Rejected

Chronic axial low back pain (LBP) is one of the most common ailments in the United States, with a significant impact on quality of life and function. Multimodal therapy is often utilized for pain relief, including opioid pain medication. Current indications for spinal cord stimulation include chronic neuropathic conditions, such as failed back surgery syndrome, radiculopathies, complex regional pain syndrome types I and II, postherpetic neuralgia, and peripheral diabetic neuropathies. While current lead placements perform remarkably when used for their appropriate indications, there is no specific indication for spinal cord stimulation in the treatment of axial LBP. However, spinal cord stimulation lead placement at the T6 mid-vertebral body can be considered in patients with significant or predominant complaints of axial LBP. Achievement of pain relief via spinal cord stimulation can reduce the administration of both opioid and non-opioid pain medications.

Several specialists in medicine use local anesthetics. In patients with kidney disease, these agents are used during catheter insertions for hemodialysis and peritoneal dialysis, arteriovenous fistula and graft procedures, kidney transplantation, parathyroidectomy, kidney biopsies, and dental and skin procedures. Patients on chronic hemodialysis use a topical application prior to use of needles for arteriovenous fistula cannulation before starting dialysis. They are also used to manage acute and chronic pain conditions, in regional nerve blockade and in multi-modal enhanced recovery protocols. Despite their frequent use by both physicians and patients, data on the use of local anesthetics in patients with kidney impairment are not well reported. This review will summarize the use of local anesthetics in chronic kidney disease, describe their pharmacology and the impact of lower estimated glomerular filtration rate on their pharmacokinetics, and suggest dose regulation in those with kidney dysfunction.

 Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization.  PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors.  There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84,  = 0.788]; 4-CA [OR: 0.75,  = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95,  = 0.927]; 4-CA [OR: 0.99,  = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09,  = 0.019) and hospital readmissions (OR: 10.2,  = 0.003).  No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions.  This is a level III, retrospective comparative study.

Suicide is the second leading cause of death in young adults. Suicide attempts by violent methods predict later completed suicide and premature mortality. Suicide prevention is a major public health issue in this specific population. The French Student Health Foundation (FSEF) developed a psychiatric ward that includes psychiatric and somatic approaches. This transdisciplinary unit provides mixed psychiatric and rehabilitation treatments for those persons who have attempted suicide and have severe somatic injuries.

Infection of humans with SARS-CoV-2 virus causes a disease known colloquially as "COVID-19" with symptoms ranging from asymptomatic to severe pneumonia. Initial pathology is due to the virus binding to the ACE-2 protein on endothelial cells lining blood vessels and entering these cells in order to replicate. Viral replication causes oxidative stress due to elevated levels of reactive oxygen species. Many (~60%) of the infected people appear to have eliminated the virus from their body after 28 days and resume normal activity. However, a significant proportion (~40%) experience a variety of symptoms (loss of smell and/or taste, fatigue, cough, aching pain, "brain fog," insomnia, shortness of breath, and tachycardia) after 12 weeks and are diagnosed with a syndrome named "LONG COVID." Longitudinal clinical studies in a group of subjects who were infected with SARS-CoV-2 have been compared to a non-infected matched group of subjects. A cohort of infected subjects can be identified by a battery of cytokine markers to have persistent, low level grade of inflammation and often self-report two or more troubling symptoms. There is no drug that will relieve their symptoms effectively. It is hypothesized that drugs that activate the intracellular transcription factor, nuclear factor erythroid-derived 2-like 2 (NRF2) may increase the expression of enzymes to synthesize the intracellular antioxidant, glutathione that will quench free radicals causing oxidative stress. The hormone melatonin has been identified as an activator of NRF2 and a relatively safe chemical for most people to ingest chronically. Thus, it is an option for consideration of re-purposing studies in "LONG COVID" subjects experiencing insomnia, depression, fatigue, and "brain fog" but not tachycardia. Appropriately designed clinical trials are required to evaluate melatonin.

To compare the effect of two comfort techniques of nitrous oxide/oxygen inhalation and dexmedetomidine combined with flurbiprofen axetil sedation and analgesia in impacted teeth extraction among patients with hypertension.

Peristomal pyoderma gangrenosum (PPG) is a rare dermatological condition associated with gastroenterological disease. Most gastrointestinal surgeons find it difficult to suspect and treat PPG, especially at early onset. The patient was an 18-year-old female. The patient underwent three-stage restorative proctocolectomy for refractory ulcerative colitis. On postoperative day (POD) 9, the trocar wound near the ileostomy site dehisced. Because the wound culture was positive, the wound was treated with an antibacterial agent as an infection. However, the wound worsened. The patient was referred to a dermatologist for diagnosis. PPG was diagnosed on POD 37. Wound management was initiated using topical steroids. The wound caused difficulties in pain and dressing management. Although infliximab was administered as a systemic therapy, it was discontinued because of allergic symptoms. Sealing therapy with hydrofiber dressing and adequate stoma pouching with stoma paste provided good exudate absorption and a clean environment by protecting the wound from stoma excretion. Oral prednisone was initiated on POD 82. Improvement in the wound condition was observed with a prednisone dose of 30 mg/day. Complete remission was achieved seven months after onset. Twelve months after the surgery, stoma closure was performed. The local cutaneous condition remained in remission without exacerbation. Suspicion of PPG can be difficult when it develops early after stoma creation. We never forget that PPG should be suspected when a progressive ulcerative lesion is found around the stoma, even early after operation. If PPG is suspected, a multidisciplinary team plays an essential role in its diagnosis and management.

The efficacy of bilateral nasociliary and maxillary nerve blocks combined with general anaesthesia on intraoperative opioids consumption, emergence and recovery outcomes in adult patients is not well established. We conducted this study to test the hypothesis that the above blocks, combined with general anaesthesia, decrease the intraoperative opioid consumption following nasal surgery.

Background and objectives People with coronavirus disease 2019 (COVID-19) have had a wide range of symptoms reported such as fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, a new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting and diarrhea. The severity of disease, mortality, symptoms of COVID-19 showed significant variation in different parts of the world. The purpose of this study was to describe epidemiological characteristics and symptoms of confirmed COVID-19 patients and to identify factors associated with the severity of the disease. Methods This is a cross-sectional descriptive study conducted on hospitalized COVID-19 patients from May 2020 to July 2020. We obtained data on the demographic characteristics, symptoms, and infection severity for 150 patients by pre-tested semi-structured interview. Information was recorded in a Microsoft Excel sheet and exported to SPSS Statistics (Armonk, NY: IBM Corp.) for analysis. Results The median age of the patients was 31.5 years, where 42% of the patients were female; 52.7% of patients were symptomatic while 47.3% of patients were asymptomatic. Common symptoms at the time of admission were fever (40.5%), sore throat (36.7%), cough (32.9%), rhinitis (19.0%), and body ache (13.9%). At least one comorbidity was reported in 20.0% of the patients, with the most common comorbidity being hypertension (14.7%). History of contact with known confirmed cases of COVID-19 within the last 14 days was present in 94% of patients. The presence of any coexisting illness was significantly higher among patients with severe disease than among those with non-severe disease (80% vs. 17.9%, p=0.012). Conclusions High proportions of COVID-19 patients were asymptomatic in our study. Fever and cough were the most common symptoms. The presence of any coexisting illness was significantly higher among patients with severe disease than among those with a non-severe disease.

The purpose of this case report and literature review is to show that familial episodic pain syndrome (FEPS) is a non-inflammatory genetically inherited pain syndrome. A 3-year-old boy presented at our hospital with pain in both his forearms and lower limbs below the knees for more than 3 years. There were no abnormalities in the blood tests, blood smears, liver and kidney function tests, trace elements tests, cellular immunity test, humoral immunity test, autoantibody tests, C-reactive protein (CRP) test, erythrocyte sedimentation rate (ESR) test, and tumor-related and bone marrow cytology examinations. Additionally, the imaging examination results showed no abnormalities. From the patient's medical history, we found that the mother of the child had a family history of a similar disease. To date, only 21 cases of FEPS3 caused by the sodium voltage-gated channel alpha subunit 11A (SCN11A) gene mutation have been reported. Although the age of onset is different, most of them are inherited in families. The results of the genetic examination revealed that the pain mainly came from the genetic inheritance of the maternal family line. The whole exon gene test revealed that the pain was caused by 2 heterozygous mutations of c.674G > T and c.671T > C in the gene.