Spirituality in Coping with Pain in Cancer Patients: A Cross-Sectional Study

Spirituality has been identified as an adaptive coping strategy and a predictor of better quality of life in cancer patients. Despite the relevance of spirituality in the health–disease process, it is noted that the assessment of the impact of spirituality in coping with pain is still incipient. The objective of this study is to assess the impact of spirituality in coping with pain in cancer patients. This quantitative cross-sectional study was carried out in a medium-sized hospital and a cancer patient support institution located in northeastern Brazil. A questionnaire with sociodemographic and clinical variables was used and the following instruments were applied: Visual Analogue Scale (VAS); Short-Form McGill Pain Questionnaire (SF-MPQ); Neuropathic Pain 4 Questions (DN4); Spiritual Wellbeing Scale (SWBS); WHOQOL Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB). Most people with no pain had higher scores on the SWBS. Neuropathic pain was identified in 23 patients and was associated with the highest level of spirituality used as a way of coping with pain. As faith increases, pain decreases in intensity by 0.394 points. On the other hand, as inner peace increases, pain increases by 1.485 points. It is concluded that faith is a strategy for coping with pain, in particular neuropathic pain, minimizing its intensity. On the other hand, greater levels of inner peace allow to increase the awareness of the painful sensation. It is expected that these findings may be useful to integrate spirituality care in healthcare facilities as a resource for positive coping for people in the process of becoming ill, contributing to the therapeutic path and favouring a new meaning to the experience of the disease.

Impactos das assistências obstétricas e dos tipos de partos: experiências de primíparas

Objetivos: conhecer impactos e experiências em partos (vaginais e cesáreos) de primíparas. Métodos: estudadas 306 puérperas de termo (SUS), impactos e experiências nos partos esperados e ocorridos. Utilizou-se escala de valores para respostas psicométricas "em nenhum momento", "alguns momentos", "frequente", "maior parte do tempo" e "tempo todo". A cada termo indicativo da frequência de ocorrência foi atribuído número de 1 a 5. O questionário possuía duas partes: na primeira indicavam aspectos positivos quanto maior a frequência de ocorrência e na segunda, as experiências negativas, onde perguntas citadas exibiam exatamente as respostas inversas. Resultados: para a via de parto preferencial no acompanhamento pré-natal e o parto realizado: 101 (53,72%) ficaram satisfeitas com seu parto vaginal ocorrido, enquanto 88 (74,58%) dos partos cesáreas, desaprovaram a cesárea resultante (p < 0, 0001). Proporções maiores, positivas e significantes foram após o parto vaginal, por ser opção pessoal, rápida recuperação, melhor sensação com recém-nascido, receio de acidentes anestésicos. Provável incapacidade para em sua execução, o tempo e a dor intraparto, geraram impactos negativos significantes (p < 0, 0001). Estatisticamente significante, menor em preferência, a cesárea surgiu favoravelmente (p< 0, 0001) contra a dor intraparto e rapidez resolutiva; porém, foi desaprovada pela possibilidade de acidente anestésico (p < 0,0001). Conclusões: Predominaram favoravelmente experiências positivas para parto vaginal, com significância estatística. Impactos negativos para eles foram o tempo, sensação dolorosa e provável incapacidade para a execução partal. As soluções sugeridas para minimizá-las: atenções assistenciais adequadas devolvendo a autoconfiança às pacientes, além da utilização da analgesia intraparto. Apesar de significantemente menor em preferência, o parto cesáreo foi avaliado positivamente pelo receio da experiência dolorosa da parturição, e por sua rapidez resolutiva. A cesárea. teve significante e negativamente contra si, a possibilidade de acidente anestésico. Objectives: to know impacts and experiences in births (vaginalists and cesareans) of primiparous. Methods: 306 mothers at term (SUS) were studied, impacts and experiences in expected and actual deliveries. A scale of values ​​was used for psychometric responses "at no time", "some moments", "frequent", "most of the time" and "all time". Each term indicating the frequency of occurrence was assigned a number from 1 to 5. The questionnaire had two parts: first indicated positive aspects, the higher the frequency of occurrence and the second, negative experiences, where the questions mentioned showed exactly the opposite answers. Results: for the preferred mode of delivery in prenatal care and delivery: 101 (53.72%) were satisfied with their vaginal delivery, while 88 (74.58%) of the cesarean deliveries disapproved the resulting cesareans (p < 0.0001). Larger, positive, and significant proportions were after vaginal delivery, as it is a personal option, quick recovery, better feeling with the newborn, fear of anesthetic accidents. Probable inability to perform, time and intrapartum pain, generated significant, negative impacts (p < 0,0001). Statistic significant, lower in preference, the cesarean appeared favorably (p<0.0001) against intrapartum pain and resolving speed; however, it was disapproved due to the possibility of an anesthetic accident (p < 0,0001). Conclusions: Positive experiences for vaginal delivery predominated, with statistical significance. Negative impacts for them were timing, painful sensation, and likely inability to perform birth. Suggested solutions to minimize them: adequate care assistance restoring self-confidence to patients, in addition to the use of intrapartum analgesia. Despite being significantly lower in preference, cesarean delivery was evaluated positively for fear of the painful experience of parturition, and for its rapid resolution. The cesarean. had significantly and negatively against itself, the possibility of an anesthetic accident.

A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. Case presentation: A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. Conclusion: Immunotherapy has been reported to show significant remission in mUC, but mostly in solid organs or bone. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy.

Is a Block of the Femoral and Sciatic Nerves an Alternative to Epidural Analgesia in Sheep Undergoing Orthopaedic Hind Limb Surgery? A Prospective, Randomized, Double Blinded Experimental Trial

Peripheral nerve blocks are commonly used in human and veterinary medicine. The aim of the study was to compare the analgesic efficacy of a combined block of the femoral and sciatic nerves with an epidural injection of ropivacaine in experimental sheep undergoing orthopaedic hind limb surgery. Twenty-five sheep were assigned to two groups (peripheral nerve block; sciatic and femoral nerves (P); epidural analgesia (E)). In group P 10 mL ropivacaine 0.5% was injected around the sciatic and the femoral nerves under sonographic guidance and 10 mL NaCl 0.9% into the epidural space while in group E 10 mL ropivacaine 0.5% was injected into the epidural space and 10 mL NaCl 0.9% to the sciatic and the femoral nerves. During surgery, heart rate, respiratory rate and mean blood pressure were used as indicators of nociception. In the postoperative phase, nociception was evaluated every hour by use of a purposefully adapted pain score until the animal showed painful sensation at the surgical site. The mean duration of analgesia at the surgical wound was 6 h in group P and 8 h in group E. Mean time to standing was 4 h in group P and 7 h in group E. In conclusion time to standing was significantly shorter in group P while the duration of nociception was comparable in both groups. The peripheral nerve block can be used as an alternative to epidural analgesia in experimental sheep.

Caseating Tuberculous Lymphadenitis- A Case Report

Introduction: Tuberculosis lymphadenitis (or tuberculous adenitis) is the most common type of infection with tuberculosis that occurs outside of the respiratory system. Tuberculosis lymphadenitis is a chronic condition caused by Mycobacterium tuberculosis in the granulomatous inflammation of the lymph node caused by caseated necrosis. The number of people who contact tuberculosis is estimated at 8 million per year, and about 3 million people die from tuberculosis in the world. Presentation of Case: In this case report we delineate the case of a female patient, 26-year-old, she had some pain and lymph node swelling in her right submandibular region since from 4 months and was diagnosed as right Caseating Tuberculous Lymphadenitis, associated with the cervical (neck) region, who was immunocompetent and HIV test negative, with a history of recurring fever, weight loss, loss of appetite for the last 4 months. On physical examination, she had swelling approximately 3×3 cm in the right submandibular region and a hard mass and painful sensation were noticed in her right submandibular region. On Fine needle aspiration cytology of submandibular lymph node reveals Caseating Tuberculous Lymphadenitis. this is extremely rare in immunocompetent individuals.

Effects of Acute Beta-Alanine Ingestion and Immersion-Plus-Exercise on Connectedness to Nature and Perceived Pain

This double-blinded, placebo-controlled, crossover study examined the effect of induced painful sensation (via acute Beta Alanine (B-ALA) ingestion) on Love and Care of Nature (LCN), heart rate (HR), rating of perceived exertion (RPE), and McGill Pain Questionnaire (MPQ) during outdoor exercise. Twenty participants volunteered on consecutive days to complete a 0.8 km (0.5 mi) up-hill hike after consuming either B-ALA (6.4 g) or placebo. Immediately after consumption participants answered LCN, RPE, and MPQ questionnaires, immersed in a natural environment for 45 min, and then completed a hike as quickly as possible without running. No difference in HR (p = 0.846), or RPE (p = 0.606) were observed between treatments. Total MPQ scores increased with consumption of B-ALA (p = 0.001). An increased LCN score was observed following exercise regardless of condition (p = 0.035). The results demonstrate that acute B-ALA supplementation is effective in increasing perceived pain sensations. The results also demonstrate an increase in LCN in the presence of increased perceptions of pain sensations during exercise.

Torsion of the uterine appendages in a 12-year-old girl

Introduction. The uterine appendage torsion (UAT) is an urgent pathology accompanied by a painful abdominal syndrome and requiring urgent diagnostic and therapeutic measures. In childhood, UAT develops mainly due to organic causes and due to the specific location of internal organs in children. The literature data on organ-preserving surgeries in the long-lasting UAT is very controversial and dubious. There are no objective criteria for assessing ovarian viability after detorsion what impacts the selection of surgical intervention tactics - unjustified adnexectomy may be performed.Clinical case. Girl P., 12 years old, was admitted to the hospital with a clinical picture of long-lasting torsion of the uterus appendages. Right uterine appendages were detorsed. The child was under observation. In two years, laparoscopic appendectomy was performed for chronic appendicitis. When examining pelvic organs, the right ovary was found reduced in size compared to the left one; there were no macroscopically visible changes; single follicles were visualized in it; the fallopian tube was not changed.Conclusion. A painful sensation before surgery indicates that the uterus appendages are viable; if there is no abdominal pain, necrosis of the ovary and fallopian tube may be suspected. A surgical tactics is chosen on making a comprehensive analysis of clinical and instrumental findings.

Trichodynia Revisited

Trichodynia refers to the painful sensation of the scalp related to the complaint of hair loss. Originally suggested to be distinguishing for telogen effluvium and related to hair loss activity and follicular inflammation, further studies have found trichodynia to be common in androgenetic alopecia as well and coexisting with psychopathologic findings. The respective studies failed to demonstrate correlations between trichodynia and quantifiable hair loss activity, nor histopathologic evidence for follicular inflammation. A symptomatic scalp is a frequent condition in specific dermatological conditions of the scalp. By definition of exclusion, we are not dealing with trichodynia in these cases. It is conceivable that neuropeptides are key players between the central nervous system and the skin immune and microvascular system. Such mechanisms would explain the noxious effects of both external stimuli and emotional distress in eliciting cutaneous nociception. Since we have begun to understand the diverse etiologies of trichodynia, and a single term does not measure up to this circumstance, it may be wiser to describe the condition depending on the type of scalp sensation and its specific disease association. Further studies are warranted into the neural/endothelial/follicular interactions both in hair growth and shedding and the psychosomatic diseases of the hair and scalp.

Functional Hyperconnectivity and Task-Based Activity Changes Associated With Neuropathic Pain After Spinal Cord Injury: A Pilot Study

Neuropathic pain (NP) is a devastating chronic pain condition affecting roughly 80% of the spinal cord injury (SCI) patient population. Current treatment options are largely ineffective and neurophysiological mechanisms of NP are not well-understood. Recent studies in neuroimaging have suggested that NP patients have differential patterns of functional activity that are dependent upon the neurological condition causing NP. We conducted an exploratory pilot study to examine functional activation and connectivity in SCI patients with chronic NP compared to SCI patients without NP. We developed a novel somatosensory attention task to identify short term fluctuations in neural activity related to NP vs. non-painful somatosensation using functional magnetic resonance imaging (fMRI). We also collected high-resolution resting state fMRI to identify connectivity-based correlations over time between the two groups. We observed increased activation during focus on NP in brain regions associated with somatosensory integration and representational knowledge in pain subjects when compared with controls. Similarly, NP subjects showed increased connectivity at rest in many of the same areas of the brain, with positive correlations between somatomotor networks, the dorsal attention network, and regions associated with pain and specific areas of painful and non-painful sensation within our cohort. Although this pilot analysis did not identify statistically significant differences between groups after correction for multiple comparisons, the observed correlations between NP and functional activation and connectivity align with a priori hypotheses regarding pain, and provide a well-controlled preliminary basis for future research in this severely understudied patient population. Altogether, this study presents a novel task, identifies regions of increased task-based activation associated with NP after SCI in the insula, prefrontal, and medial inferior parietal cortices, and identifies similar regions of increased functional connectivity associated with NP after SCI in sensorimotor, cingulate, prefrontal, and inferior medial parietal cortices. This, along with our complementary results from a structurally based analysis, provide multi-modal evidence for regions of the brain specific to the SCI cohort as novel areas for further study and potential therapeutic targeting to improve outcomes for NP patients.

Globus Pharyngeus - The Total Burden at a Tertiary Hospital in Gangtok, East Sikkim, North East India

BACKGROUND Globus Pharyngeus, previously known as Globus hystericus, is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat of indeterminate origin. It is a commonly encountered clinical condition seen in ear, nose and throat Outpatient Department (ENT OPD). It is usually long-lasting, difficult to treat and has a tendency to recur. It is a common disorder and constitutes about 4 - 5 % of all new ENT referrals with a slight female preponderance. Sikkim is second smallest state in India with a total population of 6.1 lakhs. It is a mountainous region with subtropical climate. Central Referral Hospital is the only Medical College in the state and takes care of the patients from all over the state. This study was conducted to determine the prevalence of globus pharyngeus among patients attending ENT OPD. METHODS This was a descriptive cross-sectional study done in the ENT Outpatient Department (OPD) of Central Referral Hospital, Gangtok, Sikkim among patients attending directly or referred from the government health sectors with complaints of globus symptoms in the throat. Data was entered in Microsoft Excel 16.4 version and used for statistical purposes. RESULTS The total burden of the disease was found to be 0.6 % with 73.77 % of the patients with globus positive for H. pylori infection and 36 % of them positive for laryngopharyngeal reflex (LPR). CONCLUSIONS The number of globus cases found in this study (0.6 %) was comparatively less as compared to various studies done globally (4 - 5 %). The low number of cases determined in this study may be due to the bias of selection of the study population from the only available private tertiary care centre in the state. KEYWORDS Globus Pharyngeus, Foreign Body Throat