pain

The pandemic the new Coronavirus infection has brought changes in the health status of a large number of our citizens. The consequence of this has been a higher rate of employees seeking medical care and subsequent sick leave. Crisis phenomena in the economic and social life of society are associated with the consequences of the pandemic, moreover, the stress burden on the population increases with the consequences of the pandemic. All this affects the level of performance. The transferred COVID-19 has increased the number of patients with complaints of pain in joints and muscles, with the phenomena of cardiovascular pathology, as well as in breathing, increased frequency of asthma attacks, etc. That is, complications affected a wide range of diseases [1-4]. All this is the consequence, including neurological pathology, which is closely related to stress. According to surveys of several large industrial enterprises, 31.7% of those seeking medical help report anxiety, sleep problems, and a feeling of fatigue [5]. Exacerbation of chronic diseases was recorded in more than 50% of patients with COVID-19. The figures show that more than 1/3 of the population is chronically unwell, and more often than usual they apply for sick leave, which inevitably leads to a decrease in economic indicators [6-10].

Non-Hodgkin's lymphoma involving the ovaries is unusual and may cause confusion for the clinician since its presentation could resemble other, more frequent tumors. Malignant lymphoid cells may occur in the ovary either as a primary neoplasm or as a secondary manifestation of a disseminated occult or known disease. The most common presenting symptoms or signs of malignant lymphomas involving the ovaries are abdominopelvic pain or mass. 

Aim: The current paper presents a subjective symptom survey regarding postpartum discomfort (Study 1) and a case study on postpartum care using the program developed based on the survey results (Study 2). Thereafter, health care during the postpartum period is discussed.Methods: Study 1 analyzed 1638 postpartum women who completed the Subjective Fatigue Symptom Scale (SFSS) over the period from June 2012 to December 2019. Study 2 detailed the case of a 33-year-old primiparous woman who answered questions regarding the rehabilitation care program.Results: The 1638 subjects included in Study 1 had a mean age of 32.4 ± 8.2 years and a mean postpartum duration of 4.3 ± 2.3 months. Subjective symptoms included lower back pain, shoulder stiffness, sleepiness, wanting to lie down, yawing, and eye strain. The case included in Study 2 showed certain psychological and physical changes following the exercise program. The results of Study 1 showed that motor system discomfort, such as stiff shoulders and lower back pain, occurred in women across all postpartum stages. Our results demonstrated that care and exercise geared toward improving motor system function are imperative after childbirth. Meanwhile, the results of Study 2 imply that our rehabilitation program based on postpartum physical conditions had positive psychological and physical effects.Conclusion: Taken together, our results suggest that continuing rehabilitative care based on the physical condition during each postpartum stage facilitates improvement in mothers’ physical and psychological discomfort.

Chronic foot and heel pain is a clinical dilemma that Pain Physicians often encounter in their daily practice. In the younger active patients, this is often attributed to plantar fasciitis but other rarer etiologies should also be considered. In patients who present with pain over the medial calcaneus, entrapment neuropathy of the inferior calcaneal nerve, the first branch of the lateral plantar nerve (FBLPN), also known as “Baxter’s nerve” must be considered [1,2]. Initially described in 1984 by Baxter and Thigpen, it is often overlooked as a cause of medial heel pain, particularly in athletes, where it may coexist with plantar fasciitis [3]. The nerve has a tortuous course in the foot and can be entrapped as it passes through the fascia of the abductor hallucis, travels in close proximity to a plantar spur or the medial calcaneal tuberosity, or gets enmeshed in scar tissue from prior surgery [1,3].

A 25 years old pregnant woman had a painful labor in her 38th week of pregnancy. Because of a previous delivery by a cesarean section, she underwent a second cesarean section. Her past medical and family history was unimportant. We performed the surgery under spinal anesthesia. The surgery was uneventful and the baby was in a good health. After 9 hours of surgery, she complained of painless swelling in the parotid glands. Physical examination and laboratories were normal. We started rehydration with normal saline and one dose of hydrocortisone (100 mg IV route). Close monitoring showed no problems in swallowing or any purulent discharge. Two days later, we had a complete resolution of the swelling. We discharged the woman with her child with no complaints. Our case is one of the rare cases of anesthesia mumps after spinal anesthesia. Physicians should be careful in considering such rare cases. Early diagnosis and management is the key.

Background: The clinical manifestations of Corona Virus Disease of 2019 (COVID-19) varied from patient to patient with evidence of multi-organ involvement. Many patients continue to have a wide range of symptoms for variable periods of time. The long-term effects of COVID-19 infection (post-COVID-19 illness or syndrome) are not yet been fully explored.This study aims to highlight the clinical manifestations of the acute COVID-19 infection and the longer-term manifestations of the disease among the attendants to a private GP clinic in the Urban Amman Area, Jordan.Methods: A clinical case-series study was conducted on a sample of 300 COVID-19-positive cases among patients attending my private GP clinic in the Urban Amman Area, Jordan. We used the structured questionnaire based mainly on World Health Organization (WHO) Case Report Form (CRF) verified tool for post-COVID-19. All patients with COVID-19 were included in the study. Data collection was conducted through phone calls and analyzed using the Statistical Package for Social Sciences (SPSS) software. Results: The incidence of COVID-19 among patients attending the clinic during the period of this study was 25%. Females were 135 (45%) of the study population and males were 165 (55%). The mean (SD) of age was 34.2 (5.0) years. Most of the infected staff (90%) were symptomatic and developed acute COVID-19 symptoms. Fever, Cough, Fatigue, joint pain and loss of smell and taste were the most common symptoms. 72% of the study population had fully recovered from the infection, while 28% of them continued to suffer from many long symptoms. Fatigue (28%), shortness of breath on activity (18%), Social withdrawal (18%), anxiety (17%), forgetfulness (16%), trouble concentrating (15) and depressed mood (14%) were the most frequently reported long symptoms.Conclusion: The prevalence of Post COVID-19 illness was 28% with a high public health burden calling for the public health system to address the medical and psychological needs of affected persons. Mental health and psychosocial support are recommended elements for the management of patients.

Influenza B myositis is a self-limited process that is typically accompanied by myalgia and muscle weakness, which can be caused by an acute respiratory infection. It occurs in the convalescence phase of the disease. It can usually affect preschool and school children, who present bilateral pain and tenderness in the muscle groups of the lower limbs without alterations in the neurological examination. Being able to generate an alteration in the brand or bipedestation. Its main complication is rhabdomyolysis. In Guatemala is difficult to test for viral respiratory infection and the incidence of viral myositis is unknown, for which we consider the report important because it presents a benign course and is easy to manage with the use of non-steroidal anti-inflammatory drugs, to avoid unnecessary hospitalizations. We present to case report to an 8-year-old male patient, previously healthy, with diagnostic de Influenza B myositis.

Quick and cost-effective recovery is foundational to high-quality training and good competition results in today’s sports. The aim of the research was to elucidate the effects of hand and massage chair massage on the biomechanical parameters of muscles of lower limbs and back, indicators of Pain Pressure Thresholds (PPT) and subjectively perceived fatigue. A total of 32 female recreational athletes (18 – 50 years old) were assigned to a hand massage, massage chair, or lying down the group. They were measured for muscle biomechanical properties (MyotonPro), PPT (Wagner Instruments) and subjectively perceived fatigue (VAS scale) before and after fatigue tests and treatment. The recovery procedure and subjective satisfaction with treatment were rated on a Likert scale. Changes in the median value of m. rectus femoris and m. gastrocnemius stiffness with treatment showed that hand massage could be more effective in reducing stiffness, as compared to chair massage. Hand massage may have benefits for recovery from physical exertion, but due to the individuality of subjects, detailed methodological studies are needed to evaluate the effects of massage chair vs. hand massage.

The appropriateness of opioid therapy for patients with Chronic Non-Malignant Pain (CNCP) has been questioned by a variety of researchers and policy makers [1-3]. One comprehensive review concluded that the benefits of such therapy for pain relief and functional improvement are modest at best and that opioid therapy is associated with significant harms including various symptoms (e.g., headache, nausea, sedation), development of opioid use disorder, fractures and death from overdose [3].

Background: Exclusive breastfeeding has great benefits for both the mother and the child. Few studies have been carried out on interventions to improve Exclusive Breastfeeding (EBF) practice by childbearing mothers. No study has formulated and/or implemented a hospital-based maternal counseling guide intervention to improve EBF practice. This baseline study assessed the knowledge, attitude, and practice of EBF on mothers who were enrolled in antenatal clinics for a cluster randomized trial and the disparity in the knowledge of EBF based on lactation, age, sex, and source of income.Methods: We formulated a hospital-based counseling guide on exclusive breastfeeding, which is under implementation by prenatal and nursing mothers, to promote EBF practice in the study area. A cross-sectional study was conducted in two hospitals randomly selected from twelve hospitals in Anambra State. The study was among pregnant women who were in their second trimester. The data collection took place from March to April 2022. The data were analyzed using descriptive statistics and Chi-Square. The test of significance was set at p < 0.05.Results: The control and the intervention arms had an equal number of enrolees (144) each and more than half of the participants were between the ages of 23 – 32 years. The majority of the participants showed adequate knowledge of exclusive breastfeeding as over 90% knew that EBF is important and capable of improving their baby's immunity. The participants demonstrated a positive attitude to exclusive breastfeeding and they had a significantly high level of practice of daily consumption of galactagogues. The study suggested that the majority did not practice breast milk extraction mainly because the process of extraction is painful and some do not know how to carry out the extraction.Conclusion: The mothers have the requisite knowledge of the benefits of exclusive breastfeeding to their infants and themselves. However, they do not practice EBF. Interventions to improve EBF practice should focus on educating mothers on proper breast milk extraction and storage techniques.

There are few reported cases of meningitis in pregnancy and presentation can be variable in each patient which may cause diagnostic challenges and potential delays in treatment. Here, we discuss a case of aseptic meningitis - a 36 years old Gravida 2 Para 1 pediatric physician with “the worst headache of her life” at 31+5 weeks of gestation. At presentation, she did not have any of the classic triads of meningitis (fever, neck stiffness, and/or a change in mental status) and did not report any neurological symptoms. In view of persistent headache, development of pyrexia, and evolving symptoms of photophobia, she was referred to a neurology specialist, and a lumbar puncture was performed. Findings were in line with meningitis and the polymerase chain reaction confirmed enterovirus meningitis. Although aseptic meningitis is rare, it should be considered as a differential diagnosis in patients with persistent complaints, development of associated symptoms of pyrexia, photophobia, and neck pain, as well as in patients with increased risk of exposure to viral illnesses.

Elbow hemiarthroplasty (EHA) is a highly effective procedure for treating various elbow joint disorders such as rheumatoid arthritis, osteoarthritis, and fractures involving the articular surface of the distal humerus. It involves replacing the entire distal humerus with a prosthesis and reattaching the supporting soft tissues. The EHA provides significant pain relief, improves joint function, and increases patient satisfaction, with minimal complications that can be easily managed. This case study demonstrates the value of EHA as a viable treatment option for distal humerus fractures in older adults with moderate activity levels, as a superior alternative to osteosynthesis.

Monkeypox is a sylvatic zoonotic sickness that initially affected tropical rainforest areas in the west and vital Africa earlier than spreading to other places. Its miles carried with the aid of the Monkeypox virus member of orthopoxvirus circle of relatives. The clinical features of the infection resembles to smallpox. The primary animal to human transmission is the cause of most people of human Monkeypox ailments. Severe rodent species and non-human primates function hosts for the virus. Transmission can manifest with infected people, animals or objects into contact with bodily fluids, sores on the skin or inner mucosal surfaces just like the mouth or throat, or breathing droplets. The incubation length for Monkeypox usually lasts 6 to 13 days, even though it could last as long as 21 days. The ailment is often self-proscribing, with signs and symptoms generally clearing up on their own inside 14 to 21 days. Signs can range from moderate to extreme, and lesions may be itchy or painful. Due to the discontinuation of recurring smallpox vaccination which supplied some pass- safety in past, populations have become more liable to Monkey pox. The outbreak of Monkeypox virus due to the fact that may additionally, 2022 has created a worldwide risk of the virus. In the present review, Monkeypox epidemiology, severity, therapeutics, vaccination and its transmission to non-endemic countries has been considered. Special care and guidelines may help in the containing in the spread of the infections to the non endemic countries.

Aim: This study aimed to investigate the association between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and laboratory findings in patients presenting with the complaint of leg pain due to varicose veins.Materials and Methods: A total of 160 patients with leg pain were included in this study. Sleep quality was assessed using the PSQI, and laboratory tests were conducted to evaluate ferritin, iron, vitamin B12, Thyroid Stimulating Hormone (TSH), C-reactive protein (CRP), albumin, low-density lipoprotein (LDL), and hemoglobin levels. Statistical analyses were performed using the independent t-test or Mann-Whitney U test for continuous variables and the chi-square test for categorical variables.Results: Patients with poor sleep quality had a significantly higher prevalence of leg pain complaints compared to those with good sleep quality (p < 0.001). Females were more likely to report poor sleep quality (p = 0.006). No significant associations were found between sleep quality and age, smoking status, alcohol use, or pack/year of smoking. Patients with poor sleep quality had significantly lower ferritin levels (p = 0.008), lower albumin levels (p = 0.031), and lower hemoglobin levels (p = 0.036) compared to patients with good sleep quality. However, no significant differences were observed in other laboratory parameters.Conclusion: The findings suggest a significant association between poor sleep quality and leg pain complaints in patients with varicose veins. Lower ferritin, albumin, and hemoglobin levels in patients with poor sleep quality may indicate potential underlying mechanisms linking sleep quality and leg pain. Addressing sleep quality issues in patients with leg pain could improve overall well-being and treatment outcomes.

Background: The prevalence of musculoskeletal disorders is particularly high among garment workers, which poses a serious occupational health hazard. This issue is not taken seriously as an important issue in low-income countries like Bangladesh.Aim: Determine the prevalence of musculoskeletal conditions (MSDs) among garment workers in nine body regions and explore the relationship between MSDs and the general characteristics of the participants.Materials and methods: A cross-sectional study including 383 garment workers was done. A structured questionnaire (Standardized Nordic Musculoskeletal) was used. Results: The most common form of pain in the last year was lower back pain. Nine anatomical locations were studied, and workers most commonly experienced problems with their lower back (45.4%), upper back (36.6%), and knees (33.2%). Workers reported having more trouble in the knee (31.9%), upper back (35.0%), and lower back (43.9%) regions over the past seven days. In the past year and the last seven days, shoulder injuries were the least common. Conclusion: MSDs are widespread among garment industry employees. The back condition is the most commonly affected. The development of MSD is directly correlated with age and work experience.

Gardner-Diamond syndrome or psychogenic purpura is a rare vasculopathy disorder characterized by spontaneous painful purpuric rash without a history of trauma or antiplatelet or anticoagulant therapy. It occurs in women with mental health disorders. Gardner and Diamond in 1955 described a syndrome of auto erythrocyte sensitization which presented in abnormal crops of painful inflammatory ecchymosis in 4 patients at the site of trauma followed by progressive erythema and edema. We present a 52-year-old age woman who was admitted to the internal medicine department and referred for dermatological consultation for recurrent spontaneous purpuric eruptions. The patient was under treatment for depression for many months. Her investigations and coagulation profile were nearly within normal.

Stress, pain, injuries, and errors in dental procedures are situations highly linked to dentistry derived from multiple factors making this profession a profession with high physical and mental demand to achieve quality treatment without deteriorating the health of those who perform it, in this case, the dentist, the assistant, and hygienist.The effects of wrong postures, but above all, the lack of knowledge of the proper postures, the modeling of bad habits acquired during the training stage in dental school, and the lack of work guidelines that not only take into account the dentist but also to all the work staff and the methodological organization of dental tasks can be found in the scientific literature.Magnification devices are known to improve vision, precision, and ergonomics in dentistry; advances in the area of ​​high magnification in dentistry are taking place by leaps and bounds. In recent years, a new magnification loupes design has appeared on the market, called ergonomic magnification loupes appeared that stands out from conventional Galilean and Keplerian through the lens (TTL) Flip-up loupes in terms of their postural benefits and is part of the arsenal of magnification loupes to consider in the market.The postural approach of high magnification equipment is necessary for professional practice, where the design of Ergonomic magnification loupes with consideration not only for magnification but also for the operator’s postural health which can have a significant impact on the performance and overall health of the dentist and hygienist, more if incorporated from the beginning of dental school education and training.

Introduction: Cardiac tamponade is an emergency syndrome that requires fast diagnosis and treatment; otherwise patient follows obstructive shock and cardiac arrest. Case report: A 70-year-old female was brought to the emergency department with hypoxemia. She had a history of progressive dyspnea over the past three weeks. Past medical history includes smoking. On physical examination: tachypnea, hypoxemia (SaO2 89%), jugular venous distention, arterial pressure 220/100 mmHg, heart rate rhythmic of 82 bpm. On pulmonary auscultation: diffuse and bilateral crackles. Lung ultrasound showed a bilateral B line and the echocardiogram demonstrated a pericardial effusion with signs of tamponade. A pericardiocentesis evacuated 620 ml of hemorrhagic fluid and the patient was transferred to the intensive care unit, hemodynamically stable, with SaO2 95%. At the ICU the echocardiogram, showed resolution of the cardiac tamponade and a tumor adhered to the lateral wall of the left ventricle. Chest CT demonstrated: a left lung tumor, infiltrating the pericardial sac. A pericardium biopsy demonstrated undifferentiated carcinoma. Discussion: Cardiac tamponade diagnosis requires a high level of suspicion. Respiratory failure, chest pain, and shock, observed in cardiac tamponade, are also present in different diseases. The most common finding of cardiac tamponade is dyspnea (78% of cases). Our patient had dyspnea due to pulmonary edema, secondary to left ventricle diastolic dysfunction caused by the tamponade. A bedside echocardiogram made the diagnosis of cardiac tamponade and guided the effective pericardiocentesis. Conclusion: Cardiac tamponade must be suspected in all cases of acute dyspnea. Echocardiogram is the method of choice for the diagnosis and for guiding the pericardiocentesis.

Background: Uterine inversion is a rare obstetric emergency but potentially life-threatening condition. If these are not immediately diagnosed, the massive and underestimated blood loss can lead to hypovolemic shock. Case: Case of 24 years old woman was referred from the district Public Health Center with vaginal bleeding after delivery with abdominal pain. We found fundal height postpartum is 3 fingers above symphysis and confirmed a soft mass protruding inside the vagina at the local examination. The ultrasound cannot present the fundus of the uterus and impressed a uterine inversion. Stabilization for the patient is done with fluid resuscitation and blood transfusion. The patient planned for exploratory laparotomy and we confirmed uterine inversion. We did per abdominal reposition success which was managed by Haultain’s method. Conclusion: Uterine inversion should be considered in any patient with symptoms of hemorrhage and abdominopelvic pain, with the physical findings of a soft, congested, bleeding mass within the vagina on bimanual examination. Prompt treatment consists of fluid resuscitation and anatomical repositioning is needed.

Background: Inflammatory bowel disease (IBD) is characterized by non-specific chronic relapsing inflammation of the gastrointestinal tract and extra-intestinal manifestations. It includes Crohn’s disease (CD) ulcerative colitis (UC) and unclassified colitis.Objective: To assess the clinical presentations and management of inflammatory bowel disease in Sudanese patients.Methodology: Prospective, cross-section hospital-based study was conducted at Soba University Hospital (SUH) and Ibn Sina Hospital, in a period from December 2016 to March 2017. Data was entered and analyzed with SPSS, an interview questionnaire containing demographic, clinical, type of IBD, treatment, and complications.Results: A total of 64 IBD patients were included, 50% were diagnosed with UC, 28.1% with CD and 21.9% unclassified type. The most frequent age in UC patients was 41 – 50 years 34.4%, in CD was 31- 40 years 38.9% and for the unclassified type was 51 – 70 years 57.2%. The female was higher in CD while males were higher in Ulcerative colitis disease, symptoms were diarrhea, rectal bleeding, abdominal pain, rectal pain, tenesmus and fatigue. Study participants received 5 amino salicylic acid, and steroids, especially in the oral formulation. Minimal usage of topical forms, azathioprine, and biological agents. Conclusion: The study concluded UC is more common than CD. This should be taken into account as an important update for internal medicine professionals to adjust their expectations and lines of diagnosis, and management. The emergence of the unclassified type in Sudan requires good communication between the pathologists and the physicians and MDT meetings in every patient with suspicion of IBD.