Rejected

The clinical impact of the severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic is growing, and vaccine-associated complications are becoming more evident. Although global vaccination against coronavirus disease 19 (COVID-19) is an outstanding accomplishment, safety concerns and adverse outcomes are also emerging that need to be addressed promptly. The most reported side effects of the COVID-19 vaccine include fever, myalgia, headache, and injection site reactions. Acute transverse myelitis (ATM) and interstitial lung disease (ILD) following the CoronaVac vaccine are rarely reported. We report a case of ILD followed by acute myelopathy in a female who presented with dyspnea, cough, and fever after the second dose of the COVID-19 vaccine. On the third day of admission, she developed paresthesia and bilateral upper and lower limb weakness. She was diagnosed with ILD and ATM due to the COVID-19 vaccine based on imaging and detailed investigations after ruling out all possible causes. Her neurological and respiratory manifestations improved gradually after starting intravenous methylprednisolone.

The perforation of a cecal diverticulum is a rare and challenging condition for the emergency physician.

Chronic cutaneous pain has a substantial negative impact on quality of life (QoL). Dermo-cosmetics can support therapies for treatment of chronic skin diseases, providing symptomatic relief from chronic cutaneous pain and improved QoL.

Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.

Ultrasound (US) allows non-invasive repeated assessments of diaphragmatic excursion (DE) and thickening fraction (DTF) at the bedside, reflecting diaphragmatic dysfunction (DD). We aimed at determining the prevalence and time-course of DD following elective thoracic surgery and the association with postoperative complications.

Coccygodynia has been described as a disabling pain in the coccyx usually associated with sitting or with changing position from a sitting to a standing position. Pain may radiate to the sacrum, to the lumbar spine, or laterally to the buttocks. Treatment has rarely been studied in the adolescent population. : This study aimed to assess pain relief and satisfaction after partial or total coccygectomy in pediatric and adolescent patients suffering from coccygodynia that was resistant to conservative treatment. : A retrospective, consecutive case series was performed to review the data from the hospital records of 29 patients who underwent partial or total coccygectomy from January 2016 to January 2020 in a university hospital setting. Patients suffered from coccygodynia resistant to conservative treatment. The study included 16 female (55%) and 13 male (45%) patients who ranged in age from 3 to 15 years. Patient records were assessed for postoperative complications, period of hospital stay, time to regain normal activity, postoperative pain improvement (using a 4-point Likert scale), and patients' or parents' satisfaction (using a 5-point questionnaire). : Total coccygectomy was performed in 19 patients and partial coccygectomy in 10 patients. Only 1 patient had a superficial infection after surgery. The length of hospital stay was 1.44 ± 0.97 days. Time to regain normal activity was 24.68 ± 4.32 days. Pain relief was excellent (complete pain relief) in 23 cases (79.3%) and good (relief of most pain but mild discomfort after prolonged sitting) in 6 cases (20.7%). There were no reports of fair (minimal or no pain relief) or poor (pain worse than before surgery) pain relief. In terms of patient or parent satisfaction, no one reported being "absolutely dissatisfied," 1 person was "dissatisfied" (3.4%), 3 people were "neither dissatisfied nor satisfied" (10.4%), 9 were "satisfied" (31%), and 16 were "absolutely satisfied" (55.2%). : This case series suggests that coccygectomy may be a feasible management option for pediatric and adolescent patients, with favorable outcomes including pain relief, patient or parent satisfaction, and early return to activity.

This review summarizes research advances in quality of life, symptom management, and end-of-life practices within palliative care that can benefit patients with gynecologic cancers.

Avascular necrosis of femoral head secondary to rare metabolic Gaucher's disease (GD) can cause debilitating hip arthritis in young adults. It is an autosomal recessive disorder caused due to deficiency of lysosome enzyme glucocerebrosidase resulting in accumulation of its substrate in macrophages. The activated macrophages or the Gaucher cells causes hepatosplenomegaly, anemia, and thrombocytopenia. Extensive marrow involvement causes bony deformity, necrosis, and pathological fractures in non-neuropathic GD. Total hip replacement (THR) for young adult with secondary arthritis due to avascular necrosis (AVN) of femoral head in GD is complex and has high failure rate. As the abnormal cell infiltration involves both femoral head and the acetabulum. It becomes even more challenging, when associated spinopelvic fusion preexists. The altered biomechanics needs special attention to the anteversion of the cup placement and deciding the combined ante-version angle (CAVA).

Female veterans experience higher rates of chronic pain, depression, and anxiety than do male veterans. Gynecologic examinations and procedures can be stressful, painful, and anxiety provoking. Research has shown that massage can help reduce pain and anxiety. The purpose of this study was to examine the relationship between massage and well-being in female veterans.