Ultrasound-guided Hydrodissection of Sural Nerve for Foot Pain

Background: Sural nerve entrapment is an impor­tant but infrequent cause of pain. The sural nerve provides sensation to the posterolateral aspect of the leg, lateral foot and fifth toe. Sural nerve entrapment can be challenging to treat and can cause significant limitation. We present a case of sural nerve entrapment resistant to conservative management that was effectively treated by percutaneous ultrasound guided hydrodissection of the sural nerve. Case Report: A 57 year old male came with complaints of pain and tingling sensation on both lower limbs with 50% decrease in sensation to touch (right > left) in lateral aspect of both foot. The patient had tried several conservative modalities with no success. We performed percutaneous ultrasound guided hydrodissection of the sural nerve and the patient reported complete improvement in his pain. Conclusion: Percutaneous ultrasound guided hydrodissection of the sural nerve, is a safe and effective treatment for patients with sural nerve entrapment that does not respond to conservative therapy. However, studies are needed to elucidate its effectiveness and safety profile.

Rare Case of Lumbosacral Conjoint Root Diagnosed as Sequestered Disc by MRI: A Case Report

Introduction: Conjoint nerve root is embryological nerve root abnormality mainly affecting lumbosacral region. The atypical roots present primarily as a bifid, conjoined structure originating from a wide area of the dura. The conjoint roots are highly liable to trauma due to their size and attachment to surrounding structures. The effects of compression and entrapment are augmented in the case of having stenosis of the lateral recesses where developmental changes and disc herniations deplete the available reserve space. Conjoined nerve roots are a relatively uncommon finding but are frequently left undiagnosed on preoperative imaging studies. Misinterpretation as sequestered disc can lead to devastating results especially during limited spine approach. Case Report: A 43-year-old male patient presented with low back pain gradually progressing over the last three years. Pain was radiating to his left leg associated with tingling sensation and a mild weakness in his left foot. Clinical examination revealed normal muscle bulk and tone. Strength was full bilaterally except the mild weakness 3/5 on toe dorsiflexion of the left foot. Deep tendon reflexes were 3+ at the left knee and ankle. Plantar responses were flexor. Sensation was intact, and there was no loss of sphincters control or bladder dysfunction. A standard plain lumbosacral MRI was performed. The patient was admitted for L5/S1 discectomy. Surgical intervention was recommended, during the surgery we recognized the huge conjoint root. Adhesiolysis and discectomy was done carefully without causing any serious neural injury to the conjoint root. Clinical surgical outcome was good. Pain and tingling sensation disappeared only paresthesia over the S1 dermatome. Postoperative course was uneventful, and the patient was discharged after his neurological improvement on day 7, post operation. However, the patient complained of recurrent pain on follow-up visit and continues being followed-up. Conclusion: The conjoined nerve root anomaly diagnosis is not easy and has several points of significance. If misdiagnosed, it could be incorrectly treated as a case for a herniated disc. Neurosurgeons should consider these anomalies in their differential diagnosis. Cases of conjoined nerve root anomaly may be wrongly managed and result in wrong level of surgery with a poor outcome. Researchers conclude that the correct diagnosis of root anomalies is vital for the patient, any misinterpretation could lead to catastrophic consequences.

ASMR as Idiosyncratic Experience: Experimental Evidence

The Autonomous Sensory Meridian Response (ASMR) is a tingling sensation across the scalp that occur in response to specific triggering audio and visual stimuli, connected with the Default Mode Network. Our study (N = 76) aimed to test the neurophysiology of ASMR by examining pupil diameter and brain activity. Assuming the idiosyncratic nature of ASMR, we expected results detecting opposite physiological outcomes considering pupil diameter and brain activation. We used a battery of self-reports to investigate psychological dimensions; for the physiological measures, we used two instruments: PupilCore and NeuroSky MindWave Mobile 2. The results showed an augmented pupillary diameter during the ASMR video, regardless of the perception of tingles. On the other hand, the arousal level during the ASMR video was lower than the other conditions. The difference between the two neurophysiological measures appeared as peculiar and can be considered as the promoting phenomenon for ASMR psychological outcomes.

Assessment of Inter-Institutional Post-Operative Hypoparathyroidism Status Using a Common Data Model

Post-thyroidectomy hypoparathyroidism may result in various transient or permanent symptoms, ranging from tingling sensation to severe breathing difficulties. Its incidence varies among surgeons and institutions, making it difficult to determine its actual incidence and associated factors. This study attempted to estimate the incidence of post-operative hypoparathyroidism in patients at two tertiary institutions that share a common data model, the Observational Health Data Sciences and Informatics. This study used the Common Data Model to extract explicitly specified encoding and relationships among concepts using standardized vocabularies. The EDI-codes of various thyroid disorders and thyroid operations were extracted from two separate tertiary hospitals between January 2013 and December 2018. Patients were grouped into no evidence of/transient/permanent hypoparathyroidism groups to analyze the likelihood of hypoparathyroidism occurrence related to operation types and diagnosis. Of the 4848 eligible patients at the two institutions who underwent thyroidectomy, 1370 (28.26%) experienced transient hypoparathyroidism and 251 (5.18%) experienced persistent hypoparathyroidism. Univariate logistic regression analysis predicted that, relative to total bilateral thyroidectomy, radical tumor resection was associated with a 48% greater likelihood of transient hypoparathyroidism and a 102% greater likelihood of persistent hypoparathyroidism. Moreover, multivariate logistic analysis found that radical tumor resection was associated with a 50% greater likelihood of transient hypoparathyroidism and a 97% greater likelihood of persistent hypoparathyroidism than total bilateral thyroidectomy. These findings, by integrating and analyzing two databases, suggest that this analysis could be expanded to include other large databases that share the same Observational Health Data Sciences and Informatics protocol.

Prevalence of Adverse Effects of Covishield Vaccine among Nursing Students of Selected Institutes of Assam

COVID-19 infection originated in Wuhan, China in December 2019 and affected the human health in a mass scale. Massive efforts were put urgently to develop and test the efficacy and safety of vaccines against COVID-19 as a public health emergency. Covishield vaccine was developed by the Serum Institute of India. Many reports claimed that Covishield can cause mild to severe adverse effects. This study aims to identify the prevalence of adverse effects of Covishield vaccine among nursing students of selected institutes of Assam. Methods: The online survey was conducted among 200 nursing students of Assam in the month of June-July 2021. Structured questionnaire was used to collect demographic data and to identify the adverse effects of Covishield vaccine. Data was compiled and analysed using descriptive and inferential statistics. Results: The study revealed that majority of the nursing students i.e. 90% reported pain at injection site, followed by headache (72%), fever (67%), tiredness (61.5%), muscle pain (46.5%), redness at injection site (17.5%), joint pain (16.5%), nausea and vomiting (14%), tingling sensation (6%), itching at injection site (5.5%), diarrhea (4.5%), fainting (4.4%) and breathlessness (4.4%). Among males, 83.3 % reported pain at injection site after 24 hours and for females 47.8% reported pain at injection site 24 hours, followed by 41.75% who reported pain at injection site before 24 hours. It was also found that adverse effects like tiredness and tingling are significantly associated with gender of the nursing students of Assam Key words: Covishield, vaccine, adverse effects, nursing students

КЛІНІЧНИЙ ВИПАДОК ЗАСТОСУВАННЯ СИСТЕМИ «ICON-INFILTRANT» В ТЕРАПЕВТИЧНІЙ СТОМАТОЛОГІЇ

Modern scientific and technological progress offers a new standard of treatment of odontopathology - infiltration of enamel with resins to seal cracks, chips and to level the surface in the affected area. The aim of the research is to introduce a conservative method for caries treatment using the polymer system "Icon" in the practice of therapeutic dentistry. Patient P., 20 years old, applied to the Department of Propaedeutics of Therapeutic Dentistry of PDMU with complaints of a tingling sensation from chemical stimuli, which disappeared immediately after their removal and the appearance of white matte spots on the vestibular surface of the maxillar teeth in the frontal area. From the anamnesis - the spots appeared after removing the brace system, which the patient had been wearing for 3 years. After the clinical examination, we diagnosed acute superficial dental caries 13,12,11,21,22,23. The treatment was performed in one visit with the Icon Vestibular system. Teeth are cleaned of plaque with a brush and fluoride-free toothpaste "Depural Neo". Under application anaesthesia with Sol. Lidocaini 10%, we isolated teeth with the rubber dam system. The lesions were treated with etching gel (Icon-Etch) 15% hydrochloric acid solution, left for 2 min, then washed off with water for 30 seconds, dried with dry air. To ensure high-quality adhesion of polymer resins, complete moisture removal was performed using ethanol-containing conditioner "Icon-Dry" for 30 seconds, followed by thorough air drying. To infiltrate the lesion, the vestibular nozzle was wound on the syringe "Icon-Infiltrant", infiltrate was carefully applied with a small excess on the etched enamel and left for 3 minutes. Excess was removed with floss and photopolymerized using "Icon-Infiltrant" for 40 seconds. For the second time, having screwed a new vestibular nozzle onto the "Icon-Infiltrant" syringe, the resin was applied for 1 minute. Excess material was removed and polymerized with ultraviolet light for 40 seconds. The rubber dam system was removed. The oxygen-inhibited layer was removed and the vestibular surfaces of the teeth were polished with the help of polishing discs and heads. As a result of the treatment, most of the stains disappeared, the colour, the shine of the tooth enamel 13,12,11,21,22,23 and the surface relief were restored. In 1 and 3 months after treatment, the visual and tactile examination of the vestibular surfaces of teeth revealed that the achieved aesthetic result slightly improved – the sizes of spots, which had been noticeable on the day of treatment decreased. The obtained result satisfied the patient both on the day of infiltration and in the long term. Follow-up examinations every 3 months during the year are recommended. Thus, this method allows us to stop the development of caries and non-carious lesions. It does not require anaesthesia; during treatment, intact areas of tissue are preserved and not damaged. Consequently, a high therapeutic and aesthetic result is achieved, several teeth can be cured in one session, and treatment lasts for an average of 15 minutes.

EVALUATING THE EFFECTIVENESS OF A TWO YEAR REHABILITATION OF A PATIENT WITH GUILLAIN-BARRE SYNDROME: A CASE REPORT

Aim: To present a clinical case of multiple multidiscipli­nary rehabilitation courses after a total of three episodes of Guillain-Barre syndrome (GBS). Case report: A 72-year-old female was hospitalized to Lithuanian University of Health Sciences (LUHS) Hos­pital Kaunas Clinics Neurology department, complaining of lower back pain spreading to the lateral surfaces of both legs and a cold, tingling sensation in her feet that has been continuing for two months. Subacute demyelinating polyneuropathy was diagnosed. The patient suffered a total of three episodes of GBS and underwent a course of multidisciplinary rehabilitation after each of them. Despite the worsening condition during every episode of GBS, improvements were observed in the Barthel index, Functional Independence Measure, Lovett scores and dynamometry after each course of rehabilitation. Phy­siotherapy, occupational therapy, massage, transcutaneus electrical nerve stimulation, physical therapy, speech the­rapy, psychologist consultation and social worker consul­tation were applied. After the last course of rehabilitation, our patient was autonomous within the range of a ward, able to eat served food, put clothes on the upper body with minimal help, on the lower body – with moderate help. Moderate help was needed for all other activities. Conclusions: After undergoing multidisciplinary in and outpatient rehabilitation, the condition of our patient im­proved. This case highlights the importance of both early inpatient and continuous long-term rehabilitation for the achievement of the maximum functional recovery.

A Brief Study on Retroperitoneal Paraganglioma

Paragangliomas are tumors of the autonomic nervous system, located extra-adrenally, presenting inside the base of the head, chest and abdomen. They can appear as a primary retroperitoneal neoplasm when viewed inside the abdominal cavity and might resemble as vascular malformations or any other conditions same as retroperitoneal organs particularly such as pancreas, kidney. These are relatively uncommon endocrine tumors that originate from specific tissue of the paraganglion. They synthesise, store and secrete catecholamines, which can contribute to headache, sweating, palpitation and hypertension. These may be mistaken for GISTs with no histological diagnosis and symptoms of catecholamine overload (non functional). We are reporting a case of 42 yrs male with clinical features of slow backache radiating to both lower legs and with the presence of tingling sensation. Corresponding contrast enhanced CT scan shows a para – aortic mass.

Rhinocerebral Mucormycosis in a COVID-19 Patient from Nepal: A Case Report

With the surge of cases during the second wave of COVID-19 in Nepal, a number of mucormycosis coinfection cases have also come to our attention. We present a case of a 65-year-old female who was admitted to our emergency department with complaints of pain, swelling, and tingling sensation of the left side of the face along with blood-tinged nasal discharge for 20 days. She had been tested positive for COVID-19 a month back and managed with oxygen support and corticosteroids. Magnetic Resonance Imaging showed invasive fungal sinusitis, with the positive black turbinate sign and mild extension along with the dura mater of the left temporal lobe, and left cavernous sinus. She was diagnosed with rhinocerebral mucormycosis and managed with systemic antifungal therapy and insulin. As per the treatment modality, surgical debridement could not be done because the patient did not give consent.

Program Edukasi Joint Protection Technique Pada Aktivitas Ibu Rumah Tangga

Background: Housewives are synonymous with household chores. These activities are carried out regularly, such as washing clothes, cooking, shopping, sweeping floors, washing dishes, cleaning the house. Housewives also carry out regular activities such as mopping, ironing, sweeping the yard, and gardening. Intensive activities and inappropriate positions performed by housewives have the potential to cause musculoskeletal complaints in the upper extremities such as pain or tingling sensation. Efforts that can be made to reduce these complaints are counseling on the application of the Joint Protection Technique (JPT). JPT aims to reduce pain and improve joint function through the use of an ergonomic approach such as changing movement patterns, modifying tasks and the environment. After participating in extension activities, it is hoped that housewives will be able to apply JPT in household activities without musculoskeletal complaints. Methods: Health education was carried out by distributing leaflets via the WhatApps group, lecturing on explaining images printed on leaflets and demonstrating the application of JPT in housekeeping activities. The counseling participants were housewives in RW 8, Kebakkalang, Kemiri Village, Kebakkramat District. The counseling activity took place at the house of one of the residents using equipment such as brooms, buckets of water, clothes, grocery bags, irons, and cooking utensils. Results: Counseling activities were carried out during March 2021 with 16 housewives as participants. Counseling activities still pay attention to health protocols, namely maintaining distance and wearing masks. Participants are able to demonstrate directly the application of the JPT principles in the activities of sweeping, washing clothes, shopping for vegetables, ironing, and cooking with real household context and equipment. Conclusion: Domestic work that is carried out by applying the JPT principle can be carried out without reducing the quality of the work, making the work stages simpler and not causing fatigue.