Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature

Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms—persistent headache followed by neurological deficit—in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.

Clinical Characteristics of Iraqi Women Who Had Plantar Fasciitis

Plantar fasciitis is a common complaint. This paper aimed to find the clinical characteristics of Al-Ramadi Women who had Plantar fasciitis. A specialist rheumatologist in Al-Ramadi Teaching Hospital collected this prospective report from 170 Iraqi women, aged (25-70) years, who had plantar fasciitis between 1st January 2019 to 1st January 2020. Our findings showed that the most common affected age was between (40-49) years among all women who suffered from intense sharp painful heels at the start of walking. There were 66 women (38%) between (40-49) years plus 32 women (18%) their BMI was between (30-34%). In the commonest age group, there were 37 women (21.7%) who had Calcaneal spur and five women (0.2%) who had Diabetes Mellitus. Therefore, it can be clearly said that Plantar Fasciitis is an evidence for obese due to the statistical analysis carried on the middle-aged Iraqi women who had intense sharp painful heels at the start of walking plus calcaneal spur in the lateral X-ray.

Program Studi Sarjana Fisioterapi, Universitas Muhammadiyah Pekajangan Pekalongan, Indonesia

Nausea and vomiting (emesis gravidarum) is a common complaint in the first trimester pregnant women. One of non-pharmacological therapies which are safe to give to pregnant women who experience emesis gravidarum is lemon aromatherapy. This scientific paper aims to investigate the effect of lemon aromatherapy to reduce emesis gravidarum in pregnant women in trimester I. It is a literature review with three articles taken from Google scholar. Emesis gravidarum, lemon therapy, and pregnant women in trimester I are the keywords. These articles are full-text, published in 2018-2019. The analysis result of respondents characteristics from 71 people, most of them (75%) are 20-35 years old, parity 65% of multigravida, gestational age 25% of weeks. Nausea score measurement was measured by RHODES Indeks score. The analysis result of the articles stated there is a significant different before and after intervention. The total score average before applying the intervention was 19.18 and it reduced into 10.63 after the process. It means there is a reduction for about 8.55 after the treatment. The conclusion is applying lemon aromatherapy has effectively reduced emesis gravidarum in pregnant women in trimester I. therefore, nurses were suggested to apply this therapy as an alternative ways to reduce the frequency of nausea.Keywords : emesis gravidarum lemon ; aromatherapy ; pregnant women in trimester I AbstrakMual muntah (Emesis gravidarum) merupakan keluhan yang sering terjadi pada ibu hamil trimester pertama. Salah satu terapi nonfarmakologi yang aman di berikan pada ibu hamil yang mengalami emesis gravidarum adalah aromaterapi lemon. Karya Tulis Ilmiah ini bertujuan untuk menggambarkan penerapan pengaruh aromaterapi lemon untuk mengurangi emesis gravidarum pada ibu hamil trimester I berdasarkan literature review. Desain Karya Tulis ilmiah ini berupa literature review dengan jumlah artikel tiga yang diambil dari laman jurnal google scolar dengan kata kunci “ emesis gravidarum” “Aromaterapi lemon” dan “ibu hamil trimester I,” berupa artikel fulltext, terbit tahun 2018-2019. Hasil analisa karakteristik responden dari tiga artikel menunjukan jumlah responden 71, sebagian besar 75.0 % umur 20-35 tahun, paritas 65% multigravida, usia kehamilan 25.0 % 9 minggu. Pengukuran skor mual di ukur dengan menggunakan skor Index RHODES. Hasil analisa dari tiga artikel menunjukan jumlah skor rata-rata sebelum intervensi 19,18 setelah intervensi 10,63, terdapat penurunan skor rata-rata setelah dilakukan pemberian aromaterapi lemon sebesar 8,55. Simpulan hasil menunjukan bahwa pemberian aromaterapi lemon efektif menangani emesis gravidarum pada ibu hamil trimester I. Saran bagi petugas kesehatan hendaknya bisa menerapkan aromaterapi lemon sebagai alternatif untuk mengurangi frekuensi mual.Kata Kunci : Emesis Gravidarum ; Aromaterapi Lemon ; Ibu hamil Trimester

Sleep Disorder in Tinnitus Patients

Background and Objectives One of the most common complaint of tinnitus patients has been sleep disorder. The aim of this study was to evaluate the relationship between sleep disorder and tinnitus.Subjects and Method Patients with tinnitus from July 2018 till August 2019 were enrolled. Subjects who had any acute/chronic disease in the inner and middle ear or external auditory canal, sleep apnea and had more than 3 caffeinated beverages a day was excluded. Study participants completed Beck Depression Inventory (BDI), the tinnitus symptom questionnaire, tinnitus handicap inventory (THI), Pittsburg Sleep Quality Inventory (PSQI), pure tone audiometry, a full otologic examination and an interview on past medical history.Results THI was correlated with PSQI global score and BDI. The PSQI subscale most relevant to THI was PSQI 1 (subjective sleep quality). Hearing impairment was correlated with the THI functional subscale. BDI was individually related to PSQI.Conclusion Tinnitus is found to be highly related to sleep disorder, suggesting a common pathway of aggravation and treatment target. Tinnitus is also more affected by sleep disorder than by depression. A further examination and treatment of comorbid sleep disorder in tinnitus patients is recommended.

Az időskori szédülés életminőségre kifejtett hatása

Összefoglaló. Bevezetés: A szédülés időskorban gyakori panasz, amely jelentősen befolyásolja az életminőséget. Háttere sok esetben multifaktoriális, egyes esetekben azonban jól meghatározott ok kimutatható. Célkitűzés: Kutatásunk célja az időskori szédülő populáció panaszainak, valamint életminőségének felmérése volt. Anyag és módszer: Kutatásunkba 36 (13 férfi, 23 nőbeteg, átlagéletkor ± SD, 72,78 év ± 4,6), Otoneurológiai Ambulanciánkon szédülés miatt vizsgált, 65 év feletti beteget vontunk be. Ők az általunk összeállított, panaszokkal és rizikófaktorokkal kapcsolatos kérdőív mellett a Dizziness Handicap Inventory-t is kitöltötték. Az utóbbi alapján meghatározható volt az életminőség-romlás, illetve annak mértéke. A statisztikai elemzést az IBM SPSS V24 szoftver segítségével végeztük, Mann–Whitney U-teszt és khi-négyzet-próba alapján. Minden esetben p<0,05 értéket tekintettünk szignifikáns különbségnek. Eredmények: A leggyakoribb diagnózisként a Ménière-betegséget, valamint a centrális vestibularis eltéréseket detektáltuk. A betegek visszajelzése alapján a szédülés volt a legdominánsabb tünet, amely a leggyakrabban órákig, illetve napokig tartott, és fele arányban volt forgó jellegű. Emellett a fülzúgás, a halláscsökkenés, valamint a vegetatív tünetek is dominánsak voltak. A leggyakoribb társbetegségek közül gyakoriságuk miatt kiemelendők a mozgásszervi, illetve szemészeti eltérések, a hypertonia, valamint a pszichiátriai betegségek. A betegek 77,8%-a jelzett valamilyen mértékű életminőség-romlást, és kiemelendő, hogy 30%-uk a súlyos kategóriába esett. A Dizziness Handicap Inventory kérdőívek alapján a fizikális, funkcionális, valamint emocionális részpontszámok hasonló értéket mutattak. Következtetés: Az időskori szédülés lényeges a beteg romló életminősége szempontjából. A társuló komorbiditások mellett a háttérben álló vestibularis eltérések kizárása, illetve diagnosztizálása fontos feladat. Ennek függvényében tervezhető a terápia, amely kapcsán a kísérő tünetekre is fontos hangsúlyt fektetni. Így az érintett betegek életminősége javítható. Orv Hetil. 2021; 162(47): 1891–1896. Summary. Introduction: Vertigo is a common complaint in elderly, which has significant influence on the patients’ quality of life. In many cases its background is complex, although, in some cases specific diagnosis can be made. Objective: Our study aimed to analyze the symptoms and quality of life of old-age vertiginous population. Material and method: 36 patients (13 males, 23 females, mean age ± SD, 72.78 years ± 4.6) over 65 years, examined due to vertigo at our Neurotologic Department, were enrolled. A questionnaire including questions regarding the symptoms, risk factors, along with the Dizziness Handicap Inventory was used. Statistical analysis was carried out using IBM SPSS V24 software. Mann–Whitney U and chi square tests were used. Statistical significance was defined as p<0.05. Results: Ménière’s disease and central vestibular disorders were found as the most frequent diagnoses. Vertigo was the most tormenting symptom, which usually lasted for hours or days, and was defined as rotatory in 50%. Tinnitus, hearing loss and vegetative symptoms were also dominant. The most frequent comorbidities were musculoskeletal disorders, hypertension, ophthalmological diseases and psychiatric disorders. 77.8% of the patients have reported worsened quality of life, of which 30% was detected as severe. Based on the Dizziness Handicap Inventory, physical, functional and emotional scores showed similar results. Conclusion: Vertigo in elderly is important due to its influence on patients’ quality of life. Besides comorbidities, the diagnosis of vestibular pathologies is of great importance. Therefore, therapy planning is possible, and patients’ quality of life can be improved. Orv Hetil. 2021; 162(47): 1891–1896.

The power of feeling seen: perspectives of individuals with eating disorders on receiving validation

Background A common complaint of individuals suffering from mental health conditions is feeling invalidated or misunderstood by care providers. This is notable, given that non-collaborative care has been linked to poor engagement, low motivation and treatment non-adherence. This study examined how receiving validation from care providers is experienced by individuals who have an eating disorder (ED) and the impact of receiving validation on the recovery journey. Methods Eighteen individuals who had an eating disorder for an average duration of 19.1 years (two identifying as male, 16 identifying as female), participated in semi-structured interviews on barriers and facilitators to self-compassion. Seven were fully recovered, and 11 were currently participating in recovery-focused residential treatment. Thematic analysis focused on the meaning and impact of receiving validation to participants. Results Five care provider actions were identified: (i) making time and space for me, (ii) offering a compassionate perspective, (iii) understanding and recognizing my treatment needs, (iv) showing me I can do this, and (v) walking the runway. These were associated with four key experiences (feeling trust, cared for, empowered, and inspired), that participants described as supportive of their recovery. Conclusions This research provides insight into patient perspectives of validation and strategies care providers can use, such as compassionate reframing of difficult life experiences, matching interventions to patient readiness, and modeling vulnerability.

NCOG-32. PROGNOSTIC IMPLICATIONS OF SIZE OF PITUITARY MACROADENOMAS: A COMPARATIVE ANALYSIS OF GIANT ADENOMAS WITH NON-GIANT MACROADENOMAS

BACKGROUND In this study we compared giant pituitary adenomas (GPAs) and non-giant pituitary macroadenomas (nGPAs) on the basis of presenting complaints, surgical procedures, tumor resections and outcomes. METHODS A retrospective analysis (2006-2017) of pituitary macroadenomas was performed where tumors were divided into two groups; tumors greater than 4 cm were classified as GPAs while macroadenomas smaller than 4 cm were termed as nGPAs. Both GPA and nGPA had 75 patients in each group. RESULTS The most common complaint of all patients was visual deterioration (77.3% of patients with nGPAs and 89.3% of patients with GPAs). Visual field defects were present in 55 patients (73.3%) in the nGPA group compared to 68 patients (90.7%) in the GPA group (p=0.006). The mean volume of nGPAs was 6.3 cm3 (range 0.45 cm3 to 22 cm3 while the mean volume of GPAs was 30.1 cm3 (range 10.8 cm3 to149.4 cm3) (p=0.001). The mean extent of resection was 88.9% for nGPAs whereas the mean extent of resection was 76.7% for GPAs (p=0.03). Craniotomy was required only in the GPA group (5 patients, 6.7%) (p=0.023). Tumor recurrence/progression was seen in 9.3% of patients with nGPAs and 44% of patients with GPAs (p=&lt; 0.001). Re-do surgery was required in 2.7% of nGPA cases (via transsphenoidal approach) and 32% of GPA cases; in this GPA subgroup, 22.7% patients required transsphenoidal surgeries while 9.3% patients required transcranial surgeries. Stereotactic radiosurgery in recurrence/progression accounted for 4% of nGPA patients and 22.7% of GPA patients. There were 3 mortalities, all in GPA group. Overall, nGPA group had better postoperative course as compared to GPA group. CONCLUSION The frequency of preoperative symptoms in GPAs is more significant and associated with lesser chances of gross total tumor resection, higher rates of recurrence, and worse postoperative course in comparison to nGPAs.

Association between headache and tinnitus among medical students

ABSTRACT Background: Headache is a very common complaint and it is increasingly prevalent among university students. Tinnitus consists of subjectively perceived sounds that occur in the absence of an external auditory signal. Presence of headache and tinnitus in association has implications for therapy and prognosis, because this describes the temporality of the symptoms. Recognition of the epidemiological profile of symptomatic students might contribute to interventions. Objective: To investigate the prevalence of the association between headache and tinnitus, and to describe the epidemiological profile of the study population and the chronological order of appearance of these symptoms. Methods: Cross-sectional, observational and analytical study on a sample representative of an academic center. Data referring to the epidemiological and clinical profile of headache and tinnitus among medical students were collected through an online questionnaire built using the Google Forms tool. Results: Out of the 234 participants, 26.1% reported having tinnitus and headache (p < 0.001). The participants with headache were more likely to be women (p = 0.045), white (p = 0.009) and 21-25 years old (p = 0.356). Among right-sided, left-sided and non-unilateral headaches, tinnitus was present predominantly in the non-unilateral type, but without statistical significance. Regarding timing, 18.0% of the students said that tinnitus started before headache, 57.4% said that headache started before tinnitus and 24.6% said that they started simultaneously. Conclusions: An important association between headache and tinnitus regarding lateralization and temporality was demonstrated. Thus, these data match the presumption that headache and tinnitus have a physiopathological connection.

Introduction and Approach to Headache

Headache is experienced by 93% of men and 99% of women at some time in their lives. It is the most common complaint treated by neurologists and the seventh most common complaint treated by primary care providers. Although most headaches in the general population meet the criteria for tension-type headache, migraine is the most common headache treated in clinical practice and affects 18% of women and 6% of men, typically in their peak years of productivity. Evaluation of headache should include a thorough history and general, musculoskeletal, and neurologic examinations. Paramount in the headache evaluation is the proper identification of red flags that may indicate an underlying secondary cause of headache.

Human Dignity and Tragic Choices

This essay comments on the aspirations and limits of normative ethical theory, some merits of a broadly Kantian version, the common complaint that Kantian ethics refuses to admit exceptions to familiar moral principles, objections to the idea of human dignity, examples of lies and torture, and the value of details and simplicity in ethics.