration is a rare but morbid presentation that requires timely diagnosis and management.We present the case of a 67-year-old woman with a history of recurrent pelvic organ prolapse (notably with a history of prior hysterectomy, mesh-augmented sacrocolpopexy, and transvaginal Uphold™ mesh placement). She presented with the subjective report of subacute worsening of her prolapse leading to urinary retention managed with a Foley catheter and an irreducible vaginal mass prompting evaluation. Clinical evaluation revealed bowel contents in the vagina with subsequent initiation of intravenous antibiotics, diagnostic laparoscopy converted to exploratory laparotomy, and resection of sigmoid and upper rectum with creation of left ileal end colostomy. Common risk factors for bowel evisceration include older age, postmenopausal status, history of pelvic surgery, and pessary use. In a patient with subacute worsening of prolapse and pain with the above risk factors, bowel evisceration should be considered and ruled out. Full article

This clinical case report explores the use of an erector spinae plane (ESP) block to provide perioperative analgesia in a rabbit undergoing spinal decompression surgery. A 6-year-old, 2 kg, spayed, female mixed-breed rabbit presented with acute-onset paraplegia secondary to intervertebral disc extrusion and compressive myelopathy at the L2–L3 disc space. Following neurologic examination and diagnostic evaluation, the patient underwent decompressive surgery at the L2–L3 level. An ultrasound-guided ESP block was performed at the L3 level, with 0.4 mL/kg of ropivacaine 0.5% administered bilaterally. The technique successfully provided intraoperative analgesia and maintained stable hemodynamics without complications. Postoperatively, the rabbit showed a smooth recovery with no need for opioid analgesia. The use of the ESP block was effective in reducing perioperative pain and opioid requirements, highlighting its potential role in multimodal analgesia in rabbits. Further studies are warranted to confirm the safety and efficacy of ESP blocks in this species. Full article

Background and Objectives: Research examining the difference between the effects of deep and superficial dry needling on myofascial trigger points (MTrPs) in the upper trapezius muscle is limited. Thus, this systematic review was conducted to compare the effects of these two dry needling techniques on pain and functional disability in adults with neck pain who demonstrated MTrPs. Materials and Methods: Randomised clinical trials (RCTs) were identified through an electronic search in PubMed, Scopus, Web of Science, Embase, Google Scholar, Dimensions and OpenAlex from inception until 22 September 2024. Only English-language studies were considered. Best-evidence synthesis was utilised to interpret the results of the included RCTs. Results: Of the 192 records obtained, 8 RCTs were included (2 with a low risk of bias, 4 with some risk-of-bias concerns and 2 with a high risk of bias). Overall, both deep and superficial dry needling provided short-term alleviation of pain and functional disability. No clinically meaningful differences were found between the two dry needling techniques. Conclusions: Deep and superficial dry needling seem to have similar positive effects on pain and functional disability in patients with neck pain exhibiting MTrPs. Full article

Chronic diseases, with their long-term pain and suffering, are the main cause of disability and death. In this case, social support is related to better health outcomes for patients with such diseases. This study aims to investigate the relationship between social support and health quality of life for patients with chronic diseases. It is conducted on 100 patients diagnosed with chronic diseases at Assiut University Hospital in Upper-Egypt through hospital records from January 2025 to April 2025. Data are collected using the Social Support and Health Quality of Life Questionnaire and analyzed using SPSS version 17. Participants state that the most common type of social support is emotional support, with an average of (2.32), followed by material support, with an average of (2.31), and finally informational support, with an average of (2.29). The results of this study show a statistically significant relationship between social support and quality of life among patients with chronic diseases. Thus, patients who receive greater social support experienced improved health-related quality of life through increased adherence to treatment, the adoption of health-promoting behaviors, and the adoption of healthy lifestyles that positively influence their quality of life. Full article

Background/Objectives: The aim of this study is to analyze the frequency and type of subjective adverse events reported after the use of oxytocin and carbetocin in women giving birth by cesarean section. Methods: A total of 70 pregnant women, previously scheduled for elective cesarean section, were enrolled in this study and divided into two groups. One group (OXY) received intrapartum oxytocin at a dose of 5 IU intravenously, and the other group (CARBE) received intrapartum carbetocin at a dose of 100 μg intravenously. Both drugs were used alternately to contract the uterus immediately after the expulsion of baby during the cesarean section. Results: An analysis of reported subjective adverse symptoms associated with the administration of uterotonic drugs showed a higher incidence of adverse effects in the group of women receiving oxytocin compared to those receiving carbetocin. Statistical significance was observed for all of the following reported symptoms: headache, chest pain, burning sensation and heaviness in the chest, and palpitations. Conclusions: Although chest pain, burning and heaviness in the chest, palpitations, and headaches are more common in women giving birth by cesarean section after administration of oxytocin than after administration of carbetocin, this fact appears to be of limited clinical significance from a clinical point of view. Full article

Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses. Full article

Background and Clinical Significance: Fetus papyraceus is a term describing fetal findings associated with miscarriage, wherein the fetus is not expelled, remains in the uterine cavity, and is compressed by neighboring structures, with an inability for fetal resorption due to advanced pregnancy. Case Presentation: Herein, we present the case of a 33-year-old primigravida with two previous presentations to our institution due to emotional stress without evidence of physical abuse, the last one being at the 14th week of pregnancy. The latest presentation was with complaints of intermittent lower abdominal pain and an outpatient gynecology consultation describing fetal demise, with fetal parameters corresponding to demise in the 15th to 16th week of gestation. Pregnancy termination was performed with the specimen sent for pathology, revealing fragmented placental parts, which, on section, were firm, with greyish areas and notable calcification, fragments of an umbilical cord appeared normal, and a significantly compressed fetus, which was flattened in the anteroposterior aspect with significant compressive deformation of the limbs—fetus papyraceus characteristics. Histology of the placental fragments revealed fibrin thrombi in large blood vessels, intense fibrosis of the villi with focal fibrin extravasation, and focal necrosis and inflammation, as well as extensive calcium deposits. Conclusions: Fetus papyraceus is a rare complication of intrauterine demise and fetal compression, which can vary in its degree of presenting severity and requires the co-occurrence of specific conditions. The condition is rarely associated with singleton pregnancies. Full article

Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease that entails high costs, progressive disability, and reduced quality of life (QoL). Telerehabilitation (TR), supported by new technologies, is emerging as an alternative or complement to in-person rehabilitation, potentially lowering socioeconomic impact and improving QoL. Aim: The objective of this study was to evaluate the effect of TR on the QoL of people with MS compared with in-person rehabilitation or no intervention. Materials and methods: A systematic review of randomized clinical trials was conducted (March–May 2025) following PRISMA guidelines. Searches were run in the PubMed-Medline, EMBASE, PEDro, Web of Science, and Dialnet databases. Methodological quality was assessed with the CASP scale, risk of bias with the Risk of Bias 2 tool, and evidence level and grade of recommendation with the Oxford Classification. The protocol was registered in PROSPERO (CRD420251110353). Results: Of the 151 articles initially found, 12 RCTs (598 total patients) met the inclusion criteria. Interventions included (a) four studies employing video-controlled exercise (one involving Pilates to improve fitness, another involving exercise to improve fatigue and general health, and two using exercises focused on the pelvic floor muscles); (b) three studies using a monitoring app to improve manual dexterity, symptom control, and increased physical activity; (c) two studies implementing an augmented reality system to treat cognitive deficits and sexual disorders, respectively; (d) one platform with a virtual reality headset for motor and cognitive training; (e) one study focusing on video-controlled motor imagery, along with the use of a pain management app; (f) a final study addressing cognitive training and pain reduction. Studies used eight different scales to assess QoL, finding similar improvements between groups in eight of the trials and statistically significant improvements in favor of TR in four. The included trials were of good methodological quality, with a moderate-to-low risk of bias and good levels of evidence and grades of recommendation. Conclusions: TR was more effective in improving the QoL of people with MS than no intervention, was as effective as in-person treatment in patients with EDSS ≤ 6, and appeared to be more effective than in-person intervention in patients with EDSS between 5.5 and 7.5 in terms of QoL. It may also eliminate some common barriers to accessing such treatments. Full article

Despite growing interest in humanized childbirth practices, there is still little qualitative research exploring women’s perspectives on vocalization during labor. The present study aims to analyze women’s experiences with the use of vocalization in the first and second stages of labor. A descriptive and exploratory qualitative study was conducted using semi-structured interviews with 16 women in the postpartum period between February and April 2024. Participants were recruited by convenience sampling, and data saturation was achieved when no new themes emerged from the interviews. Thematic analysis was performed using IRaMuTeQ (version 0.8 alpha 7) software. The textual corpus generated allowed classification into five thematic categories: Vocalization as an instinctive expression in natural childbirth; Functionality of vocalization during labor; Medicalized childbirth and natural childbirth; Fears during childbirth and their contributing factors; Typology of vocalization in labor. We conclude that many women reported that vocalization during labor is instinctive and functional, providing pain relief, but also serving as a means of communication, empowering women. Its expression can be strongly influenced by sociocultural, emotional, and contextual factors in each woman’s particular sphere. These findings, although limited to a specific population, suggest that healthcare professionals should consider vocalization as an individualized support tool, taking cultural differences into account. Full article

Lumbosacral radiculopathy is a frequent cause of lumbosacral pain in both dogs and humans. Targeted lumbosacral foraminal perineural injections (commonly referred to as transforaminal epidural injections) are described in dogs and are widely used in medicine to treat lumbosacral radicular pain. This cadaveric study evaluated the injectate distribution achieved by lumbosacral foraminal injections using a combined ultrasound- and fluoroscopy-guided technique to position the tip of the needle at the cranial aspect of the foramen. Ten injections were performed in five dog cadavers using a contrast-dye mixture, and distribution was assessed by fluoroscopy, CT imaging, and anatomical dissections. Perineural epidural staining of L7 at the foraminal region was achieved in 90% of injections, with transforaminal epidural spread medial to the intervertebral foramen in 80% of injections. Subarachnoid spread occurred in 50–60%, while vascular uptake was uncommon (10–20%). The technique enabled consistent needle placement, even when nerve visualisation was limited. These findings indicate that the method can reliably achieve perineural epidural staining of L7 while minimising vascular uptake, supporting its potential clinical utility for targeted drug delivery in dogs with lumbosacral radiculopathy. Further research is needed to validate safety and efficacy in live patients. Full article

Intervertebral disc degeneration is a leading contributor to chronic back pain and disability worldwide. This review comprehensively explores the complex interplay of cellular, molecular, and biomechanical alterations within the disc microenvironment that underlie intervertebral disc degeneration pathophysiology. Emphasis is placed on extracellular matrix degradation, cellular senescence, inflammation, oxidative stress, angiogenesis, and multiple forms of programmed cell death including apoptosis, pyroptosis, and ferroptosis. An in-depth analysis of key signaling pathways and regulatory molecules illustrates how these processes disrupt homeostasis and drive disease progression. Additionally, the review highlights emerging therapeutic approaches aimed at modifying the disc microenvironment, including mesenchymal and notochordal cell-based therapies, senolytics, ferroptosis inhibitors, gene therapy, and biomaterial innovations such as hydrogels, scaffolds, and nanocarriers. These strategies target degenerative cascades at the molecular level and represent a shift toward regenerative and disease-modifying interventions. While several approaches show promise in preclinical and early clinical studies, challenges related to safety, delivery, and long-term efficacy remain. This review underscores the importance of integrating molecular insights with translational innovations to develop targeted therapies for intervertebral disc degeneration and guide future research efforts. Full article

Background: Early hematoma expansion is a major determinant of poor outcomes after spontaneous intracerebral hemorrhage (ICH). Identifying reliable predictors of hematoma expansion may facilitate risk stratification and timely interventions. This study aimed to evaluate clinical, laboratory, and radiological factors associated with early hematoma expansion within 24 h. Methods: We retrospectively analyzed consecutive patients with spontaneous ICH admitted to a tertiary hospital in Korea between 2009 and 2021. Inclusion criteria were aged ≥ 18 years, primary spontaneous ICH, baseline non-contrast CT (NCCT), and follow-up CT within 24 h. Clinical, laboratory, and medication histories were collected, and NCCT/CT angiography (CTA) imaging markers (spot sign, blend sign, hypodensity, swirl sign, black hole sign, island sign, mean hematoma density) were evaluated. Early hematoma expansion was defined as an absolute volume increase ≥6 cm³ or a relative increase ≥33% on follow-up CT. Multivariate logistic regression identified independent predictors. Results: Among 899 screened patients, 581 met inclusion criteria (mean age 61.6 years; 59.7% male). Seventy-eight patients (13.4%) experienced early hematoma expansion. Independent predictors included CTA spot sign (adjusted OR 9.001, 95% CI 4.414–18.354), blend sign (OR 3.054, 95% CI 1.349–6.910), mean hematoma density <60 HU (OR 2.432, 95% CI 1.271–4.655), male sex (OR 2.902, 95% CI 1.419–5.935), and statin use (OR 2.990, 95% CI 1.149–7.782). Prior antiplatelet therapy was associated with a reduced risk of hematoma expansion (OR 0.118, 95% CI 0.014–0.981). Conclusions: Early hematoma expansion occurred in 13.4% of patients and was predicted by a combination of CTA and NCCT markers, as well as clinical and pharmacological factors. Spot sign remained the strongest predictor, while NCCT features such as blend sign and low hematoma density also provided practical prognostic value. These findings underscore the multifactorial pathophysiology of ICH expansion and highlight the importance of integrating imaging, clinical, and therapeutic variables into prediction models to improve early risk stratification and guide targeted interventions. Full article

Pronator teres syndrome is a rare proximal median neuropathy caused by compression of the median nerve at various points. It is a rare condition, and many times it is mistaken for carpal tunnel syndrome. There are many authors who refer to the pronator syndrome as a compression of the median nerve at several potential sites of entrapment in the region of the antecubital fossa, more proximal compression at the Ligament of Strutters, and more distally, including lacerus fibrosus within the pronator teres muscle and the anterior interosseous nerve. The diagnostic difficulties in a patient with severe right forearm pain during elbow flexion and pronation are presented. Routine test results, including MRI of the right elbow joint, nerve conduction study of the brachial plexus and ulnar nerve, and electromyographic study of the muscles of the right upper extremity, were normal. Ultrasonography showed an enlarged pronator teres muscle. The patient underwent surgical removal of the lacertus fibrosus. All symptoms resolved. Full article

Background/Objectives: Lipedema is a chronic, progressive disorder of the adipo-fascial tissue characterized by abnormal subcutaneous fat accumulation, inflammation, fibrosis, pain, and edema. Despite its considerable impact on patients’ quality of life, it remains underdiagnosed. Recent studies have suggested a potential overlap between lipedema and hypermobility spectrum disorders (HSDs), both involving connective tissue dysfunction. This work explores the shared pathophysiological features of lipedema and HSD, highlighting clinical correlations, comorbidities, and the need for integrated diagnostic and therapeutic approaches. Methods: A cross-sectional observational study was conducted through an online survey targeting individuals with lipedema and a control group with lymphedema. The questionnaire assessed symptoms typically associated with HSD, including musculoskeletal, gastrointestinal, urogynecological, vascular, and neuropsychological manifestations. Descriptive statistics were used to evaluate clinical patterns in both groups. Results: Among the lipedema patients, 44% reported joint hypermobility and 60% recalled being hypermobile during childhood. High rates of pediatric overweight (50%), low muscle tone (55%), and exercise-induced fatigue (70%) were observed. Adult symptoms included joint pain (notably in the ankles, knees, cervical spine, sacrum, and feet), digestive issues (50%), and thyroid disorders (24.4%). Compared with the control group, patients with lipedema showed significantly more connective tissue-related motor deficits and systemic symptoms. Conclusions: Connective tissue laxity may play a critical role in the pathogenesis of lipedema, contributing to multisystemic manifestations through vascular, lymphatic, gastrointestinal, and musculoskeletal involvement. The high prevalence of HSD-like features calls for a paradigm shift in the understanding of lipedema as a systemic disorder. Early identification of connective tissue alterations, especially in children with familial predisposition, could enable timely interventions, potentially mitigating disease progression. A multidisciplinary, evidence-based approach is essential for accurate diagnosis and effective management. Full article

Objectives: The aim of this study was to review the importance of peritoneal fluid steroid hormone concentrations to understand the mechanism of hormonal medical treatment of endometriosis-associated pain. Design: The study included a PubMed search and a pilot trial in 8 adolescents. Results: Oral contraceptives (OCs) were designed to inhibit ovulation in all women, and doses are much higher than the mean ovulation-inhibiting dose. Therefore, in most women, half a dose and in some women, even less is sufficient to inhibit ovulation. The inhibition of ovarian function and ovulation decreases estrogen and progesterone concentrations in plasma and peritoneal fluid. Surprisingly, the effect on peritoneal fluid steroid hormone concentrations has not been considered to explain the impact on endometriosis-associated pain. The lowering of the high estrogen concentrations in peritoneal fluid is sufficient to explain the pain decrease in superficial and ovarian endometriosis. A direct progesterone effect is unlikely, given the high progesterone concentrations in the peritoneal fluid of ovulatory women. In 8 adolescents, half an OC dose resulted in an apparently similar pain relief as a full dose (personal observation). Conclusions: The decrease in ovarian and superficial pelvic endometriosis-associated pain with OCs can be explained by lowering the intra-ovarian and the high estrogen concentrations in peritoneal fluid after ovulation. A direct progesterone effect is unlikely. Since OCs are severely overdosed in most women, half a dose is sufficient in most with fewer side effects, permitting individualization of therapy in women not requiring contraception. Understanding peritoneal fluid also explains that hormone replacement therapy is not contraindicated in most women with a history of endometriosis. Since the mechanisms of medical therapy of endometriosis-associated pain and the prevention of progression might be different, the growth of lesions must be monitored during treatment. Full article