Rejected

Chronic pancreatitis (CP) is an irreversible disease with increased oxidative stress. The therapeutic role of antioxidants for pain reduction in CP is debatable. A systematic review of articles in PubMed and Embase until February 2020 was performed. Only randomized controlled trials conducted on humans to evaluate the therapeutic effects of antioxidants for pain in CP were included. Studies of other design, nonhuman studies, and those that did not objectively assess pain were excluded. Twelve articles and four articles were eligible for qualitative and quantitative analysis, respectively. The four included studies had a total of 352 participants. Pain reduction as measured by a visual analog scale was not significantly different in the antioxidant group compared to placebo (standardized mean difference = -0.14 [95% confidence interval [CI] = -0.44 to 0.17]; = 0.38). Number of pain-free participants was also similar (odds ratio [OR] = 1.59 [0.97-2.59]; = 0.06). There was no difference in outcome when comparing different etiologies of CP or age group. The reduction in the number of analgesics used did not differ between both groups. Antioxidants were not associated with increased adverse events (OR = 2.59 [CI = 0.77-8.69]; = 0.12). A qualitative analysis on the effect on quality of life did not suggest any significant improvement with antioxidants. There was no significant pain reduction or change in quality of life in CP patients with use of antioxidants. This makes their routine use in the management of CP questionable. However, further studies may identify a subgroup where they are more useful.

Chronic knee osteoarthritis is a common problem with increasing of the aging population. Pulsed radiofrequency and intraarticular platelet rich plasma injection are well evidenced beneficial modalities for pain alleviation in such groups of patients.

In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables.

The nasolabial cyst is a rare, non-odontogenic, soft tissue cyst that develops submucosally in the anterior nasal floor. This cyst accounts for 0.7% of all non-odontogenic cysts. Bilateral nasolabial cyst represents only 10% of the cases. This cyst originates from the remnants of embryonic nasolacrimal duct tissue. Generally, patients present with swelling and facial deformity and rarely local pain. The definite diagnosis should be based on clinical, radiological and above all histopathologic findings. The treatment is enucleation of the cystic tissue. Following is a case report of a bilateral nasolabial cyst in a 40-year-old woman who presented with a chronic nasal obstruction.

Cervical epidural steroid injections (ESI) are performed either by interlaminar (IL) or transforaminal (TF) approaches; however, there is controversy over which is better for safety and efficacy.

Thunderclap headache (TCH) is an abrupt-onset of severe headache that needs to be thoroughly investigated because the most common secondary cause is subarachnoid hemorrhage (SAH). There has been no consensus guideline regarding the diagnostic workup. This review aims to provide an update on the evaluation of TCH.

Small ruminants are increasing in popularity as production and companion animals in the United States, and among sheep, goats, and camelids there are many disease processes and management techniques that have the potential to result in painful or noxious stimuli. In these species, many medications and therapeutic techniques can be used to reduce or eliminate the long-term consequences of pain. In this second portion of the review, we focus on the application of pain management in these species. These strategies include mono- and multimodal and the use of precision pain management, such as epidural drug administration, regional perfusions, and transdermal applications.

The efficiency of agro pesticides and fertilizers in eliminating pests and scaling up crop yield has motivated farmers to increase their use. Unfortunately, health hazards caused on farmers by these agrochemicals are of growing concern, though not well elucidated. In order to evaluate the effects of occupational exposure to agrochemicals on some key parameters of male farmers' health in Buea Subdivision, Cameroon, a total of 101 men, including 62 farmers using the agrochemicals and a reference population of 39 men not involved in occupational utilization of the agrochemicals, were interviewed on use of protective equipment, exposure symptoms and reproductive health status. Thereafter, serum cholinesterase [acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE)] activities, total antioxidant capacity and reproductive hormones [follicle-stimulating hormone (FSH), luteinizing hormone and testosterone] were assessed. Results revealed that farmers mainly used insecticides followed by fungicides, herbicides and fertilizers, but with inadequate protective measures. The use of agrochemicals resulted in several exposure symptoms including weakness, itches, burning sensation, headache, sneezing, coughing and vomiting, as well as decrease in serum AChE activity when compared to the reference population. The agrochemicals impacted negatively on the farmers' reproductive health as evidenced by increased FSH levels. Taken altogether, these results suggested that exposure to agrochemicals adversely affects farmers' health. Therefore, there is a need to further sensitize the farmers on the use of protective equipment to mitigate the exposure and resulting health hazards.