Evaluation of Clinical Diagnosis of Axial Psoriatic Arthritis or Elevated Patient-Reported Spine Pain in CorEvitas' Psoriatic Arthritis/Spondyloarthritis Registry

Objective To determine the presence of axial symptoms in patients with psoriatic arthritis (PsA) and examine differences between those with or without a diagnosis of axial PsA (axPsA). Methods Patients with PsA at their CorEvitas' (formerly Corrona) Psoriatic Arthritis/Spondyloarthritis Registry enrollment visit were stratified into 4 mutually exclusive groups based on axial manifestations: physician-diagnosed axPsA only (Dx+Sx-), patient-reported elevated spine symptoms only (Dx-Sx+; defined as Bath Ankylosing Spondylitis Disease Activity Index ≥4 and spine pain visual analog scale ≥40), physician-diagnosed and patient-reported (Dx+Sx+), and no axial manifestations (Dx-Sx-). Patient characteristics, disease activity, and patient-reported outcomes (PROs) at enrollment in each axial manifestation group were compared with the Dx-Sx- group. Associations of patient characteristics with the odds of having axial manifestations were estimated using multinomial logistic regression (reference: Dx-Sx-). Results Of 3393 patients included, 226 (6.7%) had Dx+Sx-, 698 (20.6%) had Dx-Sx+, 165 (4.9%) had Dx+Sx+, and 2304 (67.9%) had Dx-Sx-. Patients with Dx-Sx+ or Dx+Sx+ were more frequently women and had a history of depression and fibromyalgia vs patients who had Dx-Sx-. Patients with Dx+Sx- or Dx+Sx+ were more frequently HLA-B27 positive than those with Dx-Sx-. Fibromyalgia was significantly associated with increased odds of Dx+Sx- or Dx+Sx+. Disease activity and PROs were worse in patients with Dx-Sx+ or Dx+Sx+ than in those with Dx-Sx-. Conclusion Patients who had self-reported elevated spine symptoms, with or without physician-diagnosed axPsA, had worse quality of life and higher disease activity overall than patients without axial manifestations, suggesting an unmet need in this patient population.

AN OBSERVATIONAL STUDY ON ASSESSMENT OF PAIN THRESHOLD IN TRIVIDHA SATWABALA

Introduction: ‘Purusha’ the sentient being in Ayurveda is formed by the combination of Satwa (Mind), Atma (Soul) and Shareera (Body). Among these, paramount importance has been given to the role of the mind in both health and diseased states. In the present study, the term Satwa has been used to denote Satwabala or the psychic strength of an individual. The assessment of Satwabala is an important part in examination of the patient and while planning the treatment. The interrelationship of mind and body is well explained in Ayurveda. The pain inflicted on one's body has influence on his mind. Some people feel pain more intensely than others and some tolerate it so much more than others. Thus, quantification of pain with reference to psychic strength is essential for diagnostic and pain monitoring purposes in clinical practice. Aim and Objectives: The study was carried out with an aim to assess the Pain threshold in the form of Pressure Pain Threshold [PPT] and the Pain intensity in the form of the Visual Analog Scale [VAS] in three types of Satwabala. It was hypothesised that there could be a positive relation between Satwabala and Pain threshold. Methods: For the objective assessment of Pressure Pain Threshold a simple handheld pressure Algometer has been used. For the subjective measurement of experimental pain, Visual Analog Scale was used. Further, the Satwa of participants was assessed using a standard questionnaire. Results: The resultssuggested that in people between the age group of 18-40 years, there exist a statistically highly significant positive correlation between Satwabala and Pain threshold with P< 0.01. Keywords: Satwa, Satwabala, Pain threshold, Pressure Pain Threshold, Visual Analog Scale.

Functional and radiological assessment of total ankle replacement with infinity prosthesis

Objective: To present mid-term functional and radiological outcomes obtained with the use of Infinity prosthesis in Bogotá (Colombia). Methods: This cross-sectional observational study selected consecutive patients subjected to total ankle replacement with the fourth generation Infinity prosthesis (Wright Medical Technology). Results: Fifty-two patients with ankle arthrosis were followed for a mean period of 24 months, and the most frequently reported case of joint degeneration was trauma. Postoperative improvement was observed in perception of pain (visual analog scale increased from 8/10 to 2/10; p<0.0005), AOFAS functional scale (from 23 to 84.5; p < 0.0005), and range of motion (from 11° to 29°; p<0.0005). Similarly, radiological findings, implant positioning, and signs of loosening did not reveal implant failure. Conclusions: The use of fluoroscopically navigated prostheses allows us to achieve predictable outcomes, with satisfactory mid-term clinical and imaging results. Level of Evidence IV; Therapeutic Studies; Case Series.

Clinical Scale for Neuropathic Pain

Neuropathic pain caused by a lesion or disease of the somatosensory nervous system is underdiagnosed and difficult to treat. Questionnaires based on self-reported symptoms have improved diagnosis and management of neuropathic pain. Visual analog scale and numeric rating scale are most well-known unidimensional pain questionnaires. Multidimensional questionnaire or specialized questionnaire for neuropathic pain are more useful to diagnose neuropathic pain. Screening questionnaires help to identify neuropathic pain easily, and assessment questionnaires make it possible to create phenotypic profiles of neuropathic pain and determine an efficacy of management.

Beta Electroencephalographic Oscillation Is a Potential GABAergic Biomarker of Chronic Peripheral Neuropathic Pain

This preliminary investigation aimed to assess beta (β) oscillation, a marker of the brain GABAergic signaling, as a potential objective pain marker, hence contributing at the same time to the mechanistic approach of pain management. This case–control observational study measured β electroencephalographic (EEG) oscillation in 12 right-handed adult male with chronic neuropathic pain and 10 matched controls (∼55 years). Participants were submitted to clinical evaluation (pain visual analog scale, Hospital Anxiety, and Depression scale) and a 24-min high-density EEG recording (BIOSEMI). Data were analyzed using the EEGlab toolbox (MATLAB), SPSS, and R. The global power spectrum computed within the low (Lβ, 13–20 Hz) and the high (Hβ, 20–30 Hz) β frequency sub-bands was significantly lower in patients than in controls, and accordingly, Lβ was negatively correlated to the pain visual analog scale (R = −0.931, p = 0.007), whereas Hβ correlation was at the edge of significance (R = −0.805; p = 0.053). Patients’ anxiety was correlated to pain intensity (R = 0.755; p = 0.003). Normalization of the low and high β global power spectrum (GPS) to the GPS of the full frequency range, while confirming the significant Lβ power decrease in chronic neuropathic pain patients, vanished the significance of the Hβ decrease, as well as the correlation between Lβ power and pain intensity. Our results suggest that the GABAergic Lβ EEG oscillation is affected by chronic neuropathic pain. Confirming the Lβ GPS decrease and the correlation with pain intensity in larger studies would open new opportunities for the clinical application of gamma-aminobutyric acid-modifying therapies.

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees

The meniscus is one of the most important structures of the knee that needs to be saved if possible. Previous studies showed that increasing time from an anterior cruciate ligament (ACL) injury (TFI) could lead to a meniscal tear, especially medial meniscus (MM). We developed the present study to see if the TFI alone is a predictor of meniscal injury in ACL-deficient knees. We included 111 patients who had a reconstructed ACL injury at our institution from March 2015 to March 2016 in this retrospective cohort study. All demographic data, including age, gender, and body mass index (BMI), were collected. We also recorded the mechanism of injury and the TFI. We extracted the meniscal condition at the time of surgery from the surgical report. All patients were followed up for a mean of 23 months, and the Lysholm score and pain visual analog scale (VAS) score were obtained. The mean TFI of patients with MM tear was 17.4 ± 16.8 months, which was significant than the patients with lateral meniscal (LM) tear (9.3 ± 8.3 months) and intact meniscus (7.4 ± 8.1 months) (p = 0.001). Patients with TFI less than 6 months had a significantly lower rate of MM tear, and increasing TFI more than 6 months could increase the rate of MM tear (p = 0.001). We could not find any association between age, BMI, and gender and meniscal injury. At the latest follow-up, Lysholm and VAS scores in patients with and without meniscal tear were the same. Our study confirms that increasing time from the ACL injury would increase the risk of MM damage. The cutoff point for this risk factor is 6 months from initial injury; therefore, to save the meniscus, it might be better to perform ACL reconstruction within 6 months in ACL-deficient knees.

Clinical Study of Hydraulic Perfusion Pump and Traditional Water Jet Irrigation for Percutaneous Endoscopic Lumbar Discectomy

Objective: To compare clinical outcomes of hydraulic perfusion pump and traditional water jet irrigation in percutaneous endoscopic lumbar discectomy by a prospective randomized controlled study. Methods: From January 2016 to December 2018, 72 patients with lumbar disc herniation and failed conservative treatment were enrolled in this study. According to the odd number of the last digit of the hospitalization number, the patients were randomly divided into a hydraulic perfusion pump group and a traditional water jet irrigation group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative pain visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores between two groups (P>0.05). The same surgeon performed all operations. These operations were performed by hydraulic perfusion pump flushing and traditional water flushing assisted surgery. The patients were followed up for 12 to 24 months (mean 15.7 months). The operation time, blood loss, hospital time, visual analog scale (VAS) for follow-up pain after one day and two weeks, and the last follow-up JOA scores. The type and incidence of postoperative complications were compared between two groups.Results: Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was short [(65.5±21.3) min vs. (74.8±19.9) min, t=9.465, P=0.003]. Blood loss was less [(21.2±12.9) ml vs. (27.4±14.1) ml, t=8.331, P=0.012]; there was no statistical difference in hospitalization time. The pain visual analog scale (VAS) and the last follow-up JOA scores in one day, two weeks were better than preoperative, but there was no statistical difference between the groups (P>0.05). In the traditional water flushing group, the symptoms of increased intracranial pressure like headache and neck pain occurred during the operation, which was forced to shorten the operation time in 5 cases, nerve root adventitia injury in 4 cases, and postoperative recurrence in 4 cases. In the hydraulic perfusion pump group, no patient had the symptoms of increased intracranial pressure like headache and neck pain, and nerve root adventitia injury in 1 case and 2 cases of postoperative recurrence. The incidence of complications in the hydraulic perfusion group was lower than that in the traditional water flow group. Conclusion：Hydraulic perfusion pump and traditional water-flow irrigation assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results. However, the former has short operation time, clear vision in operation, less bleeding, and less in-operation and postoperative complications.

Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single centre in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirement.Methods: It was a prospective comparative study conducted in the department of surgery Smimer medical college Surat, India from July 2018 to July 2019. The study was performed on all adult patients with ultrasound documented cholelithiasis. The total number of patients studied was 50 which were divided into two groups of 25 each.Results: Demographic data were comparable for both study groups. Patients in the 3-port group had shorter mean operative time (47.3±29.8 min versus 60.8±32.3 min) for the 4-port group (p=0.04). Post-operative requirement of analgesia was less in 3 port group as compared to 4 port group. Pain visual analog scale (VAS) score, intra operative complications, post- operative complications and return to normal activity were significant in our study. Hospital stay and patient satisfaction were non- significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less analgesic requirement, early post-operative ambulance, early oral feed, and better cosmetic results.

Associations Between Skin Autofluorescence, Advanced Glycation End-Products and Chronic Low Back Pain

Objective: The aim of this study was to determine whether advanced glycation end-products (AGEs) measured by skin autofluorescence (SAF) can serve as a biomarker for chronic low back pain. 111 patients who visited the outpatient clinic were included in this prospective cohort study. They were divided into a chronic low back pain group (C group: 48 patients, mean age 52.2) and a group without low back pain (N group: 63 healthy volunteers, mean age 40.8). SAF was measured as a parameter of AGEs using an autofluorescence reader. Measurements of low back pain visual analog scale (VAS), presence of diabetes, and SAF were recorded, and correlations between VAS or diabetes and SAF were investigated. Results: The C group had significantly higher SAF (2.20 vs 1.97, p<0.05) than the N group, whereas the SAF for diabetes patients was significantly higher (2.7 vs 2.1, p<0.05) than subjects without diabetes. SAF had no correlation with VAS (P=0.18). SAF is an indicator of AGE accumulation correlated with chronic low back pain and diabetes.