Not Reviewed

Palliative care patients often present to the emergency department (ED) for various reasons e.g., acute illness, pain, altered mental status, and complications of therapy. Many visits involve less severe etiologies e.g., dyspnea, constipation, fear as patients approach the end of life, which may be more effectively and efficiently managed outside of the ED. The objective of this study is to identify and assess the frequency of presenting complaints, primary diagnosis, triage acuity, need for admission, in an Irish setting.

Cancer patients frequently report experiencing pain as one of their symptoms. Cancerrelated pain is often caused by the tumor itself, especially when the tumor is pressing on nerves. In addition to the pain caused by the tumor itself, patients also experience discomfort from the treatment, such as surgery, chemotherapy, radiation therapy, and the diagnostic procedures. The majority of today's pain therapies rely on opioid analgesics, which have not been shown to be effective. The adverse effects of opioids and their addictive properties call for the development of innovative treatment techniques. Nanotechnology offers answers to the issues raised above, which are related to the utilization of more conventional modes of therapy. These nanotechnology-based nanotherapeutics reduce the systemic toxicity, offering outstanding selectiveness and prolonged release of the analgesic drugs at the target site. Thus, these reduce cancer-induced pain in the patients. In this article, we will explain the mechanism behind the most common types of pain that are caused by cancer, including neuropathic, somatic, and visceral pain. In addition, a comprehensive discussion is held on the use of various nanotherapeutics as analgesic drug carriers, as well as on their impacts and the potential opportunities that lie ahead in the field of cancer pain treatment.

Surgery for gynecologic malignancy via midline-laparotomy leads to severe postoperative pain. Adequate pain control while sparing opioid consumption does offer benefits in postoperative complications and recovery. Intrathecal morphine (ITM) provides simple and effective analgesia. In this randomized trial, we compared postoperative opioid consumption in patients who received either ITM or a sham procedure.

Structural alterations of the triceps surae and Achilles tendon (AT) can promote plantarflexion weakness one-year following an AT repair, influencing the activation strategies of the Gastrocnemius Medialis (GM) muscle. However, this is yet to be demonstrated. We aimed to determine whether patients with plantar flexion weakness one-year after AT repair show altered GM spatial activation. In this cross-sectional and case-control study, ten middle-aged men (age 34 ± 7 years old, and 12.9 ± 1.1 months post-surgery) with a high AT total rupture score who attended conventional physiotherapy for six months after surgery, and ten healthy control men (age 28 ± 9 years old), performed maximal and submaximal (40, 60 and 90%) voluntary isometric plantarflexion contractions on a dynamometer. The peak plantar flexor torque was determined by isokinetic dynamometry and the GM neuromuscular activation was measured with a linear surface-electromyography (EMG) array. Overall EMG activation (averaged channels) increased when the muscle contraction levels increased for both groups. EMG spatial analysis in AT repaired group showed an increased activation located distally at 85-99%, 75-97%, and 79-97% of the electrode array length for 40%, 60%, and 90% of the maximal voluntary isometric contractions, respectively. In conclusion, patients with persistent plantar flexion weakness after AT rupture showed higher distal overactivation in GM.

Nocardia infection (nocardiosis) is usually acquired by inhalation; so pulmonary nocardiosis is the most common clinical presentation. Extrapulmonary localization occurs through hematogenous dissemination or contiguous spread. Nocardia can involve the central nervous system in a very reduced number of patients, mainly in immunocompromised. We present a case of a 56-year-old woman with a history of aggressive systemic mastocytosis, treated with chemotherapy 1 year ago. Patient reported intense headache, disorientation, and blurry vision without other symptoms being diagnosed with a rare brain nocardiosis by Nocardia cerradoensis. Neither bacteremia nor pulmonary involvement was detected. Brain PET/CT illustrated 18F-fluorocholine avidity on brain abscesses.

With an increasing interest in multimodal and opioid reducing pain strategies, non-steroidal anti-inflammatory drugs (NSAIDS) have become common-place in the care of injured patients. Long-standing concerns of increased anastomotic leak rate with the use of NSAIDS, however, have persisted. We hypothesized that there would be no significant risk associated with NSAID use after bowel anastomosis in trauma patients.

Regional anesthesia techniques are increasingly used in high-income countries (HICs) for both surgical anesthesia and postoperative analgesia. However, regional anesthesia has not been utilized to the same degree in low- to middle-income countries (LMICs) due to a lack of resources and trained personnel. This study evaluates patient satisfaction with, and outcomes of, ultrasound-guided regional anesthesia for extremity surgery at Kilimanjaro Christian Medical Center (KCMC) in the Northeastern zone of Tanzania.