Rejected

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is characterized by metabolic stroke, seizures, cognitive decline, lactic acidosis, ragged-red fibers, headache, and vomiting, and in 80% of cases due to the mtDNA variant m.3243A>G. We report the case of a MELAS patient carrying a variant in subunit-5 of the respiratory chain (-), rarely reported in MELAS. The patient is a 33-year-old male, who experienced a series of stroke-like episodes (StLEs) since age 23 years, which manifested clinically as seizures transient sensory disturbances, weakness, and visual or cognitive impairment. Over 9 years, these StLEs were misinterpreted as ischemic strokes, respectively, as cerebral vasculitis. He presented with mild, recurrent elevations of the creatine kinase. Initially, anti-seizure drugs and steroids appeared to be beneficial. Despite good recovery of each single StLE, the patient experienced a progressive decline of cognitive functions and activities of daily living. Cerebral imaging showed corresponding stroke-like lesions in changing locations. At age 32y, genetic work-up revealed the variant m.13513G>A in -. The patient profited significantly from a cocktail with anti-oxidants/cofactors. This case shows that the variant m.13513G>A in – can manifest as MELAS that StLEs recover spontaneously and that the course of MELAS is slowly progressive.

One of the most undesirable results after total knee arthroplasty (TKA) is severe immediate postoperative pain, resulting in patient dissatisfaction. We aimed to evaluate nefopam's analgesic efficacy after primary TKA along with related outcomes, including morphine consumption and adverse events.

This article discusses the complex relationship between acute ischemic stroke and migraine with aura, and critical nursing interventions.

Osteoid osteoma is a benign, bone forming tumor which accounts for nearly 10% of all benign bone tumors. The foot is very rarely involved, with only around 2% of osteoid osteomas being reported to occur in bones of the foot. Osteoid osteoma of the talus could present as symptoms mimicking monoarticular arthritis of the ankle. We present a case of osteoid osteoma occurring in the neck of talus, presenting such a diagnostic dilemma.

High-dose opioids induce hyperalgesia and tolerance, which negatively affects postoperative recovery. Prolonged surgery inevitably requires higher opioid doses. Ketamine reduces perioperative opioid consumption and prevents opioid-induced tolerance. However, its effects in cases of prolonged surgery remain unknown. This study aimed to evaluate the dose of intraoperative remifentanil, an ultrashort-acting µ-opioid agonist, administered after an intravenous ketamine bolus during prolonged head and neck surgery. This single-center, retrospective, observational study included 251 patients who underwent head and neck surgery (operation time ≥8 h) between January 2015 and December 2019. The participants were stratified into two groups: those who received an intravenous bolus of ketamine and those who did not (ketamine group and non-ketamine group, respectively). Propensity score-matching was used to match patients in a 1:1 ratio between the two groups, based on their covariates. The difference in intraoperative remifentanil dose administered between the two groups was assessed. After 1:1 propensity score-matching, 89 matched patients were selected from each group. The mean ± standard deviation dose of remifentanil administered was significantly lower in the ketamine group than in the non-ketamine group before (0.15±0.05 vs 0.17±0.05 µg/kg/min; =0.01) and after matching (0.15±0.06 vs 0.17±0.05 µg/kg/min; =0.03). In conclusion, intravenous ketamine administration may reduce the intraoperative dose of remifentanil required during prolonged head and neck surgery. However, further studies are required to evaluate the effect of this finding on enhanced recovery after surgery.

Herpes zoster (HZ) is a disease caused by the reactivation of the varicella zoster virus. Postherpetic neuralgia (PHN) is the most common complication of HZ.

Background Epidural morphine, a powerful analgesic, also causes significant itching in patients. This study aimed to determine the incidence of thoracic epidural morphine-induced pruritus (EMIP) after thoracotomy and to investigate preoperative laboratory parameters for predicting itching in patients who received thoracic epidural morphine (TEM). Methods The patients were divided into two groups. The itching (+) group consists of patients who developed itching (n=31). The no-itching (-) / control group (n=31) was selected among patients who did not develop itching after TEM. Preoperative hemogram values, neutrophil/lymphocyte rate (NLR), platelet/lymphocyte rate (PLR), lymphocyte/monocytes rate (LMR), preoperative and postoperative alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase (ALP), gamma-glutamyl transferase values, and whether there was itching in the first 48 hours after surgery were determined. Results The incidence of thoracic EMIP after thoracotomy was 7.9%. While preoperative and postoperative ALP was found to be lower in patients with itching compared to those without itching. The cut-off value for preoperative/postoperative ALP was 84.5/53. Decreased white blood cell (WBC) could predict pruritus with a borderline statistical significance. Conclusions The incidence of EMIP after thoracotomy was lower compared to other literature data. Infusion of morphine only into the epidural area may cause a low incidence of EMIP. Laboratory parameters ALP and WBC can predict EMIP, but other hemogram parameters, NLR, LMR, and PLR cannot predict EMIP.

Purpose Early detection of thyroid cancer has reduced mortality and improved survival of patients. Increased detection has raised the incidence of early stage disease. Some physicians underestimate the suffering of these patients due to the concept of "good cancer." The unmet needs of the survivors still need to be addressed. The objective of this paper was to evaluate the long-term quality of life (QOL) of thyroid cancer survivors. Methods A cross-sectional telephone survey of 211 thyroid cancer survivors who underwent thyroidectomy performed between 2006 and 2016 in two academic tertiary care hospitals was conducted using a validated Arabic version of the European Organization for Research and Treatment of Cancer head and neck cancer specific quality of life questionnaire (EROTC QLQ) – H&N43 questionnaire using a scale of 1-4, with 4 being most severe. Results On almost half (48.5%) of patients, thyroidectomy was performed in 2013 or earlier. Patients' perceptions of problems were very low, with a mean score of 1.56 ± 0.7). Worry about the test results (2.37 ± 1.19), future health (2.36 ± 1.22), tingling or numbness in hands or feet (2.32 ± 1.22), pain in the shoulder (2.04 ± 1.18), and dry, itchy skin (2.04 ± 1.18) were the only items that received a mean score of more than 2. No statistically significant differences in patients' problems were observed according to either tumor histopathology or type of thyroidectomy. Conclusion The overall QOL score for the patients was very good. The persistent problems identified need to be addressed in the long-term follow-up. Survivorship care plans need to be developed incorporating proper interventions.

Intervertebral disc degeneration often is a cause of low back pain (LBP) and radicular pain even without severe compression of the nerve root by hernial material. Thermodiscoplasty, or intradiscal electrothermal therapy (IDET) is used for minimally invasive treatment of discogenic pain. Pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) is used as an interventional method for radicular pain elimination. For the first time we have proposed the simultaneous combined use of these techniques. Our research's aim – to study the dynamics of pain syndrome and disability in patients undergone simultaneous combined treatment with the IDET and PRF DRG for pain associated with moderate disc herniation without spinal root severe compression, which confirmed motor and sensitive deficit absence. A retrospective analysis of 22 patients treated at the Neurospine clinic (Kyiv) from 2019 to 2020 was carried out. All patients had degenerative-dystrophic disease of the intervertebral discs L4-L5 and L5-S1 with therapeutically resistant radicular pain. The standard examination included two-plane spondylography and magnetic resonance imaging, as well as an assessment of neurological status. The discogenic origin of pain is confirmed by provocative contrasting discography. The interest of the corresponding spinal root was confirmed by performing selective radicular blockade.The treatment results were assessed using the Numerical rating scale (NRS) and the Oswestry disability index (ODI); statistical processing was carried out using Microsoft Excel and Statistica-10 program tools. There were no complications detected. All patients noted a significant reduction in pain and decrease of disability: VAS (Me) before treatment = 7.77±1.02, ODI (Ме) before treatment = 70.45±7.85; VAS (Me) immediately after surgery = 2.18±1.13. This trend persisted for six months: VAS (Me) 6 months after surgery = 2.0±0.75, ODI (Me) 6 months after surgery = 30.45±9.98. The simultaneous combined use of IDET and PRF DRG is an effective and safe treatment for therapeutically resistant chronic lumbosacral radicular pain associated with moderate disc herniation.

Various factors may lead to coagulation disturbances following cardiopulmonary bypass and surgery for congenital heart disease. In addition to the risks associated with the administration of allogeneic blood products, persistent disturbances in coagulation function and ongoing bleeding may lead to prolonged surgical times, hemodynamic alterations, intracranial hemorrhage, and even mortality. In most clinical scenarios, coagulation disturbances are treated by targeted blood product therapy including fresh frozen plasma, platelet transfusions, or the administration of cryoprecipitate. When routine blood product therapy fails, coagulation adjuncts such as activated recombinant factor VII or prothrombin complex concentrates (PCCs) may be an option to rapidly replenish depleted coagulation factors and correct coagulation disturbances. The PCC formulations including three-factor PCC, four-factor PCC, and factor eight-inhibitor bypass activator (FEIBA) have been used mainly in the adult population with sporadic case series and anecdotal reports in the pediatric population. The following manuscript discusses the various PCC products available for clinical use, reviews previous reports of their use in infants and children with an emphasis on their role following surgery for congenital heart disease, and outlines their potential role in these clinical scenarios.