Prevalence and factors associated with the correlation between malnutrition and pain in hemodialysis patients.

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs.

Successful management of a distal clavicular fracture using Titanium elastic nail (TEN) fixation.

This case report presents a unique instance of a 25-year-old male patient successfully treated with Titanium elastic nail (TEN) for a distal clavicle fracture, a method typically reserved for midshaft clavicle fractures. Distal clavicular fractures, constituting 12%-15% of all clavicle fractures, often necessitate surgical intervention to avoid complications such as malunion and persistent pain. While standard surgical therapies include Kirschner wire and hook plate fixation, this case explores the benefits of TEN, known for minimal tissue disruption and faster recovery. The patient, who suffered a severe left shoulder injury after falling, underwent a minimally invasive TEN procedure. Post-surgery, he showed a significant reduction in pain and improvement in shoulder mobility, with radiographic evaluations confirming successful fracture reduction and stable fixation. The case underscores the potential of TEN as a viable alternative for distal clavicular fractures, though further research is needed to establish comprehensive guidelines for its application.

Conservative Management of a Distal Humerus Spiral Fracture Sustained During Arm Wrestling: A Case Report and Literature Review.

Arm wrestling is a popular recreational activity that involves intense and repetitive muscular contractions of the upper extremity. Arm wrestling can result in various musculoskeletal injuries, including bone fractures. Humeral shaft fractures, particularly spiral fractures, are the most common fractures resulting from arm wrestling. Here, we present a case of a 25-year-old male patient who sustained a distal humerus spiral fracture during an arm-wrestling competition. The patient was managed conservatively with external reduction, cast stabilization, and physiotherapy with good outcomes. Despite initial angulation and rotation, the fracture healed well, and the patient regained full function of his arm within eight weeks. This case highlights the biomechanical aspects and risk factors of this type of fracture during arm wrestling and the value of protective measures such as proper technique, training, and protective equipment. It also highlights the potential for conservative management in such cases.

Prevalence of chronic pain in hemodialysis patients and its correlation with C-reactive protein: a cross-sectional study.

End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person's test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD.

Spiral Humeral Fracture During Arm Wrestling: A Case Report and Literature Review.

Arm wrestling places an axial pressure load on the humerus with the glenohumeral joint stabilized and the elbow flexed and fixed. This situation can cause humeral shaft fractures. We present a case of humeral shaft fracture in a 22-year-old healthy man following an arm-wrestling challenge. The patient is known to be a bodybuilder and athlete. He presented to our university emergency department with a swollen and tender arm and intact neurovascular structures, reporting that he had recently engaged in arm wrestling with a colleague of similar shape and power. The fracture was treated conservatively based on the patient's informed decision using closed reduction and physiotherapy. He committed to scheduled clinic visits and physical therapy sessions and showed improvement with complete recovery and normal functioning on the thirteenth week.

Prevalence of pain and its association with quality of life of patients with heart failure in a developing country: findings from a multicenter cross-sectional study.

BACKGROUND: Heart failure (HF) is considered one of the main causes of morbidity and death among chronic diseases worldwide. Patients have increasingly reported chronic pain in long-standing heart failure as a disturbing symptom. Its unknown etiology and mechanism, in addition to its insidious progressive nature, made both the doctor and the patient not notice it until it affects the quality of life (QoL) and general health status. The primary objective of this study is to find the prevalence of pain in chronic heart failure patients and its impact on their QoL. The secondary objective is to determine the predictors of QoL in HF patients. METHODS: A multicenter cross-sectional design was used. The European Quality of Life scale five dimensions scale and the Brief Pain Inventory were adopted to evaluate QoL and pain, respectively. The Statistical Package for the Social Sciences version 25 was applied to present the data. The Mann-Whitney U, Kruskal-Wallis, and Cronbach alpha tests were used. RESULTS: The final study had a total of 142 individuals. The prevalence of pain among HF patients was 84.5%. Knee pain was the main complaint among patients. Our patients' median pain severity score was 18 [5.00-25.00], while the median pain interference score was 39 [24.75-53.00]. They had a median EQ-5D score of 0.34 [0.0-0.6] and an EQ-VAS score of 50 [30-70]. Pain severity (p = 0.004 and p < 0.001, respectively) and pain interference (p < 0.001 and p = 0.001, respectively) were found to significantly associated with both QoL scores; the visual analogue scale (EQ-VAS) and EQ-5D-5L. In multivariate analysis, monthly income was the only variable significantly correlated with EQ-VAS and EQ-5D-5L, along with pain variables. CONCLUSIONS: Pain is a common symptom among patients with HF and is significantly associated with their QoL. Low income is also highly associated with poor QoL. Definitive guidelines should be achieved to increase awareness and understanding of the importance of pain management, reaching a higher QoL level, less pain, and good adherence to HF medications.

The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine.

BACKGROUND: Osteoarthritis is one of the most common musculoskeletal problems. Pain is the most common complaint and the most significant cause of decreased health-related quality of life (HRQOL) among osteoarthritic patients. The objectives of this study were to assess the impact of pain on quality of life among patients with osteoarthritis and to assess the association of sociodemographic and clinical factors with HRQOL. METHODS: Using a cross-sectional study design, we collected data from osteoarthritis patients in orthopedic outpatient clinics from four hospitals in the Palestine-West bank between November 2020 and March 2021. We used the Brief Pain Inventory (BPI) scale to assess pain and the Quality of Life scale five dimensions (EQ-5D) with the visual analog scale of the European Quality of Life (EQ-VAS) to assess HRQOL. RESULTS: In our study, 196 patients composed the final sample, with an average of 60.12 ± 13.63 years. The medians for the EQ-5D score and EQ-VAS score were 0.72 (0.508-0.796) and 70 (55-85), respectively. The pain severity score was found to have a significant negative association with both the EQ-5D and EQ-VAS scores with r of - 0.620, p <  0.001, and - 0.554, p <  0.001, respectively. Similar associations were found between pain interference score and both EQ-5D (r = - 0.822, p <  0.001) and EQ-VAS scores (r = - 0.609, p <  0.001). Multiple regression analysis showed that participants with higher educational level (p = 0.028), less diseased joints (p = 0.01), shorter duration of disease (p = 0.04), and lesser pain severity and interference scores (both with p < 0.001) had significantly higher HRQOL scores. CONCLUSIONS: We found that many variables have a significant negative impact on HRQOL among patients with osteoarthritis. Our finding provides a well-founded database to use by clinicians and healthcare professionals who work with patients with osteoarthritis, as well as educational and academic institutions.

Free Flap Transfer with Arteriovenous Loop Establishment for Upper Limb Salvage in a Crush Injury.

Constructing arteriovenous (AV) loops saves a crushed limb when healthy recipient vessels are unavailable at the site of injury by supporting a transferred free flap. Literature about using AV loops in the upper limb defect is scarce. We present a case with a devastating upper limb crush injury that was successfully managed with fibula flap transfer preceded by AV loop construction. A 38-year-old woman was admitted to our hospital with severe crushing trauma to her right forearm and hand. There was significant skin loss with injuries to blood vessels and tendons. She underwent multiple staged operations beginning with repair of the ulnar artery, debridement of necrotic tissue, and placement of 2 K-wires to stabilize the bones. Thereafter, a long saphenous AV loop was constructed between the brachial artery and the basilic vein. Finally, transfer of the fibula flap to the forearm. We used the staged procedure to provide adequate time for the AV loop maturation and adaptation. At around the patient's 7-month follow-up visit, her forearm and hand were stable, no complications related to the AV loop or the transferred fibula flap were noted. Utilizing AV loops to support transferred free flaps upper limb defects showed a promising successful outcome.