Rejected

Immune checkpoint inhibitors and their associated immune-related cutaneous adverse events are continuing to become a mainstay of cancer treatment regimens. While most rashes are mild and easily manageable, severe or persistent rashes like lichenoid dermatoses can significantly impact the quality of life and may require ICI cessation. Lichenoid dermatoses currently have no management guidelines beyond the use of topical or oral steroids. Our study is a single-institution retrospective chart review to characterize ICI-induced lichenoid eruptions, their treatments, and associated tumor response. We utilized natural language processing and our institutional medical record to identify patients with lichenoid eruptions on ICI therapy. One-hundred nineteen patients were identified, of which 108 rashes were characterized as lichenoid dermatitis and fifteen as lichenoid mucositis. Most patients presented with a diffuse distribution (86%, 101/117), with pruritus in lichenoid dermatoses (82%, 89/108) and pain in lichenoid mucositis (80%, 12/15). Successful treatments for lichenoid dermatitis included topical steroids (81%, 88/108), oral antihistamines (21%, 23/108), and oral steroids (15%, 16/108). Of lichenoid dermatitis patients, 21% (23/108) did not respond to treatment (7) or required oral steroids (16). Approximately 28% of patients who had lichenoid dermatitis had delay, reduction, or discontinuation of their ICI because of their irCAE. This descriptive study highlights the impact of lichenoid dermatitis on patients' ability to remain on ICI therapy and the need for more effective non-steroidal management strategies.

Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia.

Echovirus 18 has been recognized as an important causative pathogen of aseptic meningitis in young children worldwide, and echovirus 18-induced meningitis is rarely found in adults with immunocompetence. In this case study, we report the clinical and virological characteristics of aseptic meningitis caused by recombinant echovirus 18 in an adult with immunocompetence. A 31-year-old woman with immunocompetence was admitted to our hospital with fever, dizziness, severe headache, nausea, and vomiting for the past 1 day and was diagnosed with viral meningitis based on the clinical manifestations and laboratory results from cerebrospinal fluid (CSF). The patient received antiviral treatment with ribavirin and interferon as soon as the enterovirus infection was identified using qRT-PCR and was cured after 4 days. From the oropharyngeal swab and CSF samples, two echovirus 18 strains were isolated with a single nucleotide difference located at the 5' UTR. Phylogenetic analyses based on the VP1 gene showed that the two strains belonged to the subgenotype C2 and were clustered with sequences obtained from China after 2015, while the results from the 3D polymerase region showed that the two strains were closely related to the E30 strains. Bootscanning results using the 5' UTR to 2A region and the 2B to 3' UTR region showed that potential intertypic recombination had occurred in the 2B gene. Recombination analyses further confirmed that the two strains (echovirus 18) presented genome recombination with echovirus 30 in the nucleotide regions of the 2B gene. To the best of our knowledge, this is the first report of echovirus 18-induced meningitis in an adult with immunocompetence from mainland China, highlighting the need for close surveillance of echovirus 18 both in children and adults in the future.

The occurrence of side effects of vaccines plays an important role in their acceptance by people. Therefore, the aim of this study was to evaluate the side effects of COVID-19 vaccines (Sputnik-V, AstraZeneca, and Sinopharm) in Neyshabur health care workers (HCWs). A cross-sectional study was performed to evaluate the side effects of COVID-19 vaccines among the HCWs of the Neyshabur University of Medical Sciences from July 31, 2021, to September 6, 2021, by using a self-report checklist. We sent our checklist via an internet link to collect data such as demographic data of participants, previous COVID-19 infection (PCR+), vaccine information and side effects of vaccines. Mean, median and standard deviation were used to determine descriptive statistics and a logistic regression model was also used to determine the relationship between the type of vaccine and its side effects. 317 participants filled out the checklist; among them 47% (N= 149), 21.14% (N= 67), and 31.86% (N= 101) have been vaccinated with Sputnik-V, AstraZeneca, and Sinopharm, respectively. The percentage of side effects after the first dose was 62.15% (N= 197). The Percentage of local side effects was 76% (N= 241) and systemic side effects were 29.36% (N= 95). The most common side effects in all three vaccines were injection site pain (75.08%, N= 240), muscle pain (62.46%, N=198) and headache (52.05%, N=165). Also, the odds ratio of injection site pain, chill and sweating in those who received the AstraZeneca vaccine was 3.9(95% CI, 1.7-9.3), 3.7 (95% CI, 1.8-7.3), and 3.2 (95% CI, 1.7-63), of those who received the Sputnik V vaccine ( ≤ 0.001). The most common side effects among our participants were injection site pain, muscle pain, and headache. Most of the post-vaccination side effects are mild to moderate in severity and self-limited. Reported side effects were more common in recipients with AstraZeneca than in those with Sputnik-V and Sinopharm.

Children and adolescents increasingly commonly suffer from obesity and headache. It has been confirmed that there is an association between obesity and headache in adults; however, evidence of such an association in paediatric populations is still controversial. Therefore, this study examined the relationship between obesity and headache among children and adolescents in the US.

Chronic postsurgical pain (CPSP) after hepatectomy is highly prevalent and challenging to treat. Several risk factors have been unmasked for CPSP after hepatectomy, such as acute postoperative pain. The current secondary analysis of a clinical study sought to extend previous research by investigating more clinical variables and inflammatory biomarkers as risk factors for CPSP after hepatectomy and sifting those strongly related to CPSP to build a reliable machine learning model to predict CPSP occurring. Participants included 91 adults undergoing hepatectomy who was followed 3 months postoperatively. Twenty-four hours after surgery, participants completed numerical rating scale (NRS) grading and blood sample collecting. Three months after surgery, participants also reported whether CPSP occurred through follow-up. The Random Forest and Support Vector Machine models were conducted to predict pain outcomes 3 months after surgery. The results showed that the SVM model had better performance in predicting CPSP which consists of acute postoperative pain (evaluated by NRS) and matrix metalloprotease 3 (MMP3) level. What's more, besides traditional cytokines, several novel inflammatory biomarkers like C-X-C motif chemokine ligand 10 (CXCL10) and MMP2 levels were found to be closely related to CPSP and a novel spectrum of inflammatory biomarkers was created. These findings demonstrate that the SVM model consisting of acute postoperative pain and MMP3 level predicts greater chronic pain intensity 3 months after hepatectomy and with this model, intervention administration before CPSP occurs may prevent or minimize CPSP intensity successfully.

causes Q fever, which is found worldwide and can be acute or chronic. This case report describes a 72-year-old man whose bilateral lower limb pain revealed a paravertebral abscess at L2-L3 due to Q fever spondylodiscitis. Surgical drainage of the abscess was performed and medical treatment is ongoing. Q fever is endemic in Portugal and transmitted by inhalation of aerosols containing spores from infected animals (cattle, goats and sheep) or by ingesting cottage cheese or unpasteurized milk. It has an incubation period of 2-3 weeks and 60% of patients are asymptomatic with only 2% needing hospitalization. Primary infection can manifest in any organ and most cases are self-limiting (self-limited febrile illness, atypical pneumonia or acute hepatitis). Less than 1% of cases evolve to chronic disease, presenting as osteomyelitis or endocarditis. Chronic disease poses a diagnostic challenge and spondylodiscitis has an insidious evolution. Diagnosis requires microbiological and clinical confirmation. Serological and polymerase chain reaction tests are used for diagnosis. Acute disease is usually treated with doxycycline for 3 weeks to avoid evolution to chronic disease. Chronic disease requires 18-24 months of doxycycline with hydroxychloroquine. Acute disease can recur so follow-up is essential as chronic Q fever can result in morbidity and mortality. In Portugal Q fever is a notifiable disease due to the epidemiological risk.

Hemorrhagic Cholecystitis is a rare condition and usually represents a complication of acute cholecystitis. The clinical presentation is quite overlapping and usually involves abdominal pain that may be associated with fever, jaundice, nausea, vomiting, and finally haemobilia. It frequently involves patients with preexisting conditions such as chronic kidney disease undergoing hemodialysis or anticoagulation therapy. Due to the deadly potential of this condition attention must be high during diagnostics and treatment in order to avoid an ill-fated conclusion. To our knowledge, there is a lack of a comprehensive review on the subject as most of the literature consists of case reports or small case series. In order to give a contribution to improving the treatment strategy of this condition, we report a case successfully treated with cholecystectomy, and performed a literature review. Using the term "Hemorrhagic Cholecystitis", on PubMed database we found 67 cases reported in the English literature. The cases were analyzed by two researchers and clinical information was extrapolated and organized, aiming to create a comprehensive review on the subject, that may be clear and useful in clinical practice. KEY WORDS: Hemorrhagic cholecystitis, Surgical treatment.

Gamma Knife radiosurgery (GKR) is a technique that consists of the release of a high dose of ionizing radiation onto a therapeutic target, which has been previously delimited. This technique was described by Lars Leksell and Borje Larsson in 1951. In Colombia, there is only one GKR unit functioning machine nowadays. The objective of this study is to describe the institutional experience of a single institution with Gamma Knife Perfexion over 12 years.