Missing the Bull’s Eye: A Case Report of Tibialis Anterior Hernia

Objectives: Shin pain is a broad term used to describe lower leg pain. It is commonly seen in the athletic/sports population. Various conditions have been claimed to produce leg pain, and muscle herniation is one of these conditions. Muscle herniation is the protrusion of muscle through a defect in the overlying fascia. Although such herniation is common, it is often an underdiagnosed condition in the lower extremity. It usually occurs in athletes, especially in the anterior compartment of the leg, as a result of trauma or due to muscle hypertrophy secondary to strenuous exercise. Herniation diagnosis depends on its clinical presentation as it appears as a palpable soft tissue bulge through a fascia defect; radiological findings are used to confirm the diagnosis. Conservative treatment should be the initial approach, and surgery can be performed if conservative treatment fails. Methods: We present a case of symptomatic anterior lower leg pain, initially diagnosed as a psychosomatic disorder by two orthopedic physicians. However, tibialis anterior hernia in this patient was confirmed after physical examination by a physiotherapist and subsequent referral for ultrasonographic evaluation to a radiologist. The patient underwent an 8-week course of conservative treatment under the supervision of a physiotherapist. This treatment significantly improved the patient’s pain and function. Results: After eight weeks of conservative treatment using Minhaj protocol for Tibialis Anterior hernia, the patient has reported improvement in pain (reduction of score from eight to two on the NPRS scale) and function. The patient returned to his previous level of physical activity following eight weeks of rehabilitation. Discussion: Tibialis anterior hernia should be considered a differential diagnosis in chronic leg pain with palpable soft tissue protrusion. Conservative treatment can be chosen as the primary approach.

Cognitive behavioral treatment for irritable bowel syndrome: a recent literature review

Irritable bowel syndrome (IBS) is a gastrointestinal psychosomatic disorder that often develops and worsens with stress. Hence, it is important to treat it from both, its physical and mental aspects. We reviewed recent research on cognitive-behavioral therapy (CBT)—one of the most widely studied psychological treatments for IBS—since it focuses on addressing the cognitions and behaviors associated with IBS symptoms, and combines diverse content, such as cognitive techniques, exposure, stress management, and mindfulness, whose effects have been widely studied. Research on CBT for IBS varies not only in terms of content of the interventions, but also in terms of implementation (individual or group, face-to-face or online). Internet-delivered CBT has recently shown the possibility of providing more accessible and cost-effective psychological intervention to IBS patients in formats, other than face-to-face. In recent years, many standardized scales that allow for IBS-specific psychological assessments have been used in clinical studies of CBT for IBS. Tools that competently deliver effective interventions and properly measure their effectiveness are expected to spread to many people suffering from IBS.

Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study

Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland.Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used.Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa.Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.

Role of Gut Microbiota in the Pathophysiology of Stress-Related Disorders: Evidence from Neuroimaging Studies

<b><i>Background:</i></b> The brain and gut communicate bidirectionally via immune, neurological, and endocrine pathways, which is termed the “brain-gut interaction.” Recent studies of gut microbiota as a mediator of this interaction have provided a growing body of scientific evidence that suggests that the gut microbiota influences stress and emotional responses and stress-related disorders. <b><i>Summary:</i></b> Major advances in analytical methods have led to an increased number of studies that combine gut microbiota and neuroimaging, mainly magnetic resonance imaging, to elucidate the mechanisms. Observational studies have been done to examine brain characteristics related to gut microbiota profiles, and intervention studies have examined brain changes related to probiotic intake. Studies of healthy subjects using negative emotional stimuli have shown that the pattern of emotional response differs depending on the gut microbiota profile and that probiotic intervention can modulate emotional response and be a buffer against the negative effects of stress. In studies on irritable bowel syndrome (IBS), a typical psychosomatic disorder, IBS-specific gut microbiota were reported to contribute to visceral irritability and pain by affecting the subcortical regions. Studies on psychiatric disorders revealed that a relative abundance of <i>Bacteroides</i> that produce γ-aminobutyric acid in feces was associated with a change in brain function specific to depression and that gut microbiota have an influence on abnormalities in the reward system of attention-deficit/hyperactivity disorder.

Prevalence of Cyber Bullying Victims and its Associated Factors among Form 2 and Form 4 Secondary School Students in Kuala Terengganu, Malaysia

The number of cases of cyber bullying reported in schools had been alarming in these recent years. Increased accessibility of mobile phone and internet among secondary school students have made them more susceptible of becoming cyber bullying victims. These victims consequently will encounter mental health problems such as depression and anger that may lead to psychosomatic disorder and suicidal attempt in severe cases. This study focussed on determining the prevalence of cyber bullying and its associated factors among secondary school students. A cross sectional study was conducted among 482 of Form 2 and Form 4 school students in Kuala Terengganu. Data were collected using self-administered questionnaires. Data were analysed by using SPSS version 22. The descriptive statistics was applied to obtain frequency and percentage for categorical data. Simple logistic regression and Pearson Chi-square were used to determine the association between the independent variables and cyber bullying victimisation. The prevalence of cyber bullying victims in this study was 2.1% and total of 8.1% reported had been cyber bullied for lifetime. Four factors were found to be significantly associated with being a victim of cyber bullying; age (p = 0.010), type of school (p = 0.036), gender (p = 0.011) and perception towards family relationship (p = 0.006). In conclusion, the prevalence of cyber bullying victimisation in Kuala Terengganu is low in comparison to worldwide data. Although the prevalence is low, cyber-victimisation is progressing in numbers by year and there is a need to plan for proper intervention programs to enhance awareness among secondary school students to curb this issue.

Oxidative status in plasma, urine and saliva of girls with anorexia nervosa and healthy controls: a cross-sectional study

Background Anorexia nervosa (AN) is a serious psychosomatic disorder with unclear pathomechanisms. Metabolic dysregulation is associated with disruption of redox homeostasis that might play a pivotal role in the development of AN. The aim of our study was to assess oxidative status and carbonyl stress in plasma, urine and saliva of patients with AN and healthy controls. Methods Plasma, spot urine, and saliva were collected from 111 girls with AN (aged from 10 to 18 years) and from 29 age-matched controls. Markers of oxidative stress and antioxidant status were measured using spectrophotometric and fluorometric methods. Results Plasma advanced oxidation protein products (AOPP) and advanced glycation end products (AGEs) were significantly higher in patients with AN than in healthy controls (by 96, and 82%, respectively). Accordingly, urinary concentrations of AOPP and fructosamines and salivary concentrations of AGEs were higher in girls with AN compared with controls (by 250, and 41% in urine; by 92% in saliva, respectively). Concentrations of thiobarbituric acid reactive substances (TBARS) in saliva were 3-times higher in the patients with AN than in the controls. Overall antioxidants were lower in plasma of girls with AN compared to the controls, as shown by total antioxidant capacity and ratio of reduced and oxidized glutathione (by 43, and 31%, respectively). Conclusions This is the first study assessing wide range of markers of oxidative status in plasma, urine and saliva of the patients with AN. We showed that both, higher levels of markers of oxidative stress and lower antioxidants play a role in redox disruption. Restoration of redox homeostasis might be of the clinical relevance

Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia

Background: It remains unclear whether reactive hypoglycemia (RH) is a disorder caused by improper insulin secretion, result of eating habits that are not nutritionally balanced or whether it is a psychosomatic disorder. The aim of this study was to investigate metabolic parameters in patients admitted to the hospital with suspected RH. Methods: The study group (SG) included non-diabetic individuals with symptoms consistent with RH. The control group (CG) included individuals without hypoglycemic symptoms and any documented medical history of metabolic disorders. In both groups the following investigations were performed: fasting glucose and insulin levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), 75 g five-hour Oral Glucose Tolerance Test (OGTT) with an assessment of glucose and insulin and lipid profile evaluation. Additionally, Mixed Meal Tolerance Test (MMTT) was performed in SG. Results from OGTT and MMTT were analyzed in line with the non-standardized RH diagnostic criteria. Results: Forty subjects have been enrolled into SG. Twelve (30%) of those patients had hypoglycemic symptoms and glucose level ≤55 mg/dL during five-hour OGTT and have been diagnosed with RH. Ten (25%) subjects manifested hypoglycemic like symptoms without significant glucose decline. Patients with diagnosed RH had statistically significantly lower mean glucose at first (92.1 ± 37.9 mg/dL vs. 126.4 ± 32.5 mg/dL; LSD test: p < 0.001) and second (65.6 ± 19.3 mg/dL vs. 92.6 ± 19.3 mg/dL; LSD test: p < 0.001) hour of OGTT and insulin value (22.7 ± 10.9 lU/mL vs. 43.4 ± 35.0 lU/mL; LSD test: p < 0.001) at second hour of OGTT compared to the patients who did not meet the criteria of RH. Seventeen (43%) subjects from SG reported symptoms suggesting hypoglycemia during MMTT but none of them had glucose value lower than ≤55 mg/dL (68.7 ± 4.7 mg/dL). From the entire lipid profile, only mean total cholesterol value was significantly higher (p = 0.024) in SG in comparison with CG but did not exceed standard reference range. Conclusions: No metabolic disturbances have been observed in patients with diagnosed reactive hypoglycemia. Hyperinsulinemia has not been associated with glycemic declines in patients with this condition. Occurrence of pseudohypoglicemic symptoms and lower glucose value was more common after ingestion of glucose itself rather than after ingestion of a balanced meal. This could suggest an important role that nutritionally balanced diet may play in maintaining correct glucose and insulin levels in the postprandial period.

Modern Scientific Research In Oncological Diseases

The flow of information all over the world, the process of globulation, the rush of individual relations do not transfer its influence on the human psyche. As a result of external factors provoking negative changes in the human psyche, emotional exposure, tension, in general, a violation of the normative indicator of the state of health, psychosomatic disorder arises. The role of human psychics in the origin, course and treatment of cancer as a result of the achievements of science, the integration of science has been reflected in the research carried out in the second half of the 20th century.

Mental health and biological evolution: implications for psychiatry and psychosomatic medicine

Psychiatric disorders are common and seem to increase in prevalence worldwide. Most scientific approaches for this phenomenon fail to explain why the majority of mental disorders, unlike most somatic diseases, manifest in early adulthood, why individuals are not more resilient, and why some genes increasing the risk for mental disorders have not been selected against. In this article, an evolutionary perspective on mental health and disorder is taken. This perspective suggests that mismatches between ancestral and contemporary environments contribute to the risk for mental disorders. In addition, predictions from attachment theory and life history theory can explain individual differences with regard to the risk of developing a psychiatric or psychosomatic disorder. Insights from evolutionary approaches to psychiatric and psychosomatic disorders may contribute to improve the prevention and treatment of mental disorders.

Depression preceding the diagnosis of pancreatic cancer

Pancreatic cancer is the tumour related to higher rates of depression. Several papers have validated the association between pancreatic cancer and depression. It was noticed that in some cases the psychiatric symptoms precede the somatic ones. We present a case of a progressive and incapacitating diffuse abdominal pain, initially attributed to psychosomatic disorder. This hindered a timely correct diagnosis leading to a poor outcome. A pancreatic adenocarcinoma in an unresectable stage was confirmed by histopathology. The patient underwent chemotherapy.