Rejected

Chronic kidney disease (CKD)-associated pruritus (CKD-aP) is an underdiagnosed yet severely distressing condition that impacts 60% of patients on dialysis and many nondialysis patients with Stages 3-5 CKD. However, despite its high prevalence, there are currently limited treatment options available for these patients and a lack of treatment guidelines for clinicians. In this manuscript, we reviewed the available literature in order to evaluate the current management and treatment options for CKD-aP, including dialysis management, topical treatments, gabapentinoids, opioids and alternative medicine. We also review the available data on CKD-aP treatments in development and propose new guidelines for managing patients with CKD-aP.

, a ayurvedic medicinal plant reported for its valuable effects in various diseases. It has shown significant effects in type 1 and type 2 diabetes.

This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings.

Entrustable professional activities (EPAs) allow tasks to be delegated to trainees. A new model of pharmacy placements was developed that used EPAs to appropriately supervise students providing patient counselling for inhalers, anticoagulation and simple analgesia at a tertiary care hospital. Students were provided with clinical communication training (e.g. how to do the counselling) as well as mandatory occupational training (e.g. fire safety). Data was collected (by students and placement facilitators) relating to the number of consultations ( = 1361) and patients who received counselling ( = 308) carried out by students ( = 71) over a 20 week period. Students documented these consultations, recording information such as the patient identification details, subjective and objective history, their assessment of the patients' need, as well as any action taken and any further planned action that was required. These notes were analysed using a Quality and Utility Assessment Framework by three clinical pharmacists. Data was analysed using simple descriptive statistical analysis on Microsoft Excel. Documentation was deemed High Quality (41%), Medium Quality (35%) and Low Quality (24%). The results indicate that pharmacy students can use entrustable professional activities to contribute to clinical services, completing high-quality patient consultations that have utility in clinical practice. Further work is needed to evaluate impact on clinical service delivery and establish the educational utility of using EPAs to support the pharmacy workforce to develop their consultation skills.

Side-effects are frequently encountered in classic chemotherapy. However, the recent development of targeted treatments has resulted in a diminution of these. The most common side-effects are dermatological.

Colitis describes inflammation in the colon and is classified into defined diseases: Inflammatory bowel disease (IBD), Microscopic colitis, Ischemic colitis and Infectious colitis. The clinical significance of non-specific colitis is unclear as there are limited analysis which report the issue. Notteghem et al. (1993) showed that of 104 patients with non-specific colitis, 52.3% had another episode of symptoms within 3 years. Of these patients 54% were diagnosed with ulcerative colitis, 33% with Crohn's disease, and 13% remained unclassified, suggesting that non-specific colitis could be undiagnosed IBD. The objective of this analysis is to determine the clinical course of non-specific colitis through colonoscopy and histologic findings.

Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. The present study describes an approach that preserves all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the 1-to-2 portal and instrumentation through the 3-to-4 portal. The rest of the procedure is straightforward: curettage and bone grafting are performed through this specific approach, similarly to other techniques. This an easy and accurate approach that avoids any damage to the major cartilage surfaces of the lunate, with easy and reliable access to the intraosseous lunate bone ganglion, allowing cyst curettage and autologous bone graft in a proper and noninvasive way.

Urinary bladder is the most common urologic organ exposed to iatrogenic injury. The bladder trauma is classified into extra-peritoneal, intra-peritoneal, or combined trauma. Intra-peritoneal bladder injury is conventionally being treated with open surgical repair, mainly to explore the abdominal viscera for possible associated injuries and to insert peritoneal drain. One rare form of the iatrogenic bladder injury is catheter-related bladder injury which is very uncommon and only few cases were reported. It is mainly related to other associated medical conditions like cancer and chronic catheterization which might be causing subsequent bladder wall weakness. Therefore, it is important to collect more data about this rare type of bladder injury, particularly urethral catheterization which is one of the most common medical procedures. We present a 74-year-old male patient who developed acute kidney injury and was treated by urethral catheterization in the emergency department. The patient developed immediately severe abdominal pain. Non-contrast CT showed intra-peritoneal bladder perforation by the urethral catheter. The patient developed peritonitis and failed a trial of conservative management. Consequently, laparoscopic abdominal exploration and bladder repair was performed successfully.

Chronic kidney disease-associated pruritus (CKD-aP) is a potentially distressing condition that affects a significant proportion of patients with end-stage kidney disease undergoing dialysis. CKD-aP may lead to worsening of patients' physical and mental health-related quality of life (HRQoL) and has also been linked with worse clinical outcomes, including increased mortality. Despite these detrimental effects, evidence from real-world studies shows that CKD-aP still remains overlooked by nephrologists and underreported by patients in clinical practice. Itch is subjective and therefore its diagnosis is often dependent on patients reporting this symptom. There is an opportunity to reduce the burden of CKD-aP on dialysis patients by increasing awareness about this condition and the availability of effective treatments. It is particularly important that nephrologists and other healthcare providers routinely ask their patients if they are experiencing itch. The differential diagnosis of CKD-aP requires a step-by-step identification and exclusion of possible alternative or concomitant causes of itch. Several simple validated self-reported assessment scales are available to evaluate the presence and severity of itch in a time-efficient manner, making them suitable for use in everyday clinical practice. The impact of CKD-aP on haemodialysis patients' HRQoL should also be assessed on a regular basis. This review provides a comprehensive overview of the differential diagnosis of CKD-aP and the diagnostic tools that are available to identify itch and quantify its severity and impact on patient HRQoL. A suggested algorithm to guide the screening, diagnosis and assessment of CKD-aP among dialysis patients in real-world practice is provided.

Some wounds, particularly chronic, infected and neoplastic wounds, in addition to causing pain, damage the person's self-image, particularly when they are malodorous. For the patient himself, for their relatives and for the professionals responsible for their care, these malodorous wounds penalise the relationship and even the care. They are a source of isolation and can have severe effects on the patient. However, solutions do exist.