The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with potential or tissue damage or described in terms of such damage. Pain in patients with decreased consciousness is individual and needs to consider many aspects. Following the expansion pain definition according to the IASP in 2020, the inability to communicate does not exclude the possibility that humans experience pain. Therefore, a good pain assessment in patients with decreased consciousness can increase the value of disease management and improve the patient's quality of life both during the treatment period and after hospitalization. Because of the inability of patients with decreased consciousness to verbally convey their pain, this poses a challenge for the clinician. This literature review was aimed to describe how to understand the pain in decreased consciousness patients.

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The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with potential or tissue damage or described in terms of such damage. Pain in patients with decreased consciousness is individual and needs to consider many aspects. Following the expansion pain definition according to the IASP in 2020, the inability to communicate does not exclude the possibility that humans experience pain. Therefore, a good pain assessment in patients with decreased consciousness can increase the value of disease management and improve the patient's quality of life both during the treatment period and after hospitalization. Because of the inability of patients with decreased consciousness to verbally convey their pain, this poses a challenge for the clinician. This literature review was aimed to describe how to understand the pain in decreased consciousness patients.

Introduction: Diabetic neuropathy is the most common microvascular complication in diabetes mellitus patients. Diabetic neuropathy is known to be associated with conditions of hyperglycemia and obesity that occur in diabetic patients. Hyperglycemia in diabetic patients can be monitored through HbA1c levels. This study aimed to assess the relationship between HbA1C values and body mass index with the severity of diabetic neuropathy based on nerve conduction velocity examination. Methods: A study with a cross-sectional design with a total of 25 subjects with diabetes mellitus. The severity of diabetic neuropathy was determined based on Baba's diabetic neuropathy classification (BDC), degrees 0 to 4. In all study subjects, plasma HbA1c levels were examined, and body mass index was assessed. The relationship between categorical variables was tested with the chi-square test, and the relationship between numerical and categorical variables with a one-way ANOVA test, the value was considered statistically significant if the p-value <0.05. Results: The 25 subjects with diabetes found a mean age of 54.88 (±SD 8.918) years, with a gender distribution of 46.4% for women and 42.9% for men. The average HbA1c level was 8.9560 (± 2.21850), and the highest body mass index was obese (50%). There was a significant relationship between HbA1c levels and the severity of diabetic neuropathy based on electrophysiological examination (p<0.05), but there was no significant relationship between the value of body mass index and the severity of diabetic neuropathy. Conclusion: Increased HbA1c levels are associated with increased severity of peripheral neuropathy in patients with diabetes mellitus.

Intracranial artery stenosis is the most frequent cause of ischemic stroke. Yet there is no recommendation for population-based screening with the goal of primary stroke prevention strategies. Framingham risk score D’Agostino’s modification has been shown as highly accurate screening to assess the risk of intracranial artery stenosis that lead to stroke. The aims of study to determine the correlation between Framingham risk score and degree of asymptomatic intracranial artery stenosis among stroke prone person. In the study, 32 patients were included. Intracranial stenosis was assessed by transcranial Doppler (TCD). Stenosis defined if the mean flow velocity (MFV) value was abnormal. Artery stenosis was most common in the left middle cerebral artery (MCA) (34.4%). After multiple linear regression analysis was done, only MFV of right carotid siphon artery (CSA) (p = 0.060; r = - 0.493), MFV of left anterior cerebral artery (ACA) (p = 0.073; r = 0.332), MFV of left MCA (p = 0.065; r = 0.341), had significant correlation. The conclusion appears that the stroke risk score has moderate correlation with the degree of asymptomatic intracranial artery stenosis, especially with MFV of right CSA, left ACA and left MCA.