Are menstrual symptoms associated with central sensitization inventory? A cross-sectional study

BACKGROUND

Dysmenorrhea is a prevalent pain condition that affects women of reproductive age, who are monthly exposed to this pain, usually until they reach the adult age, or even after that, which can predispose them to Central Sensitization. The present study aimed to observe the association between menstrual characteristics and central sensitivity symptoms in women.

METHODS

Cross-sectional study. Brazilian women (n=10,402) answered an online form comprised of questions regarding their gynecological history, the Numerical Rating Scale for pain and the Central Sensitization Inventory, part A. For the analysis, we separated women into two groups: Central Sensitivity Symptoms group (n=5,200) and No-Central Sensitivity Symptoms group (n=5,202). We performed a binary logistic regression with the backward insertion method for the variables with p<0.05 in the bivariate analysis between groups. The significance level was set at 5%.

RESULTS

Prevalence of dysmenorrhea was 67.3%, and 32.2% of women in the Central Sensitivity Symptoms group reported pain >8 during their menstrual period. The logistic regression showed that greater levels of menstrual pain (Odds Ratio 1.12), gynecological diseases (Odds Ratio 1.51), presence of dysmenorrhea since adolescence (Odds Ratio 1.20) and irregular menstrual cycles (Odds Ratio 1.47) increased the likelihood of women presenting with Central Sensitivity Symptoms (p<0.05 for all comparisons).

CONCLUSIONS

The present study shows that Central Sensitivity Symptoms are present in about 50% of women and are associated with menstrual characteristics such as dysmenorrhea-related pain intensity, cycle regularity, presence of dysmenorrhea since adolescence accompanied by gynecological diseases.

SIGNIFICANCE

Central sensitivity symptoms occur in 50% of women, and are more present in women with dysmenorrhea. They are associated with cycle regularity, presence of dysmenorrhea since adolescence, and gynecological diseases.

LIMITATIONS

Women that suffer from dysmenorrhea and of higher socioeconomic and educational levels may have been more propense to respond to the invitation; as such, the findings of the present study should be carefully interpreted.

Use of inlet radiographs in the assessment of reduction after the surgical treatment of developmental dysplasia of the hip

AIMS

This pilot study aimed to evaluate prospectively the use of inlet radiographs of the hip as an alternative method of the assessment of reduction after the surgical treatment of developmental dysplasia of the hip (DDH).

PATIENTS AND METHODS

The children in this study underwent surgery between January 2013 and January 2015. All had inlet radiographs and CT scans post-operatively. Data were analysed by determining inter-observer reliability and intra-observer reproducibility, using the kappa value (K). Differences were settled by discussion between the two observers until a consensus was reached. The sensitivity and specificity of the radiographic and CT results were compared. A total of 26 radiographs were obtained from 23 children, with a mean age of 2.38 years (one to five).

RESULTS

Similar high levels of intra- and inter-observer agreement were observed (K = 0.834, 95% confidence interval (CI)). There was a high agreement between the radiographic and CT results (K = 0.834, 5% CI), with excellent sensitivity and a specificity of 95.5%.

CONCLUSION

These results suggest that inlet radiographs may be a reliable method of assessing the reduction of the hip after the surgical treatment of DDH. Cite this article: Bone Joint J 2017;99-B:697-701.

Comparison of Transpulmonary Thermodilution and Calibrated Pulse Contour Analysis with Pulmonary Artery Thermodilution Cardiac Output Measurements in Anesthetized Dogs

Background

Transpulmonary thermodilution (TPTD_CO) and calibrated pulse contour analysis (PCA_CO) are alternatives to pulmonary artery thermodilution cardiac output (PATD_CO) measurement.

Hypothesis

Ten mL of ice‐cold thermal indicator (TI₁₀) would improve the agreement and trending ability between TPTD_CO and PATD_CO compared to 5 mL of indicator (TI₅) (Phase‐1). The agreement and TA between PCA_CO and PATD_CO would be poor during changes in systemic vascular resistance (SVR) (Phase‐2).

Animals

Eight clinically normal dogs (20.8–31.5 kg).

Methods

Prospective, experimental study. Simultaneous TPTD_CO and PATD_CO (averaged from 3 repetitions) using TI₅ and TI₁₀ were obtained during isoflurane anesthesia combined or not with remifentanil or dobutamine (Phase‐1). Triplicate PCA_CO and PATD_CO measurements were recorded during phenylephrine‐induced vasoconstriction and nitroprusside‐induced vasodilation (Phase‐2).

Results

Mean bias (limits of agreement: LOA) (L/min), percentage bias (PB), and percentage error (PE) were 0.62 (−0.11 to 1.35), 16%, and 19% for TI₅; and 0.33 (−0.25 to 0.91), 9%, and 16% for TI₁₀. Mean bias (LOA), PB, and PE were 0.22 (−0.63 to 1.07), 6%, and 23% during phenylephrine; and 2.12 (0.70–3.55), 43%, and 29% during nitroprusside. Mean angular bias (radial LOA) values were 2° (−10° to 14°) and −1° (−9° to 6°) for TI₅ and TI₁₀, respectively (Phase‐1), and 38° (5°–71°) (Phase‐2).

Conclusions and Clinical Importance

Although TI₁₀ slightly improves the agreement and trending ability between TPTD_CO and PATD_CO in comparison to TI₅, both volumes can be used for TPTD_CO in replacement of PATD_CO. Vasodilation worsens the agreement between PCA_CO and PATD_CO. Because of PCA_CO's poor agreement and trending ability with PATD_CO during SVR changes, this method has limited clinical application.

Subclinical pulmonary abnormalities in childhood-onset systemic lupus erythematosus patients

Objective

The aims of this study were to analyze the pulmonary function of childhood-onset systemic lupus erythematosus (cSLE) patients and to identify possible correlations between the high-resolution computed chest tomography (HRCT) score, disease activity, disease cumulative damage, and the participants’ quality of life.

Methods

Forty cSLE patients, median age: 14.1 years (range: 7.4–17.9), underwent spirometry and plethysmography. Carbon monoxide diffusing capacity (DLCO), HRCT, disease activity, disease cumulative damage, and quality of life were assessed.

Results

Pulmonary abnormalities were evident in 19/40 (47.5%) cSLE patients according to spirometry/DLCO. Forced expired volume in one second (FEV1%) was the parameter most affected (30%). The HRCT showed some abnormality in 22/30 patients (73%), which were minimal in 43%. Signs of airway affects were found in 50%. Twelve patients were hospitalized due to cSLE-related pulmonary complications before the study began (median discharge: 2.1 years earlier). Total lung capacity (TLC%), vital capacity (VC%), forced vital capacity (FVC%), and FEV1% were significantly lower in the group with hospitalization compared to the group without hospitalization ( p = 0.0025, p = 0.0022, p = 0.0032, and p = 0.0004, respectively). Of note, DLCO was positively correlated with disease duration ( r = +0.4; p = 0.01). The HRCT-score was negatively correlated with FEV1/VC ( r = −0.63; p = 0.0002), FEV1 ( r = −0.54; p = 0.018), FEF25%–75% ( r = −0.67; p < 0.0001), and HRCT-score was positively correlated with resistance ( r = +0.49; p = 0.0056).

Conclusions

Almost half of patients with cSLE had subclinical pulmonary abnormalities, especially airway abnormalities. The cSLE-related pulmonary complications seem to determine long-term functional damage.

Plasticity of maritime pine (Pinus pinaster) wood-forming tissues during a growing season

The seasonal effect is the most significant external source of variation affecting vascular cambial activity and the development of newly divided cells, and hence wood properties. Here, the effect of edapho-climatic conditions on the phenotypic and molecular plasticity of differentiating secondary xylem during a growing season was investigated. Wood-forming tissues of maritime pine (Pinus pinaster) were collected from the beginning to the end of the growing season in 2003. Data from examination of fibre morphology, Fourier-transform infrared spectroscopy (FTIR), analytical pyrolysis, and gas chromatography/mass spectrometry (GC/MS) were combined to characterize the samples. Strong variation was observed in response to changes in edapho-climatic conditions. A genomic approach was used to identify genes differentially expressed during this growing season. Out of 3512 studied genes, 19% showed a significant seasonal effect. These genes were clustered into five distinct groups, the largest two representing genes over-expressed in the early- or late-wood-forming tissues, respectively. The other three clusters were characterized by responses to specific edapho-climatic conditions. This work provides new insights into the plasticity of the molecular machinery involved in wood formation, and reveals candidate genes potentially responsible for the phenotypic differences found between early- and late-wood.

[Is it possible to predict the number of nebulizations and the use of intravenous corticosteroid in children with asthma attacks in the emergency room?]

OBJECTIVE: To identify the number of nebulizations needed and the demand for intravenous corticosteroids in children with asthmatic attack, considering clinical and functional characteristics presented at the moment children were admitted to the emergency room. METHODS: We prospectively evaluated 130 children with asthmatic attack and from 1 to 13 years of age. At the moment children were admitted, they were evaluated according to clinical score, arterial oxygen saturation (pulse oximetry), and peak expiratory flow. Next, children received a standard treatment and were observed for the number of consecutive nebulizations required and the use of corticosteroid. Using regression analysis, we assessed the parameters evaluated for a correlation with the number of nebulizations and the use of intravenous corticosteroid. RESULTS: Eighty-eight children (67.7%) received from 1 to 3 nebulizations and 42 children (32.3%), 6 nebulizations. Sixty-eight children (52.3%) received corticosteroid. The initial values for clinical scores, arterial oxygen saturation, and peak expiratory flow showed a significant correlation with the number of nebulizations required and the need for corticosteroids. CONCLUSIONS: According to our results, it is possible to predict and anticipate, at the time chidren are admitted with asthmatic attack, the need for corticosteroid and more nebulizations, which can change the prognosis and the time of evolution of the attack.

Characterization of the ecdysteroid UDP-glucosyltransferase (egt) gene of Anticarsia gemmatalis nucleopolyhedrovirus

The Anticarsia gemmatalis nucelopolyhedrovirus (AgMNPV) egt gene was cloned, sequenced and its expression characterized by RT-PCR and western blot analysis. Sequence analysis of the gene indicated the presence of an open reading frame (ORF) of 1482 nucleotides, which codes for a polypeptide of 494 amino acids. ATATA box and a conserved regulatory sequence (CATT) found in other baculovirus early genes were present in the promoter region of the egt gene. A poly-A consensus sequence was present in the 3' untranslated region (3'-UTR) of the gene. Homology comparisons showed that the EGT protein of AgMNPV is most closely related (95.9% amino acid sequence identity) to the EGT from the Choristoneura fumiferana DEF nucleopolyhedrovirus (CfDEF). Transcriptional analysis of the AgMNPV egt gene showed that egt-specific transcripts can be detected both early and late in infection. The EGT protein was detected, by western blot analysis, in the intra- (from 12 to 48 h post-infection) and extra-cellular (from 12 to 96 h post-infection) fractions of infected insect cells. The AgMNPV Bgl II-F fragment, which has homology to the AcMNPV ie-1 gene, was cloned and used to cotransfect SF21 cells with the cloned AgMNPV egt gene. EGT activity was observed, suggesting that AgMNPV ie-1 can transactivate egt expression.

[Interatrial electromechanic resynchronization by dual atrial pacing in the prevention of paroxysmal atrial fibrillation --report of a case]

We presented the case of a 78 year old woman who five years ago underwent myectomic surgery, and aortic valvular replacement, for obstructive cardiomyopathy and valvular aortic stenosis. After surgery, the aortic transvalvular gradient was insignificant (20 mm/Hg). In spite of this she suffers from frequent AF crises, (3 times a month), with a cardiac frequency of 140-150/min. She was in sinus bradycardia (40-45/min), which was a clear counter-indication for the use of antiarrhythmic drugs. Her ECG showed sinusal bradycardia with 45/min, a two-phase P-wave (positive-negative) in DII, DIII aVF, and bimodal P-wave in DI. Furthermore, she showed a 1st degree auriculo-ventricular block with complete left-branch block. In her echocardiogram there was concentric left ventricular hypertrophy, with diastolic disfunction and left atrial dilatation. In the auricular IEGM we observed a slowed-down interauricular conduction (right atrium-left atrium = 120 msecs); The A-wave was fragmented. The auriculo-ventricular Wenckbach point was at 90/min. In view of these findings we proceeded with the implantation of a DDD-pacemaker with biauricular stimulation, as follows: 1. We used two auricular electrodes, one with an active fixation to the crista terminalis of the right atrium and the other (having in mind the stimulation of the left atrium) applied to the proximal coronary sinus. These two electrodes were connected to the auricular pin of the pacemaker by means of an "Y"--type Biotronick adaptor. 2. The right ventricular stimulation was done with a normal, bipolar ventricular electrode, on the apex of the ventricle. After biauricular, simultaneous, stimulation, we proceeded with interauricular re-synchronization. After this procedure, the A-wave no longer appeared fragmented, and the right auricular--left auricular waves were then simultaneous and with two-phase morphology. Three months later the interauricular resynchronization procedure was induced and without any antiarrhythmic drugs, the Holter showed no cardiac arrhythmias, there is no auricular fibrillation. The morphology of the P-wave has changed. The patient has an improved exercise capacity and a better quality of life.

Burn-induced linear IgA dermatosis

There have been several reports of linear IgA dermatosis (LAD) associated with drug exposure and lymphoproliferative malignancy, but trauma and burns have been suggested only in patients with bullous pemphigoid. We present a case of burn-induced LAD in a 48-year-old caucasian male presenting with a recent history of blistering eruption on the periphery of a cicatricial area caused by boiling methyl alcohol. Clinically, he presented a widespread bullous eruption. The direct immunofluorescence examination of a perilesional biopsy revealed an intense homogeneous linear pattern of IgA deposition consistent with the diagnosis of LAD. The patient responded to therapy with systemic steroids.

Laugier-Hunziker syndrome: case report and treatment with the Q-switched Nd-Yag laser

We report the case of a 46-year-old Caucasian female presenting with mucocutaneous pigmentation on the lips, oral mucosa, hands, feet and nails, as well as on a psoriatic plaque. She was successfully treated with Q-switched Nd-Yag laser, with double frequency, for both the mucosal and cutaneous lesions.

Delayed resolution of pneumonia. When is slow healing too slow?

Slowly resolving or nonresolving pneumonia is a clinical challenge, but we believe it can be dealt with in a rational and decisive manner. The following risk factors have been established for delayed radiographic resolution of pneumonia and should be considered in patient evaluation: Coexisting medical conditions History of smoking, Advanced age, Multilobar involvement, Persistent fever or leukocytosis. Diabetes, chronic obstructive pulmonary disease, renal failure, and alcohol abuse can impair immune function, which slows normal clearing of infiltrates. Common and uncommon infectious agents, conditions that mimic pneumonia (eg, a neoplasm, congestive heart failure), and pulmonary complications (eg, abscess) can also result in delayed resolution.

[Acute and chronic sequential atrioventricular pacing in patients with obstructive-type hypertrophic myocardiopathy resistant to medical therapy]

An evaluation was undertaken regarding two female patients suffering from obstructive hypertrophic cardiomyopathy, with high and strongly symptomatic gradients, as well as evidencing a resistance to medication with beta-blockers, verapamil and disopyramide when administered in maximal doses. These patients were provided with the implant of a definitive type DDD pacemaker, with an auricular electrocatheter placed on the right auricular appendix, and with a bipolar ventricular catheter placed on the apex of the right ventricle. The generator was programmed with a short AV so as to ensure that the ventricular stimulation would at any given time be the result of the ventricular contraction would be initiated at the apex portion of the right ventricle. With these therapeutics, we observed not only a reduction or even the gradient, but also the complete elimination of the existing symptoms--angor, dyspnea, dizziness, palpitations and fainting--with the resulting normalcy of the quality of life of the patients. All taken into account we are of the opinion that these therapeutics are, in the case of patients suffering from obstructive hypertrophic cardiomyopathy, a valid alternative for surgical treatment by means of myectomy or myotomy, but without the morbidity and mortality rates presented by such methods.

Dot-enzyme-linked immunosorbent assay (Dot-ELISA) for detection of pneumococcal polysaccharide antigens in pleural fluid effusion samples. Comparison with bacterial culture, counterimmunoelectrophoresis and latex agglutination

A dot-enzyme-linked immunosorbent assay (Dot-ELISA) for pneumococcal antigen detection was standardized in view of the need for a rapid and accurate immunodiagnosis of acute pneumococcal pneumonia. A total of 442 pleural fluid effusion samples (PFES) from children with clinical and laboratory diagnoses of acute bacterial pneumonia, plus 38 control PFES from tuberculosis patients and 20 negative control serum samples from healthy children were evaluated by Dot-ELISA. The samples were previously treated with 0.1M EDTA pH 7.5 at 90 degrees C for 10 min and dotted on nitrocellulose membrane. Pneumococcal omniserum diluted at 1:200 was employed in this assay for antigen detection. When compared with standard bacterial culture, counterimmunoelectrophoresis and latex agglutination techniques, the Dot-ELISA results showed relative indices of 0.940 to sensitivity, 0.830 to specificity and 0.760 to agreement. Pneumococcal omniserum proved to be an optimal polyvalent antiserum for the detection of pneumococcal antigen by Dot-ELISA. Dot-ELISA proved to be a practical alternative technique for the diagnosis of pneumococcal pneumonia.

Pulmonary rehabilitation in the elderly patient

Pulmonary rehabilitation in the elderly can be a rewarding experience for the patient and the health care provider. Rehabilitation programs are well established as a means of enhancing standard medical therapy, optimizing functional capacity, and restoring a patient to the highest possible level of independent function. The demonstrated benefits of pulmonary rehabilitation include an improved quality of life, increased exercise endurance, improved ability to perform daily tasks, reduced hospitalization, and improved psychosocial adjustment. Participation in a group program helps reduce social isolation, whereas postprogram patient-support groups help to keep patients motivated and positive in their outlook. Through pulmonary rehabilitation the elderly patient learns to accept and overcome the reality of his or her disease rather than dwell on its limitations. An individually tailored comprehensive rehabilitation program can make the difference between a fulfilling life and a life of pulmonary disability.