While the pain- and stress-reducing effects of music are well investigated, effects of visual art and the combination of both modalities (music and visual art) are much less explored. We tested the (1) pain- and (2) stress-reducing effects of a multimodal (music + visual art) aesthetic experience-expecting stronger effects than single modal aesthetic experiences (music or visual art)-and, in an exploratory manner, (3) investigated underlying mechanisms of aesthetic experience and (4) individual differences. In a repeated-measures design (music, visual art, multimodal aesthetic experience, control), 42 female participants submitted their self-selected movingly beautiful visual artworks and music pieces to the lab, where pain and stress were induced by a cold pressor test. Pain (global pain perception, pain intensity, pain affect, pain tolerance) and stress responses (subjective reports, autonomic [electrocardiography, electrodermal activity, salivary alpha-amylase] and endocrine activity [salivary cortisol]) were measured. Individual differences of the experience, trait empathy and absorption were investigated. Exposure to multimodal art resulted in longer pain tolerance (M = 80.19s; SD = 61.05) compared to visual art (M = 56.63s; SD = 47.86), but not compared to music (M = 81.34s; SD = 64.19; p < .001; η² = .039). Other measures of pain intensity, stress intensity, and pain affect did not differ across the conditions. Exposure to all types of art distracted participants' attention from pain, prompted mind wandering, and elicited greater enjoyment than the control condition. While participants were overall more stressed during the cold pressor test, no differences emerged across the four conditions (p = 0.38; η² = .012). Also, no differences were found regarding cortisol and alpha-amylase. Regarding individual differences, higher trait absorption was associated with longer pain tolerance in the multimodal condition (b = 0.58, SE = 0.29, t(120)=2.02, p = .046) and with lower pain intensity in the music-only condition (b = -0.27, SE = 0.12, t(120)=-2.20, p = .030), compared to the other conditions. In conclusion, exposure to art can influence pain; however, the underlying mechanisms require further research.
University students often use smartphones for daily tasks, which can lead to awkward posture and musculoskeletal pain in the hand, wrist, and fingers due to prolonged use. This review aims to investigate the relationship between smartphone use and hand pain among university students. For this review, we collected and analyzed original English-language articles published between 2014 and 2024. Keywords were selected from the MeSH database. We excluded review articles, books, letters, reports, and other non-original sources, as well as studies that focused on mobile phones or populations other than university students and smartphone users. Additionally, articles addressing pain in other body parts, injuries, and complications from smartphone use, as well as those published during the COVID-19 pandemic, were also omitted. We utilized various keyword combinations related to "university", "students", "smartphone use", "addiction", "overuse", "hand", "pain", "musculoskeletal pain", "wrist", "fingers", "thumb", "risk factors", "characteristics", and "posture" in the search, along with the use of "AND", "OR", or no conjunctions, and the use of quotation marks for one, two, or a few keywords. Literature was obtained from databases such as Web of Science, ScienceDirect, Scopus, PubMed, and ProQuest. A total of 18 studies were selected from 390 primary literature sources, following the PRISMA framework. A total of 393 articles were found in the initial search. Duplicate articles were removed, leaving 259 that were examined according to inclusion and exclusion criteria. After assessing the relevance of titles and abstracts, screening, and qualitatively evaluating journals, 18 articles were included in the study. Brazil, Saudi Arabia, and Turkey had the highest number of articles (n = 3 or 16.6% of articles). The age group investigated was 18 to 26 years old. Based on the identified risk factors, the articles were discussed in three groups: (1) role of smartphone duration, addiction, and hand pain (83.3% of studies investigated the duration of smartphone use, while 38.8% surveyed smartphone addiction), (2) the effect of smartphone holding posture on the hand and hand pain (38.8% of studies), and (3) the relation of smartphone physical characteristics to hand pain (27.7% of studies). Daily usage duration ranged from less than or equal to 4 h/day (53.2%) to 7 h or more (73.9%). The reported range of smartphone addiction among students was between 15.9% and 66.6%. The reported prevalence of wrist, hand, and thumb pain was 19.2% to 68.7%. Between 14.75% and 41% of students use their right hand to hold smartphones and type with their right thumb, while 24% to 77.79% use both hands and both thumbs. The size and weight of smartphones can predict hand pain. The amount of time spent using a smartphone, how it is held, how long it has been owned, smartphone addiction, holding posture, frequent thumb movements, preferred hand position, screen size, weight of the smartphone, and smartphone -related the purpose of usage are all risk factors that can lead to pain in the hand, wrist, palm, thumb, and other fingers.
Trigeminal neuropathic pain (TNP) is a chronic and debilitating condition frequently resistant to conventional pharmacological therapies. Although cannabinoids have emerged as a potential adjunctive treatment, objective clinical documentation of their effects in orofacial neuropathic pain remains limited. We report two female patients with refractory TNP-one post-traumatic and one idiopathic-who experienced insufficient relief despite trials of anticonvulsants, antidepressants, topical agents, and local interventions. Both patients received a balanced tetrahydrocannabinol (THC):cannabidiol (CBD) sublingual formulation (20 mg/mL each) following a structured titration protocol and were monitored over 8 weeks. Outcomes were assessed using the Douleur Neuropathique 4 Questions (DN4), the visual analog scale (VAS), the World Health Organization Quality of Life-BREF (WHOQOL-Bref), and qualitative sensory testing (QualST). Additionally, three-dimensional facial stereophotogrammetry was employed to objectively quantify areas of hyperfunction and allodynia. Treatment resulted in a marked analgesic response (VAS reduction from 9 to 4 and from 10 to 2), qualitative changes in pain phenotype-from shock-like to predominantly burning-and functional improvement in mastication and oral hygiene. Stereophotogrammetry demonstrated a substantial reduction in sensitized regions, with extraoral hyperfunctional area decreasing from 113.72 to 27.54 cm2 and complete resolution of allodynia by week 8. WHOQOL-Bref scores improved in both patients, with physical domain scores increasing from 50.0 to 60.7 and from 25.0 to 39.3, accompanied by gains in psychological well-being. No serious adverse events were recorded. These cases illustrate the potential clinical relevance of cannabinoids as an adjunctive approach for refractory TNP and highlight the importance of multidimensional assessment strategies. The findings should be interpreted cautiously given the descriptive nature of case reports; however, they underscore the need for controlled studies to further investigate the efficacy and safety of cannabinoid-based therapies in orofacial neuropathic pain.
Recurrence and chronic pain remain significant challenges in incisional hernia repair, and evidence on the optimal mesh placement is limited. This review aimed to determine whether there is a difference in the risk of recurrence and chronic pain based on mesh placement in patients undergoing incisional hernia repair. Studies with adults undergoing elective incisional hernia repair for defects < 10 cm were included. PubMed, Embase Ovid, and Cochrane CENTRAL were searched on August 18, 2025. RCTs were assessed with Cochrane's Risk of Bias tool, version 2. Cohort studies were evaluated with Cochrane's Risk Of Bias In Non-randomized Studies of Interventions, version 2. Meta-analyses and a network meta-analysis were conducted to compare recurrence rates across placements. The protocol was pre-registered in PROSPERO (CRD420251148033). Twenty-two studies with 10,832 patients were included. Crude recurrence rates were highest for preperitoneal (12.8%) and lowest for retromuscular (3.0%) mesh positions. In the network meta-analysis, retromuscular (RR 0.3, 95% CI 0.1-0.8) and intraperitoneal (RR 0.4, 95% CI 0.2-0.9) placements were significantly associated with a lower risk of recurrence compared with onlay. However, the certainty of evidence was very low due to high risk of bias and heterogeneity, limiting confidence in these estimates. Four studies reported chronic pain, but substantial heterogeneity precluded meta-analysis. Retromuscular mesh placement may reduce recurrence compared with onlay mesh. However, these findings were limited by clinical and statistical heterogeneity across studies. Reports on chronic pain were few and heterogeneous, needing further research on the link between chronic pain and mesh placement.
Inadequate analgesia during painless colonoscopy can result in undesirable body movements, undermining patient safety and procedural success. Oxycodone, known for its dual κ- and μ-receptor agonism, may provide effective analgesia with a reduced incidence of adverse effects compared to other opioids. However, the optimal intravenous dose of oxycodone for suppressing body movement during colonoscopy has not been established. This prospective, single-center, dose-finding study enrolled adult patients scheduled for painless colonoscopy. All participants received intravenous oxycodone in combination with propofol, with the oxycodone dose determined according to the Dixon and Massey up-and-down sequential allocation method. The primary outcome was the median effective dose (ED5 0) of oxycodone required to suppress body movement during colonoscope insertion. Body movement was graded, and a positive response was defined as movement graded ≥2. The ED5 0 was estimated as the mean of crossover midpoints after at least seven reversal pairs, and the 95% confidence interval (CI) was determined by probit regression. Adverse events within 20 minutes after the procedure, including agitation, abdominal pain, nausea or vomiting, dizziness or headache, and postural instability, were also recorded. A total of 36 patients were enrolled. The calculated ED5 0 of oxycodone for suppression of body movement during colonoscope insertion was 0.055 mg/kg, 95% CI: 0.047-0.063 mg/kg. Intravenous oxycodone, when dosed by the Dixon up-and-down method, is effective and safe for analgesia during painless colonoscopy. ChiCTR:ChiCTR2300077446.
Autonomic painful diabetic gastropathy is an uncommon and often overlooked cause of recurrent abdominal pain in individuals with diabetes. We describe a young man with type 1 diabetes who developed repeated episodes of severe epigastric pain and vomiting after a traumatic event, with all routine investigations failing to identify a structural, metabolic, or functional cause. His symptoms were resistant to standard therapies but showed rapid and sustained improvement with centrally acting sympatholytic treatment, and autonomic testing later supported underlying dysautonomia. This case highlights the importance of considering autonomic gastrointestinal involvement in unexplained, recurrent abdominal pain in diabetic patients, as early recognition can guide targeted therapy and help avoid unnecessary investigations and hospitalizations.
Septic arthritis of the spinal facet joint (SAFJ) is a rare spinal infection predominantly affecting adults and remains exceptional in pediatric and adolescent populations. Spinal epidural abscess (SEA) may occur as a complication and can lead to severe neurological deficits if diagnosis and treatment are delayed. We herein report two adolescent patients with lumbar SAFJ complicated by SEA. The first case involved a 14-year-old boy presenting with acute low back pain, fever, and rapid neurological deterioration culminating in cauda equina syndrome, requiring urgent surgical decompression and prolonged antibiotic therapy. The second case involved a 15-year-old girl presenting with acute low back pain and radiculopathy with a minor neurological deficit, successfully managed with conservative antibiotic treatment alone. Clinicians should maintain a high index of suspicion for SAFJ in children and adolescents presenting with acute localized back pain and fever. Early MRI evaluation is crucial to detect facet joint infection and epidural extension before the onset of neurological deterioration. Prompt individualized management, guided primarily by neurological status, can result in excellent functional outcomes.
Effective pain management is a cornerstone in the treatment of patients with multiple rib fractures, as inadequate analgesia can impair ventilation and increase the risk of pulmonary complications. Bilateral rib fractures, in particular, can significantly compromise respira-tory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. Regional analgesic techniques play a crucial role in improving respiratory function while reducing reliance on opioids and their associated adverse effects. We report the case of a patient with multiple bilateral rib fractures following thoracic trauma who presented with severe pain and compromised respiratory function. Initial management with systemic analgesic proved inadequate. Multimodal regional analgesia was therefore initiated with a bilateral erector spinae plane block, resulting in rapid pain relief and improved oxygenation. Given the limited duration of analgesia provided by a single-shot erector spinae plane block, thoracic epidural analgesia was subsequently established via epidural catheter. Continuous low-dose epidural local anesthetic infusion ensured sustained analgesia, prevented pain recurrence, and supported ongoing improvement in respiratory function throughout the clinical course. This case highlights that a multimodal regional analgesic approach, combining an erector spinae plane block followed by thoracic epidural analgesia, may represent an effective and feasible strategy for optimizing pain control and respiratory outcomes in patients with bilateral rib fractures. Such an approach may also reduce the need for systemic opioid therapy while optimizing clinical outcomes and minimizing associated risks.
Spinal cord injury (SCI) causes persistent physical and psychological impairments and is associated with reduced quality of life. Telemedicine may improve rehabilitation access and follow-up care, but its effectiveness across multiple outcome domains in SCI remains uncertain. This study aimed to evaluate the effects of telemedicine interventions on psychological health, quality of life, sleep, functional independence, and participation, and pain intensity in individuals with SCI. We searched PubMed, Web of Science, Embase, Ovid MEDLINE, and Cochrane CENTRAL until 17 February 2026. We included English-language randomized controlled trials (RCTs) of telemedicine interventions in individuals with SCI. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Risk of Bias 2 (RoB 2; Cochrane) tool. Random-effects meta-analyses used the Hartung-Knapp-Sidik-Jonkman method with restricted maximum likelihood estimation of between-study variance. Effects were summarized as standardized mean differences (SMD) or mean differences (MD) with 95% CIs. For main meta-analyses, 95% prediction intervals were reported when at least 5 studies were available, but not for analyses with fewer than 5 studies or for subgroup meta-analyses. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). We included 33 studies (35 reports). Telemedicine improved the World Health Organization Quality of Life-BREF (WHOQOL-BREF) social domain (MD 3.27, 95% CI 0.64 to 5.89; P=.03) and sleep quality at 3 months (MD -2.24, 95% CI -3.82 to -0.67; P=.04). Depressive symptoms also improved in the >3-≤6 months follow-up subgroup (SMD -0.31, 95% CI -0.57 to -0.04; P=.03). Overall effects for depressive symptoms were not significant (SMD -0.11, 95% CI -0.26 to 0.05; prediction interval -0.37 to 0.15; P=.16; I²=36.3%), while findings for anxiety, other WHOQOL-BREF domains, sleep quality at 1 month, functional outcomes, and pain intensity generally favored telemedicine but did not reach statistical significance. Approximately half of the studies were rated as low risk overall on RoB 2, with most remaining studies rated as having some concerns and a smaller subset rated as high risk. GRADE certainty was high for the >3-≤6-month depressive-symptoms subgroup, moderate for the WHOQOL-BREF social domain, Pittsburgh Sleep Quality Index (PSQI), and Spinal Cord Independence Measure (SCIM), and low for depressive symptoms overall, anxiety, and pain intensity. Telemedicine may improve selected outcomes in SCI, with the most consistent evidence for social aspects of quality of life, sleep after sustained intervention exposure, and a more favorable effect on depressive symptoms in midterm follow-up subgroup analyses. These results suggest telemedicine as a practical adjunct for extending SCI rehabilitation access and continuity. Further trials should focus on optimizing intervention components, intensity, and patient targeting.
Methadone is a long-acting opioid with multifaceted analgesic properties that is under increasing investigation as an intraoperative analgesic in cardiac surgery. A systematic search of United States National Library of Medicine Database (MEDLINE) and Excerpta Medica Database (EMBASE) databases identified publications investigating the use of intraoperative methadone in adult cardiac surgical patients. The risk of bias and quality of evidence of these studies were assessed, and data from these reports were extracted and presented in a narrative format. Sixteen eligible publications were included. Although the quality of the studies was moderate to high, the certainty of the evidence is low due to the limited available data regarding optimal dosing strategies, timing of administration in relation to cardiopulmonary bypass, and long-term safety outcomes. The composite data suggest that a single dose of intraoperative methadone results in less postoperative pain and opioid consumption postoperatively without any increased risk for QTc prolongation or respiratory depression. Doses of 0.1 to 0.3 mg/kg are reported in the cardiac surgery literature; however, there is evidence of a dose-response relationship with methadone's analgesic benefits and increased deliriogenic side effects. Studies using 0.1 mg/kg reveal equivocal analgesia, whereas the studies administering ≥0.2 mg/kg consistently report lower postoperative pain scores and opioid consumption compared to short-acting intravenous (IV) opioids. Crucially, the use of cardiopulmonary bypass significantly impacts methadone's plasma concentrations and must be considered when determining the optimal dose and timing of administration. Further, recent observational studies offer valuable insight into methadone's role in multimodal enhanced recovery after cardiac surgery protocols. Additional trials are needed to refine methadone usage in this population.
Lumbar disc herniation (LDH) is a common clinical spinal disorder, with the L5/S1 segment being a frequently affected site due to its unique anatomical and biomechanical characteristics. Conventional minimally invasive spinal endoscopic techniques, such as percutaneous transforaminal endoscopic discectomy (PTED), percutaneous endoscopic interlaminar discectomy (PEID), and unilateral biportal endoscopy (UBE), have inherent limitations in treating L5/S1 LDH. These include difficulty bypassing the high iliac crest (for PTED), a steep learning curve (for PEID), and potential impairment of spinal stability (for UBE). To address these challenges, this study applied Arthroscopic-assisted uni-portal spine surgery (AUSS) via a modified interlaminar approach combined with 4-0 absorbable suture annular repair for L5/S1 LDH, reporting its short-term clinical outcomes and detailing key technical points. A 45-year-old male patient presented with a 1-year history of low back pain, which worsened over 1 month with persistent right lower limb radicular pain, unresponsive to conservative treatment. Preoperative lumbar MRI and CT confirmed L5/S1 disc herniation, with T2-weighted MRI showing low signal intensity of the herniated disc and axial CT demonstrating direct compression of the right S1 nerve root by the herniated nucleus pulposus. The patient underwent the modified procedure: during surgery, a portion of the ligamentum flavum was excised to expose the herniated nucleus pulposus, while the remainder was retracted and preserved. After complete removal of the herniated nucleus pulposus, full-thickness annular suturing was performed using 4-0 absorbable sutures, with knot tying performed extracanalicularly and pushed into place using a dedicated knot pusher. At 1, 3, and 12 months postoperatively, the incision healed well without complications such as infection, nerve injury, or cerebrospinal fluid leakage. Imaging re-evaluation showed no recurrence of L5/S1 disc herniation and a smooth posterior annular margin. The patient experienced significant relief of low back and leg pain, resuming normal daily activities within 1 month postoperatively. The visual analogue scale (VAS) score decreased from 7 preoperatively to 1, the Japanese Orthopaedic Association (JOA) score reached 25, and the Oswestry Disability Index (ODI) decreased from 68% preoperatively to 12%. Arthroscopic-assisted uni-portal spine surgery via the modified interlaminar approach combined with annular suturing is a safe, feasible, and effective treatment for L5/S1 LDH. Its core advantages include bypassing anatomical barriers such as the high iliac crest, maximizing the preservation of spinal osseous and ligamentous structures, ease of operation, high surgical efficiency, and a low short-term recurrence rate. This procedure is a targeted optimization of the traditional interlaminar approach, providing a valuable treatment option for L5/S1 LDH, especially in cases where conventional endoscopic techniques are limited. However, the results of this single-case study cannot be generalized to long-term efficacy, and large-sample, multi-center follow-up studies are needed for further validation.
Abdominal paracentesis is a key diagnostic and therapeutic intervention in patients with cirrhosis and ascites, yet it can be painful, especially in the presence of peritonitis. While local anesthetic infiltration is the conventional method for pain management, regional anesthesia techniques such as the ultrasound-guided transversus abdominis plane (TAP) block offer an effective, opioid-sparing alternative. We present the case of a 33-year-old woman with cirrhosis and suspected spontaneous bacterial peritonitis who underwent a large-volume paracentesis in the emergency department following a TAP block. The block provided effective somatic analgesia, improved procedural tolerance, and minimized opioid use. The case highlights the utility of TAP blocks as part of a multimodal pain management strategy for paracentesis in select emergency department patients. Broader implementation may enhance patient comfort, reduce the need for systemic analgesia, and provide valuable procedural training opportunities for emergency physicians.
Isolated fallopian tube torsion (IFTT) is an uncommon but important cause of acute lower abdominal pain, particularly in premenarchal girls. Its nonspecific clinical presentation and inconclusive imaging findings often lead to delayed or incorrect diagnosis. We report the case of a 13-year-old premenarchal girl who presented with right iliac fossa pain and was initially found to have a para-ovarian mass on ultrasonography. Her symptoms temporarily subsided with conservative management; however, she re-presented with worsening pain. Diagnostic laparoscopy revealed torsion of the right fallopian tube associated with a hemorrhagic para-tubal cyst. A right salpingectomy was performed due to irreversible ischemic changes of the tube. This case highlights the challenges of diagnosing IFTT in young females. It aims to increase awareness among clinicians as early surgical intervention can preserve tubal function and prevent complications.
The management of cervical ossification of posterior longitudinal ligament (OPLL) with unilateral radiculopathy poses significant challenges. Posterior uniportal endoscopic laminotomy offers a minimally invasive alternative, yet its application in OPLL-related stenosis remains technically demanding and underreported. A 49-year-old female presented with progressive left upper limb radiculopathy, numbness, weakness, and cervicobrachial pain due to OPLL-induced severe neuroforaminal and lateral recess stenosis at C6-C7 and C7-T1. Through a single 1-cm incision, posterior endoscopic decompression was performed via unilateral laminotomy at both target levels. The procedure was completed in 1.5 h with minimal blood loss. Postoperatively, the patient showed rapid symptomatic improvement, with significant reduction in pain and recovery of grip strength by 6-month follow-up. Integrating contemporary evidence with technical experience, we outline key procedural insights to support the adoption of this technique in selected OPLL cases. Posterior uniportal endoscopic laminotomy is a feasible and effective minimally invasive option for selected OPLL patients with unilateral radiculopathy. It achieves clinical improvement while preserving spinal motion and avoiding fusion-related complications, provided patient selection and surgical technique are optimized.
Intravenous drug use (IVDU) is strongly associated with severe infections including abscesses, endocarditis, necrotizing fasciitis, and osteomyelitis. When untreated, acute osteomyelitis can progress to chronic disease with biofilm-mediated antimicrobial resistance, soft tissue necrosis, and eventual limb loss. Reports of extreme cases requiring major amputation remain uncommon in the literature. We report the case of a 32-year-old female with a history of substance use disorder who presented with a chronic right forearm wound after more than one year without definitive treatment. Despite prior medical recommendations for amputation, the patient declined intervention and was lost to follow-up. She re-presented with worsening pain, soft tissue necrosis, exposed bone, and a pathological fracture. Operative management included a transhumeral amputation with confirmation of acute osteomyelitis and osteonecrosis on pathology. This case highlights the clinical and social challenges of managing chronic osteomyelitis in patients with IVDU, including delayed care, limited adherence, and high rates of antimicrobial resistance. Optimal management requires a multifaceted approach combining aggressive surgical debridement or amputation with systemic and local antibiotic therapy. Emerging treatment frameworks, such as the Philadelphia Treatment Algorithm for Xylazine-Associated Wounds, provide evidence-based guidance for similarly complex infections. Patients with substance use disorder are at increased risk for devastating complications of chronic osteomyelitis, including limb loss. Early recognition, structured treatment algorithms, multidisciplinary management, and integration of addiction treatment are critical to improving outcomes in this vulnerable population.
Technology-assisted planning is increasingly integrated into reconstructive plastic surgery, including virtual reality, augmented reality, and three-dimensional (3D) printing. 3D printing has been especially useful in maxillofacial surgery, both for patient-specific cutting guides for osteotomies and for biomodels to customize osteosynthesis plates. However, to our knowledge, there have been no reports of a 3D-printed cutting guide to harvest a custom iliac crest bone flap based on the deep branch of the superficial circumflex iliac artery perforator (SCIP) flap, together with a biomodel of the foot skeleton with the bone defect for intraoperative use. We report a 36-year-old man with a 45-mm bone defect of the first metatarsal and a 9 × 8 cm skin defect on the dorsum of the right foot after firearm trauma. Computer-aided design and computer-aided manufacturing (CAD/CAM) using open-source software were used to prepare a cutting guide that allowed harvesting a bone flap of precise dimensions and a biomodel that enabled intraoperative adjustment of the flap without pedicle division. Reconstruction was achieved with a 45-mm bone flap based on the deep branch of the SCIP and a 9 × 8 cm skin flap based on the superficial branch of the SCIP. Both flaps survived without complications; bone consolidation was observed at 4 months, and at 10 months, the patient had an adequate, pain-free gait. This case illustrates that an open-source, low-cost 3D-printing workflow may be a useful adjunct for planning and execution of metatarsal reconstruction with osteocutaneous free flaps.
Galeazzi fracture-dislocation is a complex injury involving a distal radius fracture and distal radioulnar joint (DRUJ) dislocation, typically treated through surgical intervention. However, persistent DRUJ dislocation remains a common complication following surgery. This report presents two cases of persistent DRUJ dislocation after surgical treatment of Galeazzi fractures. Both patients underwent initial radial fixation with plate and screws but developed limitations in forearm supination and pain due to residual DRUJ dislocation. Radiographs confirmed the dislocation, and subsequent surgeries addressed the causes, including radial malalignment, soft tissue entrapment, and untreated ulnar styloid fractures. Following reoperation, both patients achieved full recovery with pain relief and restored forearm mobility. This case report emphasizes the importance of comprehensive intraoperative evaluation and early detection of DRUJ dislocation to prevent long-term dysfunction and complications.
BACKGROUND IgA-associated vasculitis (IgAV), although relatively uncommon in adults, is frequently associated with increased vasculitis severity. Sudden abdominal pain and bloody diarrhea are among the usual manifestations of IgAV in children. In older patients, clinical manifestations of the disease may be typical, but advanced age and comorbidities can make the final diagnosis unexpected. CASE REPORT A 67-year-old man with multiple underlying medical conditions, including diabetes mellitus and arterial hypertension, was admitted with acute abdominal pain. Baseline evaluation revealed venous ischemic necrosis of the ileum and concurrent acute kidney injury. Given the patient's age and diabetic status, an atherogenic etiology was initially considered. Further diagnostic investigation, including renal biopsy, identified features consistent with IgAV. The patient's clinical course was complicated by simultaneous gastrointestinal and renal involvement, highlighting the systemic nature of the vasculitis. CONCLUSIONS Although IgAV is predominantly a pediatric condition, its presentation in older adults is rare and often atypical, commonly mimicking other vascular or ischemic disorders; this pattern may delay diagnosis and appropriate treatment. The present case emphasizes the need to maintain awareness of IgAV in older patients who present with acute abdominal symptoms, particularly when renal dysfunction is present. Advanced age and diabetic status are associated with increased severity and worse renal outcomes, underscoring the need for thorough evaluation and close monitoring. This report contributes to the limited literature on IgAV in older patients; it illustrates the diagnostic and therapeutic challenges in this population.
Simultaneous ruptures of the quadriceps tendon and contralateral patellar tendon are exceedingly rare, particularly in patients without serious comorbidities or other known predisposing factors. We present the case of an obese 31-year-old man without metabolic syndrome or any other known predisposing risk factors who suffered a right quadriceps tendon rupture and simultaneous left patellar tendon rupture, and tear of the anterior horn of the left lateral meniscus. These injuries occurred while walking downstairs and missing a step. He presented with bilateral knee pain, ecchymosis, and the inability to extend either leg. The diagnosis was confirmed by imaging, and he underwent surgical repairs of both tendons as well as the left lateral meniscus. Thereafter, the postoperative course was uncomplicated. By six months post-surgery, he was able to regain full range of motion in both knees with minimal pain and a normal gait. This case highlights the importance of early recognition, prompt surgical intervention, and structured rehabilitation in achieving optimal recovery in a complex and rare extensor mechanism injury.
To examine the association between unmet need for effective pediatric care coordination and the prevalence of ≥1oral health problem among children with mental, emotional, developmental, and behavioral disorders in the United States. Data were from the 2022-23 National Survey of Children's Health (N = 25,576). Oral health problems were defined as ≥1 of the following: gum disease, dental cavity, or dental pain, reported by parents of children aged 3-17 with mental, emotional, developmental, and behavioral disorders (≤12 months). A multivariable Poisson regression model was used to examine the associations between ≥1 oral health problem and effective pediatric care coordination, adjusting for sociodemographic characteristics, region, and dental visits. Of the 17,388 children who needed care coordination, those without effective pediatric care coordination (25.9%) had a higher adjusted prevalence ratio (aPR) of ≥1 oral health problem compared to those who received effective pediatric care coordination (17.3%; aPR: 1.49, 95% CI: 1.33-1.66) after adjusting for covariates. Our study reports a strong association between the unmet need for effective pediatric care coordination and the prevalence of ≥1 oral health problem among children with mental, emotional, developmental, and behavioral disorders.