Effectiveness of Hypnoanalgesia in Paediatric Dermatological Surgery

Background and objective. Stress in surgical settings has subtle psychological and physiological repercussions in children. The objective is to evaluate whether hypnosedation is effective in reducing the doses of sedation and analgesia required during the periprocedural period in children undergoing dermatological surgery, without negatively affecting pain and satisfaction. Patients and methods: A prospective, longitudinal, observational study where paediatric patients (aged 5–16 years) scheduled for dermatological surgery were analysed according to whether they received hypnosis or distraction during surgery (both common procedures at the centre). As outcome measurements we used sedation doses (propofol) during surgery and the need for analgesia; pain assessment post-surgery and at 24 h using a visual analogue scale (VAS) or revised face pain scale (FPS-r) (both 0–10) depending on age, as well as patient and guardian satisfaction (on a scale of 0–10). Results: Of the 68 patients eligible during the follow-up period, 65 were included. Of these, 33 were treated with hypnosis and 32 with distraction. Children who underwent hypnosis required less total propofol (45.5 ± 11.8 mg vs. 69.3 ± 16.8 mg; p < 0.001) and metamizole in the immediate postoperative period (34.4% vs. 65.6%; p = 0.018). After 24 h, they required less ibuprofen (9.1% vs. 28.1%; p = 0.048) and paracetamol (48.5% vs. 75.0%; p = 0.028). Mean pain according to VAS or FPS-r at 24 h was 3.1 with hypnosis vs. 4.3 with distraction (p < 0.001). Overall satisfaction was higher in the hypnosis group (8.7 ± 0.1 vs. 8.1 ± 0.2; p = 0.009). Conclusions: Hypnoanalgesia in children undergoing dermatological outpatient surgery could not only reduce sedation and analgesia requirements, but also improve child and guardian(s) satisfaction.

Connectivity-based thalamus parcellation and surgical targeting of somatosensory subnuclei

OBJECTIVE The anatomy of the posterolateral thalamus varies substantially between individuals, presenting a challenge for surgical targeting. Patient-specific, connectivity-based parcellation of the thalamus may effectively approximate the ventrocaudal nucleus (Vc). This remains to be robustly validated or assessed as a method to guide surgical targeting. The authors assessed the validity of connectivity-based parcellation for targeting the Vc and its potential for improving clinical outcomes of pain surgery. METHODS A cohort of 19 patients with regional, chronic neuropathic pain underwent preoperative structural and diffusion MRI, then progressed to deep brain stimulation targeting the Vc based on traditional atlas coordinates. Surgical thalami were retrospectively segmented and then parcellated based on tractography estimates of thalamocortical connectivity. The location of each patient’s electrode array was analyzed with respect to their primary somatosensory cortex (S1) parcel and compared across patients with reference to the thalamic homunculus. RESULTS Ten patients achieved long-term pain relief. Sixty-one percent of an average array (interquartile range 42%–74%) was located in the S1 parcel. In patients who achieved long-term benefit from surgery, array location in the individually generated S1 parcels was medial for face pain, centromedial for arm pain, and centrolateral for leg pain. Patients who did not benefit from surgery did not follow this pattern. Standard stereotactic coordinates of electrode locations diverged from this pattern. CONCLUSIONS Connectivity-based parcellation of the thalamus appears to be a reliable method for segmenting the Vc. Identifying the Vc in this way, and targeting mediolaterally as appropriate for the region of pain, merits exploration in an effort to increase the yield of successful surgical procedures.

NSAIDs medication for headache as the presenting symptom with migraine and COVID‐19

Headache is one of the most prevalent disorders of the nervous system. Headache is also the most common symptom of a variety of diseases, 4Department of XXX, Faculty of XXX, City, Country including migraine, COVID-19. International Classification of Headache Disorders (ICHD) lists over a thousand different types of headaches. Migraine is a widely known type of primary headache. Much research supports that the enhancement in migraine intensity related to chronic migraine such as neurogenic neuroinflammation, possibly leading to increased cytokine expression via activation of protein kinases in neurons and glial cells of the trigeminovascular system like some of the other headache diseases. No currently drug class available, either specific (triptans, ergots) or non-specific (opioids, paracetamol, NSAIDs), is effective in all types of headaches, in all patients and all attacks of the same patient. However, non-steroidal anti-inflammatory drugs (NSAIDs) minimize prostaglandin synthesis by blocking cyclooxygenase, which is included in the pathophysiology of migraine headaches. We searched the employed source was The Journal of Headache and Pain database by using NSAIDs with Headache, Migraine, and COVID-19 keywords. The search was performed from April 2021 and included 2017-2018-2019- 2020-2021 (last five years) the studies and reviews from the Journal of Headache and Face Pain Sites. Additionally, we noted the published or on-going studies, eight of these, about NSAIDs information contain searches that exist in the 12th European Headache Federation Congress (jointly with 32nd National Congress of the Italian Society) Study of Headaches’ book. Also, we included relationship migraine with COVID-19 studies to highlight the connection between the headache, which is one of the most common symptoms of both migraine and COVID-19, and the importance of managing migraine pain with NSAIDs during corona processing.

PENGARUH SENAM YOGA TERHADAP NYERI HAID PADA REMAJA PUTRI KELAS X MAN 2 KOTA PROBOLINGGO (Di Madrasah Aliyah Negeri 2 Kota Probolinggo)

Masa remaja berhubungan dengan suatu fenomena fisik yang berhubungan dengan pubertas. Pubertas merupakan suatu bagian penting dari masa remaja yang lebih menekankan proses biologis yang mengarah pada kemampuan reproduksi. Pada saat ini perempuan akan mengalami ovulasi dan menstruasi yang terkadang juga disertai nyeri haid (dysmenorrhea). Berdasarkan Studi Pendahuluan yang dilakukan peneliti didapatkan hasil wawancara dari 15 siswi, terdapat 13 siswi yang mengalami dysmenorrhea. Penelitian ini bertujuan untuk mengetahui Pengaruh Senam Yoga terhadap Nyeri Haid pada Remaja Putri Kelas X MAN 2 Kota Probolinggo. Jenis penelitian ini adalah pra eksperimental dengan rancangan one group pretest posttest design. Populasi penelitian ini adalah seluruh siswi kelas X MAN 2 Kota Probolinggo yang berjumlah 172 siswi. Sampel penelitian ini sejumlah 35 siswi dengan tekhnik sampling Proportional Random Sampling. Variable independent adalah Senam Yoga dan variable dependent adalah Nyeri Haid. Instrumen penelitian menggunakan pengukuran skala nyeri Face Pain Scale – Revised (FPS-R). Pengolahan data menggunakan editing, coding, scoring, tabulating dengan analisa data spearman Rank. Hasil penelitian menunjukkan bahwa sebelum dilakukan senam yoga hampir setengah dari responden mengalami nyeri haid dengan skala 3 (lebih nyeri) dengan jumlah 16 responden (45,7%). Sedangkan setelah dilakukan senam yoga hampir setengah dari responden mengalami nyeri haid dengan skala 2 (sedikit nyeri) sebanyak 12 responden (34,3%). Uji statistik Spearman rank menunjukan bahwa r value = 0,000 < α (0,05) sehingga H1 diterima.Kesimpulan penelitian ini ada Pengaruh Senam Yoga terhadap Nyeri Haid pada Remaja Putri Kelas X MAN 2 Kota Probolinggo. Kata Kunci : Senam Yoga, Nyeri Haid, Siswi Kelas X

PENGEMBANGAN KECERDASAN EMOSIONAL DAN SPIRITUAL SANTRI MELALUI PROGRAM TAHFIDZ DI PONDOK PESANTREN ROUDLOTUL QUR’AN CILACAP

This article aims to find out how to develop emotional intelligence and spiritual intelligence in students through the tahfidz program. This research is a qualitative research, taking the background of the Islamic Boarding School Roudlotul Qur'an Cilacap. The results showed that: 1) the concept of the tahfidz program, starting from planning routine deposit activities, sima'an al-Qur'an, and tahsin Al-Qur'an activities, 2) The tahfidz program is carried out three times a day by dividing the students into four groups , then when gathered in the santri assembly simultaneously put the santri's right hand above their head by reading surah al A'la verses 1-19 followed by reading a fragment of the burdah prayer with a pat on the forehead and ending with the recitation of their respective prayers and wishes. 3) the emotional and spiritual intelligence of the students tends to increase. Students are able to learn and master these skills if they have the motivation and effort to understand personal emotional experiences, motivate themselves, understand the emotions of others, and develop relationships with others. Likewise with spiritual intelligence, a person is able to get closer to the Creator by increasing spiritual abilities, the ability to face pain and fear, has a quality of life, and lives a devoted and responsible life.

171 Habitual Sleep Duration and Chronic Pain in the US Population Over A 10-Year Period: Implications for Sleep Health Disparities

Introduction Chronic pain is linked with sleep disturbances, which worsen pain experiences. The nature of the bi-directional relationship between sleep and chronic pain has not been explored at the population level, especially among racial/ethnic minorities, a group disproportionately burdened by chronic pain. To address this gap, we investigated the relationship between sleep and chronic pain experiences in the US population and conducted race-stratified analyses. Methods Data from the CDC National Health Interview Survey (NHIS) was used, from 2007-2016. Sleep duration was categorized as &lt;=4hrs, 5-6hrs, 7-8hrs, 9hrs, or 10+hrs. N=298,698 provided data for analysis. Chronic pain outcomes included arthritis, joint pain, neck pain, back pain, jaw/face pain, and migraines/headaches. Covariates included age, sex, body mass index, and employment status. Race/ethnicity was included as a covariate and interaction term, categorized as Non-Hispanic White, Black/African-American, Mexican-American, Other Hispanic/Latino, Asian/Pacific-Islander, Indian/Subcontinent, American Indian/Alaskan Native, and Multiracial/Other. Weighted logistic regression analyses examined sleep as predictor and pain as outcome, adjusted for covariates. Post-hoc analyses examined sleep-by-race/ethnicity interactions. Results Prevalence in the population was 24.7%, 40.0%, 4.8%, 15.7%, 29.5%, and 15.0% for arthritis and joint, jaw/face, neck, back, and migraine/headache pain. In adjusted analyses compared to 7-8hrs, arthritis was more likely among &lt;=4hrs (OR=2.6,p&lt;0.0005), 5-6hrs (OR=1.5,p&lt;0.0005), 9hrs (OR=1.1,p=0.002), and 10+hrs (OR=1.2,p&lt;0.0005). Joint pain was also more likely among &lt;=4hrs (OR=2.8,p&lt;0.0005), 5-6hrs (OR=1.6,p&lt;0.0005), 9hrs (OR=1.1,p=0.002), and 10+hrs (OR=1.2,p&lt;0.0005). Jaw/face pain was also more likely among &lt;=4hrs (OR=3.0,p&lt;0.0005), 5-6hrs (OR=1.6,p&lt;0.0005), 9hrs (OR=1.2,p=0.001), and 10+hrs (OR=1.4,p&lt;0.0005). Neck pain was more likely among &lt;=4hrs (OR=3.0,p&lt;0.0005), 5-6hrs (OR=1.6,p&lt;0.0005), and 10+hrs (OR=1.2,p&lt;0.0005). Back pain was also more likely among &lt;=4hrs (OR=3.1,p&lt;0.0005), 5-6hrs (OR=1.7,p&lt;0.0005), and 10+hrs (OR=1.3,p&lt;0.0005). Migraines/headaches were also more likely among &lt;=4hrs (OR=3.6,P&lt;0.0005), 5-6hrs (OR=1.8,P&lt;0.0005), and 10+hrs (OR=1.4,P&lt;0.0005). Significant sleep-by-race/ethnicity interactions were seen for joint (p=0.002), jaw (p&lt;0.0005), and neck (p=0.002) pain, but not back pain (p=0.08), migraines/headaches (p=0.28), or arthritis (p=0.45). Conclusion Habitual short and long sleep are associated with a wide range of chronic pain conditions. Bidirectional relationships should be explored as a public health priority. Race/ethnicity interactions suggest that the sleep/pain experience differs by group (reasons should be explored). Support (if any) R01MD011600, R01DA051321, K24AG055602, R01AG041783

Efficacy of the Newly Invented Eyelid Clamper in Ultra-Widefield Fundus Imaging

Background: Ultra-widefield fundus imaging is widely used for obtaining wide angle images of the retina in one single image. Although it has a potential to obtain a wide area of retinal photographs, images are often obstructed by eyelashes or eye lids. In this study, we used a newly invented eyelid clamper, which can keep an eye open without touching conjunctiva or lid margin, to assess the efficacy in clinical use by comparing with conventional tape fixation. Methods: Ultra-widefield fundus images were captured with an ultra-widefield imaging system in 19 patients who visited to the outpatient clinic of Department of Ophthalmology, Keio University Hospital with the eyelid clamper or a conventional tape fixation. The area of imaged retinas was outlined and quantified with pixels. After obtaining images, patients answered a questionnaire. Results: The average number of pixels in total areas with the eyelid clamper or with tape fixation were 4.31 ± 0.35 and 4.32 ± 0.34 mega pixels, respectively, showing no significant difference between the groups (p = 0.889). The average face pain scale of the eyelid clamper was 1.13 on a scale of 0 to 5. The number of patients who did not feel any pain was nine (47.4%). Conclusions: The eyelid clamper can be applied in clinical setting and can better support obtaining sufficiently wide fundus images compared to a conventional tape fixation.

Ramsay Hunt syndrome affecting the vagus nerve with epiglottic ulcers as the first manifestation: a case report

Ramsay Hunt syndrome involving the vagus nerve is very rare. We herein describe a 53-year-old man who developed severe pharyngeal pain after alcohol intoxication. Antibiotic treatment was ineffective. Laryngoscopy showed an ulcer on the right side of the epiglottis. As the condition progressed, the patient developed hoarseness. He then gradually developed multiple herpes lesions on the right side of the head, face, and neck along with right peripheral facial paralysis. Corticosteroid, analgesic, antiviral, and nutritional nerve therapy resulted in disappearance of the herpes lesions, epiglottis ulcer, pharyngeal pain, and right head and face pain. The facial paralysis slightly improved, but the hoarseness did not improve. The patient was discharged with an unsatisfactory outcome, and he attempted treatment with acupuncture. After 6 months, the right facial paralysis and hoarseness disappeared. Our case emphasizes the importance of early diagnosis and treatment of atypical Ramsay Hunt syndrome as well as timely communication, enhancement of trust, and reduction of disputes between doctors and patients.