Rejected

Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. . Here, we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultrasonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis, or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection.

Diverticulitis and ulcerative colitis (UC) are two separate colonic pathologies with different underlying mechanisms. Diverticulosis involves herniation of mucosal and submucosal tissue through muscular tissue in response to increased intraluminal pressure. In contrast, it is believed that the muscular tone in patients with UC is reduced due to chronic inflammatory changes. Thus, it has been reported that there may be an inverse relationship between the presence of diverticulosis in patients with UC, in that UC may possibly be protective against developing diverticular disease. Consequently, the co-presence of both pathologies is uncommon. Here we present a case in which a woman with a history of UC and recurrent diverticulitis after elective partial colectomy was admitted for recurrent acute diverticulitis. It is quite challenging to diagnose diverticulitis in ulcerative colitis patients given the usually similar presentation with abdominal pain, diarrhoea and hematochezia. A level of high suspicion is required for diagnosis.

Arachnoid cysts (ACs) are benign, congenital, fluid-filled collection between two layers of the arachnoid membrane accounting for about 1% of all the intracranial space occupying lesions. These lesions are usually asymptomatic and detected incidentally by magnetic resonance imaging (MRI) or computed tomography scan imaging (CT). However, these lesions can present as spontaneous chronic subdural hematoma (CSDH) causing neurological deficits that require neurosurgical intervention.

Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The " uremberg ntegrated sychosomatic cute Unit" (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting.

Intrathecal (IT) clonidine has been observed to reduce 24-hour opioid requirements and time to first analgesic request after cesarean delivery, but has not been specifically studied in patients with opioid use disorder (OUD).

Pain relief is the most important issue in the long-term outcome of arthroplasty surgery, with nearly one-third of patients still suffered persistent pain and caused dissatisfaction after the surgery.

Irrational Self-Medication (SM) practice leads to incorrect diagnosis and is a risk factor for disease exacerbation and serious health consequences. Hence Responsible SM is vital for better health outcomes. In the present community-based study we explored the SM practice during the last 3 months, frequency, outcome, medications used, reasons influencing SM, source of the drug, and information. Data were analyzed using SPSS; chi-square test was performed to indicate significance, Odds ratio, Pearson correlation, univariant and multivariant regression analysis were performed to find out factors and predictors of SM. A total of 611 residents completed the survey. SM was practiced by 52.9% of participants during the last 3 months, with a frequency of one to two times. Headache (64.8%), pain (35.4%), fever/flu (31.4%), cold & cough (21.9%) and dysmenorrhea (20.9%) were illnesses managed using pain killers (75.9%), multivitamins (25.5%), anti-pyretic (24.7%) and herbal medicines (18.5%). Minor illness (67.9%), earlier experience (33.9%) and shortness of time to attend healthcare facilities (18.8%) were the reasons for practicing SM. Distance to healthcare and routine physical activity have significantly influenced the SM practice. Residents stated that inappropriate SM would lead to negative outcomes, including drug side effects (70%), Interaction (34.2%), poor treatment outcome (32.6%) and return of symptoms (26.5%). Interestingly, two-thirds of participants (68.9%) have recommended SM in case of minor illnesses only, 85.3% of respondents have expressed their desire to learn more about appropriate SM, and 76.6% are willing to return their leftover or unused medications to drug take-back centers.

Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. This is especially understudied among very old (aged ≥ 80) Mexican Americans, a fast-growing segment of the United States (US) population.

We report the case of an 86-year-old female patient with chronic neck pain who presented with an initial misleading clinical picture suggesting an ischaemic stroke. No recent or previous anticoagulation treatment or fall history was reported. The patient developed a paraplegia of the upper limbs needing magnetic resonance imaging which revealed a compressive cervical haematoma. The patient benefitted from cervical laminectomy and evacuation of the cervical haematoma. Motricity in upper extremities was recovered but paresis in the lower extremities persisted 1 week after surgical intervention.

Periarticular injections with a combination of local anesthetics, non-steroidal anti-inflammatory analgesics (NSAIDs), and epinephrine are becoming increasingly popular in the perioperative analgesia of artificial joint replacement. However, data on the efficacy and safety of local injection NSAIDs are still scarce. The purpose of this study was to investigate the efficacy and safety of a local injection of Flurbiprofen Ester Lipid microspheres into the inflammatory model of femoral shaft closed fractures in rats. A systemic inflammatory model was induced in SD rats (60) by closed femoral shaft fracture; 12 non-fractured rats were used as the blank control group (group A). The systemic inflammation model of 60 rats was divided into 5 groups (12 in each group); Group B: intramuscular injectionof the same amount of normal saline at different time points as a negative control; Group C: intravenous injection of Flurbiprofen Ester microspheres (4.5 mg/kg) at different time points; Group D: intramuscular injection of Flurbiprofen Ester microspheres (2.25 mg/kg) at different time points; Group E: intramuscular injection of Flurbiprofen Ester microspheres (4.5 mg/kg) at different time points; Group F: intramuscular injection of Flurbiprofen Ester microspheres (9 mg/kg) at different time points. The behavioral test observed the behavior of the rats. Then, the inflammation factors of CRP, IL-6, COX-1, COX-2 and TNF-αby ELISA were recorded. Through the behavioral test it could be found that the effect of the intramuscular and intravenous injections of Flurbiprofen Ester microspheres was similar. Fracture rats with a local injection of Flurbiprofen Ester microspheres showed lower inflammation levels measured by COX-1, CRP, and TNF-α compared with the control group. Pathological sections at 24, 48, and 96 h after surgery did not display any local muscle necrosis at the local injection site. These findings suggested that a Flurbiprofen Ester microsphere muscular injection exhibited a similar effect to an intravenous injection. The local injection of Flurbiprofen Ester microspheres significantly reduced the inflammatory response in fracture rats and did not increase the risk of muscle necrosis, suggesting its feasibility in local injection analgesia.