Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) among Young Landmine Amputees

How to Cite This Article: Poor Zamany Nejat Kermany M, Modirian E, Soroush M, Masoumi M, Hosseini M. Phantom Limb Sensation (PLS) and Phantom Limb Pain (PLP) Among Young Landmine Amputees. Iran J Child Neurol. Summer 2016; 10(3):42-47. AbstractObjectiveTo determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.Materials & MethodsAll youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.ResultsThere were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups. Significant relationship was observed between age of casualty and duration of injury with PLP.ConclusionPhantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation. References Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth 2001; 87:107-16.Tseng CC, Chen PY, Lee YC. Successful treatment of phantom limb pain and phantom limb sensation in the traumatic amputee using scalp acupuncture. Acupunct Med 2014;32(4):356-8.Davis RW. Phantom sensation, phantom pain, and stump pain. Arch Phys Med Rehabil 1993;74:79–91.Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983;17(3):243–256.Gupta R. FRCA, FFPMRCA, EDRA. Pain Management. Phantom Pain Syndromes. 2014, pp 71-74.Davidson JH, Khor KE, Jones LE. A cross-sectionalstudy of post-amputation pain in upper and lower limb amputees,experience of a tertiary referral amputee clinic. Disabil Rehabil 2010;32(22):1855-62.Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning inpersons with limb loss. J Pain. 2010; 11(1): 79–86.Anwar F. Phantom limb: Review of literature. KMUJ. 2013; 5(4): 207-12.Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005; 86(10):1910-19.Husum H, Resell K, Vorren G,Heng YV, Murad M, Gilbert M, et al. Chronic pain in land mine accident survivors in Cambodia and Kurdistan. SocSci Med 2002; 55(10):1813-6.Wartan SW, Hamann W, Wedley JR, McColl I. Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997; 78(6):652-9.Krane EJ, Heller LB. The prevalence of phantom sensation and pain in pediatric amputees. J Pain Symptom Manage 1995; 10(1): 21-9.Wilkins KL, McGrath PJ, Finley GA, Katz J. Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998; 78(1): 7–12.Mariane L. Simmel. Phantom experiences following amputation in childhood. J Neurol Neurosurg Psychiat 1962; 25(1): 69-78.Mohammadi Seilabipour N, Mohammadi Fallah S, Kazemi H, Shariat SV. Phantom limb correlates among amputee war veterans. Adv Cognitive Sci 2013; 15(2): 32-9.Modirian E, Shojaei H, Soroush MR, Masoumi M. Phantom pain in bilateral upper limb amputation. DisabilRehabil 2009; 31(22): 1878-81.Explosive remnants of war-Unicef. http://www.unicef. org/sowc2013/focus_war_remnants.htmlRayegani SM, Aryanmehr A, Soroosh MR, Baghbani M. Phantom Pain, Phantom Sensation, and Spine Pain in Bilateral Lower Limb Amputees: Results of a National Survey of Iraq-Iran War Victims’ Health Status. JPO 2010; 22(3): 162-165.Subedi B, GrossbergGT. PhantomLimbPain:Mechanisms and Treatment Approaches. Pain Res Treat 2011, Article ID 864605, 8 pages.Laura L. Burgoyne, Catherine A. Billups, José L. JirónJr, Roland N. Kaddoum, Becky B. Wright, George B. Bikhazi, et al. Phantom limb pain in young cancer-related amputees: Recent experience at St. Jude Children’s Research Hospital. Clin J Pain 2012; 28(3): 222–5.Sin EI, Thong SY, Poon KH. Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital. Singapore Med J. 2013; 54(2): 75-81.Melzack R, Israel R, Lacroix R and Schultz G. Phantom limbs in people with congenital limb deficiency or amputation in early childhood. Brain 1997; 120(9): 1603– 20.Rahimi A, Mousavi B, Soroush M, Masumi M, Montazeri A. Pain and Health-Related Quality of Life in War Veterans with Bilateral Lower Limb Amputations. Trauma Mon2012; 17(2):282-286.Ketz AK. The experience of phantom limb pain in patients with combat-related traumatic amputations. Arch Phys Med Rehabil 2008, 89(6): 1127-32.Boyle M, Tebbi CK, Mindell ER, Mettlin CJ. Adolescent adjustment to amputation. Med Pediatr Oncol 1982; 10(3): 301-12.Patricia A. McGrath, Loretta M. Hillier. Phantom limb sensations in adolescents: A case study to illustrate the utility of sensation and pain logs in pediatric clinical practice. J Pain Symptom Manage 1992; 7(1): 46–53.Vida L. Tyc. Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clin Psychol Rev 1992; 12(3); 275–291. 

Mental health disorders in child and adolescent survivors of post-war landmine explosions.

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions. METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders. RESULTS: Seventy-eight child and adolescent survivors with a mean age of 16.11 ± 2 years old were identified and agreed to participate in the study. The mean age of the victims at the time of injury was 8.2 ± 3.12 years old (range 2-15). Thirty-seven (47.4 %) of the adolescent survivors suffered from at least one psychiatric disorder. Twenty-nine survivors (37.1 %) were newly diagnosed and needed to start medication and psychiatric treatment. The most common findings were anxiety disorders (34.6 %), including posttraumatic stress disorder (PTSD) in 20 (25.6 %), and generalized anxiety disorder (GAD) in 7 (9 %) subjects. Mild-Moderate depression was found in 5 (6.4 %) subjects. No personality disorders were observed, and two patients suffered from mental retardation. The study results revealed a significant association between age of casualty, duration of injury and limb amputation, and types of psychological disorders. CONCLUSION: Child and adolescent survivors of landmine explosions had a high prevalence of psychiatric disorders

Mental Health Status, Life Satisfaction, and Mood State of Elite Athletes During the COVID-19 Pandemic:a follow-up study in the phases of home confinement, reopening, and semi-lockdown condition

Scientific reports notified that the pandemic caused by the Coronavirus disease 2019 (COVID-19) has raised an unprecedented mental health emergency worldwide. Abrupt changes in daily routine, environmental constraints, adopted home confinement measures, and uncertainty about a date for returning to usual activities can potentially affect mental health and sports activities in athletes. Hence, we designed a cross-sectional study with a within-subjects design to investigate the impact of the pandemic on mental health, mood states, and life satisfaction of elite athletes. During the three phases of home confinement (April 14–24, n = 525), reopening (May 9–19, n = 464), and current semi-lockdown (July 20–31, n = 428), elite athletes voluntarily responded to an online survey. The self-report questionnaire was prepared to collect demographic and epidemiological variables of interest and the COVID-19-related information. All participants also completed the Profile of Mood State (POMS), General Health Questionnaire-28 (GHQ-28), and Satisfaction with Life Scale (SWLS). The main result is that the training rate, mental health, life satisfaction, and positive mood have decreased during the home confinement period as compared with the reopening and semi-lockdown phases. However, the need for psychosocial services has increased during the pandemic period. The present study provides the first preliminary evidence that home confinement conditions during the COVID-19 pandemic might have negatively influenced elite athlete’s mood state, mental health, and life satisfaction, as well as training rates. Monitoring the psychological parameters of elite athletes and developing strategies to improve their mental health during the COVID-19 pandemic should be on the agenda. Next studies, therefore, seem reasonable to focus on active interventions for athletes during the ongoing COVID-19 pandemic

Some biomarkers of acute kidney injury are increased in pre-renal acute injury

Pre-renal acute kidney injury (AKI) is assumed to represent a physiological response to underperfusion. Its diagnosis is retrospective after a transient rise in plasma creatinine, usually associated with evidence of altered tubular transport, particularly that of sodium. In order to test whether pre-renal AKI is reversible because injury is less severe than that of sustained AKI, we measured urinary biomarkers of injury (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), γ-glutamyl transpeptidase, IL-18, and kidney injury molecule-1 (KIM-1)) at 0, 12, and 24 h following ICU admission. A total of 529 patients were stratified into groups having no AKI, AKI with recovery by 24 h, recovery by 48 h, or the composite of AKI greater than 48 h or dialysis. Pre-renal AKI was identified in 61 patients as acute injury with recovery within 48 h and a fractional sodium excretion <1%. Biomarker concentrations significantly and progressively increased with the duration of AKI. After restricting the AKI recovery within the 48 h cohort to pre-renal AKI, this increase remained significant. The median concentration of KIM-1, cystatin C, and IL-18 were significantly greater in pre-renal AKI compared with no-AKI, while NGAL and γ-glutamyl transpeptidase concentrations were not significant. The median concentration of at least one biomarker was increased in all but three patients with pre-renal AKI. Thus, the reason why some but not all biomarkers were increased requires further study. The results suggest that pre-renal AKI represents a milder form of injury

Sudden deterioration due to intra-tumoral hemorrhage of ependymoma of the fourth ventricle in a child during a flight: a case report

<p>Abstract</p> <p>Introduction</p> <p>To the best of our knowledge, the association between air travel and intra-tumoral hemorrhage in pediatric populations has never been described previously.</p> <p>Case presentation</p> <p>We report the case of a two-and-a-half-year-old Caucasian, Iranian boy with a hemorrhaging brain tumor. He had a posterior fossa midline mass and severe hydrocephalus. He had been shunted for hydrocephalus four weeks earlier and was subsequently referred to our center for further treatment. The hemorrhage occurred in an infra-tentorial ependymoma, precipitated by an approximately 700-mile air journey at a maximum altitude of 25,000 feet.</p> <p>Conclusions</p> <p>A pre-existing intra-cranial mass lesion diminishes the ability of the brain to accommodate the mild environmental disturbances caused by hypercarbia, increased venous pressure and reduced cerebral blood flow during long air journeys. This is supported by a literature review, based on our current knowledge of physiological changes during air travel.</p

Biomarkers in early diagnosis of acute kidney injury

Acute Kidney injury (AKI) is common and frequently fatal. Delay in plasma creatinine based diagnosis of AKI has compromised clinical trials of experimentally promising therapies of kidney injury. Therefore, a number of potential early urinary and plasma biomarkers of renal cell injury have been evaluated in several clinical and experimental studies. However, many uncertainties remain in the diagnostic and predictive capability of these biomarkers in various forms of AKI, especially in heterogeneous population. The overall aim in this project was to analyse the diagnostic and predictive performance of some novel AKI biomarkers in a heterogeneous high-risk population. This project focused on the performance of plasma and urinary cystatin C (CysC) as markers of kidney function and injury respectively and both as predictors of mortality. This involved separate analysis of plasma and urinary CysC clinical data, and an experimental study investigating the performance of urinary CysC in the presence of albuminuria. Finally, the ability of fractional urinary biomarkers (fractional excretion of sodium (FENa) and urea (FEurea) to distinguish between so-called pre-renal AKI and established AKI was assessed. Clinical data came from the EARLYARF study, which was initiated by Professor Zoltan Endre prior to commencement of my PhD project. I participated in data collection and data entry for the large part of this study and I was provided access to the database to address the objectives of my thesis. The hypotheses were explored by analysing data arising from this study. The experimental study of the effect of proteinuria and albuminuria on urinary CysC arose from the observation of cystatinuria in children with proteinuria. This was explored in an animal model of transient albuminuria, which I developed. Plasma CysC has been proposed as an alternative to plasma creatinine as a measure of renal function. In Chapter 3, relative changes of plasma CysC and plasma creatinine were compared in critically ill patients. I was able to demonstrate that plasma CysC generally increased prior to plasma creatinine. Plasma CysC and creatinine were similarly moderately predictive of death or the need for dialysis. Plasma CysC was a more effective and earlier surrogate marker of decreased renal function than plasma creatinine in a general intensive care unit population. In Chapter 4, the utility of urinary CysC as a diagnostic marker of AKI, and predictor of mortality in critically ill patients was evaluated. Urinary CysC was diagnostic of and predictive of death. Unexpectedly, it was also found to be diagnostic of sepsis. Concentrations of urinary CysC were significantly higher in the presence of sepsis (p<0.0001) or AKI (p<0.0001). There was no interaction between sepsis and AKI on the urinary CysC concentrations (p=0.53). Urinary CysC was independently associated with AKI, sepsis, and death within 30 days. Low molecular weight (LMW) proteins, including albumin and novel urinary biomarkers of AKI such as CysC and neutrophil gelatinase-associated lipocalin (NGAL) are normally absorbed from the glomerular filtrate by receptor-mediated transport. The effect of albuminuria on urinary excretion of novel biomarkers was evaluated in Chapter 5. Bovine serum albumin (BSA) induced transient increases in albuminuria, proteinuria and cystatinuria. Clinical proteinuria in the EARLYARF patient cohort was associated with increasing CysC and NGAL concentrations. Proteinuria may increase the threshold of novel biomarkers for detection of AKI by increasing the excretion of LMW protein biomarkers. The structural correlates of prerenal AKI are unknown. FENa and FEurea are often used to differentiate reversible prerenal from established AKI. However, FENa is misleadingly low in patients with AKI due to sepsis. In chapter 6, it was hypothesised that pre-renal AKI is reversible only because injury is less severe rather than because it is a unique physiological response to renal underperfusion. Patients were stratified according to duration of AKI: (i) recovery within 24 hours (AKI 24), (ii) recovery between 24 and 48 hours (AKI 24-48), (iii) no recovery within 48 hours or renal replacement therapy (AKI 48). Patients with no AKI within 48 hours served as controls. Pre-renal AKI-FENa and pre-renal AKI-FEurea were defined as recovery within 48 hours with on admission value of FENa <1 and FEurea <35 respectively. All urinary biomarkers increased with increasing duration and severity of AKI. CysC, NGAL and interleukin -18 (IL-18) concentrations were greater in both pre-renal AKI-FENa and pre-renal AKI-FEurea compared with controls. The result suggests that prerenal AKI represents the milder end of a continuum of renal cellular injury

The effectiveness of interpersonal group therapy on depression and emotion regulation in women with bulimia nervosa

Background and Aim: Bulimia nervosa is characterized by repeated episodes of binge eating (consuming large amounts of food in a short period of time, for example, less than two hours, on average once a week for the past three months) without regular use of disproportionate weight control compensatory behaviors. This research was conducted with the aim of determining the effectiveness of interpersonal group therapy on psychological well-being in women with bulimia nervosa. Methods: The research method was semi-experimental with a pre-test-post-test design with a control group and a two-month follow-up test. 30 research samples were selected from the community of women suffering from bulimia nervosa who referred to the Iranian Bulimia Association in Tehran in October and November 2018 and were randomly replaced in two experimental and control groups. The required findings were collected using the psychological well-being questionnaire (Ryff et al., 1989) in three times: pre-test, post-test and follow-up test, and using variance analysis with repeated measurements. Was analyzed. Results: The results showed that interpersonal group therapy is effective in improving the psychological well-being of bulimia nervosa patients (p≥0.005). Bonferroni test showed that this effect is stable over time. Conclusion: Considering the effectiveness of interpersonal group therapy on psychological well-being, it is suggested to use interpersonal group therapy for women with bulimia nervosa