Rejected

Pain is a common problem for patients receiving home care, often limiting mobility and contributing to functional decline. Pharmacological pain management is common, but all drugs bring some risk of side effects and adverse reactions. The opioid epidemic has brought into question analgesic prescribing patterns across all care settings. This study, which used data collected between 2012 and 2014, examines the pain medications used by older adults with activity-limiting pain receiving home care physical therapy in a large metropolitan home care agency. Eighty-five percent of subjects took at least one analgesic medication on admission to home care, and of these, 51.3% were using an opioid, 33.1% used acetaminophen, and 23.2% used nonsteroidal anti-inflammatory drugs (NSAIDs). At the 60-day follow-up, the most common medication classes taken by participants included acetaminophen (38%), opioids (35.9%), and NSAIDs (31.6%). We found racial/ethnic differences in analgesic use at baseline but not at follow-up. At baseline, analgesic use differed by pain type, but there were no differences at follow-up. The high use of medications to control pain by patients receiving home care, particularly opioid use, underscores the importance of providers being alert to potential adverse drug reactions.

Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone.

Pain adversely affects the quality of life in cancer patients. Although conventional oral analgesics and co-analgesics manage 80%-90% of pain, interventional pain management techniques may be useful in the management of cancer pain refractory to opioid analgesia or in patients unable to tolerate systemic opioids. Herein, we report three cases depicting the successful role of erector spinae plane block in our palliative care unit for the management of different chronic cancer pain.

Although the gut microbiota consists of bacteria, viruses, and fungi, most publications addressing the microbiota-gut-brain axis in irritable bowel syndrome (IBS) have a sole focus on bacteria. This may relate to the relatively low presence of fungi and viruses as compared to bacteria. Yet, in the field of inflammatory bowel disease research, the publication of several papers addressing the role of the intestinal mycobiome now suggested that these low numbers do not necessarily translate to irrelevance. In this review, we discuss the available clinical and preclinical IBS mycobiome data, and speculate how these recent findings may relate to earlier observations in IBS. By surveying literature from the broader mycobiome research field, we identified questions open to future IBS-oriented investigations.

Existing interventions for postmastectomy pain syndrome (PMPS) address the neural component while overlooking a possible myofascial component.

Lesions in the iliopsoas compartment carry a broad differential diagnosis, including infection, tumor, or hematoma, and less commonly, retroperitoneal fibrosis, atrophy secondary to paralysis or muscle disease, foreign body, calcifications secondary to trauma, or rhabdomyolysis. Iliopsoas lesions are oftentimes accompanied by nonspecific symptoms, resulting in a delayed diagnosis. We present the case of a 43-year-old male with acute radiating groin pain who was found to have a traumatic iliopsoas hemorrhagic lesion causing ureteral compression and ureteral dilatation, all presumably originating from a new-onset weight-training program. The patient had a drain placed for fluid removal and decompression, with the initial pathologic specimen confirming muscle fibers and an inflammatory process. Further patient symptomology with combined imaging and pathologic persistence yielded a diagnosis of a germ cell tumor. The importance of a plausible differential diagnosis combined with clinical diagnostic persistence must be stressed to all clinicians. Our patient's unrelenting inguinal pain led to a justified repeat psoas mass biopsy, imaging, and laboratory workup that led to a diagnosis of psoas germ cell tumor and immediate chemotherapy plan.

To investigate the roles of autonomic regulation and psychologic condition in the development of tinnitus in patients with chronic temporomandibular disorders (TMD).

Postdural puncture headache (PDPH) in the obstetric anesthesia practice is one of the most annoying, common, and important problems.

Early Childhood Caries (ECC) is a chronic childhood disease affecting children worldwide. Severe cases of ECC can significantly affect child's Oral Health Related Quality of Life (OHRQoL) owing to its consequences. The purpose of present study was to find out association between severe early childhood caries (s-ECC) and OHRQoL of children and their parents/care-givers visiting a Government dental hospital in Delhi, India.