bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of Examination Under Fluoroscopy for
the Assessment of Sacroiliac Joint Dysfunction
Authors: Beakley Burton D
Published: February 2021

Background: Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single
physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity
and specificity.
Objective: To evaluate the use of fluoroscopy in the diagnosis of SI joint pain.
Study Design: Prospective double blind comparison study
Setting: Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana.
Methods: Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic,
presented with unilateral low back pain of more than 2 months’ duration. Patients with previous back
surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test,
and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance,
asking each patient to point to the most painful area. Pain was provoked by applying pressure with the
heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a
radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI
joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with
1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction
in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5%
bupivacaine and 40 mg methylprednisolone.
Results: Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the
positive and negative predictive values were determined for both the conventional examinations, as
well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was
constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination
were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and
0.57 respectively. The area under ROC curve was 0.812 which is considered a “good” test; however
the area under ROC for the conventional examination were between 0.52 -0.58 which is considered
“poor to fail”.
Limitations: Variation in anatomy of the SI joint, small sample size.
Conclusions: Multiple structures of the SI joint complex can result in clinical symptoms of pain. These
include intra-articular structures (degenerative arthritis, and inflammatory conditions) as well as extraarticular structures (ligaments, muscles, etc.).
Key words: Sacroilliac joint disease, radicular pain, thigh thrust test, compression test, distraction
test, Gaenslen test, Patrick test (FABER test)
Contrast Dispersion Pattern and Efficacy of
Corticosteroid at the Glenohumeral Joint in
Adhesive Capsulitis
Authors: Kim Sang Jun
Published: February 2021

Background: Corticosteroid injection has a wide range of success in adhesive capsulitis but the
reason for this has not yet been explained. We hypothesized that this difference might be due to the
distribution of the corticosteroids injected into the joint cavity because particulate steroid deposits in
the capsule and will not be moved over time by shoulder motion.
Objectives: The purpose of this study is to determine whether the therapeutic efficacy of particulate
corticosteroid injection into the glenohumeral joint differs according to the dispersion pattern.
Study Design: Prospective evaluation.
Setting: Outpatient clinics at a tertiary university hospital
Methods: Seventy-two patients diagnosed as having adhesive capsulitis received a corticosteroid
injection at the glenohumeral joint. The posterior capsule and the subscapular bursa were selected
as dispersion sites and the dispersion of contrast dye was expressed as a ratio (%). Two weeks
and 3 months after the injection clinical improvement (“not improved,” “slightly improved,” “much
improved”), numeric rating scale (NRS), and passive range of motions (PROM) were evaluated. The
dispersion of the contrast dye was compared according to the clinical improvements by an analysis
of variance test. Pearson correlation test was done to find the relationship between PROM and the
dispersion and between change of NRS and the dispersion.
Results: The distribution in the subscapular area was 30.0% in the “much improved” group,
22.0% in the “slightly improved” group, and 37.1% in the “no improvement” group which was
not significantly different (P = 0.179). Correlations between changes of NRS and the dye distribution
were not statistically significant (P = 0.429 at 2 weeks and P = 0.629 at 3 months).
The change of passive external rotation 3 months after the injection was significantly correlated with
the dye distribution (P = 0.035).
Limitations: Because of diverse pathologic findings in adhesive capsulitis, further studies will be
needed to address the effect of the dye distribution on the pain improvement according to pathologic
findings revealed by magnetic resonance imaging (MRI).
Conclusion: External rotation of the shoulder in adhesive capsulitis has greater improvement as
the corticosteroid solutions injected into the glenohumeral joint are increasingly dispersed to the
subscapularis area. However, this does not affect the pain improvement after the injection.
Key words: Adhesive capsulitis, dispersion, contrast dye, subscapularis, glenohumeral joint,
corticosteroid, range of motion, numeric rating scale
High Prevalence of Hypovitaminosis D in Indian
Chronic Low Back Patients
Authors: Bansal Dipika
Published: February 2021

Background: Vitamin D has a significant role to play in bone metabolism and neuromuscular
function. Several researchers have indicated that Vitamin D deficiency may be possibly related to
chronic musculoskeletal pain including chronic low back pain (CLBP).
Objectives: The present study was conducted to determine the prevalence of hypovitaminosis D
and its contribution to chronic lower back pain.
Study Design: Controlled study
Setting: Outpatient pain clinic of tertiary care hospital.
Methods: Data presented in this manuscript are from patients who were screened for inclusion in
an open label, single arm clinical trial aimed to assess the effectiveness of vitamin D supplementation
in patients with CLBP. Consecutive patients visiting the outpatient pain clinic of a tertiary care
hospital with a diagnosis of CLBP with or without leg pain were recruited. A visual analogue
scale (VAS) was used to measure low back pain intensity, and the Modified Oswestry disability
questionnaire (MODQ) was used to measure functional ability. Plasma 25-OHD levels of all patients
were measured and the prevalence of hypovitaminosis D was calculated. The multivariate logistic
regression model was used to investigate the association between vitamin D deficiency and patient
characteristics.
Results: A total of 328 patients were included in the study. Mean age of the study population
was 43.8 years. Two hundred eighty-two (86%) (men 153/172 [89%], women 129/156 [83%]) of
patients had below normal plasma vitamin D levels. Among these, 217 (66%) (men 126 [73%],
women 91 [58%]) were found to be deficient and 65 (20%) (men 27 [16%], women 38 [24%])
were had insufficient levels. Multivariate regression analysis found that men were significantly
more prone to have deficiency as compared to women (OR = 1.78 (1.10 – 2.88), P = 0.02). We also
found a significantly positive relationship between vitamin D deficiency and increased functional
disability (OR = 1.53 (1.24 – 1.87), P = 0.01). However, we did not find any relationship with pain
severity, presence of other co-morbidities and educational level.
Limitations: Not possible to access a good quality data on sun exposure and vitamin D dietary
inake dieat in study population. No bone scans were performed.
Conclusion: The result of this study provides a message about the high prevalence of
hypovitaminosis D in the Indian CLBP population. Clinical guidelines for managing CLBP
should include assessment of vitamin D status, together with advice on appropriate vitamin D
supplementation in those found to be deficient.
Clinical trial registration: CTRI/2014/03/004459
Key words: Chronic low back pain, disability, hypovitaminosis D, India, pain severity, prevalence,
vitamin D, visual analogue scale
Is Serum Hypovitaminosis D Associated
with Chronic Widespread Pain Including
Fibromyalgia? A Meta-analysis of Observational
Studies
Authors: Chang Ke-Vin
Published: February 2021

Background: Chronic widespread pain (CWP) is a global musculoskeletal disorder leading to
disability and a reduced quality of life. Low levels of serum vitamin D has long been proposed
to be associated with CWP, but previous research remains inconclusive.
Objectives: To determine whether hypovitaminosis D was independently associated with
CWP.
Study Design: Meta-analysis of observational study.
Methods: Electronic databases were searched for studies published up to November 2014
comparing the prevalence of hypovitaminosis D and serum vitamin D levels between participants
with and without CWP. The crude and adjusted odds ratios (ORs) of hypovitaminosis D with
CWP were calculated. Subgroup analysis according to gender, threshold of hypovitaminosis,
and definition of patients was performed, as well as meta-regression to test the linear
relationship between crude ORs and the latitude of study locations.
Results: Twelve studies were included, comprising 1,854 patients with CWP. The patient
group showed a significantly higher risk of hypovitaminosis D than the control group (crude
OR, 1.63; 95% CI, 1.20 – 2.23). The association was slightly attenuated after adjusting
confounders, with a pooled adjusted OR of 1.41 (95% CI, 1.00 – 2.00). There was an increase
in ORs of hypovitaminosis D using a lower diagnostic value of serum vitamin D (8 and 10
ng/mL). The subgroup analysis according to gender and definition of CWP did not reveal
significant between-group differences. The meta-regression showed no linear relationship
between latitude and the crude ORs.
Conclusions: There was a positive crude association between hypovitaminosis D and CWP,
and the association was likely to remain after adjusting confounding factors. Use of a cut-off
value of hypovitaminosis D (8 – 10 ng/mL) could better define the population with and without
CWP. Further prospective follow-up studies are warranted to clarify the causal relationship
between hypovitaminosis D and CWP.
Key words: Vitamin D, fibromyalgia, chronic widespread pain, meta-analysis
Prevalence of Neuropathic Pain in Patients
Scheduled for Lumbar Spine Surgery:
Nationwide, Multicenter, Prospective Study
Authors: Cho Yong Eun
Published: February 2021

Background: There is limited evidence about surgical outcomes after lumbar spinal surgery in
patients with neuropathic pain (NP) or the prevalence of NP proportions among patients with
degenerative lumbar diseases who are candidates for a surgical interventions.
Objective: The objectives of this study were to investigate the prevalence of NP among patients
scheduled for lumbar spinal surgery and the relationship between health-related quality of life
(HRQoL) and NP. This study also aimed to identify the risk factors related to NP and compare the
clinical outcomes after surgical treatment between patients with and without NP.
Study Design: This study was a nationwide, multicenter, prospective, and observational study. It
was conducted from September 2011 to May 2013, and included a total of 1,109 patients who were
scheduled for lumbar spinal surgery from 44 spinal centers (both orthopedics and neurosurgeons).
Setting: Multicenter study
Methods: Patients were diagnosed of having NP if the Leeds Assessment of Neuropathic
Symptoms and Signs (LANSS) pain scale was ≥ 12 points. The patients were investigated to assess
the differences in their clinical outcomes one week and 3 months after surgery and were followedup with regards to pain and HRQoL to explore the risk factors affecting NP.
Results: Of 1,109 recruited patients, 404 (36.4%) suffered from NP (mean age 62.06 years; 37.9%
men) with mean LANSS score of 17.44 ± 4.06, while 705 (63.6%) had nociceptive pain with mean
LANSS score of 6.03 ± 3.52. At baseline, patients with NP showed lower HRQoL and more severe
pain compared to nociceptive pain patients. However, 3 months after surgical treatment, the NP
group showed greater improvement in pain NRS (P = 0.087) and EQ-5D (P = 0.029) as compared to
nociceptive pain group. Longer symptom duration was identified as a risk factor for NP (OR 1.003,
respectively, P = 0.020).
Conclusion: There was a high prevalence of NP in Korean patients scheduled for lumbar spine
surgery, and these patients suffered greater pain and lower HRQoL than nociceptive pain patients.
The more remarkable improvement NP patients showed after treatment highlights the importance
of appropriate diagnosis and treatment of NP.
Key words: Neuropathic pain, lumbar surgery, spine, HRQoL, LANSS, prevalence
Accuracy of Ultrasound-Guided Genicular Nerve
Block: A Cadaveric Study
Authors: Kesikburun Dr. Serdar
Published: February 2021

Background: Genicular nerve block has recently emerged as a novel alternative treatment in
chronic knee pain. The needle placement for genicular nerve injection is made under fluoroscopic
guidance with reference to bony landmarks.
Objective: To investigate the anatomic landmarks for medial genicular nerve branches and to
determine the accuracy of ultrasound-guided genicular nerve block in a cadaveric model.
Study Design: Cadaveric accuracy study.
Setting: University hospital anatomy laboratory.
Methods: Ten cadaveric knee specimens without surgery or major procedures were used in the
study. The anatomic location of the superior medial genicular nerve (SMGN) and the inferior medial
genicular nerve (IMGN) was examined using 4 knee dissections. The determined anatomical sites of
the genicular nerves in the remaining 6 knee specimens were injected with 0.5 mL red ink under
ultrasound guidance. The knee specimens were subsequently dissected to assess for accuracy. If
the nerve was dyed with red ink, it was considered accurate placement. All other locations were
considered inaccurate.
Results: The course of the SMGN is that it curves around the femur shaft and passes between the
adductor magnus tendon and the femoral medial epicondyle, then descends approximately one
cm anterior to the adductor tubercle. The IMGN is situated horizontally around the tibial medial
epicondyle and passes beneath the medial collateral ligament at the midpoint between the tibial
medial epicondyle and the tibial insertion of the medial collateral ligament. The adductor tubercle
for the SMGN and the medial collateral ligament for the IMGN were determined as anatomic
landmarks for ultrasound. The bony cortex one cm anterior to the peak of the adductor tubercle
and the bony cortex at the midpoint between the peak of the tibial medial epicondyle and the initial
fibers inserting on the tibia of the medial collateral ligament were the target points for the injections
of SMGN and IMGN, respectively. In the cadaver dissections both genicular nerves were seen to be
dyed with red ink in all the injections of the 6 knees.
Limitations: The small number of cadavers might have led to some anatomic variations of
genicular nerves being overlooked.
Conclusions: The result of this cadaveric study suggests that ultrasound-guided medial genicular
nerve branch block can be performed accurately using the above-stated anatomic landmarks.
Key words: Knee pain, genicular nerve, nerve block, osteoarthritis, ultrasonography, cadaver
study, injection, accuracy
Brachial Plexus Block for Cancer-Related Pain: A
Case Series
Authors: Zinboonyahgoon Nantthasorn
Published: February 2021

Neoplastic brachial plexopathy (NBP) is caused by a cancerous infiltration into the brachial
plexus, presenting often as severe pain in the affected upper extremity. Such pain can be
resistant to medical treatment. Invasive interventions such as brachial plexus neurolysis with
phenol or cordotomy may result in severe complications including permanent neurological
damage and death. Continuous brachial plexus and paravertebral block with local anesthetic
have been reported to successfully control pain from NBP, but these techniques are logistically
challenging and frequently have catheter-related complications.
We report a series of patients who received single-shot brachial plexus blocks with a mixture of
local anesthetic and corticosteroid (bupivacaine 0.25% with methyl-prednisolone 20 – 120 mg)
for the treatment of refractory cancer-related pain in the brachial plexus territory, mostly from
NBP. Theoretically, such blocks could provide immediate analgesia from the local anesthetic and
a longer-lasting analgesia from the slow-release steroids.
Responders reported a sustained decrease in their pain (lasting from 2 weeks to 10 months),
a significant decrease in their opioid and non-opioid (ketamine, gabapentin) consumption,
overall satisfaction with the block, and unchanged or improved function of their limb. The ideal
candidate for this procedure is a patient who has pain that is predominantly neuropathic from
a lesion within the brachial plexus and with anatomy amenable to ultrasound-guided nerve
block.
Our case series suggests that, in the appropriately selected patient, this technique can safely
and effectively alleviate pain from NBP. The procedure is simple, spares limb function, and can
be diagnostic, predicting response to more complex procedures. To the best of our knowledge,
this is the first report using this technique for NBP.
Key words: Brachial plexus block, neoplastic brachial plexopathy, intractable pain, cancer
pain, pain intervention
Effectiveness of Suprascapular Nerve Pulsed
Radiofrequency Treatment for Hemiplegic
Shoulder Pain: A Randomized-Controlled Trial
Authors: Aras Berke
Published: February 2021

Background: Hemiplegic shoulder pain is one of the most common complications after stroke.
Although there are many treatment strategies for this complication, sometimes very resistant
cases are also seen.
Objectives: To evaluate the effect of suprascapular nerve pulsed radiofrequency (PRF)
treatment for hemiplegic shoulder pain (HSP).
Study Design: A prospective randomized-controlled trial.
Setting: University hospital.
Methods: This study included 30 patients with HSP following stroke. The patients were
randomly assigned to receive PRF to the suprascapular nerve (PRF group, n = 15) or suprascapular
nerve block (NB) with lidocaine (NB group, n = 15). The patients were randomized into 2 groups
(n = 15 both). In addition, the patients received physical therapy to the shoulder, including hot
pack, transcutaneous electrical nerve stimulation, and stretching and strengthening exercise (5
days per week for 3 weeks in a total of 15 sessions). Visual Analog Scale (VAS) for pain, the Goal
Attainment Scale (GAS) during upper-body dressing, and shoulder range of motion (ROM) were
assessed at baseline, 1 month, and 3 months after the procedure.
Results: Between the groups, comparison revealed that decrease in the VAS score was
statistically significantly higher at the first (3.5 1.9 vs. 1.2 1.0) and third month (4.2 1.7 vs. 1.2
0.9) in the PRF group compared with the NB group (P < 0.01). The PRF group had significantly
higher increases in shoulder ROM compared with the NB group (P < 0.05).The positive changes
in GAS score at month 3 in the PRF group was significantly higher than that in the NB group (P
< 0.05).
Limitation: There is a need for further studies with a longer follow-up period.
Conclusions: In light of these findings, the combination of PRF applied to the suprascapular
nerve and physical therapy was superior to the combination of suprascapular NB and physical
therapy.
Key words: Hemiplegic shoulder, stroke, pain, radiofrequency, suprascapular nerve.
Mandatory Review of Prescription Drug Monitoring
Program Before Issuance of a Controlled Substance
Results in Overall Reduction of Prescriptions
Including Opioids and Benzodiazepines
Authors: Abd-Elsayed Alaa
Published: February 2021

Background: To date, there is limited research on whether the various types of mandatory usage
of prescription drug monitoring programs (PDMP) have any effects on prescribing patterns, drug
usage, patient care, and drug diversion (8-10). Within the United States (US), there is wide variation
in individual states’ requirements for the usage of PDMPs.
Objective: The objective of this study was to determine whether mandatory prescriber review of
a PDMP prior to each issuance of a controlled substance resulted in a reduction in the total number
of controlled substance prescriptions dispensed.
Study Design: A retrospective review of the State of Wisconsin’s PDMP controlled substance
database from April 2015 to March 2019 was performed. The evaluation compared the number
of prescriptions among individual drug classes (opioids, benzodiazepines, stimulants) dispensed
throughout the state before and after April 1st, 2017, when implementation of a state law
mandating the review of the PDMP during each patient encounter prior to issuing a prescription
for a controlled substance took effect.
Setting: Research was conducted using Wisconsin’s PDMP controlled substance database from
April 2015 to March 2019. During this time, controlled substance policy has come to the forefront
of the nation due to issues with an opioid epidemic.
Methods: Descriptive analysis was used to express data as n and % for categorical data and
average ± standard deviation for numerical data. Before- and after-prescription totals were
analyzed using a paired t test and Levene’s test for equality of variances. The P value was considered
significant at a level ≤ .05.
Limitations: Limitations to this study included its retrospective design, focus on a single US state,
and possible unforeseen contributors to cause and effect.
Results: Prior to the enforcement of the state’s mandatory PDMP legislation, an average of
844,314 controlled substance prescriptions were written monthly. Following the implementation
of the law, the average monthly total prescriptions written within the state decreased to 708,063.
This was an average monthly reduction of 136,251 prescriptions written or 16.1%. Statistically
significant reductions were also seen in opioid and benzodiazepine subgroups (23.0%, 16.3%).
Conclusion: Our study suggests that state-enforced mandatory usage of a PDMP, which records
all controlled substance prescriptions filled by a pharmacy such as opioids, benzodiazepines,
amphetamines, etc. at every encounter prior to prescribing any controlled substance, can
provide for a significant reduction in controlled substance prescriptions, specifically opioids and
benzodiazepines.
Key words: Prescription drug monitoring program, opioids, mandatory usage, benzodiazepines,
Wisconsin
Radiculopathy Following Vertebral Body
Compression Fracture: The Role of Percutaneous
Cement Augmentation
Authors: Gimarc David
Published: February 2021

Background: Vertebral cement augmentation is a commonly used procedure in patients with
vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease,
or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can
experience symptomatic relief following the procedure.
Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral
body compression fractures presenting for cement augmentation, and present their postoperative
outcomes.
Study Design: Retrospective cohort study.
Setting: Interventional pain practice in a tertiary care university hospital.
Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty
(VP) procedures in a 7-year period within our practice were evaluated through a search of the
electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive
preprocedural radiculopathy in our patients. Evaluation of each patient’s relative improvement
following the procedure, respective to the initial presence or absence of radicular symptoms
(including and above T10, above and below T10, and below T10) was included as a secondary
endpoint. Additional subanalysis was performed with respect to patients demographics, fracture
location, and primary indication for the procedure (osteoporosis, trauma, etc.).
Results: A total of 302 procedures were performed during this time period, encompassing
544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of
patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve
impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly
complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little
to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete
resolution, whereas patients with fractures above and below T10 were likely to not see any
resolution. Men and women without initial radiculopathy symptoms were more likely to see little
to no resolution, regardless of fracture location.
Limitations: This retrospective study used an electronic chart review of clinicians’ notes to
determine the presence of radiculopathy and their relative improvement following the procedure.
Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the
evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be
an important marker for those patients who may experience greater benefit from the procedure.
Key words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture,
spine, cement augmentation
Identification of Candidate Genes Associated
with Postherpetic Neuralgia Susceptibility
Authors: Yan Min
Published: February 2021

Background: Postherpetic neuralgia (PHN) is one of the most common complications of herpes
zoster (HZ). Heritable factors have been found to play a role in various clinical pain symptoms.
However, the effect of gene variability on the susceptibility of PHN remains poorly understood.
Objectives: The aim of this study was to evaluate whether genetic variation in pain pathway
genes was associated with PHN susceptibility in the Chinese population.
Study Design: Case–control study.
Setting: Department of Anesthesiology and Pain Medicine in a university hospital.
Methods: Seventy patients with PHN and 111 patients with HZ without developing PHN were
enrolled. All patients received standardized antiviral agents and analgesics as needed during the
acute phase of HZ. Twenty-four candidate genetic polymorphisms in 12 genes (IL1B, SCN9A,
KCNK9, TRPV1, P2RX7, HTR1A, HTR2A, ADRB1, ADRB2, BDNF, COMT, and OPRM1) were
genotyped in all patients. Multivariable logistic regression analyses were used to identify genetic
variations associated with PHN susceptibility while controlling for potential confounders.
Results: Our results suggested that only variation in P2RX7 gene was associated with PHN
susceptibility. The P2RX7 rs7958311 AG heterozygous genotype carriers had a decreased risk for
PHN in the overdominant model (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.21–0.77; P
= 0.005), and codominant model (OR, 0.44; 95% CI, 0.20–0.98; P = 0.045). The P2RX7 rs7958311
GG homozygote genotype was associated with an increased risk for PHN under a recessive model
(OR, 2.15; 95% CI, 1.01–4.56; P = 0.046). There were no significant associations between the
other 23 single-nucleotide polymorphisms and PHN susceptibility.
Limitations: Lack of validation cohort to verify the findings.
Conclusions: In the present study in the Chinese population, we found purinergic receptor P2X7
rs7958311 may contribute to PHN development after HZ. Future larger independent cohorts are
warranted to replicate these initial findings.
Key words: Herpes zoster, postherpetic neuralgia, polymorphisms
Trends of Expenditures and Utilization of Facet
Joint Interventions in Fee-For-Service (FFS)
Medicare Population from 2009-2018
Authors: Manchikanti Laxmaiah
Published: February 2021

Background: The trends of the expenditures of facet joint interventions have not been
specifically assessed in the fee-for-service (FFS) Medicare population since 2009
Objectives: The objective of this investigation is to assess trends of expenditures and
utilization of facet joint interventions in FFS Medicare population from 2009 to 2018.
Study Design: The study was designed to analyze trends of expenditures and utilization of
facet joint interventions in FFS Medicare population from 2009-2018 in the United States. In
this manuscript:
• A patient was considered as undergoing facet joint interventions throughout the year.
• A visit included all regions treated during the visit.
• An episode was considered as one per region utilizing primary codes only.
• Services or procedures were considered all procedures (multiple levels).
Data for the analysis was obtained from the standard 5% national sample of the Centers
for Medicare & Medicaid Services (CMS) physician outpatient billing claims for those enrolled
in the FFS Medicare program from 2009 to 2018. All the expenditures were presented with
allowed costs and also were inflation adjusted to 2018 US dollars.
Results: This analysis showed expenditures increased by 79% from 2009 to 2018 in the
form of total cost for facet joint interventions, at an annual rate of 6.7%. Cervical and lumbar
radiofrequency neurotomy procedures increased 185% and 169%. However, inflation-adjusted
expenditures with 2018 US dollars showed an overall increase of 53% with an annual increase of
4.9%. In addition, using inflation-adjusted expenditures per procedures increased, the overall 6%
with an annual increase of 0.7%. Overall, per patient costs, with inflation adjustment, decreased
from $1,925 to $1,785 with a decline of 7% and an annual decline of 0.8%. Allowed charges
per visit also declined after inflation adjustment from $951.76 to $849.86 with an overall decline
of 11% and an annual decline of 1.3%. Staged episodes of radiofrequency neurotomy were
performed in 23.9% of patients and more than 2 episodes for radiofrequency neurotomy in
6.9%, in lumbar spine and 19.6% staged and 5.1% more than 2 episodes in cervical spine of
patients in 2018.
Limitations: This analysis is limited by inclusion of only the FFS Medicare population, without
adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the
Medicare population.
Conclusions: Even after adjusting for inflation, there was a significant increase for the
expenditures of facet joint interventions with an overall 53% increase. Costs per patient and
cost per visit declined. Inflation-adjusted cost per year declined 7% overall and 0.8% annually
from $1,925 to $1,785, and inflation-adjusted cost per visit also declined 11% annually and
1.3% per year from $952 in 2009 to $850 in 2018.
Key words: Facet joint interventions, facet joint nerve blocks, facet joint neurolysis, facet
joint injections, Medicare expenditures
Relationship Between Epidural Steroid Dose and
Suppression of Hypothalamus-Pituitary-Adrenal
Axis
Authors: Moon Ho Sik
Published: February 2021

Background: The suppression of hypothalamic-pituitary-adrenal (HPA) axis is a common
complication associated with epidural steroid injections (ESIs). However, the effect of different
doses is unknown.
Objectives: The primary objective was to compare the differences in the duration of HPA
suppression following treatment with different doses of ESI; triamcinolone acetate (TA) 40 mg and
TA 20 mg. The secondary objectives were to compare the extent of salivary cortisol (SC) reduction,
the incidence of adrenal insufficiency (AI), and the differences in a numeric rating scale (NRS)
depending on the varying levels of TA dose used for ESI.
Study Design: A double-blind, parallel-group, randomized controlled trial.
Setting: Pain clinics in a university hospital.
Methods: The patients were treated with TA epidurally and divided into 2 groups (T20 and T40)
depending on the dose of TA (20 mg and 40 mg). The SC concentration was measured before and
after ESI to calculate the duration of HPA axis suppression, the extent of SC concentration reduction,
and the SC recovery rate. Additionally, NRS and adrenocorticotropic hormone stimulation tests
were used.
Results: Thirty patients were analyzed. The T40 group showed longer HPA suppression (19.7 ±
3.1 days) compared with that of the T20 group (8.0 ± 2.4 days). The recovery rate of the T40 group
was lower than that of the T20 group (P < 0.015). However, there was no difference in the extent
of reduction in SC concentration after ESI, the occurrence of AI, and pain reduction.
Limitations: There were selection bias and no placebo control.
Conclusions: Although the difference in pain relief according to the ESI dose is not significant,
the HPA suppression is prolonged with a higher dose than a lower dose, and the recovery is slower.
Therefore, the time interval between consecutive ESIs should be adjusted depending on the steroid
dose to ameliorate the adverse effects of steroids.
Key words: Adrenal insufficiency, adverse effects, cushing’s syndrome, epidural injections,
glucocorticoids, optimal dosage, pituitary-adrenal system, salivary cortisol
Value and Validity of Coronavirus Antibody
Testing
Authors: Mahajan Amit
Published: February 2021

Background: The interventional pain management community saw the COVID-19 pandemic
decimate elective interventional procedures and new patient visits across the United States until
the reopening of America and the restarting of interventional procedures and elective surgical
procedures began again. Health care providers, along with essential workers and patients,
continue to be concerned about functioning in a safe and responsible manner. Consequently, a
level of comfort is created by the testing health care workers with long exposure to new patients
and patients undergoing interventions in high risk environments.
As the United States and the world suffers from an ongoing infodemic, there are substantial
amounts of misinformation, and some appropriate information being produced on molecular,
antigen and antibody testing. Consequently, this manuscript is undertaken to describe the value
and validity of coronavirus antibody testing.
Methods: Literature review.
Results: Antibody tests detect antibodies or immunoglobulins that are produced as the human
immune response to SARS-CoV-2 infection. A positive result suggests that the individual has
potentially been exposed to SARS-CoV-2. When immunoglobulins M (IgM) antibodies are present,
they can indicate an active or recent infection, whereas immunoglobulin G (IgG) antibodies show
up later in the infection process and can often indicate a past infection, but does not exclude
recently infected patients who can still be contagious, especially when IgM antibodies are also
concurrently detected. While past knowledge indicates that for viral infections, IgG antibodies
usually persist longer than IgM antibodies and provide immunity from re-infection, it is not clearly
known if that is true for COVID-19.
Limitations: A narrative review with paucity of literature.
Conclusion: Antibody tests have been developed to detect IgG only, both IgG and IgM, or total
antibodies. At present, multiple antibody tests are available for use in the United States. In a review
of 54 available studies through the end of April, mostly from China, the accuracy of pooled results
for combination IgG/IgM tests was 91.4% (95% CI, 87.0 - 96.6) for 15 to 21 days post-symptom
onset. Thus, antibody tests provide a promise and a peril in the ongoing Covid-19 pandemic.
Key words: Corona, COVID-19, antigen testing, antibody testing, IgM antibodies, IgG antibodies
The Other Side of the COVID-19 Curve: A
Model for the Safe Reintegration of Elective
Interventional Pain Procedures
Authors: Hascalovici Jacob
Published: February 2021

Background: Throughout the COVID-19 pandemic, clinicians have had to think
quickly, adapt to changing recommendations sometimes on a daily basis, and have often
had to rely on trial-and-error-based treatment protocols under various conditions. As we
move on past the apex of the COVID-19 curve, new treatment protocols for the safe
reintegration of elective interventional pain procedures into chronic pain practice are
needed.
Methods: Literature review and description of a model for the safe reintegration of
interventional pain procedures.
Limitations: A narrative review with paucity of literature.
Discussion: Herein we describe one such model in the hopes that through similar
knowledge sharing, we can draw on others experiences to reach a collective conclusion
on the safest, most effective, and efficient way(s) to move forward.
Key words: COVID-19, interventional pain procedures, safety
RISK STRATIFICATION OF HEART FAILURE BY ISCHEMIC MITRAL REGURGITATION IN PATIENT WITH MYOCARDIAL INFARCTION
Authors: Nambirajan J. , Saheer Moosa , Chakkravarthi D. , Kumar Praveen
Published: February 2021

One of the important complications which causes the increase of mortality and economic burden on patient is the ischemic MR. Its main pathophysiology is the remodeling of the LV after MI which causes the hemodynamic load and heart failure. However, the data on relationship between ischemic MR and duration of heart failure is very few. We prospectively studied 300 patients who admitted for acute myocardial infarction in our hospital. All patients were assessed by echocardiography and graded MR as mild, moderate, and severe according to regurgitant jet area which is less than 20%, 20 – 40%, and more than 40% of the left atrial area, respectively. The median duration of follow up was 1 year (range 6-12 months). Mild and moderate or severe ischemic MR was present in 40.2 and 6.4% of patients respectively. The hazard ratios for HF were 2.9 (95% condence interval (CI), 1.9–4.3; P<.001) and 3.7 (95% condence interval (CI), 2.1-6.5; P<.001) in patients with mild and moderate or severe ischemic MR respectively, with compared to patients without ischemic MR, after adjusting for ejection fraction and other clinical variables like age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior wall infarction, ST elevation infarction and coronary revascularization. In patients with mild ischemic MR, the adjusted hazard ratio for death was 1.1 (95% CI 0.7-1.7; P=.42), where as in moderate or severe ischemic MR it was 2.1 (95% CI 1.3-3.5; P=.02).
“EPIDEMIOLOGICAL AND CLINICAL CHARACTERIZATION OF COVID19 PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY OF 245 CASES IN A GOVERNMENT TEACHING INSTITUTE OF NORTH INDIA.”
Authors: Jain Divya , Shukla Umesh , Madan Jyotsna , Bhakri Bhanu K , Gupta Devendra Kumar , Motiani Poonam , Sharma Vikrant
Published: February 2021

Background and objectives: Worldwide literature on presentation of patients infected with novel coronavirus shows huge variability in terms of severity and outcome depending on the demographic characteristics of the affected population. We aim to present epidemiological and clinical characteristics of COVID-19 patients admitted at our facility. Methods: Retrospective analysis of epidemiological, and clinical characteristics of patients admitted at a dedicated COVID hospital in North India. Results: Records of 245 patients were analyzed. The mean (SD) age was 32 (17.87) years ranging from 1 day to 81 years. Children <18 years of age constituted around 18% of the study population of which only about a fourth (23%) were symptomatic. About 52.4% of patients were males. Almost 40% cases were detected through contact tracing of known infected patients and in about 56% cases the source of infection was indeterminate. About 67% were asymptomatic and most of the symptomatic patients had mild disease. Among the symptomatic patients cough (19.9%) and fever (17.1%) were most common symptoms followed by throat irritation. Comorbidities were present in 32 (13.06%) patients, of which hypertension in 6.12% was the most common. There were 22 (8.97%) health care workers (HCW) among the patients. Majority of the affected HCW were working in areas with relatively low infection risk. Six (2.44%) patients required oxygen supplementation. The mean duration of stay in hospital was 9.6 ±.57 days. Interpretations & Conclusions: Our observations indicate a relatively younger age of affected population and high proportion of asymptomatic patients. Children are usually asymptomatic with relatively better prognosis.
“A STUDY TO ASSESS THE EFFECTIVENESS OF A PLANNED TEACHING
PROGRAM ON KNOWLEDGE REGARDING WARNING SIGNS AND
PRIMARY PREVENTION OF MENTAL ILLNESS AMONG
ADOLESCENTS AT SELECTED SCHOOLS OF AHMEDABAD CITY.”
Authors: Jain Amee , Patel Palak
Published: February 2021

A study to assess the effectiveness of a planned teaching Program on knowledge regarding warning signs and Primary
prevention of mental illness among Adolescents at selected schools of Ahmedabad city. The objectives of the study were:
To assess the level of knowledge regarding warning signs and primary prevention of mental illness among adolescents at selected schools of
Ahmedabad city, To evaluate the effectiveness of planned teaching programme on warning signs and primary prevention of mental illness among
adolescents at selected schools of Ahmedabad city, To nd out the association between the level of knowledge regarding warning signs and
primary prevention of mental illness with selected demographic variables. Quantitative research approach was used. One group pre-test post-test
research design was adopted for the study. Total 120 samples were selected from the selected schools of Ahmedabad city through non-probability
convenience sampling technique. The researcher used structured knowledge questionnaire for data collection. As a part of intervention planned
teaching program on warning signs and primary prevention of mental illness was carried out among adolescents at selected schools of
Ahmedabad city. The post test score was measured with same questionnaires after 7 days. The collected data were analyzed by using descriptive
and inferential statistical method. T test was used to evaluate the effectiveness of planned teaching program. Pre-test mean: 10.10 and Post-test
mean: 15.73, Mean difference: 5.63, and the standard deviation of Pre-test: 4.16, Post-test: 5.82. “t” value: 14.42 with degrees of freedom (120-
1=119), highly signicant at 0.05% level of signicance. Hence PTP is effective in terms of imparting knowledge. Researcher had found the
association with demographic variables. i.e., Age & Standard of the study.
BRENNER TUMOR -AN OVERVIEW
Authors: Susila C. , Jeyachandran Muneeswari , Dinesh Subasri
Published: February 2021

The ovaries are an essential part of the reproductive system to produce
ovum which helps to regulate hormones and play a prime role in
pregnancy and fertility in women health. In contrast, Excess growth of
abnormal tissue in any part of ovaries affect the normal reproductive
function among women. Generally, Ovarian tumors are prevalent
forms of neoplasm among women and it attributes for about 30% of
female reproductive cancers. Ovarian cancer is the one of the most
habitual female carcinomas, and the fourth main cause of death among
cancer demise in female. These tumors act in different ways, and
predominantly they are discovered after procuring a bigger volume.
There are four major groups of ovarian cancer which are surface
epithelial, sex cord or stromal, germ cell and metastatic tumors.
Brenner tumor is one of the subtypes of surface epithelial carcinoma
which resembles transitional neoplasm of urinary tract.
Peningkatan Kemampuan Baca pada Siswa Kelas 2 SD Negeri 6 Klablim Kota Sorong melalui Media Kartu Huruf
Authors: Kambu Yulita
Published: February 2021

Tujuan penelitian tindakan kelas ini adalah untuk meningkatkan prosespembelajaran kemampuan membaca lancar pada siswa kelas 2Kelas 2 SD Negeri 6 Klablim Kota Sorong Distrik Sorong Timur tahun pelajaran 2015/2016. Penelitian ini didesain dua siklus, dalam setiap siklus terdiri dari dua pertemuan. Setiap siklus mencakup tahapan diantaranya: perencanaan, pelaksanaan, observasi, dan refleksi. Subjek penelitian seluruh siswa kelas 2 yakni 34 siswa. Teknik pengumpulan data menggunakan dokumentasi, observasi, dan wawancara, sedangkan analisis data yang digunakan adalah model analisis kualitatif. Berdasarkan hasil penelitian tindakan kelas yang dilakukan sebagai berikut: 1). Melalui penggunaaan media kartu huruf dapat meningkatkan ketrampilan membaca siswa yang dapat dilihat dengan adanya peningkatan pada prosentase siswa yang tuntas yakni pratindakan sebesar 56% siklus pertama pertemuan 1 sebesar 70% naik pada siklus pertama pertemuan 2 sebesar 88%, siklus kedua pertemuan 1 sebesar 100% dan siklus ke dua pertemuan 2 sebesar 100%. 2). Melalui penggunaan media kartu huruf dapat meningkatkan keaktifan dan kekreatifan siswa pada scat pelaksanaan pembelajaran bahasa Indonesia, khususnya dalam pembelajaran membaca.
Pengaruh Model Pembelajaran Inkuiri Terbimbing terhadap Hasil Belajar IPA pada Materi Panca Indra Manusia Bagi Siswa Kelas IV SD Inpres 12 Kabupaten Sorong
Authors: Asrul Asrul , Tiro Abdul Rachman , Risakotta Heryani
Published: February 2021

Tujuan penelitian ini adalah untuk mengetahui Pengaruh Model Inkuiri Terbimbing Terhadap Hasil Belajar IPA Pada Materi Panca Indra Manusia Bagi Siswa Kelas IV SD Inpres 12 Kabupaten Sorong, Tahun Ajaran 2019/2020. Metode yang digunakan dalam  penelitian ini adalah  metode  pra eksperimen dengan desain penelitian One Grup Pretest Postes. Sampel  yang digunakan adalah seluruh siswa kelas IV  yang berjumlah 29  siswa yang diperoleh dengan teknik sampling jenuh. Instrumen yang digunakan adalah Pretest dan Postes, Dokumentasi serta lembar tes tertulis dalam bentuk pilihan ganda.. Hasil analisis ketuntasan belajar pada nilai rata-rata pretes 47,6 posttest 75,5 hasil uji reliabilitas diperoleh Kuder dan Richardson (K-R 20) untuk instrument  test sebesar 0,723 yang berarti memiliki tingkat reliabilitas tinggi. Uji normalitas hasil belajar Pretest siswa memiliki taraf signifikansi 0,119 > 0,050, posttest siswa memiliki taraf signifikansi  067 > 0,05. Uji hipotesis diperoleh t hitung sebesar 4.008 dengan dk = n – 1 (29-1=28) diperoleh t tabel  sebesar 1.701. Berdasarkan hasil analisi data nilai yaitu  t hitung > t tabel (4.008 > 1.701), dengan besarnya taraf signifikansi 0,05, yakni (0,000 < 0,05) maka Hipotesis diterima, Dengan demikian dapat disimpulkan bahwa terdapat Pengaruh Positif Model Inkuiri Terbimbing Terhadap Hasil Belajar IPA Pada Materi Panca Indra Manusia Bagi Siswa Kelas IV SD Inpres 12 Kabupaten Sorong.
Pengaruh Motivasi Orang Tua terhadap Minat Baca Siswa Kelas III SD Inpres 26 Kabupaten Sorong Tahun Pelajaran 2016/2017
Authors: Mursalim Mursalim , Solehun Solehun , Pramudia Rian
Published: February 2021

Penelitian ini bertujuan mengetahui pengaruh motivasi orang tua terhadap minat baca seorang anak dan mengentahui hal apa aja yang menjadi daya tarik siswa agar mempunyai minat untuk membaca yang tinggi. Penelitian ini menggunakan pendekatan eksperimen yang dikaji dengan cara kuantitatif. Populasi penelitisn ini adalah seluruh siswa kelas III berjumlah 31 siswa, sedangkan sampel berjumlah 20 siswa dengan terdiri dari 10 siswa laki-laki dan 10 siswa perempuan yang dipilih secara  random. Instrumen yang digunakan adalah angket yang terlebih diuji reliabilitas dan validitas instrumen. Hasil data yang diperoleh diuji menggunakan teknik analisis regresi linier sederhana. Hasil penelitian ini menunjukkan bahwa terdapat pengaruh yang mendorong minat siswa untuk membaca diperoleh hasil t hitung = 19 > t tabel = 1,729 maka sekitar 75% siswa memperoleh motivasi yang baik sehingga 80% memiliki minat baca yang tinggi. Sehingga hasil penelitian ini dapat disimpulkan bahwa motivasi orang tua berperan besar dalam membentuk sebuah minat untuk membaca buku dalam diri seorang siswa yang dimana apabila terus dilakukan akan berdampak sangat baik bagi prestasi maupun masa depan siswa tersebut.