Rejected

Osteoarthritis of the thumb base is the second most prevalent arthritis of the hand. Management is primarily conservative, consisting of analgesia, splinting, physiotherapy, and steroid injections. Surgery is considered when conservative measures fail. The primary objective was to assess the safety and efficacy of the surgical interventions and therein, evaluate whether any superiority exists among the available interventions. Efficacy was evaluated by examining four parameters: pain, function, range of movement and strength of the joint postoperatively. Safety was determined by comparing the rate and severity of postoperative complications. A systematic search of MEDLINE (2014-2019), EMBASE (2014-2019), CINAHL (2014-2019) and CENTRAL (2014-2019) databases was carried out. Abstracts were screened for relevant studies. Randomised controlled trials were only considered. Eight studies were included in the quantitative synthesis. The procedures evaluated are: Trapeziectomy (T), trapeziectomy with ligament reconstruction (T + LR), trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI), trapeziectomy with allograft suspension (T + ALS) and joint arthrodesis (A). Low-moderate quality evidence suggests that T + LRTI yields better range of movement (palmar abduction) when compared with (T) alone; (SMD 0.61, 95% CI 0.22 to 1.00, random-effects, = 0.002). Comparing adverse events showed that arthrodesis carries a greater risk of adverse events when compared with T + LRTI; (RR 0.33, 95% CI 0.17 to 0.61, random-effects, = 0.0005). In addition, T + LRTI is preferred over arthrodesis by patients (OR 0.29 95% CI 0.09 to 0.95; = 0.04). This difference was no seen in the other comparison groups. It is difficult to declare with any degree of certainty which procedure offers the best functional outcome and safety profile. Results suggest T + LRTI yields good postoperative range of movement. Arthrodesis demonstrated an unacceptably high rate of moderate-severe complications and should be considered with careful consideration.

The aim of the study was to examine the short-term changes of elastic adhesive tape application on pain intensity and the range of motion (ROM), cervical region proprioception sense, and cervical flexor endurance of patients with chronic neck pain.

This prospective study aimed to investigate the role of migraine in favouring the onset of persistent postural perceptual dizziness (PPPD) following paroxysmal positional vertigo (PPV).

: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) range from asymptomatic infections to multiple organ failure and death. Among the organs affected is the heart. This does not only affect people who already have previous cardiovascular problems, but also healthy people. This is a reason not to overlook any symptoms or to perform targeted examinations, even if apparently unrelated to the heart, for quick recognition and timely therapy. : This review recapitulates the current state of knowledge on the potential mechanisms and manifestation of myocarditis in patients with COVID-19 infection. : A web-based search of published data was performed for all relevant studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were included. The analysis of the studies evaluated highlights a male predominance, with the average age of patients being 55 years. The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. Finally, we wanted to use a general evaluation without distinguishing between various countries, taking into consideration only the peer or reviewer, regardless of the declared value of the journals that have been published. and critical findings: The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. In most patients, elevated levels of cardiac and inflammatory biomarkers were measured. Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of myocarditis with features of cardiac edema and cardiac injury. Nine patients underwent histopathological examination. Treatment with corticosteroids and immunoglobulins was the most applied strategy following the administration of antivirals. : Despite the exponentially growing knowledge on the management of COVID-19 infection, current available data on SARS-CoV2-correlated myocarditis are still limited, and several difficulties may be encountered in the differential diagnosis of acute myocarditis in the context of COVID-19 disease. : While diagnostic criteria and evaluation strategies for myocarditis are well described, no guidelines for the diagnosis and treatment of myocarditis in COVID-19 patients have yet been established. Therefore, further research is needed to advance the understanding of this disease process and define the most appropriate strategic approach in these patients.

A 72-year-old male with a history of chronic lymphocytic leukemia (CLL) was admitted to hospital with a productive cough and an episode of diarrhea and vomiting. He was initially treated for pneumonitis and sepsis. On the 12th day of his admission, he reported chest pain. Changes on his electrocardiogram were suggestive of myocardial ischemia and an elevated troponin rise was detected from his blood tests. A diagnosis of acute coronary syndrome was made but due to his frailty, he was medically managed. His echocardiogram revealed an external echogenic mass which invaded the anterolateral left ventricular wall. Further imaging with cardiac magnetic resonance imaging (MRI) and computed tomography (CT) thorax demonstrated external encasement of left circumflex coronary artery with mediastinal mass, leading into downstream myocardial ischemia and subsequent necrosis. He was considered suitable for aggressive radiotherapy/chemotherapy but passed away 7 days later. This case highlights the unusual case where an acute myocardial infarction can be attributed to direct infiltration and external compression of coronary artery by mediastinal tumor and the value of multi-modality imaging (echocardiogram, CT, and MRI) in identifying the cause of myocardial ischemia in patients with CLL in the end stages of the disease. < It is unusual that acute coronary syndrome is caused by direct tumor infiltration and obstruction of a major epicardial vessel. This case highlights the interesting and unusual scenario where tumor growth results in complete occlusion of the obtuse marginal coronary artery in a patient with chronic lymphocytic leukemia. By using multi-modal imaging, we were able to characterize the lesion and the coronary involvement.>.

This article provides an overview of a diverse group of primary headache disorders that are categorized in the International Classification of Headache Disorders, 3rd Edition (ICHD-3), as "other primary headache disorders." This article provides clinicians with a distilled understanding of the diagnoses and their epidemiology, pathophysiology, and management.

Data regarding the analgesic effects of melatonin after the surgery is scare. So far, only one study has investigated the analgesic effect of melatonin during cesarean section. : The present study was performed to investigate the effect of preoperative oral melatonin on pain intensity after cesarean section during spinal anesthesia.

To compare the onset, duration and depth of anesthesia, postoperative pain, duration of analgesia and adverse reaction between 0.5% ropivacaine and 2% Lignocaine hydrochloride with adrenaline (1:80,000) in 40 patients having bilaterally impacted mandibular third molars.

Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulness-based cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms.

Colonic ischemia is the most common form of gastrointestinal ischemia, which frequently affects the elderly population. The diagnosis and treatment can be challenging since it is prevalent in patients who are debilitated and have multiple comorbidities. However, most cases remain undetected until further complications emerge. Some of these patients will develop prolonged complications like chronic ischemic colitis or stricture requiring surgical intervention. Here we present a case of a colonic stricture secondary to recurrent ischemic colitis in an elderly female patient with multiple medical problems.