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Journal of Clinical Medicine Jun 2024Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges... (Review)
Review
Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. A systematic literature review was conducted in accordance with the PRISMA guidelines. We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights.
PubMed: 38930119
DOI: 10.3390/jcm13123590 -
Diagnostics (Basel, Switzerland) Jun 2024Neck pain is commonly referred to an ENT specialist and can be caused by the little-known inflammatory condition of the lateral thyrohyoid ligament. The pathophysiology...
OBJECTIVE
Neck pain is commonly referred to an ENT specialist and can be caused by the little-known inflammatory condition of the lateral thyrohyoid ligament. The pathophysiology of this condition is believed to be inflammation subsequent to over-exertion or cervical trauma. Typically, patients present with chronic unilateral neck pain. Elicitation of localized tenderness over the axis of the lateral thyrohyoid ligament on palpation is a key finding for its diagnosis. We present an unusual case with an acute course and subcutaneous inflammation and discuss its management in an effort to raise awareness for this often-misdiagnosed syndrome.
METHODS
A systematic literature research on PubMed was performed selecting patients with a definitive diagnosis of thyrohyoid syndrome or lateral thyrohyoid ligament syndrome.
RESULTS
We collected 54 cases from three studies. This condition is an important differential diagnosis for acute or chronic antero-lateral or unilateral neck pain.
CONCLUSION
No specific radiological findings are defined and a CT scan is therefore not necessary for its diagnosis, but ultrasound is a useful tool to primarily assess any neck lesion. Once the diagnosis is made, a local infiltration of steroids is the most sustainable treatment option and relapse prevention.
PubMed: 38928643
DOI: 10.3390/diagnostics14121227 -
Frontiers in Medicine 2024This meta-analysis aims to examine how effective ketamine is in the management of acute and preventing chronic post-thoracotomy pain by synthesizing the available...
OBJECTIVE
This meta-analysis aims to examine how effective ketamine is in the management of acute and preventing chronic post-thoracotomy pain by synthesizing the available research.
METHOD
A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library till May 2023. Randomized Controlled Trials (RCT) examining the influence of ketamine on post-thoracotomy pain in adults were included. The intervention group included ketamine plus morphine, while the control group included morphine only. The outcome measures were opioid intake and pain scores at rest and on moving/coughing. Evidence quality was evaluated using the Cochrane Risk of Bias and GRADE assessment.
RESULTS
Nine articles comprising 556 patients were selected for meta-analysis. The intervention group had a significant decrease in pain at rest (Std. Mean Difference (SMD = -0.60 with 95% CI [-0.83, -0.37]) and on movement/cough (SMD = -0.73 [-1.27, -0.18]) in the first postoperative days. Also, the ketamine group had lower opioid consumption (mg) in comparison with controls (SMD = -2.75 [-4.14, -1.36], -value = 0.0001) in postoperative days 1-3. There was no data to assess the long-term effect of ketamine on chronic pain.
CONCLUSION
This meta-analysis shows that ketamine use can lower acute pain levels and morphine use after thoracotomy. In the future, larger RCTs using standardized methods and assessing both short-term and long-term analgesic effects of ketamine are necessary to deepen the understanding of the issue.
PubMed: 38919936
DOI: 10.3389/fmed.2024.1394219 -
Journal of Orthopaedic Surgery and... Jun 2024Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in... (Review)
Review
BACKGROUND
Compartment syndrome is a well-known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting.
CASE PRESENTATION
53-year-old male who presented with progressively worsening low back pain and paresthesias one day after high-intensity deadlifting. Laboratory testing found the patient to be in rhabdomyolysis; he was admitted for intravenous fluid resuscitation and pain control. Orthopedics was consulted, and Magnetic Resonance Imaging revealed significant paravertebral edema and loss of muscle striation. Given the patient's lack of improvement with intravenous and oral pain control, clinical and radiographic findings, there was significant concern for acute paralumbar compartment syndrome. The patient subsequently underwent urgent fasciotomy of bilateral paralumbar musculature with delayed closure.
CONCLUSION
Given the paucity of literature on paralumbar compartment syndrome, the authors' goal is to promote awareness of the diagnosis, as it should be included in the differential diagnosis of intractable back pain after high exertional exercise. The current literature suggests that operative cases of paralumbar compartment syndromes have a higher rate of return to pre-operative function compared to those treated non-operatively. This case report further supports this notion. The authors recommend further study into this phenomenon, given its potential to result in persistent chronic exertional pain and irreversible tissue damage.
Topics: Humans; Male; Middle Aged; Compartment Syndromes; Low Back Pain; Rhabdomyolysis; Lifting
PubMed: 38909253
DOI: 10.1186/s13018-024-04860-3 -
BMC Gastroenterology Jun 2024The primary objective of this study is to comparatively assess the safety of nasogastric (NG) feeding versus nasojejunal (NJ) feeding in patients with acute pancreatitis... (Meta-Analysis)
Meta-Analysis Comparative Study
Comparative safety assessment of nasogastric versus nasojejunal feeding initiated within 48 hours post-admission versus unrestricted timing in moderate or severe acute pancreatitis: a systematic review and meta-analysis.
BACKGROUND
The primary objective of this study is to comparatively assess the safety of nasogastric (NG) feeding versus nasojejunal (NJ) feeding in patients with acute pancreatitis (AP), with a special focus on the initiation of these feeding methods within the first 48 h of hospital admission.
METHODS
Studies were identified through a systematic search in PubMed, EMbase, Cochrane Central Register of Controlled Trials, and Web of Science. Four studies involving 217 patients were included. This systematic review assesses the safety and efficacy of nasogastric versus nasojejunal feeding initiated within 48 h post-admission in moderate/severe acute pancreatitis, with a specific focus on the timing of initiation and patient age as influential factors.
RESULTS
The results showed that the mortality rates were similar between NG and NJ feeding groups (RR 0.86, 95% CI 0.42 to 1.77, P = 0.68). Significant differences were observed in the incidence of diarrhea (RR 2.75, 95% CI 1.21 to 6.25, P = 0.02) and pain (RR 2.91, 95% CI 1.50 to 5.64, P = 0.002) in the NG group. The NG group also showed a higher probability of infection (6.67% vs. 3.33%, P = 0.027) and a higher frequency of multiple organ failures. Subgroup analysis for early intervention (within 48 h) showed a higher risk of diarrhea in the NG group (RR 2.80, P = 0.02). No significant differences were found in the need for surgical intervention, parenteral nutrition, or success rates of feeding procedures.
CONCLUSION
This meta-analysis highlights the importance of considering the method and timing of nutritional support in acute pancreatitis. While NG feeding within 48 h of admission increases the risk of certain complications such as diarrhea and infection, it does not significantly impact mortality or the need for surgical intervention.
Topics: Humans; Intubation, Gastrointestinal; Enteral Nutrition; Pancreatitis; Time Factors; Acute Disease; Diarrhea; Hospitalization; Jejunum
PubMed: 38902639
DOI: 10.1186/s12876-024-03290-z -
Canadian Journal of Anaesthesia =... Jun 2024Online video sharing platforms like YouTube (Google LLC, San Bruno, CA, USA) have become a substantial source of health information. We sought to conduct a systematic... (Review)
Review
BACKGROUND
Online video sharing platforms like YouTube (Google LLC, San Bruno, CA, USA) have become a substantial source of health information. We sought to conduct a systematic review of studies assessing the overall quality of perioperative anesthesia videos on YouTube.
METHODS
We searched Embase, MEDLINE, and Ovid for articles published from database inception to 1 May 2023. We included primary studies evaluating YouTube videos as a source of information regarding perioperative anesthesia. We excluded studies not published in English and studies assessing acute or chronic pain. Studies were screened and data were extracted in duplicate by two reviewers. We appraised the quality of studies according to the social media framework published in the literature. We used descriptive statistics to report the results using mean, standard deviation, range, and n/total N (%).
RESULTS
Among 8,908 citations, we identified 14 studies that examined 796 videos with 59.7 hr of content and 47.5 million views. Among the 14 studies that evaluated the video content quality, 17 different quality assessment tools were used, only three of which were externally validated (Global Quality Score, modified DISCERN score, and JAMA score). Per global assessment rating of video quality, 11/13 (85%) studies concluded the overall video quality as poor.
CONCLUSIONS
Overall, the educational content quality of YouTube videos evaluated in the literature accessible as an educational resource regarding perioperative anesthesia was poor. While these videos are in demand, their impact on patient and trainee education remains unclear. A standardized methodology for evaluating online videos is merited to improve future reporting. A peer-reviewed approach to online open-access videos is needed to support patient and trainee education in anesthesia.
STUDY REGISTRATION
Open Science Framework ( https://osf.io/ajse9 ); first posted, 1 May 2023.
PubMed: 38902576
DOI: 10.1007/s12630-024-02791-5 -
Archives of Physical Medicine and... Jun 2024To systematically review the literature for efficacy Gleno-humeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes DATA SOURCES:... (Review)
Review
OBJECTIVE
To systematically review the literature for efficacy Gleno-humeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes DATA SOURCES: PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, and Google Scholar and Web of Science were searched for relevant studies published.
STUDY SELECTION
A review of randomized controlled trials and quasi-experiments conducted in English language that assessed the effectiveness of Gleno-humeral Internal Rotation Deficit (GIRD) and the risk of upper extremity injury in athletes who perform overhead movements. The review included seven randomized controlled trials and two quasi-experiments out of 5403, which involved a total of 360 participants.
DATA EXTRACTION
Two reviewers independently screened the articles, scored methodological quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials.
DATA SYNTHESIS
The efficacy of different types of techniques was evaluated. Joint mobilization, sleeper stretch, cross body stretch, myofacial release, kinesio and rigid taping showed improvement in pain score and range of motion. Furthermore, self-myo-facial release tends to improve internal rotation; sleeper stretch and crossbody stretch tend to improve internal rotation with 40 percent decline in pain. However kinesio-taping and rigid taping showed good result in improvement of internal rotation Acute results determined that the (Metabolic equivalent) MET group had significantly more horizontal adduction ROM post-treatment compared to the control group (p=0.04). No differences existed between MET and joint mobilizations or joint mobilizations and the control group for horizontal adduction (p>0.16). No significant between group differences existed acutely for internal rotation (p>.28). There were no significant between group differences for either horizontal adduction or internal rotation at the 15- minute posttests (p>0.70).
CONCLUSIONS
In conclusion, the study evaluated the efficacy of various techniques in improving pain score and range of motion in individuals with Gleno-humeral Internal Rotation Deficit (GIRD). Joint mobilization, sleeper stretch, cross body stretch, myofascial release, kinesio-taping, and rigid taping all showed improvements in pain score and Range of motion. However, there were no significant between-group differences for either horizontal adduction or internal rotation at the 15-minute post-tests. Overall, these findings suggest that a combination of these techniques may be effective in treating individuals with GIRD.
PubMed: 38897400
DOI: 10.1016/j.apmr.2024.05.027 -
Journal of Clinical Medicine May 2024: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function... (Review)
Review
Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: Systematic Review and Meta-Analysis.
: The aim of this meta-analysis was to determine the effects of respiratory muscle training (RMT) on functional ability, pain-related outcomes, and respiratory function in individuals with sub-acute and chronic low back pain (LBP). : The study selection was as follows: (participants) adult individuals with >4 weeks of LBP; (intervention) RMT; (comparison) any comparison RMT (inspiratory or expiratory or mixed) versus control; (outcomes) postural control, lumbar disability, pain-related outcomes, pain-related fear-avoidance beliefs, respiratory muscle function, and pulmonary function; and (study design) randomized controlled trials. : 11 studies were included in the meta-analysis showing that RMT produces a statistically significant increase in postural control (mean difference (MD) = 21.71 [12.22; 31.21]; decrease in lumbar disability (standardized mean difference (SMD) = 0.55 [0.001; 1.09]); decrease in lumbar pain intensity (SMD = 0.77 [0.15; 1.38]; increase in expiratory muscle strength (MD = 8.05 [5.34; 10.76]); and increase in forced vital capacity (FVC) (MD = 0.30 [0.03; 0.58]) compared with a control group. However, RMT does not produce an increase in inspiratory muscle strength (MD = 18.36 [-1.61; 38.34]) and in forced expiratory volume at the first second (FEV1) (MD = 0.36 [-0.02; 0.75]; and in the FEV1/FVC ratio (MD = 1.55 [-5.87; 8.96]) compared with the control group. : RMT could improve expiratory muscle strength and FVC, with a moderate quality of evidence, whereas a low quality of evidence suggests that RMT could improve postural control, lumbar disability, and pain intensity in individuals with sub-acute and chronic LBP. However, more studies of high methodological quality are needed to strengthen the results of this meta-analysis.
PubMed: 38892764
DOI: 10.3390/jcm13113053 -
Pain Jun 2024Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain...
Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
PubMed: 38888742
DOI: 10.1097/j.pain.0000000000003288 -
British Journal of Anaesthesia Jun 2024Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential... (Review)
Review
BACKGROUND
Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential to identifying patients at high risk for severe postoperative pain and for developing analgesic strategy. This systematic review and meta-analysis summarises PPS and assessed its correlation with postoperative pain.
METHODS
PubMed, Scopus, Cochrane Library, and PsycINFO were searched up to October 1, 2023, for studies reporting the association between PPS and postsurgical pain. Two authors abstracted estimates of the effect of each method independently. A random-effects model was used to combine data. Subgroup analyses were performed to investigate the effect of pain types and surgical procedures on outcomes.
RESULTS
A total of 70 prospective observational studies were included. A meta-analysis of 50 studies was performed. Postoperative pain was negatively associated with pressure pain threshold (PPT; r=-0.15, 95% confidence interval [CI] -0.23 to -0.07]) and electrical pain threshold (EPT; r=-0.28, 95% CI -0.42 to -0.14), but positively correlated with temporal summation of pain (TSP; r=0.21, 95% CI 0.12-0.30) and Pain Sensitivity Questionnaire (PSQ; r=0.25, 95% CI 0.13-0.37). Subgroup analysis showed that only TSP was associated with acute and chronic postoperative pain, whereas PPT, EPT, and PSQ were only associated with acute pain. A multilevel (three-level) meta-analysis showed that PSQ was not associated with postoperative pain.
CONCLUSIONS
Lower PPT and EPT, and higher TSP are associated with acute postoperative pain while only TSP is associated with chronic postoperative pain. Patients with abnormal preoperative pain sensitivity should be identified by clinicians to adopt early interventions for effective analgesia.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO (CRD42023465727).
PubMed: 38879440
DOI: 10.1016/j.bja.2024.05.010