Heel Pain Management in Haglund's Deformity Targeting Sural Nerve Branches under Ultrasound Guidance: Case Report.

Introduction: Haglund's deformity is an abnormality of the bone and soft tissue of the foot, also known as retrocalcaneal exostosis, Mulholland deformity, and "pump bump". The etiology is not well known. Probable causes include a tight Achilles tendon, a high arch of the foot, and hereditary. The clinical features consist of pain at the posterior aspect of the heel which is predominantly present when the patient begins to walk after a period of rest or inactivity. Case Report: We report a case of a 60-year-old teacher with left heel pain for 3 years, unable to stand or walk for more than 15 min due to pain. We diagnosed him as a case of Haglund's deformity and treated him with ultrasound-guided injections targeting the superficial branches of the sural nerve. This case report illustrates a rarely described modality for the management of heel pain due to Haglund's deformity. Targeting superficial branches of the Sural nerve under ultrasound guidance can act as a superior treatment modality for the management of heel pain due to Haglund's deformity. Conclusion: Haglund's deformity is a cause of pain in the hindfoot that should be taken into account in the differential diagnosis of any patient presenting with heel pain. Ultrasonography has proved to be an important cost-effective tool in the diagnosis and management of various ankle pathologies like Haglund's deformity, thereby reducing the sole dependence on surgical management. Targeting the superficial (cutaneous) branches of the sural nerve can give satisfactory long-term relief of heel pain in patients with Haglund deformity.

Recent trends in chronic pain medicine.

Chronic pain presents as an unequalled challenge for physicians, owing to the complexity of biochemical and biological pathways involved in pain transmission and high variability of pain perception among individuals. Often, there is an inadequate response to conservative treatment, and opioid treatment has its own drawbacks, such as side effects and opioid dependence. Hence, novel strategies have evolved for the effective and safe management of chronic pain. Radiofrequency technique, regenerative biomaterial, platelet-rich plasma, mesenchymal stem cells, reactive oxygen species scavenger nanomaterial, ultrasound-guided interventional pain management procedures, endoscopic spinal procedures, vertebral augmentation therapy, and neuromodulation are some of the promising and upcoming modalities in the armamentarium of pain physicians.

Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain - a double-blind, randomized clinical trial.

Background: Postoperative endodontic pain is an enigma for the dentist. This study aimed to evaluate the analgesic effect of 300 mg gabapentin or 75 mg pregabalin in reducing postoperative endodontic pain compared with a placebo. Methods: Ninety patients who needed root canal treatment with an initial numerical rating scale (NRS) pain score of > 4 (T0) were randomly divided into three groups (n=30). Patients were then administered either 300 mg gabapentin (group A), 75 mg pregabalin (group B), or a placebo (group C) 30 min prior to the start of endodontic treatment. A single operator performed single-visit endodontics, and pain was evaluated immediately after endodontic treatment (T1) and at 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), and 72 h (T7) using the NRS. Ibuprofen/paracetamol (400 mg/325 mg) was administered as a rescue dose if needed. Results: Pregabalin performed significantly better when compared with gabapentin at all time points except at 72 h after treatment (P=0.170). The placebo group showed significantly higher pain scores than the other two groups. The percentage of pain relief was maximum for pregabalin (92.1%), followed by gabapentin (87.6%) and placebo (69.1%) at 72 h after treatment completion. Conclusion: This study showed that pretreatment with a single dose of pregabalin and gabapentin both had greater analgesic effects than a placebo. They can be effectively used to reduce postoperative endodontic pain.

Effect of brushing on the color stability of nanohybrid composite after immersion in brewed beverages - an in vitro study.

Background and aims: In today's world, everyone is mindful of one's appearance and appreciates aesthetics. Of the various restorative materials available, composites are considered as the most aesthetic with good color stability. This study aims at finding the effect of brushing on the color stability of nanohybrid composite after being immersed in various beverages. Methods: Thirty disk specimens were prepared for each staining solution (N=30), with a total of 90 specimens. The disk specimens for each staining solution were then sub divided into 2 groups (N=15): brushing and non-brushing. After preparation, the specimens were soaked in distilled water for 24 hours in separate containers. Baseline color of the samples was evaluated using spectrophotometer. The samples were then immersed in tea, coffee or water. The groups of samples to be brushed were held in the mold and 20 strokes of brushing using an electronically powered toothbrush were done on each side of the disk sample. The color was re-evaluated after a period of 14 days. Results: When comparing among the three beverages, tea showed the highest ΔE*ab indicating greatest discoloration when compared to coffee and water. This can be graded as tea > coffee > water. However, statistically there was no significant difference between tea and coffee. When compared within tea, coffee, or water specimens the non-brushed specimens showed greater discoloration compared to the brushed specimens both clinically and statistically. Conclusion: When immersing the specimens in the solutions, tea showed more color change compared to coffee, making the specimens clinically unacceptable. However, brushing the specimens reduced the discoloration when compared to non-brushing, making the coffee specimens clinically acceptable.

MALPOSITIONED LMA CONFUSED AS FOREIGN BODY IN NASAL CAVITY.

We present a case of confusing white foreign body in the nasal cavity detected during Endoscopic Sinus Surgery (ESS) in a 35-yr-old male which turned out to be a malposition of classic laryngeal mask airway (LMA). Although malposition of LMA is a known entity to the anesthesiologist, if ventilation is adequate, back folded LMA in nasal cavity might not be recognized by the surgeon and lead to catastrophic consequences during endoscopic sinus surgery. In principle, misfolding and malpositioning can be reduced by pre usage testing, using appropriate sizes, minimizing cuff volume, and early identification and correction of malposition.

A large cutaneous horn of the glans penis: a rare presentation.

Cutaneous horn (cornu cutaneum) is a relatively uncommon lesion consisting of a projectile, conical, dense, hyperkeratotic nodule which resembles the horn of an animal. Cutaneous horns most frequently occur in sun-exposed parts and are typically found in the face and the scalp, but may also occur on the hands, eyelids, nose, chest, neck, shoulder and penis. Their occurrence on the penis is uncommon. We report a 42-year-old man presenting with penile cutaneous horn. The association with malignancy on the penis makes proper identification of these lesions essential. Standard treatment involves local excision, but the presence of malignancy mandates a partial penectomy.

Breast tuberculosis- clinical spectrum and management.

Objective of the study was to report the clinical spectrum, investigative profile and management of breast tuberculosis patients attending a tertiary care hospital. Breast tuberculosis is an uncommon form of tuberculosis. Knowledge of its varied clinical presentation and diagnostic modalities help in diagnosing this easily treatable disease. Retrospective data of 63 consecutive patients with breast tuberculosis was analyzed and information regarding demographic details, clinical presentation, cytology, histopathology and management was noted. Breast tuberculosis is essentially a disease of females (98.41%). 49.20% patients were below 30 years of age and 68.25% were from rural areas. Incidence of tubercular mastitis increases with parity (71.42% with p > 2). Commonest presentation was with painless lump (73%). Nodulocaseous tubercular disease was found in 74.60% patients whereas, 6.3% were of disseminated variety. Primary focus was detected in lungs in 11.1% patients, while 46.03% presented with loco-regional lymph nodes. FNAC was found to be a sensitive tool of diagnosis in 74.60% patients; however 25.39% cases were diagnosed with biopsy. ATT remained mainstay of treatment with surgical intervention as and when required. Breast tuberculosis despite being uncommon is not rare. Although diagnosis is not difficult but one should know where to suspect. Once confirmed treatment outcome is often rewarding.