Search Results (6,306)

Background: Thoracic paravertebral catheters are increasingly used in neonates to avoid neuraxial techniques during thoracoscopic tracheoesophageal fistula (TEF) repair. Catheter fracture and retention are exceedingly rare in this population, and optimal management remains undefined. Learning Objectives: Recognize this complication risk in neonatal paravertebral placement; identify appropriate imaging when retention is suspected; discuss conservative and surgical approaches; and understand the importance of early transparent communication with caregivers. Case: A 2-day-old term neonate weighing 2.90 kg underwent thoracoscopic repair of type C tracheoesophageal fistula with intraoperative placement of an ultrasound-guided right paravertebral catheter for continuous analgesia. The catheter was placed at the T5 vertebral level using a 20 G, 2-inch Tuohy needle with an in-plane lateral-to-medial approach. Saline hydrodissection was used to confirm entry into the paravertebral space. A 24 G radiopaque Perifix One catheter was initially inserted but proved difficult to advance. During attempted removal, some resistance was encountered, and both the needle and catheter were withdrawn together. Subsequent inspection suggested possible catheter shortening, raising concern for a retained fragment. A second catheter of size 20 G advanced via an 18 G needle was then successfully placed at the same level and was removed without complications on postoperative day 3. Comparison with an intact reference catheter revealed that the first-placed 24 G catheter was approximately 1.5 cm shorter, although the tip appeared intact. The pain physician promptly notified both the clinical teams and the family. One month later, during routine imaging for respiratory distress, a curvilinear opacity was noted at the T9 vertebral level. Dedicated thoracic spine films confirmed a 7 mm retained paravertebral catheter fragment. Multidisciplinary consensus (pain team, anesthesia, NICU, and surgery) determined that the fragment was small, non-metallic, and remote from critical structures. Conservative management with long-term follow-up was chosen. The family was informed early during initial suspicion and again upon confirmation. At 17-month follow-up, the child remained asymptomatic. Discussion: Retained catheter fragments are rare in pediatric regional anesthesia and may be radiographically occult early. In neonates, re-operation for a tiny, inert foreign body may cause more morbidity than observation. Prevention depends on appropriate equipment selection, catheter integrity checks pre- and post-placement, careful technique, and attention to resistance or difficulty during advancement or removal. Clear and timely communication with caregivers preserves trust when complications or iatrogenic uncertainty arise. Conclusions: In this neonate, a small retained paravertebral catheter fragment was identified incidentally and was safely managed with conservative observation. When such fragments are non-metallic, stable, and located away from critical structures, non-operative management with close follow-up may be an appropriate and safe approach. Full article

Background and Objectives: The aging process impacts physical function and quality of life, often exacerbated by chronic conditions such as low back pain. This pilot study explored the feasibility and preliminary outcomes of a 12-week machine-based Classical Pilates program on quality of life and low back pain in older adults. Materials and Methods: An exploratory mixed-methods approach was used. The quantitative phase included 13 participants (Mage = 64.76 ± 4.71) to evaluate quality of life. All 13 participants were assessed for low back pain and quality of life, and 4 females participated in a focus group for a qualitative analysis of perceived benefits. The intervention consisted of two individual sessions per week. Results: Preliminary quantitative analysis revealed an increase in the physical domain of quality of life (p < 0.05). There was a reduction in pain intensity and global pain values (p < 0.05). Qualitative data provided context for these preliminary findings, with participants reporting perceived improvements in mobility, body awareness, pain management, and sleep quality, alongside notable psychosocial benefits. Conclusions: Preliminary findings suggest that a 12-week individual machine-based Pilates program is feasible and may be associated with improvements in the physical domain of quality of life and perceived low back pain in active older adults. Due to the complete absence of a control group and the very small sample size, it is impossible to isolate the intervention’s efficacy from natural progression or placebo effects. Consequently, these results are strictly exploratory and hypothesis-generating. The mixed-methods approach highlights that individualized machine-based Pilates may provide self-reported psychosocial and daily living benefits, supporting the need for future well-powered randomized controlled trials. Full article

Background and Clinical Significance: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Among its various etiologies, uterine atony accounts for approximately 70% of cases, while other causes include genital tract trauma, pathologic placentation, and intrapelvic arterial injury. Uterine artery embolization (UAE) has emerged as a preferred management option for severe PPH due to its high success rates of 89–98% and fertility preservation benefit. Despite its efficacy, UAE can lead to complications, such as pain, re-bleeding, infection, persistent vaginal discharge, ovarian insufficiency, and uterine necrosis—a rare but serious complication occurring in 1.4–2.7% of cases. Case Presentation: We present three cases of uterine necrosis following UAE from a single center (CHA Bundang Medical Center) between 2003 and 2024. All patients developed persistent high-grade fever approximately two weeks after the procedure, despite an initial response to antibiotic therapy. Imaging studies, including contrast-enhanced CT and MRI, revealed uterine ischemia and necrosis, and all patients ultimately required total hysterectomy. Conclusions: Uterine necrosis is a rare but potentially life-threatening complication of UAE that should be suspected in patients with persistent high-grade fever beyond the typical post-procedural course. Early imaging evaluation, particularly with contrast-enhanced modalities, is essential for prompt diagnosis. Timely surgical intervention, including hysterectomy, may be required to prevent severe morbidity. Full article

In Uganda, in 2019, 6.8 million people experienced health conditions that are amenable to rehabilitation. This is largely due to musculoskeletal disorders such as low back pain (LBP). Measuring effective coverage of rehabilitation means assessing whether a population that needs rehabilitation services receives the interventions with sufficient quality to produce the desired health gain. This study reports on the first measurement of effective coverage of rehabilitation in Uganda and globally using chronic primary LBP as the tracer health condition. A population survey was conducted to administer the WHO global tracer indicator questions. The survey questions were used to identify respondents with chronic primary LBP experiencing limitations in functioning and to determine utilization of rehabilitation services. The WHO Disability Assessment Schedule (WHODAS) 2.0 12-item was used for the measurement of an improvement in functioning that is meaningful to service users. The questions were nested in the Iganga–Mayuge Health and Demographic Surveillance Site (IMHDSS) update round 22 in seven sub-counties in rural Eastern Uganda between June and September 2023. Data collection followed a training session on survey administration and data capture for enumerators, field supervisors, research managers and lead scientists from the Makerere University Centre for Health and Population Research and a pilot testing of the data collection tool. Survey administration resulted in data collection for 8645 respondents aged 18 years and above. Specifically, 15.2% of the respondents had experienced chronic LBP in the last 12 months, of which 88.5% had experienced pain that was severe enough to affect their usual household, recreational or work activities. A total of 46% of this population in need of rehabilitation had been utilizing rehabilitation services (crude coverage), with no difference between women and men. Only 7.05% of the respondents with chronic primary low back pain experiencing limitations in functioning had been managed with sufficient quality to produce the desired health gain, defined by a minimal but meaningful improvement in functioning (effective coverage). Full article

Background: Acute compartment syndrome (ACS) is a limb-threatening surgical emergency most commonly associated with fractures or high-energy trauma. Non-fracture-related ACS in athletes is uncommon and may lead to delayed diagnosis. Repetitive blunt trauma during combat sports has rarely been described as a potential mechanism. Case Methods: The case concerns a 21-year-old elite-level kickboxing athlete who developed acute compartment syndrome of the left lower leg following repeated calf kicks sustained during sparring. The patient presented with rapidly progressive calf pain, swelling, compartment firmness, paresthesias and weight bearing difficulties. CT angiography demonstrated diffuse edema of the posterior compartments associated with a large intramuscular soleus hematoma without active arterial bleeding. Results: In view of the severity of the symptoms and the characteristic clinical presentation, an emergency fasciotomy was performed in operating room. Progressive closure was achieved using the vessel loop shoelace technique, allowing gradual tension-free closure. Wound healing progressed without infection, and physiotherapy was introduced with joint mobilization. The patient achieved full functional recovery after 6 months. Conclusions: This case illustrates an atypical etiology of ACS—repetitive targeted calf strikes—and underscores the importance of early recognition even in the absence of fracture or major trauma. Clinical vigilance remains paramount, and prompt surgical intervention is critical to prevent irreversible muscle and nerve damage. Awareness of such mechanisms is particularly relevant for clinicians managing athletes in combat sports. To our knowledge, this is the first documented case of ACS secondary to repeated calf kicks in kickboxing. Full article

Background: Osteosarcoma remains the most common primary malignant bone tumor in children and adolescents, with largely unchanged survival outcomes in recent decades. Non-invasive biomarkers for preoperative risk stratification are urgently needed. Circulating immune checkpoint proteins (ICPs) and bone remodeling factors (BRFs) represent promising candidates; however, their combined prognostic value in osteosarcoma remains unclear. Methods: We prospectively analyzed plasma samples from 47 patients with osteosarcoma, selecting the earliest available sample before disease progression or the last follow-up. A panel of ICPs and BRFs was quantified using multiplex immunoassays. sHVEM and sCD27 were used to construct a two-marker ICP signature (ICP2); subtypes were defined by unsupervised consensus clustering (k = 2) applied to log₂-transformed sHVEM and sCD27 concentrations, and sOPN was included for integrative analysis. Survival associations were assessed using Kaplan–Meier analysis and Firth’s penalized Cox regression. The model performance was evaluated using Harrell’s C-index. Results: Two ICP2 subtypes were identified (type1, n = 26; type2, n = 21). ICP2-type2 was associated with significantly worse progression free survival (PFS) (p = 0.0045) and overall survival (OS) (p = 0.0024) and remained an independent predictor after adjusting clinicopathological factors. The ICP2 model demonstrated high discriminative performance (C-index 0.924 for PFS and 0.903 for OS). Internal validation by leave-one-out cross-validation (LOOCV), in which consensus clustering was re-derived at each fold, yielded corrected C-indices of 0.612 for PFS and 0.806 for OS (versus apparent estimates of 0.687 and 0.689, respectively), confirming acceptable-to-good discrimination after accounting for overfitting. Elevated sOPN was associated with poorer survival in the exploratory analyses, although its prognostic value was less consistent under a pre-specified cutoff. In the combined models, sOPN provided modest additional value for OS stratification, with the grdgfdgICP2-type2/OPN-high subgroup exhibiting the poorest outcome. Conclusions: The circulating sHVEM/sCD27 signature defines prognostically distinct osteosarcoma subtypes with a strong discriminative performance. This minimally invasive model may support preoperative risk stratification. Integration with sOPN suggests a potential biological link between immune regulation and bone remodeling, warranting validation in larger cohorts. Full article

Background/Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for postpartum pain management. However, previous studies have indicated that NSAIDs may increase systolic blood pressure, particularly in patients receiving antihypertensive therapy. The aim of the present study was to assess whether postpartum ibuprofen administration is associated with a higher risk of severe postpartum hypertension and increased mean arterial pressure (MAP) compared with acetaminophen. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science to identify relevant studies. Only randomized controlled trials were considered eligible for inclusion. For dichotomous outcomes, effect sizes were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CIs). For continuous outcomes, mean differences (MDs) with 95% CIs were calculated. Statistical heterogeneity among studies was assessed using the I² statistic. A fixed-effects model was applied in cases of low heterogeneity (I² < 20%). Results: No significant difference was observed in the prevalence of severe postpartum hypertension between the ibuprofen and acetaminophen groups (RR 1.07, 95% CI 0.84 to 1.35; p = 0.59; I² = 0%). Similarly, MAP did not differ significantly between groups (MD −0.05 mmHg, 95% CI −1.53 to 1.42; p = 0.94; I² = 0%). Conclusions: No increased risk of postpartum hypertension or difference in mean arterial pressure was observed between the ibuprofen and acetaminophen groups, supporting the safety of ibuprofen for postpartum analgesia in women with hypertensive disorders of pregnancy. Full article

Adenomyosis is a benign gynecologic condition characterized by ectopic endometrial glands and stroma present within the myometrium. Background/Objectives: The gold standard in diagnosis is the histology of hysterectomy specimens. Due to the heterogeneity of this disease, there is a lack of valid classification. The most important symptoms are chronic pelvic pain and abnormal uterine bleeding, followed by infertility. Noninvasive diagnostic tools have been sought, with ultrasound being a valuable option. The objective of our study was to evaluate the correlation of transvaginal ultrasound, used in addition to three-dimensional ultrasonography and Doppler, with the histology of adenomyosis. Methods: An observational retrospective study was conducted between January 2015 and November 2018 on 160 women with adenomyosis managed by hysterectomy. All patients underwent transvaginal sonography combined with 3D and Doppler sonography. Results: Comparing the location of adenomyosis in the myometrium observed using ultrasound with histological findings, a statistically significant correlation was observed (p = 0.0001). Symptoms were associated with the location of the lesions, heavy period in internal adenomyosis (p ≤ 0.001), and infertility (p = 0.001), while pelvic pain was observed in external adenomyosis (p = 0.03). Deep endometriosis was associated with external adenomyosis (p = 0.001). An ill-defined junctional zone was observed via Doppler investigation in internal adenomyosis (p = 0.0001), also correlated with the symptoms. Histology confirmed all cases of adenomyosis, with statistically significant similarities regarding pattern, location, and depth (p < 0.001). Conclusions: The increasing use of 3D and Doppler evaluations enhances TVUS importance, and 3D TVUS offers high diagnostic capacity for adenomyosis, in accordance with histological findings. This procedure facilitates the adoption of therapeutic modalities other than surgery with uterus preservation. Full article

Background: Neuropathy and neuropathic pain (NP) are globally prevalent, remain difficult to manage, and are often exacerbated by underlying lifestyle factors. Alcohol use, particularly in the context of chronic consumption or dependence, is a recognized contributor to peripheral nerve damage, yet its association with neuropathy/NP has not been systematically evaluated. This systematic review synthesizes the current evidence on alcohol exposure, including quantity, frequency, and dependency, and its association with the incidence, prevalence, and severity of neuropathy/NP. Methods: This systematic review included observational studies assessing alcohol consumption patterns or dependence in relation to neuropathy/NP outcomes and was conducted in accordance with PRISMA guidelines. Exposure types were analyzed independently, and pooled odds ratios and relative risks were generated when sufficient data were available. The review was registered with PROSPERO number CRD42023484158. Results: Following de-duplication and exclusions, 76 studies were included, comprising cohort (n = 15), case–control (n = 12), and cross-sectional (n = 49) designs. While associations varied by study design and exposure category, alcohol dependence and consumption were more consistently linked with increased neuropathy incidence and severity, including electrophysiological evidence of compromised function. Notably, in studies examining alcohol cessation, abstinence was linked to clinical improvements in neuropathy/NP symptoms such as hypoesthesia and muscle weakness. While heterogeneity and risk of bias were present, largely due to the subjective classification of alcohol exposure and a lack of universally applied objective neuropathy measurement tools, multiple pooled estimates reached statistical significance. Conclusions: Evidence from observational studies supports an association between alcohol use, especially dependence, and the development and progression of neuropathy/NP, although causality remains unproven. Abstinence may offer therapeutic benefit, though further abstinence- and/or harm reduction-related interventional studies are required to clarify causality and guide low-cost, adjunctive strategies for alcohol-related neuropathy/NP. Full article

Background: The erector spinae plane block (ESPB) is a commonly used interventional method in the treatment of post-herpetic neuralgia (PHN). ESPB can be performed under the guidance of ultrasound or fluoroscopy, and there are limited data in the literature regarding the effectiveness of ESPB using these two imaging modalities on pain. In this study, we aimed to compare the effectiveness of ESPB performed under the guidance of ultrasound and fluoroscopy on pain reduction in PHN. Methods: Patients between the ages of 18 and 90 years with thoracal pain related to PHN and scheduled to undergo the ESPB were enrolled in the prospective observational study. Patients were divided into two groups: those who underwent a single-shot fluoroscopy-guided (FS) or ultrasound-guided (USG) ESPB. The Numeric Rating Scale-NRS was used to assess pain intensity, and the DN-4 questionnaire was used to assess the presence of neuropathic pain (NP). Results: In the final analysis, data from a total of 48 patients, 24 from each group, were evaluated. No statistically significant difference was found between the two groups in terms of demographic data and initial clinical features. While a significant decrease in NRS scores was seen in both groups at the first and third months, no significant difference was seen between the two groups. There was no significant change in the number of patients with NP in either group compared to baseline. Conclusions: Both ultrasonography and fluoroscopy-guided ESPB appear to be effective in reducing pain in PHN. Further studies are needed for the efficacy of ESPB on NP. Full article

Objective: The aim of this study was to explore the clinical response and tolerability of topical 1% amitriptyline in patients with burning mouth syndrome in a real-world clinical setting. Methodology: A retrospective observational study was conducted through a review of the clinical histories of patients diagnosed with burning mouth syndrome, treated at the Dental Clinic of the Morales Meseguer Hospital (Murcia, Spain). All the patients were treated with topical amitriptyline for a period of four weeks. The following parameters were evaluated at the start of the treatment and at the end of the four weeks: pain or mouth burning, through the visual analog scale (VAS); anxiety and depression, with the Hospital Anxiety and Depression (HAD) scale; sleepiness, with the Epworth Sleepiness Scale (ESS); sensation of dry mouth (VAS) and basal sialometry for the objective measurement of salivary flow. Results: Of the 32 patients that were initially included, 27 were ultimately analyzed. After 4 weeks of treatment with 1% topical amitriptyline, a significant improvement was observed in mouth pain or burning, measured with the VAS, with a decrease in the median of 7.5 (IQR 6–9) to 5 (IQR 5–7) (p < 0.001). Likewise, significant improvements were recorded in the anxiety (HAD-A) and depression (HAD-D) scores, with significant reductions after the treatment (p = 0.019 and p = 0.009, respectively). No statistically significant differences were observed in the subjective sensation of dry mouth (VAS) (p = 0.054) or in the total production of saliva (p = 0.477). Conclusions: Treatment with 1% topical amitriptyline for four weeks was associated with a reduction in pain and emotional distress in patients with burning mouth syndrome, with very few reported adverse effects. As an exploratory retrospective study with a limited sample size reflecting real-world clinical practice, these findings suggest that 1% topical amitriptyline may represent a useful therapeutic option in the management of burning mouth syndrome. However, the results should be interpreted with caution, and further prospective controlled studies are needed to confirm these findings. Full article

Apitherapy is a complementary therapeutic approach based on the use of bee-derived products, particularly bee venom (BV), also known as apitoxin. Bee venom is a complex mixture of biologically active compounds, including peptides, enzymes, and biogenic amines, that exhibit diverse pharmacological activities. Major bioactive constituents such as melittin, apamin, adolapin, and phospholipase A2 have attracted increasing scientific interest due to their anti-inflammatory, antioxidant, antimicrobial, analgesic, and immunomodulatory properties. This review provides a comprehensive overview of the biological effects and therapeutic potential of bee venom in the management of chronic diseases, particularly diabetes, cancer, and neurological disorders. Evidence from experimental and clinical studies suggests that BV and its components can modulate multiple molecular pathways associated with oxidative stress, inflammation, apoptosis, and immune responses. These mechanisms contribute to potential benefits in glycemic control, tumor suppression, neuroprotection, and pain management. Additionally, bee venom has been investigated for its capacity to influence signaling pathways involved in cellular proliferation and survival, highlighting its potential as a complementary strategy in the treatment of complex diseases such as neurodegenerative disorders, including Parkinson’s and Alzheimer’s diseases. Despite these promising therapeutic effects, the clinical use of BV remains limited due to safety concerns, particularly the risk of allergic reactions, systemic toxicity, and anaphylaxis. Recent advances in drug delivery systems and nanotechnology may help improve the safety and efficacy of BV-based therapies by enabling targeted delivery and controlled dosing. Overall, bee venom represents a promising source of bioactive compounds with potential applications in translational and integrative medicine; however, further well-designed clinical trials and mechanistic studies are necessary to establish its safety, efficacy, and long-term therapeutic value. Full article

Chronic wound management remains a significant clinical challenge, requiring adaptive therapeutic approaches to achieve wound closure that nonetheless frequently prove fruitless. Balancing the initial pro-inflammatory response with debris removal and tissue rebuilding remains elusive in most cases, leading to pain, drastic quality-of-life deterioration, and, eventually, amputation. Meanwhile, patient adherence is an overarching theme. Furthermore, non-surgical alternatives that effectively promote tissue rebuilding are essential for patients seeking to avoid further invasive procedures. We report a patient with a recalcitrant ulcer managed using human amniotic membrane dressing (hAM-pe) and a bovine collagen matrix (BCM) in spatially distinct areas as an intra-patient control. Methodology included clinical monitoring and ad hoc molecular and histological analyses to assess inflammatory markers and tissue architecture. Following 59 days of observation, the superior evolution of the hAM-pe-treated zone led to the clinical decision to extend hAM-pe treatment over the adjacent BCM area, resulting in total wound closure. The hAM-pe-treated site demonstrated accelerated closure and clinical resolution of inflammation without the presence of a granulomatous response. Molecular analysis revealed downregulated pro-inflammatory mediators (IL-1β, TNF-α, CXCL-10) and upregulated markers associated with angiogenesis (VEGF, CD34) and tissue repair (Arginase-1). In this case, the non-surgical hAM-pe treatment was associated with a favorable healing trajectory, characterized by superior inflammation resolution and enhanced tissue organization (collagen type I/III maturation). While these descriptive findings suggest the potential advantages of amniotic membrane dressings in promoting advanced tissue repair, they remain limited to this individual observation. Further research in larger cohorts is required to validate these mechanisms. Full article

Background/Objectives: Trigeminal neuralgia (TN) is a debilitating neurological condition characterized by recurrent, severe pain linked to peripheral and central sensitization within trigeminal pathways. Current pharmacologic treatments are limited by inadequate efficacy or dose-limiting side effects, and botulinum neurotoxin type A (BoNT/A) has emerged as a viable option. However, its potential use in the management of TN is hampered by methodological limitations in existing studies and a lack of pivotal clinical trials. This study investigated the efficacy, optimal treatment site, preventive utility, and duration of effect of incobotulinumtoxinA (Inco/A), a BoNT/A, in a model of TN. Methods: An infraorbital nerve chronic constriction injury model was used to induce mechanical allodynia in male Sprague–Dawley rats, reproducing the trigeminal sensitization seen in TN. The effects of subcutaneous Inco/A (1, 2, and 4 U) were measured using the mechanical sensitivity (von Frey) test to evaluate the dose response, effect of injection location, potential preventive nature of treatment, and duration of benefit. Results: Inco/A produced a robust, dose-dependent reduction in mechanical allodynia, predominantly via a local mechanism of action. Both preventive and therapeutic administration of Inco/A was efficacious, with significant reduction in allodynia even when administered up to 28 days before nerve injury. The anti-allodynic effect persisted up to 56 days post-injection. Conclusions: Inco/A is highly effective in alleviating mechanical allodynia in a validated rat model of TN. The findings highlight Inco/A as a promising candidate for clinical translation in TN and related neuropathic pain syndromes and support systematic investigation in well-controlled human trials. Full article

Background: Patellar tendinopathy is a common musculoskeletal condition that may impair functional performance and limit physical activity. While structural and mechanical factors have been widely investigated, the role of proprioceptive function and its interaction with behavioral and central pain-related mechanisms remain unclear. This study aimed to investigate the relationship between knee joint position sense, kinesiophobia, and central sensitization in individuals with chronic patellar tendinopathy. Methods: A total of 42 recreational athletes with clinically diagnosed chronic patellar tendinopathy were included in this cross-sectional study. Knee joint proprioception was assessed using joint position sense testing at multiple knee flexion angles with a continuous passive motion device. Kinesiophobia and central sensitization were evaluated using the Tampa Scale of Kinesiophobia and the Central Sensitization Inventory, respectively. Joint position sense values of the involved and contralateral extremities were compared, and correlation analyses were performed to examine associations between joint position sense and psychosocial variables. Results: The involved extremity demonstrated significantly greater absolute angular error compared to the contralateral side at higher knee flexion angles (≥60°, p < 0.01), whereas no significant differences were observed at lower angles. A moderate positive correlation was found between joint position sense error and kinesiophobia at higher flexion angles (≥30°, p < 0.01). No significant association was identified between joint position sense error and central sensitization across any of the tested angles (p > 0.05). Conclusions: Proprioceptive function is impaired in individuals with chronic patellar tendinopathy, particularly under increased mechanical demand. The association between joint position sense deficits and kinesiophobia, but not central sensitization, suggests a potential relationship between movement-related fear and sensorimotor alterations. These findings highlight the importance of incorporating proprioceptive assessment and addressing kinesiophobia in the clinical management of patellar 36 tendinopathy. Full article