Nociplastic pain concept,a mechanistic basis for pragmatic approach to fibromyalgia

Clinical Rheumatology - Nociplastic pain (NP), as a mechanistic term, denotes pain arising from altered nociception without clear evidence of tissue or somatosensory damage. Fibromyalgia (FM), a...     

Diagnostic yield of blood clot culture in the accurate diagnosis of enteric fever and human brucellosis

Culture of blood is the most frequent, accurate means of diagnosing bacteremia in enteric fever and brucellosis. However, conventional blood culturing is slow in isolating bacteria causing these diseases. In this work, we evaluated the performance of blood clot culture and conventional whole blood cultures in the accurate diagnosis of enteric fever (253 cases) and human brucellosis (71cases). The blood clot culture was found to be much more sensitive for both Salmonella (more by 34.4%, P< 0.001) and Brucella (more by 22.6%, P<0.001) than whole blood culture. Bacterial growth was significantly faster in cultures of blood clot compared to whole blood (1.1 versus 2.6 days for Salmonella, 3.1 versus 8.2 days for Brucella melitensis, respectively). The rapid confirmation of the etiological agent would facilitate an early institution of appropriate antimicrobial therapy, thereby reducing clinical morbidity especially in an endemic population. It is worthwile practicing blood clot culture for the accurate diagnosis of enteric fever and brucellosis in developing countries where diagnostic facilities by advanced technologies like automated culture systems and PCR are not available.     

Two sides on the fibromyalgia coin: physical pain and social pain (invalidation)

Clinical Rheumatology - Although fibromyalgia (FM) has been traditionally defined by the extent of physical pain sites alongside other non-pain symptoms, recent evidence has highlighted the...     

Cecal fecaloma mimicking colonic neoplasm

Summary We present the case of a young man with chronic diarrhea associated with an apparent cecal neoplasm roentgenographically. The lesion was diagnosed as a fecaloma only after the curative right hemicolectomy specimen was examined.     

Diaphragmatic hernia in children

Twelve cases of congenital diaphragmatic hernia in children are analysed and the surgical approach is discussed. The use of the thoraco-abdominal incision for reduction and repair of the hernia is recommended in all except the neonates.     

Localizing the contractile deceleration point (CDP) in patients with abnormal esophageal pressure topography

Background The contractile deceleration point (CDP) is an important landmark for interpreting esophageal pressure topography (EPT) plots. Previous analysis in normal subjects confirmed that the CDP could be localized using an algorithm that found the time during peristalsis at which a maximal length of the distal esophagus was contracting concurrently (tML method). This study aimed to test the tML method for localizing CDP in patients with abnormal motility. Methods High‐resolution manometry studies of 75 patients with normal and disordered peristalsis were analyzed. Two experts, JEP and YX, used the original tangent‐intersection method to score CDP coordinates for the first two swallows of each study. Alternative computerized algorithms tested against the expert were: (i) the tML method, (ii & iii) the intercept between the leading edge of the 30‐mmHg isobaric contour and a line 2.0 cm (or 10% of esophageal length) proximal to the esophagogastric junction (EGJ) at rest, or (iv) the ‘tML‐3 cm’ method, which added the stipulation that the CDP be within 3 cm of the EGJ. Key Results All tested algorithms were highly correlated with the expert. However, the tMl‐3 cm method was better in the sense that it eliminated outliers (>1 s discrepancy with the expert) that occurred with the other methods usually attributable to weak distal peristalsis. Conclusions & Inferences Optimal automated CDP localization was achieved in both normal and a spectrum of abnormal motility using the tML method with the added stipulation that the CDP be restricted to within the distal 3 cm of the EGJ at rest.     

Intranasal ketamine reduces pain of digital nerve block; a double blind randomized clinical trial

BackgroundLow dose ketamine can be used as analgesic in acute pain management in the emergency department (ED).ObjectiveEfficacy of IN ketamine in acute pain management in the ED.MethodThis is a double blind randomized clinical trial on patients older than 15 years who needed digital nerve block (DNB). Participants randomly received IN Ketamine (1 ml = 50 mg) or placebo (normal saline, 1 ml) 5 min before DNB. In both groups, patients' pain score was recorded by visual analogue score (VAS) at baseline, after DNB and 45 min after completion of DNB. Adverse effects of ketamine and changes in vital signs were also recorded and compared with placebo group.ResultsA total number of 100 patients were enrolled in the study with the median (IQR) age of 36.5 (26) years, including 65 men and 35 women. IN ketamine resulted in less pain compared to placebo after performing DNB and 45 min after the procedure. Median (IQR) basic VAS score was 50 (15) in ketamine group, and 49 (27) in control group. Median (IQR) block pain VAS score was 28.5 (19) in ketamine group and 47.5 (31) in control group. Median (IQR) procedural pain VAS score was 21.5 (16) in ketamine group and 43.5 (29) in control group. Only 7 patients had adverse effects in either group.ConclusionThe findings of this study suggest that IN ketamine can be effective in reducing pain in patients with acute pain, without adding significant side effects.