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  1. Clinical implication of regional osteopenia in complex regional pain syndrome: a retrospective comparative study
    Kim J, Rho H, Yoo Y, Cha J, Park S, Kim H, et al.
    Reg Anesth Pain Med, 2025 Feb 17.
    PMID: 39961729 DOI: 10.1136/rapm-2024-106111
    BACKGROUND: Despite the significant role of impaired bone metabolism in complex regional pain syndrome (CRPS), the clinical implications of osteopenia remain a focal point of investigation. We examined the prevalence and risk factors of affected limb osteopenia in CRPS and its association with the response to sympathetic blockade.

    METHODS: 167 patients with CRPS who underwent CT of their affected limbs were retrospectively reviewed. After conducting univariable analyses where regional osteopenia determined by CT was dependent and other clinical factors were independent variables, the first multivariable analysis assessed risk predictors associated with regional osteopenia in CRPS. Next, after conducting univariable analyses where sympathetic block response was dependent and others, including regional osteopenia, were independent variables, the second multivariable model predicted factors associated with the response to sympathetic blockades, followed by receiver operating characteristic curve analysis.

    RESULTS: Among 116 patients, regional osteopenia was identified in 72.2% early (<1 year) and 52.5% persistent CRPS. In the first multivariable analysis adjusted for age, sex, body mass index (BMI), and other variables with p values<0.1 from initial univariable analyses, older age (OR 1.06; 95% CI 1.02 to 1.10) and positive three-phase bone scintigraphy (TPBS) (OR 3.94; 95% CI 1.46 to 10.66) were significantly associated with regional osteopenia. In the second multivariable model adjusted for age, sex, BMI, and other variables with p values<0.1 from univariable analyses, early phase (OR 5.49; 95% CI 1.44 to 20.88), regional osteopenia (OR 5.11; 95% CI 1.49 to 17.53), and positive TPBS (OR 6.30; 95% CI 2.21 to 17.93) were significantly associated with positive responses to sympathetic blockade in CRPS, showing excellent performance characteristics with a predicted probability>0.358 (sensitivity 0.86; specificity 0.76).

    CONCLUSION: Regional osteopenia in the affected limb can anticipate positive responses to sympathetic blockade when combined with TPBS in early CRPS.

  2. Postoperative Maladaptive Behavior, Preoperative Anxiety and Emergence Delirium in Children Undergone General Anesthesia: A Narrative Review
    Zainal Abidin H, Omar SC, Mazlan MZ, Hassan MH, Isa R, Ali S, et al.
    Glob Pediatr Health, 2021;8:2333794X211007975.
    PMID: 33889680 DOI: 10.1177/2333794X211007975
    Over the years, the number of pediatric patients undergoing surgeries are increasing steadily. The types of surgery vary between elective to emergency with involvement of multidisciplinary teams. The development of day care surgery unit is expanding where the patients will only come to the hospital on the day of surgery and discharge home after such as satisfactory parameters achieved, minimal to no pain, minimal to no bleeding from surgical site and able to tolerate fluids. Hospitalization and surgery could contribute to significant psychological disturbance to the children. These issues are not being addressed as children have difficulty in conveying their problems and fear. They do however express it through negative behavioral changes.
  3. Fulltext Case report: Unusual cause of difficulty in intubation and ventilation with asthmatic-like presentation of Endobronchial Tuberculosis
    Seevaunnamtum SP, Mohd Ariff Ghazali NA, Nazaruddin WM, Besari AM, Fariza NHN, Omar SC, et al.
    Respir Med Case Rep, 2017;22:292-294.
    PMID: 29159029 DOI: 10.1016/j.rmcr.2017.10.011
    Endobronchial Tuberculosis is hazardous in causing circumferential narrowing of tracheobronchial tree despite the eradication of tubercle bacilli in the initial insult from Pulmonary Tuberculosis. They may present as treatment resistant bronchial asthma and pose challenge to airway management in the acute setting. We present a 25 year-old lady who was newly diagnosed bronchial asthma with a past history of Pulmonary Tuberculosis that had completed treatment. She presented with sudden onset of difficulty breathing associated with noisy breathing for 3 days and hoarseness of voice for 6 months. Due to resistant bronchospasm, attempts were made to secure the airway which led to unanticipated difficult intubation and ventilation. Subsequent investigations confirmed the diagnosis of Endobronchial Tuberculosis and patient was managed successfully with anti TB medication, corticosteroids and multiple sessions of tracheal dilatation for tracheal stenosis. This case highlights the unusual cause of difficulty in intubation and ventilation due to Endobronchial Tuberculosis, which required medical and surgical intervention to improve the condition.
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