Articles: pain-clinics.
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J Coll Physicians Surg Pak · Jul 2021
Case ReportsSarcoidosis Presenting with Bilateral Optic Disc Edema as the Initial Presentation.
Sarcoidosis is a chronic, progressive, granulomatous inflammatory disease of unknown etiology that affects multiple organ systems. Granulomatous anterior uveitis is the most common eye finding, and optic nerve involvement at presentation is rarely seen. Here, we report a 43-year man referred to our clinic with eye pain, decreased vision, floaters and bilateral papillitis, vitritis and cystoid macular edema. ⋯ In this case, sarcoidosis initially presented with bilateral papillitis and vitritis without granulomatous uveitis, and successful results were obtained with methylprednisolone and immunosuppressive treatment without any relapse or systemic involvement of sarcoidosis. Sarcoidosis should be considered in patients presenting with optic nerve inflammation, even when granulomatous inflammation or vasculitis are not present, which are specific for ocular sarcoidosis. Key Words: Edema, Optic disc, Papillitis, Sarcoidosis.
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Diabetic myonecrosis or muscle infarction (DMI), a clinicoradiological entity is an underdiagnosed complication of diabetes mellitus. It refers to spontaneous aseptic necrosis of skeletal muscles commonly of the lower limb without evidence of any large vessel disease. It presents as painful swollen limb without any external insult in patients with long-standing diabetes mellitus with other microvascular complications especially nephropathy. We present four instances of DMI in our patients who had end-stage renal disease with a varied course.
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This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief. The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. ⋯ In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ± 48.7 mg/dL and 48.0 ± 20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI. Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.
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Randomized Controlled Trial Multicenter Study Comparative Study
Effects of Intravenous Eptinezumab vs Placebo on Headache Pain and Most Bothersome Symptom When Initiated During a Migraine Attack: A Randomized Clinical Trial.
Intravenous eptinezumab, an anti-calcitonin gene-related peptide antibody, is approved for migraine prevention in adults. It has established onset of preventive efficacy on day 1 after infusion. ⋯ Among patients eligible for preventive migraine therapy experiencing a moderate to severe migraine attack, treatment with intravenous eptinezumab vs placebo shortened time to headache and symptom resolution. Feasibility of administering eptinezumab treatment during a migraine attack and comparison with alternative treatments remain to be established.
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Meta Analysis
Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs.
Analgesics that contain codeine are commonly prescribed for postoperative pain, but it is unclear how they compare with nonopioid alternatives. We sought to compare the effectiveness of codeine and nonsteroidal anti-inflammatory drugs (NSAIDs) for adults who underwent outpatient surgery. ⋯ We found that adult outpatients report better pain scores, better global assessments and fewer adverse effects when their postoperative pain is treated with NSAIDs than with codeine. Clinicians across all specialties can use this information to improve both pain management and opioid stewardship.