Evaluation of early ocular discomfort after glaucoma surgery: trabeculectomy versus Ahmed glaucoma valve implantation

ABSTRACT Purpose: This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. Methods: A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning. This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. Results: The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). Conclusion: Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group.

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Diagnostic Contradictions in Carpal Tunnel Syndrome / Contradições diagnósticas na síndrome do túnel do carpo

Abstract Objective Given the divergence of opinions on the need for complementary tests such as ultrasonography (US) and electroneuromyography (ENMG) for the diagnosis of carpal tunnel syndrome (CTS), we aimed to elucidate which of them presents greater accuracy for the confirmation of the presence or not of this condition. Methods A total of 175 patients from a hand surgery outpatient clinic were clinically evaluated, and the results of clinical trials (Tinel, Phalen and Durkan), US (normal or altered), and ENMG (normal, mild, moderate and severe) were noted, crossed, and submitted to a statistical analysis to verify the agreement between them. Results with the sample had a mean age of 53 years, with a prevalence of female patients (159 cases). Of the patients with positive clinical test, 43.7% had normal US and 41.7% had no alterations on the ENMG. Negative results were found on the Tinel in 46.9%, on the Phalen in 47.4%, and on the Durkan in 39.7%. In the crossing between the results of the ENMG and those of the other diagnostic methods, there was little statistical agreement between them. Conclusion There was no agreement between the results of the clinical examinations, the US and the ENMG in the diagnosis of CTS, and there is no clinical or complementary examination for CTS that accurately determines the therapeutic approach. Level of Evidence IV, Case Series.

Resumo Objetivo Diante da divergência sobre a necessidade de exames complementares, como ultrassonografia (US) e eletroneuromiografia (ENMG) para o diagnóstico da síndrome do túnel do carpo (STC), objetivamos elucidar qual deles apresenta maior precisão na confirmação da presença ou não desta afecção. Métodos Um total de 175 pacientes de um ambulatório de cirurgia da mão foram avaliados clinicamente, e os resultados dos testes clínicos (Tinel, Phalen e Durkan), da US (normal ou alterada) e da ENMG (normal, leve, moderada e grave) foram anotados, cruzados, e submetidos a análise estatística para verificar a concordância entre eles. Resultados A idade média da amostra era de 53 anos, sendo prevalente o sexo feminino (159 casos). Dos pacientes com teste clínico positivo, 43,7% apresentavam US normal, e 41,7%, ENMG sem alterações. Foram encontrados resultados negativos no Tinel em 46,9% no Phalen em 47,4%, e no Durkan em 39,7%. No cruzamento entre a ENMG e os demais métodos diagnósticos, houve pouca concordância estatística. Conclusão Não houve concordância entre os resultados dos exames clínicos, da US e da ENMG no diagnóstico da STC, e não há exame clínico ou complementar para STC que determine a conduta terapêutica com precisão. Nível de Evidência IV, Série de Casos.

Focus on autism spectrum disorder s sensory abnormalities and the integration of mechanism research and intervention treatment / 中国学校卫生

Abstract@#Sensory abnormalities are common in patients with autism spectrum disorder (ASD), and its manifestations are complex and diverse, which may be an important factor that affects and aggravates core damages such as social barriers and rigid behaviors. However, at present, there is obviously insufficient emphasis on sensory abnormality in ASD, and a lack of questionnaires and evaluation tools for comprehensively evaluating the characteristics of sensory abnormality in China. The research on the peripheral and central nervous mechanisms behind abnormal behavior is still in its infancy, sensory evaluation tools and methods should be developed and enriched as soon as possible, for ultraearly identification and clinical accurate classification of ASD. Future researches on the neural mechanism related to sensory abnormality should be promoted for targeted intervention therapy,and individualized and diversified intervention in ASD and individualized and diversified.

Hansen’s disease Like Sensory Loss Following Chikungunya Infection: A Rare Manifestation

Chikungunya means “that which bends up,” indicating severe incapacitating arthritis or polyarthralgia. It is a viral infection caused by the chikungunya virus (CHIK V) belonging to the family Togaviridae and is transmitted by the mosquitoes Aedes aegypti and Aedes albopictus. It is a self-limiting condition with a high fever of up to 40°C (104°F), debilitating arthritis/polyarthralgia, and cutaneous involvement. CHIK V virus affects the joints causing tenosynovitis and enthesopathy presenting as arthralgia. Leprosy is also associated with the loss of sensation, arthritis/arthralgias including involvement of several joints and tenosynovitis specially during reactions. Apart from leprosy, numerous other conditions can present with loss of sensation, which must be ruled out while considering leprosy. We report two patients with chikungunya who presented with a loss of sensation like leprosy

Síndrome de POEMS: a propósito de un caso / POEMS syndrome: A case report

RESUMEN El síndrome POEMS es una enfermedad de patogenia desconocida. El acrónimo deriva de las principales manifestaciones clínicas de este cuadro: polineuropatía, organomegalia, endocrinopatía, gammapatía monoclonal y trastornos de la piel. Estudios recientes sugieren la asociación de mutaciones genéticas con inmunoglobulina λ. En este reporte presentamos el caso de un paciente de 56 años, con un cuadro clínico de diez meses de evolución. Al inicio, se presentó un edema en los miembros inferiores e hipertricosis, y luego aparecieron los síntomas gastrointestinales, linfadenopatía inguinal y parestesia de miembros inferiores. Enfatizamos la importancia de este caso clínico debido a que, en nuestro país, los informes de pacientes con el síndrome POEMS son escasos, y en el departamento de La Libertad no existe ningún reporte. Además, el tiempo para diagnosticar esta enfermedad es prolongado.

ABSTRACT POEMS syndrome is a disease of unknown pathogenesis. The acronym stands for the disease's main clinical manifestations: polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin disorders. Recent studies suggest the association of genetic mutations with immunoglobulin λ. We report the case of a 56-year-old male patient with a 10-month clinical picture, whose initial signs and symptoms were lower limb edema and hypertrichosis, followed by gastrointestinal symptoms, inguinal lymphadenopathy and lower limb paresthesia. We emphasize the importance of this clinical case, given the limited reports of POEMS syndrome at the national level and no reported cases in the department of La Libertad, and the long time it takes to diagnose such disease.

Electrodiagnostic Testing Characteristics of Diabetic People with Carpal Tunnel Syndrome / Características eletrofisiológicas das pessoas diabéticas com síndrome do túnel do carpo

Abstract Objective The present study aimed to correlate electroneuromyography (ENMG) findings in diabetic and nondiabetic subjects with carpal tunnel syndrome (CTS). Methods In total, 154 patients were evaluated in a hand surgery outpatient clinic. All ENMG tests were bilaterally performed by a single neurologist. Qualitative variables were described for all patients with CTS according to their diabetic status, and the chi-squared test was used to reveal any association. A joint model was adjusted to determine the influence of diabetes on ENMG severity in CTS patients. Results The sample consisted of 117 women and 37 men, with an average age of 56.9 years old. Electroneuromyography demonstrated bilateral CTS in 82.5% of the patients. Diabetes was identified in 21.4% of the cases. Severe ENMG was prevalent. Conclusion There was no association between diabetes and ENMG severity in patients with CTS. Level of evidence IV, case series.

Resumo Objetivo O presente trabalho teve por objetivo verificar se existe correlação entre a síndrome do túnel do carpo (STC) e eletroneuromiografia (ENMG) de pacientes diabéticos e não diabéticos. Métodos Foram avaliados 154 pacientes em um ambulatório de cirurgia da mão. Todas as ENMGs avaliadas foram realizadas por um único neurologista, bilateralmente. As variáveis qualitativas foram descritas para todas as pessoas em acompanhamento devido à STC segundo a presença de diabetes e foi verificada a associação com uso do teste qui-quadrado. Foi ajustado o modelo conjunto para verificar a influência da diabetes na gravidade da ENMG em pacientes com STC. Resultados Foram incluídos no presente estudo 117 mulheres e 37 homens, com média de idade de 56,9 anos. Eletroneuromiografia demonstrando STC bilateral foi observada em 82,5% das pessoas. Pessoas diabéticas foram identificadas em 21,4% dos casos. Eletroneuromiografia com padrão grave foi prevalente. Conclusão Não houve associação entre a presença de diabetes e a gravidade da ENMG em pessoas com STC. Nível de evidência IV, série de casos.

Onset of Trigger Finger after Carpal Tunnel Syndrome Surgery: Assessment of Open and Endoscopic Techniques / Frequência do aparecimento de dedo em gatilho no pós-operatório da síndrome do túnel do carpo em duas técnicas cirúrgicas: Aberta e endoscópica

Abstract Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure (n = 34). These findings were compared with a retrospective cohort submitted to ET (n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.

Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.

Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Clinical analysis and literature review of 6 cases of burning mouth syndrome-like symptoms caused by the long-term oral administration of omeprazole / 口腔疾病防治

Objective @#To analyze the oral adverse drug reactions induced by omeprazole and provide a reference for rational clinical drug use.@*Methods@#From January 2019 to June 2020, the clinical data of patients with burning mouth syndrome caused by omeprazole were collected and analyzed. Additionally, the related literature was reviewed. @*Results@#Among the six patients, omeprazole was taken orally for as little as 6 months and as long as more than 5 years. The symptoms of burning mouth syndrome were mainly burning sensation in the mouth and paresthesia on the tongue that might be accompanied by extremity numbness. Vitamin and trace element supplementation was administered. The patient discontinued omeprazole, and symptoms disappeared after symptomatic treatment for 1 month to half a year. Literature review suggests that the reason may be associated with peripheral or central nervous system injury, altered saliva composition, and impaired vitamin and micronutrient intake caused by omeprazole.@*Conclusion @# The cause of burning mouth syndrome-like symptoms may be related to peripheral nerve injury caused by omeprazole and saliva changes. The main treatment is withdrawal and symptomatic treatment.

Parestesia após a exodôntica do terceiro molar: protocolo proposto / Paresthesia after third molar surgery: proposed protocol

Objetivo: Determinar a prevalência de parestesia do nervo alveolar inferior em exodontias dos terceiros molares mandibulares realizadas por estudantes de Odontologia. Material e métodos: O presente estudo retrospectivo incluiu os prontuários de 226 pacientes submetidos à exodontia dos terceiros molares mandibulares durante o período de julho de 2015 a agosto de 2017 por estudantes de Odontologia da Liga Acadêmica de Cirurgia da Universidade Federal de Campina Grande, Campus-Patos, Paraíba, Brasil. Resultados: Foram removidos 238 terceiros molares mandibulares de pacientes com faixa etária entre 16 a 42 anos, sendo a maioria dos pacientes do gênero feminino (71,68%). Nove dos pacientes (3,9%) relataram algum grau de comprometimento no território de inervação do nervo alveolar inferior com remissão total do sintoma no período de 3,7 meses. A prevalência da parestesia em relação ao número de terceiros molares inferiores extraídos foi de 1:25. Conclusão: A prevalência de parestesia decorrente da exodontia de terceiros molares mandibulares realizadas por estudantes de Odontologia é de 3,9%... (AU)

Objective: To define the prevalence of inferior alveolar nerve damage in mandibular third molar extractions performed by dentistry students. Materials and methods: The present retrospective study included the medical records of 226 patients submitted to mandibular third molar extraction during the period from July 2015 to August 2017 by students of Dentistry of the Academic League of Surgery of the Federal University of Campina Grande, Campus- Patos, Paraíba, Brazil. Results: 238 mandibular third molars were extracted from patients aged 16 to 42 years, with the majority of patients being females (71.68%). Nine of the patients (3.9%) reported some degree of involvement in the territory of innervation of the inferior alveolar nerve with total suspension of the symptom in the period of 3.7 months. The prevalence of damage in relation to the number of lower third molars extracted was 1:25. Conclusion: The prevalence of damage resulting from mandibular third molar extraction performed by dentistry students is 3.9%... (AU)

Relação da exodontia de terceiros molares e a ocorrência de parestesia do nervo alveolar inferior: uma revisão narrativa / Relationship of third molar extraction and occurrence of lower alveolar nerve paresthesia: a narrative review

Terceiros molares inferiores podem apresentar uma estreita relação com o nervo alveolar inferior, aumentando as chances de lesão durante o ato cirúrgico. Objetivo: descrever a relação entre a exodontia de terceiros molares e a ocorrência da parestesia do nervo alveolar inferior. Revisão de literatura: cirurgia para exodontia de dentes terceiros molares é o procedimento mais frequentemente realizado entre as cirurgias bucais e, como todo tipo de cirurgia, possui riscos e acidentes e/ou complicações que podem acometer os pacientes tal como a parestesia. Esta é uma condição que altera a sensibilidade de determinada área e pode ocorrer em consequência de traumas diretos ao nervo ou pela compressão deste, devido a hematoma e edema, levando a desconforto e incômodo. Considerações finais: é importante o profissional cirurgião-dentista atentar para o planejamento correto, criterioso e fazer uso de exames complementares, a fim de precaver possíveis complicações durante o ato cirúrgico. Caso a parestesia aconteça, podem ser utilizados tratamentos medicamentosos, a laser ou cirúrgicos, com resultados em longo prazo positivos e reversão do caso.(AU)

Lower third molars may present a close relation with the inferior alveolar nerve increasing the chances of injury during the surgical act. In view of this, this literature review aims to describe the relationship between the extraction of molars third and the occurrence of inferior alveolar nerve paresthesia. Paresthesia is a condition that alters the sensitivity of a certain area and can occur as a result of direct trauma to the nerve or compression of the nerve due to hematoma and edema. It leads to discomfort and discomfort, and it is important for the professional to attend to the correct, judicious planning and to make use of complementary exams. If paraesthesia occurs, medical, laser or surgical treatments are used, with positive long- -term results and reversal of the case. (AU)

A Study of Supraclavicular Brachial Plexus Block by Paresthesia Technique Success Rate and Complications: An Hospital Based Study

Background: The advantage of regional anaesthesia overgeneral anaesthesia are many and well documented. Brachialplexus can be blocked by various methods includingparesthesia technique, nerve stimulation technique and ultrasound guided. The present study was undertaken forassessing time taken to perform block, Successful blockade,complication of supraclavicular brachial plexus block byparesthesia technique.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with aim of assessing success rateand Complications of brachial plexus block. A total of 100patients were enrolled in the present study. Ethical approvalwas obtained from institutional ethical committee and writtenconsent was obtained from all the patients after explaining indetail of the entire research process. Complete demographicdetails of all the patients were obtained. All the results wererecorded in Microsoft excel sheet and were analyzed by SPSSsoftware.Results: Mean time to perform block was 5.35 minutes andsuccesfull blockade in 92% patients, in 6% patient’s partialblockade and in 2% patient’s complete failure of block.Incidence of complications were vessels puncture 8 % patientsand pneumothorax 1% patients.Conclusion: Supraclavicular brachial plexus block byparesthesia technique is an easy and relatively safe procedurefor the upper limb surgeries below mid shaft of humerus withfew complications and provide good post-operative analgesia.

Scalp dysesthesia. Case report / Disestesia do escalpo. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Scalp dysesthesia is characterized by the presence of several localized or diffuse symptoms, such as burning, pain, pruritus or stinging sensations, without objective findings in the physical examination of the patient that can explain and link the existing symptomatology to some other etiology. The aim of this study was to describe a case of scalp dysesthesia, from its clinical and laboratory investigation and the conduct adopted. CASE REPORT: A 38-year-old male patient, first assigned to the Dermatology Service, with complaints of pruritus in the scalp for 5 years. In the consultation at the Pain Service, the patient complained of daily, intermittent and burning dysesthetic sensations, such as tingling and pruritus in the bipariethoccipital region, worsening with heat and associated with severe pain in the cervical region. Upon physical examination, evidence of excoriations associated with this pruritus was found. The patient received conservative pharmacological treatment, with significant improvement of the symptomatology after 3 months. CONCLUSION: Larger prospective studies are needed to further characterize the pathogenesis of scalp dysesthesia, to generate optimization of the available therapeutic options and consequently improve the care that is given to patients. This report corroborates with some findings already described in the literature, such as the association with cervical alterations and the improvement through the use of low-dose antidepressants and anticonvulsants such as gabapentin.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disestesia do escalpo caracteriza-se pela presença de diversos sintomas localizados ou difusos, como queimação, dor, prurido ou sensações de picada, sem achados objetivos no exame fisico do paciente que possam explicar e ligar os sintomas existentes à alguma outra etiologia. O objetivo deste estudo foi descrever um caso de disestesia de escalpo, desde a sua investigação clínica e laboratorial, até a conduta adotada. RELATO DO CASO: Paciente do sexo masculino, 38 anos. Primeiramente foi ao serviço de Dermatologia com queixa de prurido em couro cabeludo há cinco anos. Na consulta do Serviço de Dor, o paciente queixava-se de sensações disestésicas como: formigamento e prurido em região biparieto-occipital que piora com o calor, associada à dor de forte intensidade, diária, intermitente e em queimação na região cervical No exame fisico, foram encontradas evidências de escoriações ligadas a esse prurido. O paciente recebeu tratamento farmacológico conservador, com melhora importante do sintoma após 3 meses. CONCLUSÃO: São necessários maiores estudos prospectivos para caracterizar ainda mais a patogênese da disestesia do escalpo, gerar otimização das opções terapêuticas disponíveis e, consequentemente, melhora na atenção prestada aos pacientes acometidos. Este relato corroborou alguns achados já descritos na literatura, como a associação com alterações cervicais e a melhora por meio do uso de antidepressivos em baixas doses e de anticonvulsivantes como a gabapentina.

Arm and hand function in hemodialysis patients: a cross sectional analytical study / Função do braço e da mão em pacientes em hemodiálise: um estudo analítico transversal

Aims: To investigate the arm and hand function in hemodialysis patients. Methods: Upper limb function using validated questionnaires such as Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Cochin and Boston were applied to 57 chronic renal failure patients on hemodialysis and 60 healthy controls. Epidemiological data, data on pain and paresthesia in the upper limb and handgrip strength were obtained. Results: The three questionnaires showed worse performance of upper limb function in chronic renal failure patients than controls: DASH questionnaire with P = 0.05; Cochin questionnaire with P = 0.0004 and Boston questionnaire with P = 0.03. The questionnaire scores were affected by presence of pain (P = 0.05 for DASH and < 0.0001 for Boston questionnaires) and paresthesia (DASH with P = 0.003; Cochin with P = 0.01 and Boston questionnaire with P < 0.0001). Handgrip strength was lower in hemodialysis patients when compared with controls (P = 0.02) but did not affect the performance of any of the studied questionnaires. Conclusions: Upper limb function is impaired in hemodialysis patients and the main associations found were with pain and paresthesia.

Objetivos: Investigar a função do braço e da mão em pacientes em hemodiálise. Métodos: A função dos membros superiores foi investigada utilizando-se questionários validados, como Disability of the Arm, Shoulder and Hand Questionnaire (DASH), Cochin e Boston, sendo aplicada a 57 pacientes com insuficiência renal crônica em hemodiálise e 60 controles saudáveis. Foram obtidos dados epidemiológicos tais como dor e parestesia no membro superior e força de preensão manual. Resultados: Os três questionários apresentaram pior desempenho da função do membro superior em pacientes com insuficiência renal crônica do que os controles: questionário DASH com P = 0,05; questionário de Cochin com P = 0,0004 e questionário de Boston com P = 0,03. Os escores do questionário foram afetados pela presença de dor (P = 0,05 para DASH e <0,0001 para questionários de Boston) e parestesia (DASH com P = 0,003; Cochin com P = 0,01 e Boston com P <0,0001). A força de preensão manual foi menor nos pacientes em hemodiálise quando comparados aos controles (P = 0,02), mas não afetou o desempenho de nenhum dos questionários estudados. Conclusões: A função do membro superior é prejudicada em pacientes em hemodiálise e as principais associações encontradas foram com dor e parestesia.

Qué pensar antes de decir que el paciente tiene un diagnóstico psiquiátrico. Parte I / What do you think before that you said: the patient has a psychiatric diagnosis. Part I

Resumen Los pacientes refieren sus síntomas en una gran variedad de términos como: "estoy cansado", "me duelen las articulaciones", "me pica todo el cuerpo", "tengo la boca seca", entre otros. Ante estos síntomas el médico piensa de manera automática en un número limitado de patologías que le son familiares, pero existen muchas otras causas a estos síntomas que no se tienen en cuenta. El desconocimiento del médico hace que en el paciente se genere inconformidad al no tenerse un diagnóstico correcto y un tratamiento adecuado, esto lleva a múltiples consultas y que el médico llegue a preguntarse a sí mismo "¿será que este paciente tiene un diagnóstico psiquiátrico?". En este artículo se enumeran las causas frecuentes de estos síntomas mencionados, se describen causas que son pocas veces sospechadas y las claves clínicas para que el médico pueda hacer el diagnóstico de éstas. La primera parte desarrollará los síntomas: fatiga, parestesias, prurito, artralgias, ansiedad y cambios en el comportamiento. La segunda parte desarrollará los síntomas: intolerancia a los alimentos, xerostomía, síncope, disfagia y manifestaciones en pacientes con cirugía bariátrica.

Abstract Patients refer their symptoms in a variety of terms such as: "I am tired", "my joints hurt", "my body itches", "my mouth is dry", among others. Given these symptoms, the doctor automatically thinks in a limited number of pathologies that are familiar to him, but there are many other causes to these symptoms that are not taken into account. The lack of knowledge of the doctor causes the patient to be dissatisfied by not having a correct diagnosis and adequate treatment, this leads to multiple visits and the doctor comes to ask himself "will this patient have a psychiatric diagnosis?". This article lists the frequent causes of these symptoms, describes causes that are rarely suspected and the clinical keys for the doctor to diagnose them. The first part will address the symptoms: fatigue, paresthesia, pruritus, arthralgia, anxiety and changes in behavior. The second part will develop the symptoms: intolerance to food, xerostomia, syncope, dysphagia and manifestations in patients with bariatric surgery.

Comparison of postoperative paresthesia after sagittal split osteotomy among different fixation methods: a one year follow-up study

OBJECTIVES: Postoperative paresthesia is a common complication after sagittal split osteotomy (SSO). This study aimed to compare paresthesia among different fixation methods one year postoperative. MATERIALS AND METHODS: This prospective cohort study assessed subjects in four groups: class II with miniplate fixation (Group 1), class II with three-screw fixation (Group 2), class III with miniplate fixation (Group 3), and class III with three-screw fixation (Group 4). Paresthesia was evaluated one year postoperative based on a 0-10 visual analogue scale. Pearson correlation was used to evaluate associations of age and mandibular movement with paresthesia. ANOVA was used to compare paresthesia among groups. RESULTS: A total of 80 subjects were enrolled, with 20 subjects in each of the four groups. The Pearson correlation test demonstrated a significant correlation between mandibular movement and paresthesia (P=0.001). Comparison of paresthesia among the groups showed significant differences among groups 1 and 2, 2 and 3, and 3 and 4 (P<0.05). CONCLUSION: The three-screw fixation method led to more paresthesia one year postoperative compared with miniplate fixation. In addition, the magnitude of mandibular movement had a positive correlation with paresthesia.

Prognosis in case of nerve disturbance after mandibular implant surgery in relation to computed tomography findings and symptoms

PURPOSE: The aim of this study was to evaluate the computed tomography (CT) imaging findings and clinical symptoms of patients who complained of neurosensory disturbances after mandibular implant surgery, and to investigate the relationships of these parameters with the prognosis for recovery. METHODS: CT scans were reviewed in 56 patients with nerve disturbance after mandibular implant surgery. Two oral radiologists classified the imaging findings into intrusion, contact, close, and separate groups according to the distance from the inferior border of the implant to the roof of the mandibular canal (MC). The symptoms of 56 patients were classified into 8 groups and the frequency of each group was investigated. Patients were categorized according to symptom improvement into no recovery and recovery groups, and the relationships of recovery with the CT classification and specific symptom groups were analyzed. RESULTS: Thirty-eight of the 56 nerve disturbance cases showed improvement. The close and separate groups in the CT classification had a strong tendency for recovery (90.9% and 81.8%, respectively) (P<0.05). Although the lowest recovery rate was found in the intrusion group, it was non-negligible, at 50%. The 6 patients with a worm crawling feeling all improved, while the 8 cases with a tightening sensation showed the lowest recovery rate, at 12.5%, and the symptom of a tightening sensation occurred only in the intrusion and contact groups. CONCLUSIONS: The closer the implant fixture was to the MC on CT images, the less likely the patient was to recover. Regarding paresthesia symptoms, while a worm crawling feeling is thought to be a predictor of recovery, a tightening sensation appeared to be associated with a lower recovery rate.

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.