YokoCo

The mainstay of treatment for diabetic peripheral neuropathic pain is pharmacotherapy, but the current National Institute for Health and Care Excellence guideline is not based on robust evidence, as the treatments and their combinations have not been directly compared.

Background Lateral epicondylitis or 'Tennis elbow' is a common cause of elbow pain in the middle-aged group caused by tendinosis of the common extensor origin of the forearm muscles. Though no obvious aetiology is identified in most cases, it could be attributed to repetitive overuse of wrist extensors or supinator muscles. This condition is generally self-limiting but may become persistent in a few cases. Radiofrequency microtenotomy (RFM) is a minimally invasive surgical procedure for recalcitrant lateral epicondylitis of the elbow. This involves targeted coblation of pathological tissue at significantly lower temperatures. Objectives The aim of this study was to evaluate the therapeutic efficacy and report long-term results and recurrences in patients treated with RFM. Methods We present long-term results with a mean eight-year follow-up in a case series of 19 patients. All patients had a minimum of six months (mean 23.25 months and range: 6-36 months) of conservative management which included steroid injections prior to being offered RFM. This was a retrospective case series of 20 elbows (in 19 patients) who underwent RFM. The majority of patients (65%) were females. The operation was carried out in the dominant arm in 55% of patients. Results Results were analysed by comparing pre-operative and post-operative QuickDASH scores (Disabilities of the Arm, Shoulder and Hand Score) obtained at one year and eight years post-operatively. We found an improvement in QuickDASH scores from a mean of 61.7 pre-operatively to 18.9 (p-value < 0.0001) and 8.5 (p-value < 0.0001) at one year and eight years, respectively. The mean pain component of the QuickDASH scores decreased from 4.8 to 2.0 and 1.5, respectively, at one year and eight years (p-value < 0.0001). More than 83% of the patients had excellent to good functional improvement. Conclusion RFM is a reliable modality for treating recalcitrant lateral epicondylitis of the elbow with excellent long-term results.

Thromboinflammation plays a central role in severe COVID-19. The kallikrein pathway activates both inflammatory pathways and contact-mediated coagulation. We investigated if modulation of the thromboinflammatory response improves outcomes in hospitalized COVID-19 patients.

Francisella tularensis is a re-emerging organism causing more significant outbreaks of tularemia and fear of bioterrorism. It can be challenging to recognize tularemia due to its variable presentation, especially in low-incidence areas. Physicians must be mindful of this life-threatening infectious disease and consider it a differential diagnosis in patients with fever of unknown origin. We encountered a case of pulmonary tularemia with a unique presentation of severe headache and fever.

Anywhere in the alimentary canal, you can find a gastric duplication cyst, a spherical muscle formation lined by mucosal membrane. It is an uncommon example of a group of congenital intestinal abnormalities. Gastric cysts typically develop on the stomach's greater curvature. A Caucasian 4-year-old boy came in with his family after experiencing colicky central stomach pain for 2 days, along with vomiting for 4 days, decreased oral intake, a temperature of up to 38.5°C and regular bowel movements. A region of the transverse colon with degraded and inflammatory serosa covered in omentum with black necrotic sections was seen during the procedure.

Trigeminal trophic syndrome (TTS) is an unusual complication that occurs secondary to trigeminal nerve injury. The insult to the nerve can lead to anesthesia, hypoesthesia, and paresthesias producing sensations such as burning or itching. The combination of both leads to repeated self-inflicted skin trauma in an attempt to alleviate these sensations, eventually leading to ulceration of the skin. We report a case of a 71-year-old male patient with a scalp ulcer who had an episode of herpes zoster ophthalmicus four months prior to presentation.

The severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) causes COVID-19, which is known to cause fever, dry cough, exhaustion, headache, and loss of taste and smell. Although fever, sore throat, and cough have historically been the utmost characteristic symptoms of the illness, published case reports have recently started to emphasize additional uncommon and unusual presentations of infection with the coronavirus. In COVID, the musculoskeletal system is seldomly involved. In addition to reviewing the causes and imaging characteristics of COVID-19-related illnesses of the musculoskeletal system, we elaborate on a case of a middle-aged man who developed myositis as sequelae to the COVID-19 infection.

Monkeypox is a contagious viral disease that spreads between animals and people. The UK government guidance described the first case of 'Monkey Pox' in 1958, when it was found only in monkeys used for research purposes. Fortunately, for a third world fast developing country like India, monkeypox does not spread easily in the population but spread by close physical contact between people, and there is limited information available about the impact on pregnancy. The virus can enter the body through broken skin, the respiratory tract, or mucous membranes (the moist inner lining of cavities and some organs in the body). The signs and symptoms of monkeypox virus infection in people who are pregnant appear similar to those in nonpregnant people. The symptoms include fever, lymphadenopathy, lethargy, pharyngitis, headache, myalgias, and rash. Rash associated with monkeypox virus infection can be found in the anogenital area (most commonly reported location in this current outbreak), trunk, arms, legs, face, and the palms and soles. The diagnostic approach to a patient with suspected monkeypox virus infection is the same for pregnant and nonpregnant people. If a patient is present with signs and symptoms of monkeypox virus infection, diagnostic testing should be considered, especially if the person has risk factors for monkeypox virus infection. There are limited data on monkeypox infection during pregnancy. It is unknown whether pregnant people are more susceptible to monkeypox virus or whether infection is more severe in pregnancy. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Preterm delivery and neonatal monkeypox infection have also been reported. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Infection control practices for the care of patients who are pregnant with monkeypox infection are the same as those for patients who are not pregnant with monkeypox infection. This includes appropriate isolation of patients with monkeypox; training for health-care personnel on maternity and newborn care units on correct adherence to infection control practices and personal protective equipment (PPE) use and handling; and ensuring sufficient and appropriate PPE supplies are positioned at all points of care. Furthermore, visitors to pregnant or postpartum patients with monkeypox should be strictly limited to those essential for the patient's care and well-being, and should have no direct contact with the patient. Use of alternative mechanisms for patient and visitor interactions, such as video-call applications, should be encouraged for any additional support. CDC also recommends pregnant, postnatal, and breastfeeding women should be prioritized for medical treatment as there is a significant risk to the baby. They also identify these groups as eligible for treatment.

Epstein-Barr virus (EBV) infection typically presents with pharyngeal symptoms and subclinical transaminitis. We present a case of a 27-year-old woman with no known past medical history who presented with painless jaundice and dark-colored urine for three days. Her review of systems was negative for fever, sore throat, nausea, vomiting, pruritus, or rash. Her last sexual contact was six months ago with a male partner, and she only drank alcohol socially. Family and surgical history were non-significant. Physical examination revealed 3+ bilateral conjunctival icterus without abdominal tenderness or organomegaly. She had elevated transaminases: alanine transaminase (ALT) of 1287U/L and aspartate aminotransferase of (AST) 1057U/L but her alkaline phosphatase (ALP) was only slightly above normal at 109U/L (normal range 35-104U/L), with a direct hyperbilirubinemia – total bilirubin 9.5mg/dl, direct bilirubin 6.8mg/dl; the abdominal ultrasound revealed non-dilated bile ducts. Hepatitis A, B, and C serology was negative, but her EBV serology showed an infection. She had incidental thalassemia minor without splenomegaly or asterixis. She was managed conservatively, and her liver enzymes trended down with supportive management. Although EBV is an uncommon cause of painless jaundice, this diagnosis should be considered, especially when other more common causes of jaundice have been ruled out. A high index of suspicion should be maintained to detect EBV hepatitis as it can easily be diagnosed through serological testing.

There are many different types of gallbladder diseases, mainly resulting from inflammation. The long-term presence of an insult to the gallbladder leads to chronic inflammation, which is a nidus for complications such as Mirizzi syndrome and gallbladder cancer, both of which can become mimics of one another. Preoperative diagnosis of either gallbladder cancer or Mirizzi syndrome is often difficult, leading to late diagnosis and complicating the patient's treatment course. We report a case of a 65-year-old male who presented with abdominal pain and significant weight loss, with no physical evidence of jaundice and normal liver function. This was initially diagnosed as acute cholecystitis and Mirizzi syndrome before being diagnosed as gallbladder adenocarcinoma on final histology.