Uncategorized

 Chronic lunotriquetral (LT) ligament tears are a source of ulnar-sided wrist pain. Left untreated, complete tears of the LT ligament may progress to a volar intercalated segment instability deformity and eventual carpal arthritis. Various treatments have been proposed, one of which is LT arthrodesis. LT arthrodesis has been criticized for high rates of nonunion frequently requiring reoperation, and therefore has largely fallen out of favor. However, our experience has been quite different from the literature. This study examines a single surgeon's experience with LT arthrodesis over a 15-year period.  A retrospective review of the senior author's practice over a 15-year period was performed. All adult cases of LT arthrodesis for chronic LT injuries were included. Headless compression screw and cancellous bone graft from the distal radius were used for primary arthrodesis in all cases. The primary outcome was rate of union, and secondary outcomes were time to union, secondary or salvage procedures, and range of motion. Nonparametric statistical analysis was used to calculate differences in outcomes.  Twenty-eight patients met inclusion criteria. The median age was 45.5 (interquartile range [IQR] 35-50) years and 75% were male. The dominant hand was most commonly affected. Eighty-six percent of patients achieved union, one patient required redo arthrodesis, and one patient went on to wrist salvage. Three patients developed a pain-free pseudoarthrosis. Median time to radiographic union was 8.8 (IQR 5.9-11.9) weeks.  Despite multiple previous reports, this study demonstrates that LT arthrodesis for chronic LT injuries is a safe technique with high rates of successful union. Further comparative studies are warranted to determine the optimal treatment for chronic LT injuries.

Takayasu Arteritis (TA), a chronic inflammatory condition of the aorta and its major branches, causes narrowing and ultimate occlusion of major vessels and may manifest as cerebrovascular insufficiency, organ ischemia, and systemic arterial hypertension (HTN). Herein, we report a case of a 35-year female with the pulseless disease but no other clinical signs except headache and neck pain on exertion despite the fact that three out of four vessels of the aortic arch were occluded. Diagnosis of TA was based on clinical findings, radiological imaging, and doppler studies. This case report highlights the clinical importance of unexplained headaches and absent peripheral pulses in the screening of TA. Key Words: Takayasu arteritis, Unexplained headache, Neck pain.

Pain education initiatives are typically targeted at health professionals, with less attention being placed on the education of other target audiences. Recent curriculum changes across undergraduate liberal studies degree programs at The University of Sydney presented an opportunity to develop an online course entitled Health Challenges: Pain and Society, which was aimed at a non-traditional target audience. To promote student engagement about the problem of pain for society, the course was designed using the Community of Inquiry framework. This paper reports on an Educational Design Research study, investigating the effectiveness of the course in engaging students across two cohorts, in 2019 and 2020. Learning analytics were collected from the Learning Management System each year. The level of student engagement in non-assessable tasks was measured using multiple linear regression. Students' degree type and majors were recorded. In 2020, the quality of student workbook responses was recorded. In both cohorts, engagement with the workbooks was a predictor of academic achievement. In 2020, a significant interaction effect between quantity and quality of engagement was observed. Our findings highlight the importance of designing online learning to facilitate successful engagement for non-traditional target audiences about the issue of chronic pain for society.

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep, with a worldwide estimate of 936 million sufferers. Treatments of OSA include continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, positive upper airway pressure, oro-maxillofacial surgery, hypoglossal nerve stimulation, and bariatric surgery, and others, with CPAP being the most commonly prescribed treatment. In this review, the neurologic conditions of stroke, cognitive decline, epilepsy, and migraines will be discussed as they relate to OSA. Additionally, the literature regarding improvement in these conditions following treatment with CPAP will be explored.

The novel coronavirus (severe acute respiratory syndrome coronavirus-2) has led to a global pandemic. In the adult population, coronavirus disease 2019 (COVID-19) has been found to cause multiorgan system damage with predicted long-term sequelae. We present a case of a 10-year-old boy with a history of ROHHAD (rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation) who presented with hypoxia, emesis, and abdominal pain. Imaging found bilateral ground glass opacities in the lungs and a pericardial effusion. Laboratory evaluation was concerning for elevated inflammatory markers. Remdesivir, hydroxychloroquine, and anticoagulation (heparin and enoxaparin) were utilized. The patient's severe respiratory failure was managed with conventional mechanical ventilation, inhaled nitric oxide, and airway pressure release ventilation. We hope that this report provides insight into the course and management of the severe acute pediatric COVID-19 patient, specifically with underlying comorbidities such as ROHHAD. Clinical trial registration is none.

Lung cancer is the leading cause of cancer death. Surgery remains the main method of managing early-stage disease. Minimal-access video-assisted thoracoscopic surgery results in less tissue trauma than open surgery; however, it is not known if it improves patient outcomes.

Whether preexisting sarcopenia is an independent risk factor for postoperative pneumonia (POP) for patients with oral cavity squamous cell carcinoma (OCSCC) remains unclear. Therefore, we conducted a propensity score-matched population-based cohort study to compare the risk of acute and late POP for patients with sarcopenic and nonsarcopenic OCSCC who underwent curative surgery.

The VEPs provide an objective measure of brain function, analyzing integrity of visual processing. With patients affected with schizophrenia, the changes with the implementation of VEP are evident, such as symmetrical deceleration of the impulse and the continuance of latency, which points to a degenerative illness, suggesting the presence of optical neuritis or hemianopsia conjoined with mentioned intracranial illness.

Although several studies and reports have shown the potential analgesic use of serotonergic psychedelics in cancer pain, phantom limb pain and cluster headache, evidence supporting their use for chronic pain is still limited. The past years have seen a considerable renewal of interest toward the therapeutic use of these compounds for mood disorders, resulting in a marked increase in the number of people turning to psychedelics in an attempt to self-medicate a health condition or improve their wellbeing. In western countries particularly, this population of users overlaps substantially with chronic pain sufferers, representing a unique opportunity to evaluate the effects these compounds have on pain and wellbeing. Here, we report results from an online survey conducted between August 2020 and July 2021 in a population of 250 chronic pain sufferers who had experience with psychedelics, either in microdoses (small sub-hallucinogenic doses), macrodoses (hallucinogenic doses), or both. Macrodoses, while less often used for analgesic purposes than microdoses, were reported to induce a higher level of pain relief than both microdoses and conventional pain medications (including opioids and cannabis). Although the effects were weaker and potentially more prone to expectation bias than with macrodoses, our results also suggested some benefits of psychedelics in microdoses for pain management. The reported analgesic effect appeared unrelated to mood improvements associated with psychedelic use, or the advocacy of psychedelic use. Taken together, our findings indicate interesting potential analgesic applications for psychedelics that warrant further clinical research.