Rejected

The crisis of prescription opioid addiction in the USA is well-documented. Though opioid consumption per capita is lower in the UK, prescribing has increased dramatically in recent decades with an associated increase in deaths from prescription opioid overdose. At one Scottish Emergency Department high rates of prescribing of take-home co-codamol (30/500 mg) were observed, including for conditions where opioids are not recommended by national guidelines. An Implementation Science approach was adopted to investigate this.

Older adults with concurrent low back and hip pain are predisposed to reductions in physical performance and health-related quality of life. Yet no study to date has assessed whether or not coexisting hip impairments increase fall risk in older adults with chronic low back pain (CLBP). The objective of this study was to determine if hip osteoarthritis (OA) signs and symptoms per American College of Rheumatology (ACR) criteria are associated with fall risk over a 1-year span.

Pheochromocytoma is a rare, often undiagnosed adrenal tumor that typically presents in early adulthood and is characterized by intermittent surges of catecholamines. While this "Great Mimic" may present with a variety of vague complaints such as headache, abdominal pain, or palpitations, it may also appear as a severely hypertensive patient with multi-organ failure and cardiopulmonary collapse known as pheochromocytoma crisis. Management of hypertensive emergency in these patients is unique, and the associated metabolic derangements, coagulopathy, thromboembolic events, and risk of adrenal capsule rupture add significant complexity, morbidity, and mortality to these cases. Emergency providers should learn when to suspect this uncommon but life-threatening diagnosis in order to properly manage these potentially critically ill patients.

Atopic dermatitis (AD) is a chronic allergic inflammatory skin disease characterized by complex pathogenesis including skin barrier dysfunction, immune-redox disturbances, and pruritus. Prolonged topical treatment with medications such as corticosteroids, calcineurin inhibitors, and T-cell inhibitors may have some potential side-effects. To this end, many researchers have explored numerous alternative therapies using natural products and mineral compounds with antioxidant or immunomodulatory effects to minimize toxicity and adverse-effects. In the current study, we investigated the effects of mineral complex material (MCM) treatment on 2, 4-dinitrochlorobenzene (DNCB)-induced AD-like skin lesions in SKH-1 hairless mice.

Background Preventive strategies in the form of early identification and isolation of patients are the cornerstones in the control of COVID-19 pandemic. We have conducted this study to develop a clinical symptom-based scoring system (CSBSS) for the diagnostic evaluation of COVID-19.  Methods In this study, 378 patients presenting to screening outpatient clinic with clinical suspicion of COVID-19 were evaluated for various clinical symptoms. Statistical associations between presenting symptoms and reverse transcription-polymerase chain reaction (RT-PCR) results were analysed to select statistically significant clinical symptoms to design a scoring formula. CSBSS was developed by evaluating clinical symptoms in 70% of the total patients. The cut-off score of the CSBSS was determined from ROC (receiver operating characteristics) curve analysis to obtain a cut-off for optimum sensitivity and specificity. Subsequently, developed CSBSS was validated in the external validation dataset comprising 30% of patients. Results Clinical symptoms like fever >100F, myalgia, headache, cough and loss of smell had significant association with RT-PCR result. The adjusted odds ratios (95% confidence interval [CI]) for loss of smell, fever >100°F, headache, cough and myalgia were 5.00 (1.78-13.99), 2.05 (1.36-3.07), 1.31 (0.67-2.59), 1.26 (0.70-2.26) and 1.18 (0.50-2.78), respectively. The ROC curve and area under the curve of development and validation datasets were similar. Conclusion The presence of fever >100°F and loss of smell among suspected patients are important clinical predictors for the diagnosis of COVID-19. This newly developed CSBSS is a valid screening tool that can be useful in the diagnostic evaluation of patients with suspected COVID-19. This can be used for the risk stratification of the suspected patients before their RT-PCR results are generated.

Chronic migraine is a condition with gradually increasing prevalence among adolescents which causes severe headaches resulting in functionality loss. Factors contributing to migraine becoming chronic and negatively affecting quality of life in adolescence are still unclear. Parallel with these, we aimed to examine the effect of psychiatric symptoms on headache severity and functionality loss among adolescents with chronic migraine.

Fever is one of the frequent reasons for admission to the emergency department. Studies comparing oral forms of non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol with intravenous (IV) forms for fever are common in the literature. Our study is the first emergency department study comparing IV forms of ibuprofen and paracetamol in the treatment of febrile patients.

Non – pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH.

Numerous patients receive acute migraine care in the Emergency Department (ED) setting. A shift of this care to the outpatient Neurology Clinic and outpatient Infusion Center setting has the potential to optimize clinical management while decreasing resource utilization.

In the present study we aimed to investigate the effects of nano-curcumin supplementation on gene expression and serum levels of IL-4 and TGF-β in migraine patients. Forty participants with episodic migraine were randomly allocated to receive 80 mg nano-curcumin ( = 20) or placebo ( = 20) in a randomized double-blind clinical trial for two months. At the beginning and the end of the study, the interictal serum levels and gene expression of IL-4 and TGF-β in peripheral blood mononuclear cells (PBMCs) isolated from migraine patients were measured, using ELISA and real-time PCR methods, respectively. Intra-group assays showed a significant rise in the gene expression of both IL-4 and TGF- β ( < 0.05) in nano-curcumin group after two months of treatment, however the serum levels was only significantly changed for IL-4 ( < 0.05). On the contrast, inter-group assays revealed no statistical differences between nano-curcumin and placebo group in terms of IL-4 and TGF-β gene expression, while the serum levels of IL-4 was observed to be increased significantly ( 0.03) following two month nano-curcumin supplementation. The findings of the present trial suggest that the treatment with nano-curcumin could induce significant levels of IL-4, in favour of anti-inflammatory effects, while has a minimal effects on the both gene expression and serum levels of TGF-β. Further studies are required to determine the exact mechanism of action of curcumin in patients with migraine.