Rejected

Extramedullary hematopoiesis can occur during normal fetal development or as a compensatory mechanism in chronic anemia when the primary sites of hematopoiesis fail. When it occurs, it is mostly seen in sites such as the liver, spleen, and lymph nodes. Extramedullary hematopoiesis is seen in patients with abnormal morphology of red blood cells like thalassemia and abnormal red blood cell shape like hereditary spherocytosis. The incidence of extramedullary hematopoiesis in sickle cell disease is very rare. We report a case of focal adrenal extramedullary hematopoiesis in a 21-year-old patient with sickle cell disease who presented with pain in the right thorax. A retroperitoneal mass was seen in the MRI of the abdomen of the patient suggestive of extramedullary hematopoiesis. Our case highlights the importance of physician awareness of this rare pathology for proper diagnosis and management.

The authors present a clinical case of a female patient with depression who developed lichen planus during the COVID-19 pandemic and describe the anamnesis, skin and mental status of the patient. The phenomenon of amplified itching in the clinical picture in the post-covid period in the framework of depressive cataesthetic hyperesthesia is considered. A comprehensive psychosomatic assessment of the condition and the inclusion of approaches of psychocorrection in basic dermatotropic therapy contributed to the normalization of mood, rapid and complete reduction of itching, improvement of the skin status and patient's quality of life.

Although studies on the improvement of pain after exercise are increasingly diverse, whether Tai Chi Quan can improve the pressure pain thresholds remains unknown. This study was to observe the effect of Tai Chi Quan on the pressure pain thresholds of lower back muscles in healthy women.

Plant-based natural products as anti-nociceptors have enormous potential as safer alternatives to conventional opiates and NSAIDS. (black pepper) is one of the major culinary spices with medicinal attributes.

This current concept, narrative review provides the latest integrated evidence of the musculoskeletal injuries involved with trail running and therapeutic strategies to prevent injury and promote safe participation. Running activities that comprise any form of off-road running (trail running, orienteering, short-long distance, different terrain, and climate) are relevant to this review. Literature searches were conducted to 1) identify types and mechanisms of acute and chronic/overuse musculoskeletal injuries in trail runners, 2) injury prevention techniques most relevant to running trails, 3) safe methods of participation and rehabilitation timelines in the sport. The majority of acute and chronic trail running-related musculoskeletal injuries in trail running occur in the lower leg, primarily in the knee and ankle. More than 70% are due to overuse, and ankle sprains are the most common acute injury. Key mechanisms underlying injury and injury progression include inadequate neuromotor control-balance-coordination, running through fatigue, and abnormal kinematics on variable terrain. Complete kinetic chain prehabilitation programs consisting of dynamic flexibility, neuromotor strength and balance, and plyometrics exercise can foster stable, controlled movement on trails. Patient education about early musculoskeletal pain symptoms and training adjustment can help prevent injury from progressing to serious overuse injuries. Real-time adjustments to cadence, step length, and knee flexion on the trail may also mitigate impact-related risk for injury. After injury occurs, rehabilitation will involve similar exercise components, but it will also incorporate rest and active rest based on the type of injury. Multicomponent prehabilitation can help prevent musculoskeletal injuries in trail runners through movement control and fatigue resistance.

The diagnostic criteria for Tolosa-Hunt syndrome (THS) were updated in 2013 in the 3 Edition of the International Classification of Headache Disorders. It is now possible to diagnose THS based on the presence of granulomatous inflammation demonstrated on magnetic resonance imaging (MRI) without confirmation by biopsy. No previous study has reported the use of arterial spin labeling (ASL) perfusion MRI for diagnosing THS. Here, we report a case of THS in which ASL was used in the initial identification and to monitor therapeutic response following steroid therapy.

Ankle blocks are commonly used as surgical anesthetics and for postoperative analgesia during foot surgeries. It is chiefly an infiltration block which utilizes a localized anesthetic approach for providing surgical anaesthesia for a variety of foot procedures. Thus, in this systematic review, we focus primarily on the use, effectiveness, success and failures of regional ankle blocks in outpatient surgeries and hereby compare them with other anesthetic techniques and agents commonly used. Literature search was carried out using PubMed, Medline, Embase, Scopus and Cochrane Library for the studies existing till April 2021. Search was conducted by two independent reviewers separately keeping in view the structured format of the review. Data were thoroughly read and were extracted manually into a structured data extraction form. After going through the databases, 252 relevant articles were identified as per the search strategy. Among those 99 duplicate records were taken away. Among the remaining one hundred fifty-three records, one hundred thirty-eight records were excluded majorly going through their titles and abstracts. Next matching our inclusion criteria and going through the full texts, fifteen studies were excluded. Lastly, after excluding the reviews and case studies we included relevant 11 studies that compared the efficacy of ankle block in outpatient foot and ankle surgery in the present analysis. Seven studies used anatomic landmark guided (ALG) approach, three studies used ultrasound guided (USG) approach, while one study included both approaches. The results showed a significantly lower VAS score postoperatively at 24 hrs. It was observed that in general, immediately after surgery the VAS pain scores are low due to the continued analgesic effect provided by the ankle block. 0.25%-0.5% bupivacaine was the most common single long-acting local anesthetics used. Patient satisfaction ranged from 66%-95.8%. Major complications included block failure and consequent requirement of general anesthesia and few cases of transient nerve injuries. Therefore, this systematic review supports the fact that ankle block has advantages like excellent success rates with minimal side effects, high levels of patient satisfaction and decreased hospital expenses. Thus, it proves to be a safe and highly effective means of regional anesthesia for the majority of foot and ankle surgeries in outpatient settings.

Migraine is a primary headache disorder with a prevalence of 11.6% globally and 27% in Saudi Arabia. Irritable bowel syndrome (IBS) has a prevalence of 9.2% worldwide. The prevalence of IBS has not been established nationally. However, provincial studies for migraine and IBS have been conducted nationwide. There is a significant link between migraine and IBS globally. Migraineurs had a considerably greater prevalence of IBS than nonmigraineurs (OR = 2.49, 95% CI 2.22-2.78). Patients with IBS have 60% higher odds for migraines. This identifies an association that needs to be investigated in a nationwide manner. The study has two main aims. The first is to measure the prevalence of migraine and irritable bowel syndrome in Saudi Arabia. The second is to observe the association and the relationship between migraine and irritable bowel syndrome in Saudi Arabia. A cross-sectional study was conducted among the general population of Saudi Arabia between March 2021 and June 2021, whose ages are 15 years old or greater. Participants filled an online self-administered survey. The data collection tools included the Migraine Screen Questionnaire (MS-Q) for migraine symptoms, migraine severity (MIGSEV) scale for severity of migraine, and the IBS module of the Rome IV Diagnostic Questionnaire (R4DQ) for IBS symptoms and their subtype. With 2802 participants, the majority of the study samples were males, who constituted 52.5%. Among the study's sample, the prevalence of migraine consisted of 27.4%, and the prevalence of IBS was 16.4%. The odds of having IBS in migraineurs were much higher than in those without migraine (OR 4.127; 95% CI 3.325-5.121), and the association was statistically significant ( < 0.001). In conclusion, there is a strong association between migraine and irritable bowel syndrome in Saudi Arabia.

Transient global amnesia (TGA) is a clinical syndrome characterized by anterograde amnesia, mild retrograde amnesia, and confusion up to 24 hours. Most commonly seen in patients older than 50 years, TGA results from the temporary impairment of short-term memory formation. Clinically, patients have time disorientation and often ask repeated questions regarding the day's events. Vomiting, headache, blurry vision, dizziness, and nausea may be present. A physically or psychologically stressful precipitating event, such as emotional stress, significant physical exertion, exposure to extreme temperatures, high-altitude conditions, Valsalva maneuver, acute illness, or sexual intercourse, is often the cause. The pathophysiology of TGA is not well understood but may be related to impaired venous drainage of the hippocampus. The diagnosis is primarily clinical, but recent studies suggest that magnetic resonance imaging may be helpful. TGA is self-limited and resolves within 24 hours. There is no established treatment for episodes. The lifetime recurrence rate is 2.9% to 23.8%. Recent evidence suggests an association between TGA and migraine headaches as well as takotsubo cardiomyopathy. No apparent increased risk of cerebrovascular events occurs in patients who have had an episode of TGA. There is conflicting evidence as to whether an episode of TGA predisposes to future seizures or dementia.

Cross-sensitization of pelvic organs is one theory for why symptoms of gut sickness and interstitial cystitis/bladder pain syndrome overlap. Experimental colitis has been shown to trigger bladder hyperactivity and hyperalgesia in rats. The chemokine receptor CXCR4 plays a key role in bladder function and central sensitization. We aim to study the role of CXCR4 and its inhibitor AMD3100 in colon-bladder cross-organ sensitization.