Carpal tunnel syndrome (CTS) is a condition when median nerve, located in the carpal tunnel, is being suppressed by the surrounding structure. In 1854, the first clinical narration of median nerve compression in a carpal tunnel was found. CTS causes pain, tingling, and weakness in the half ring finger, middle finger, index finger, and thumb. These complaints lead the patients to seek medical help by a visiting doctor. CTS has become the major cause of upper extremity chronic neuropathic pain. CTS affects women 3.6 times more than men. This would cause high costs in medical treatment, rehabilitation, work hours lost compensation, initial pension costs, and new worker training. This makes CTS as a major problem in the field of employment. Carpal tunnel syndrome occurs as a result of chronic repetitive forceful work and other risk factors such as sex, age, heredity, hormonal, and weight. Knowledge of the diagnosis and comprehensive management of CTS are important to the doctor. Recent management based on the newest guidelines are important for clinician knowledge update. Correct diagnosis will lead to appropriate management based on recent CTS guidelines, which in turn will improve the quality of life for patients with CTS. This article will comprehensively discuss the diagnosis and recent management. Abbreviations:  CTS - Carpal tunnel syndrome; NHIS - National Health Interview Study; EDX - Electrodiagnostic studies; SCT - Scratch Collapse Test; CSA - Cross-sectional area; PRP - Platelet-rich plasma; LLLT - Low-Level Laser Therapy; US – Ultrasound; DN - Dry needling; ECTR - Endoscopic carpal tunnel release; PDI - perineural dextrose injection; BCTQ - Boston Carpal Tunnel Questionnaire Key word: Carpal tunnel syndrome (CTS); neuropathy; pain; numbness; safe working environment; human; disease Citation: Hidayati HB, Subadi I, Fidiana, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: A review. Anaesth. pain intensive care 2022;26(3):394-404. DOI: 10.35975/apic.v26i3.1902 Received: August 16, 2021; Reviewed: April 24, 2022; Accepted: April 28, 2022

Introduction: Pneumonia is an infectious disease attacking lower respiratory tract. It has one of the highest number of world’s mortality and morbidity in children. Many risk factors are suspected as the reasons why the disease still occur a lot. One of the major risk factors is birth weight which makes their immune system immature and easier to get various complications and infections. The aim of this study is to analyze birth weight as risk factor of pneumonia in children under 5 years old. Methods: This was an analytical study with case control design. This study was held in Primary Health Care of Tambakrejo, from August to December 2017. The sample size was 22 respondents for each case and control group. Technique of sampling was total sampling. Secondary data were collected by medical records at the health center and Kartu Menuju Sehat (KMS). Data were entered into Microsoft Excel then statistically analyzed using IBM SPSS 22. The data were analyzed by Fisher’s Exact Test.Results: During August to December 2017, there were 22 respondents which were diagnosed with pneumonia in Tambakrejo Primary Health Center. Two of them (4.55%) had low birth weight and the rests had normal birth weight (95.45%). The analyze result stated that there is no significant correlation between pneumonia incidence and birth weight. Conclusion: Birth weight is one of pneumonia risk factors without significant impact.

Background & Objective: Neuropathic pain (NP) is a pain due to a somatosensory lesion. NP leads to disruption of health, work, social relationships, hobbies, sleep, mood, and cognitive function. Up till now, the treatment of NP remains unsatisfactory. It makes many patients seek alternative therapies, including wet cupping therapy (WCT). We aimed to analyze the effects of WCT against NP in chronic constriction injury (CCI) in a rat model by assessing the increase in time withdrawal latency (TWL) and GABA-A receptors expression in the spinal cord. Methodology: We used CCI as one of the NP models in Rattus norvegicus species of rats and treated with WCT. We used 21 four months old male rats, divided into 3 groups (n = 7); P1 (sham CCI group), P2 (CCI group), and P3 (CCI plus WCT group). WCT was given two times every week for three weeks with 5 min of first cupping using −200 mmHg, and followed by ten punctures and then 5 min of second cupping using −200 mmHg. TWL assesment was conducted by using hotplate. Expresion of GABA-A receptor was evaluated with immunohistochemistry. Results: WCT significantly increased TWL with P = 0.0001 and decreased expresion of GABA-A receptors in the spinal cord of CCI rat model. Conclusion: This research concluded that wet cupping therapy could increase time withdrawal latency and decrease the expression of GABA-A receptors in the spinal cord in chronic constriction injury rat model. This result suggests a promising method in controlling neuropathic pain. However, further investigations are required to understand the mechanism. Abbreviations: CCI: Chronic Constriction Injury; CT: Cupping Therapy; DCT: Dry Cupping Therapy; NP: Neuropathic Pain; TWL: Time Withdrawal Latency; WCT: Wet Cupping Therapy; Key words: Chronic constriction injury; CCI rat model; GABA-A receptors; Neuropathic pain; Pain; Time withdrawal latency; TWL; Wet cupping therapy. Citation: Hidayati HB, Qurnianingsih E, Widjiati, Khaerunnisa S, Puspamaniar VA, Susetyo RD. Wet cupping therapy increases the time withdrawal latency (TWL) and decreases GABA-A receptor expression in the spinal cord in a rat model of neuropathic pain. Anaesth. pain intensive care 2022;27(1):97−103; DOI: 10.35975/apic.v27i1.2124 Received: July 05, 2022; Reviewed: July 08,2022; Accepted: December 12, 2022

Tiroidektomi merupakan pembedahan yang sering dilakukan di seluruh dunia dengan indikasi pada tumor ganas atau jinak maupun kelainan fungsi tiroid. Pembedahan pada leher sejatinya merupakan prosedur yang berisiko tinggi karena dilakukan pada struktur yang menempel pada pembuluh darah, saraf, dan jalan napas sehingga diperlukan manajemen perioperatif yang baik. Sari pustaka ini bertujuan untuk merangkum berbagai hal yang perlu diperhatikan dalam manajemen terkini perioperatif pembedahan tiroid. Pengelolaan preoperatif mencakup kendali gejala dan tanda hipertiroid atau hipotiroid, puasa, pemberian antibiotik profilaksis, serta manajemen jalan napas. Selama operasi, terdapat hal khusus yang perlu diperhatikan terkait penggunaan obat anestesi, pemantuan hemodinamik, serta upaya pencegahan cedera saraf. Selain itu, beberapa komplikasi pascaoperatif yang perlu dideteksi dan ditangani secara dini, antara lain hipokalsemia, hematoma, cedera nervus laringeus rekurens, kejadian nyeri, mual, dan muntah, serta trakeomalasia. Seluruh tata laksana perioperatif tersebut memerlukan kerjasama multidisiplin.

Fahr's disease is a very rare disease with a prevalence of 1/1,000,000 individuals. We present a case report of a male with sudden double hemiparese and basal ganglia calcification leading to the diagnosis of Fahr's disease. A 59 years old male presented to the emergency department with a chief complaint of unable to move his upper and lower extremities in a sudden. The complaint begins with weakness of the right side of the body, followed by weakness of the left side of the body the day after. The serum levels of calcium, magnesium, phosphorus, and Parathyroid Hormonal (PTH) have not been measured due to the patient’s financial problems. CT scan of the brain showed bilateral, symmetrical, wide areas of calcification over the fossa posterior, basal ganglia, periventricular, and parietal area, which were suggested as Fahr’s disease. The patient is being treated with the injection of neuroprotectant, antibiotic, vitamin, neuropathic analgesia, and fluids. He is also being consulted with medical rehabilitation to get some physical treatments. Treatment goals include: increase and or maintain ROM, prevent contractures, strengthens weak muscles that may be underutilized, improvement and maintenance of postural stability in static postures and during mobility, and fall prevention. Our case highlight sudden double hemiparese which different from previous literature which says that neurological deficit symptoms appear with a chronic nature and the importance of combining pharmacological therapy and physical therapy as in this patient to reduce the patient's morbidity.