Rejected

Pheochromocytoma and paraganglioma are neuroendocrine tumors that occur less commonly among children compared to adults. The excess catecholamines secreted by the tumor cells result in hypertension, tachycardia, excess sweating, and headache. Other symptoms include abdominal pain or distension caused by the adrenal mass. Here, we report a case of pheochromocytoma arising from the left adrenal medulla in a 14-year-old boy, which was exclusively secreting norepinephrine, as suggested by elevated plasma and 24-hour urinary norepinephrine and its metabolite normetanephrine. The epinephrine and its metabolite metanephrine were within normal limits. He presented with abdominal pain, recurrent vomiting, and headache and was noted to have elevated blood pressure. He underwent adrenalectomy after controlling his blood pressure with an alpha-blocker Prazosin. His blood pressure remained stable after surgery, and his plasma-free metanephrines returned to normal limits. He tested negative for hereditary paraganglioma-pheochromocytoma gene panel.

This study reports on the prevalence and impact of pain in individuals with different chronic respiratory diseases attending pulmonary rehabilitation (PR). A retrospective review of medical records data was conducted for 488 participants who had attended a PR programme over a 2-year period. Data on pain and medication history taken from multidisciplinary medical records, together with participant demographics and PR outcomes, were extracted. We compared pain among participants with different types of chronic respiratory disease. The overall prevalence of pain was 77%, with a significantly higher prevalence among individuals with obstructive lung diseases (80%) compared with restrictive lung diseases (69%;  = 0.04). Some participants (17%) who took pain medications did not discuss pain with their clinicians. The presence of pain and different reporting of pain did not have a negative impact on the PR programme completion rate ( = 0.74), improvements in exercise capacity ( = 0.51), or health-related quality of life (all four chronic respiratory disease questionnaire domains, >0.05). The prevalence of pain is high among individuals with chronic respiratory disease attending PR. The presence or absence of pain was not negatively associated with the programme completion rate or PR outcomes; therefore, pain should not deter clinicians from referring patients to PR.

Benign bone tumors are commonly treated with intralesional curettage and bone graft, with autogenous bone graft being the gold standard. However, autogenous bone graft has its limitation, and artificial bone graft substitutes were developed as an alternative. PRO-DENSE™ (Wright Medical Technology, Arlington, Tennessee) is a calcium sulfate and calcium phosphate mixed bone graft substitute that is biodegradable and osteoconductive, which has made them a popular choice among surgeons. However, long-term studies of this treatment method for benign tumors are still limited. In this report, we present a case of progressive femoral neck osteolysis caused by an inflammatory reaction to PRO-DENSE™ two years after intralesional curettage and bone grafting of a benign bone tumor.  A twenty-one-year-old female with fibrous dysplasia underwent intralesional curettage with the use of PRO-DENSE™ bone substitute to fill the cavitary defect. She developed an inflammatory reaction to the bone graft substitute leading to increasing pain and osteolysis requiring a reoperation. Bone graft substitute has many advantages; however, they should be used with discretion due to many unknown regarding their safety and long-term outcomes.

Chronic shoulder pain occurs rarely after a vaccination and is hypothesized to arise from the effects of unintentional vaccine injection into the subacromial bursa, rotator cuff, capsule or underlying bone. The avascular nature of the rotator cuff, as well as unknown genetic and environmental factors, may predispose to the persistence of pain and disability, referred to as vaccination-related shoulder dysfunction and shoulder injury related to vaccine administration (SIRVA).

The study contributed to filling a knowledge gap in the area of intimate partner violence (IPV). Previous studies conducted in Ghana have investigated the causes and types of IPV, leaving a gap on the consequences the violence had on the victims. Using a population of local economic migrants (hereafter, head-load carriers), a qualitative design with emphasis on phenomenology was employed to investigate the effects of IPV on 20 head-load carriers in two major cities in Ghana (Kumasi and Accra). The analysis performed on the data, using interpretive phenomenological analysis, revealed that IPV affected the head-load carriers' health, employment, and human relationships. Each of the participants spoke of one or more health complications, which they attributed to IPV. Among the health-related effects reported by the head-load carriers were body pains, wounds, depression, suicide ideation, headache, and abdominal pains that resulted from the termination of an unwanted pregnancy. All the head-load carriers recounted the detrimental outcomes of IPV on their job and human relationships. After they had experienced IPV, some of the victims could not go to work due to fear of stigmatization and those who were able to could not work as they usually do due to severe pain. At their workplace, some of the IPV victims became aggressive toward customers and coworkers, whereas others remained isolated. These negatively impacted on their human relationship skills and earnings. Based on the findings, there is the need for policies that seek to address IPV to consider the effects on victims' employment, earning, and behavior.

Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.

This is the first report of reversible cerebral vasoconstriction syndrome (RCVS) as a complication of a SARS-CoV-2 vaccination. A 38-year-old female developed visual impairment due to scotomas and thunderclap headache 18 days after the second shot of the Moderna SARS-CoV-2 vaccine. Multimodal cerebral MRI revealed an acute cortical ischemic lesion in the territory of the right posterior cerebral artery (PCA) on T2-weighted images, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) maps and absence of the PCA on magnetic resonance angiography (MRA). RCVS was diagnosed as the cause of the ischemic lesion. RCVS partially resolved upon nimodipine and anti-seizure drugs within nine days. In conclusion, this case shows that a SARS-CoV-2 vaccination can be followed by RCVS, manifesting as headache, stroke, and epileptiform discharges, and responding favorably to nimodipine.

Electrodermal activity (EDA) has been found to be a highly sensitive, accurate and non-invasive measure of the sympathetic nervous system's activity and has been used to extract biomarkers of various pathophysiological conditions including stress, fatigue, epilepsy, and chronic pain. Recently, various robust signal processing techniques have been developed to obtain more reliable and accurate indices that capture the meaningful characteristics of the EDA using data collected from laboratory-scale devices. However, EDA also has the potential to monitor such physiological conditions in active ambulatory settings, for which the developed tools must be deployed in wearable devices. In this paper, we studied the feasibility of obtaining the highly-sensitive spectral indices of EDA using a wearable device. EDA signals were collected from left hand fingers using a wearable device and a laboratory-scale reference device, while N=18 subjects underwent the Head up Tilt test and the Stroop test to stimulate orthostatic and cognitive stress, respectively. We computed two time-domain indices, the skin conductance level (SCL) and nonspecific skin conductance responses (NS.SCRs), and two spectral indices, the normalized sympathetic components of the EDA (EDASympn), and the time-varying EDA index of sympathetic control (TVSymp). The results showed similar performances for EDASympn and TVSymp indices across both devices. While spectral indices obtained from both devices performed similarly in response to orthostatic and cognitive stress, time-domain exhibited large variation when obtained by the wearable device. Further research is required to develop and refine such devices, as well as the indices used to analyze EDA results.Clinical Relevance- This study proves the feasibility of obtaining spectral indices of EDA using a wearable device, which can be used to develop wearable tools to detect pain, stress, fatigue, between others.

: Gait impairment has been associated with neck pain. It is relevant to understand the possible influence of narrow-based walk and an attention-demanding secondary task on gait performance in neck pain.: To investigate the effects of tandem walk and cognitive and motor dual-tasks on gait speed in persons with chronic idiopathic neck pain (CINP) compared with controls.: A cross-sectional study. Thirty participants with CINP and 30 asymptomatic controls participated in the study. Gait speed was assessed using a timed 10-m walk test at a comfortable pace under four conditions: (1) comfortable walk (as reference); (2) tandem walk (single task); (3) cognitive dual-task walking; and (4) motor dual-task walking. Dual-task interference was calculated.: There was no difference in comfortable gait speed between groups (= 0.40). The CINP group had slower gait speed during the tandem walk than controls (= 0.02). The dual-task interference on gait speed was not different between groups ( = 0.67 for cognitive, = 0.93 for motor).: Participants with CINP had impaired gait stability during tandem walk. An attention-demanding secondary task did not influence gait speed in individuals with CINP compared to controls. The study suggests that tandem walk could be considered as an assessment tool and part of rehabilitation for neck pain.

To determine the involvement of the endocannabinoid (EC) family member in the pathophysiology of endometriosis (EMS).