Interventional Pain Medicine and Neuromodulation
Volume:2 Issue: 1, Dec 2022

Since the emergence of ultrasonography, many specialists, including anesthesiologists, have become interested in its practices. Technological innovations in portable ultrasonography devices and their quality enable anesthesiologists to use ultrasonography in various medical conditions and improve their diagnostic and therapeutic interventions. This article clarifies the significance of point-of-care ultra-sonography (POCUS) and highlights the challenges ahead. POCUS can help regional anesthesiologists and pain physicians in vascular access, airway management, focused cardiac ultra-sound (FoCUS), lung ultrasound, gastric ultrasound, focus assessment with sonography in trauma (FAST), regional and neuraxial nerve blocks, and acute and chronic pain management. However, similar to any new clinical method, there are challenges to POCUS, especially in developing countries like Iran. These challenges include the need for more budget allocation for medical equipment and portable devices, developing a comprehensive local curriculum and transparent framework to train residents and postgraduates, creating and/or revising university policies, clinical coordination with healthcare networks, and collaboration with healthcare providers. This article expresses the importance and effectiveness of point-of-care sonography performed by anesthesiologists and pain specialists in Iran and highlights the challenges ahead.

Deep brain stimulation (DBS) is a surgically-based treatment for advanced Parkinson’s disease (PD) that has undergone technological developments. Artificial intelligence (AI) has been used successfully in many healthcare problems, including DBS. Indeed, DBS method is expected to change with the increasing growth of artificial intelligence, especially machine learning methods. So here we explore how AI can improve the results of DBS treatment.

Neurodegenerative diseases can make life difficult and lead to death in many cases. They also can be difficult, time-consuming, and costly to diagnose with enough accuracy/certainty. Artificial intelligence (AI) has shown promise in tackling some of the challenges present in medical imaging and is anticipated to become a crucial tool in health care applications in the near future. In particular, deep learning methods have displayed great performance in various subfields of image processing, including but not limited to image segmentation, image synthesis, and image reconstruction. In this paper, many state-of-the-art applications of deep learning models in image processing were reviewed.

Context: 

Despite major advancements in the field, the current neurosurgical practice requires an interdisciplinary approach. It is known that surgical practice and other cancer-eliminating treatments can be combined for optimal results. However, recent attempts have failed to address many debilitating conditions, indicating an emergent need for novel interdisciplinary therapeutic approaches.

Evidence Acquisition: 

We searched PubMed and Google Scholar for the keywords “immunoinformatics,” “in silico,” “neurology,” and “neurosurgery.” Without time restriction.

 The immune system is versatile because it is involved in physiological brain function and affects the course of central nervous system (CNS) disease and infection. A novel approach combines neurosurgery and immunoinformatics for optimal results. For instance, brain tumors, such as glioblastoma multiforme (GBM), are still associated with a severely reduced survival of patients, and resection of tumors may provide little help. In silico approaches could help to identify molecular pathways and design immunotherapies for such conditions at a significantly increased speed compared to traditional vaccinology approaches.

 The neurosurgical practice could be affected by different infectious organisms. These organisms can be targeted by in silico vaccinology techniques. Here, we provide a brief overview of bioinformatics/immunoinformatics and discuss the possible role of immunoinformatics in neurosurgery. In light of the current Coronavirus disease-2019 (COVID-19) epidemic, projections for future studies are also included.

 Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics.

 This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children.

 This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery.

 The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block.

 It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

 Primary dysmenorrhea is a prevalent condition characterized by menstrual pain in the absence of pelvic pathology, which can affect quality of life (QOL).

 This study aimed to assess the QOL in medical students with dysmenorrhea in Iran.

 This cross-sectional study included 298 female students between December 2021 and August 2022. The EQ-5D-3L questionnaire was used to assess the QOL of subjects. Also, age, weight, height, sleep hours per day, and exercise hours per week were evaluated. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22. The chi-squared test and Fisher’s exact test were used for data analysis.

 The mean age of students was 20.32 ± 3.19 years, and the prevalence of dysmenorrhea was 83.6% (n = 249). There was a significant difference in daily activity (P < 0.05) and exercise hours per week (P < 0.05) between the two groups. Pain and discomfort were remarkably higher in group with dysmenorrhea (P < 0.01). In addition, personal care was significantly reduced among subjects with dysmenorrhea (P < 0.05). Sleep hours per day, body mass index (BMI), age, mobility, and anxiety were similar between the two groups.

 According to our results, dysmenorrhea was significantly related to impaired QOL, considering some aspects such as daily activity.

 The reluctance to accept vaccination could severely affect global efforts to control the COVID-19 pandemic.

 The present study investigated the willingness to accept COVID-19 vaccines and related factors among Isfahan University of Medical Sciences students.

 This study was conducted in June-July 2021 at Isfahan University of Medical Sciences. A total of 324 students completed the designed questionnaire in this population-based, web-based, cross-sectional study. SPSS 25.0 software was used to analyze the data.

 The estimate of willingness to accept the COVID-19 vaccine in the study participants was 91.7%. The highest percentage of acceptance was related to medical students. Education level (P = 0.002) and acceptability (P <0.001) had a significant relationship with the willingness to receive the vaccine. Participants were eager to receive vaccines made in the United States (28.15%), Russia (17.90%), and Iran (16.14%). Among the vaccines, the most preferred was the Pfizer-BioNTech COVID-19 vaccine.

 The tendency to accept the COVID-19 vaccine in participants was acceptable and satisfactory. Students could positively influence people's attitudes toward receiving the COVID-19 vaccine.

Post-dural puncture headache (PDPH) is an iatrogenic complication. It can disturb daily activities and particularly breastfeeding after delivery. Epidural blood patch (EBP) is still a last resort and treatment of choice after administration of certain proposed drugs. The use of intravenous (IV) adrenocorticotropic hormone (ACTH) has been suggested for treatment even in refractory cases in a literature review. EBP is an invasive procedure and not desirable for most patients. The associated case report highlights the important role of ACTH in alleviating PDPH and its priority for administration prior to EBP. We hope this report prompts the anesthesiology community to provide a more evidence-based approach to the role of ACTH in the better management of PDPH.

 Bupivacaine is one of the most widely used local anesthetics in spinal anesthesia. Clonidine is a known adjuvant added to prolong the duration of anesthesia. Amongst the complications related to spinal block, neurological complications can be the most troublesome.

 We presented a case where the reversal of motor and sensory blockade after spinal anesthesia with bupivacaine and clonidine was extremely delayed in the absence of any neurological injury.

 Such cases remind the significance of timely and elaborate assessment in the detection of iatrogenic complications and the unpredictability of physiological and pharmacological interactions.

 This study aims to determine the urine concentrations of malondialdehyde (MDA), and tumor necrosis factor-alpha (TNF-α) biomarkers with pain intensity in a patient with low back pain (LBP) compared to healthy controls. Also, the correlation between these biomarkers and clinical findings of pain intensity was determined during 25 weeks to find a molecular diagnostic factor of disease progression.

 Participants in this case study are students at Shahed University, Iran. A 22‑year‑old man patient with a three-month history of progressive LBH and gait instability and an age, sex, and body mass index (BMI) matched healthy man was enrolled for 25 weeks. Spinal MRI (Siemens 1.5 T) revealed disc degeneration and displacement. LBP symptoms were diagnosed by a neurologist using ICD-9 diagnostic codes. Other diseases that affect the urine levels of MDA and TNF-α in the patient, such as allergic or infectious diseases, have been ruled out. After collecting demographic information, the facial pain scale (FPS) and numerical rating scale (NRS) for pain and 24-hour urine samples of a healthy person and a patient were collected weekly for 25 weeks. Samples were analyzed for MDA and TNF-α.

 During the experiment, urinary MDA levels were significantly elevated while TNF-α levels were not changed in LBP patients compared to control individuals (P ≤ 0.001). Furthermore, the assessment of LBP by the FPS and NRS pain scores was only correlated with urinary MDA levels, and urinary TNF-α levels did not change during the experiment. Pearson correlation analysis revealed a positive correlation between pain scores during 25 weeks and urine concentrations of MDA (r = 0.60, P-value < 0.001). According to the present study, chronic LBP patients had higher levels of MDA in their urine than those who did not have chronic LBP. There was a significant positive association between urine MDA level and pain intensity progression.

 Lower abdominal surgery often leads to severe postoperative pain and challenge for anesthetists regarding its management. A multimodal approach with regional anesthesia techniques might be an opportunity. Erector spinae plane block (ESPB) is usually used for pain management in thoracic and abdominal surgery. New surgical indications are increasingly suggested for lumbar ESPB (spine and urological surgery) both in pediatric and adult procedures. In this case report, we present the results of the fascial block at the lumbar spine in an adult patient for lower abdominal surgery. The purpose of this procedure is to offer the patient an alternative to neuraxial anesthesia/analgesia and opioid-sparing anesthesia.

 Bilateral lumbar ESPB in a 46-year-old female patient scheduled for bilateral open ureteral reimplantation surgery after iatrogenic injury was performed at the Civil Hospital of Teramo in Italy (January 2022). Postoperative pain evaluation reported a substantial absence of pain. The patient was promptly mobilized, and the postoperative course was free of complications. There was no additional opioid administration.

 To the best of our knowledge, this has been the first described lumbar ESPB case for intraoperative and postoperative analgesia in adult bilateral ureters replacement and reimplantation after iatrogenic injury. We suggest bilateral lumbar ESPB, as already reported for numerous lower abdominal surgeries, as a valid alternative in perioperative pain management in adults’ ureteral reimplant.