Rejected

Copaifera species folkloric names are "copaíbas, copaibeiras, copaívas or oil stick", which are widely used in Brazilian folk medicine. Among all ethnopharmacological applications described for Copaifera spp oleoresins, their anti-inflammatory effect stands out. However, the knowledge of anti-inflammatory and antinociceptive properties of Copaifera pubiflora Benth is scarce.

Topical pain relief products differ in the type of drug, concentration, and formulation. All these factors influence the drug transit through the skin barrier, and its eventual retention in the skin as a reservoir for subsequent release. In addition, the drug potency can be different, which is important for the product efficacy. We studied here ex vivo human skin permeation and retention of five over-the-counter NSAID gels containing 2.32% diclofenac (DIC) and 5-10% etofenamate (ETF). The potency of the permeated/retained drug amounts were compared using a composite parameter, the Index of Relative Topical Anti-inflammatory Activity (IRTAA), which is calculated as the product of the skin permeation/retention and the drug relative potency. The IRTAAs of the DIC gel were 94 – 667-fold higher and 72 – 208-fold higher for transdermal delivery and skin retention, respectively, than IRTAAs of the ETF gels. These superior IRTAAs indicate that DIC delivered by this topical formulation would achieve a higher bioactivity and would form a potent drug reservoir relevant for its subsequent long-lasting release.

A carotid body tumor (CBT) is a rare highly vascular tumor. Therefore, the assessment of the tumor's vessels preoperatively is significant to decrease the risk of vascular complications intraoperatively. We report a case of carotid body tumor in a 40-year-old female who presented with a headache and a pulsatile right neck mass. She underwent computed tomography (CT), which demonstrated a well-circumscribed tumor mass measuring 3 X 2.7 X 3.6 cm. Preoperatively, selective embolization was performed in which Onyx 18 (Medtronic, Dublin, Ireland) and precipitating hydrophobic injectable liquid (PHIL) 25% (Microvention Inc, California) were used, and that achieved 95% embolization of tumor blood supply. One day after embolization, complete surgical resection was done by a multidisciplinary team.

Epidural analgesia is an efficient method of controlling pain and has a wide spectrum of therapeutic and diagnostic applications. Potential complications may occur in a delayed fashion, can remain undiagnosed, and can be a source of significant morbidity. We present a 37-year-old woman presented with severe spontaneous occipital headaches, diplopia, and dizziness that occurred spontaneously six weeks after giving birth. Her primary method of pain control during labor was epidural analgesia. Her neurologic exam revealed a cranial nerve six palsy with ptosis, and her brain MRI demonstrated a Chiari I malformation which had not been previously diagnosed. CT myelography of the lumbar spine revealed extradural contrast extravasation within the interspinous soft tissue at L1-L2, which was the site of her prior epidural procedure. She underwent epidural blood patch administration, and her cranial nerve palsy resolved along with all of her other symptoms. The development of concurrent Chiari I malformation and cranial nerve palsy after epidural anesthesia is an exceptionally rare occurrence. Neurologic complications after epidural anesthesia are likely under-reported, since patients are often lost to follow-up or have subtle neurologic signs which can easily be missed. This frequently delayed presentation emphasizes the importance of patient education and the necessity of a detailed neurological exam when symptoms occur.

Neuropathic pain is a debilitating condition caused by lesion or disease of the somatosensory nervous system. Integrative modalities such as yoga, acupuncture, and massage are evidenced therapies for pain management. Additionally, medical cannabis and cannabinoids are emerging therapies for treatment of neuropathic pain (4,28). The authors of this study report a case of chronic neuropathic pain treated with integrative interventions.

Spinal pain due to facet joint disease is difficult to diagnose since the clinical history and physical examination findings are usually nonspecific. Facet joint disorders have a wide range of causes and, because of the potential for chronic back pain and disability, an accurate diagnosis is essential. The most frequent cause of pain in facet joints is osteoarthritis, which can be assessed at radiography, CT, or MRI. Ganglion and synovial cysts of the facet joints can cause compressive symptoms of adjacent structures, especially radiculopathy, lower back pain, and sensory or motor deficits. In ankylosing spondylitis, imaging findings of the facet joints are useful not only for diagnosis but also for monitoring structural changes. In septic arthritis of the facet joints, an early diagnosis at MRI is essential. Gout and metabolic diseases are best evaluated at dual-energy CT, which allows the depiction of crystals. Traumatic dislocations of facet joints are usually unstable injuries that require internal reduction, fixation, and fusion and can be well assessed at CT with three-dimensional reconstructions. Facet joint neoplasms like osteoid osteoma, plasmacytoma, tenosynovial giant cell tumor, and osteochondroma are best evaluated at CT or MRI. The authors provide an overview of key imaging features of the most common facet joint disorders along with anatomic tips and illustrative cases. Acknowledging key imaging findings for the differential diagnosis of facet joint disorders plays a crucial role in the diagnostic accuracy and proper treatment approach for such entities. RSNA, 2021.

This case report describes a 65-year-old female with iatrogenic opioid use disorder for chronic lower back pain, who developed Takotsubo cardiomyopathy on multiple occasions following buprenorphine induction. This patient had three opioid transfers to buprenorphine, over 4 years, two of which were complicated by Takotsubo cardiomyopathy. In the transfer where she did not develop Takotsubo cardiomyopathy, she was treated with high doses of the centrally acting agonist, clonidine (three times a day, total of 600 mcg/day), up to and including the day of her transfer. This case highlights the potential consequences of a precipitated withdrawal with buprenorphine in an opioid transfer and its possible prevention with clonidine. To our knowledge, this is the first description of the recurrent Takotsubo cardiomyopathy in an opioid transfer setting. Given that buprenorphine is a partial agonist, in the presence of a full opioid agonist, it can precipitate withdrawal within minutes to hours of its administration. Opioid withdrawal can result in a sympathetic overdrive. Although complications of opioid withdrawal are extensively documented, cardiotoxicity is uncommon. As the use of buprenorphine and its new injectable formulations rise, it is important for prescribers to be aware of this life threatening complication. The prophylactic administration of clonidine can be considered to reduce the risk of cardiotoxicity, as well as manage opioid withdrawal symptoms.

Constipation is a common problem in children with spastic cerebral palsy (sCP) with a prevalence that reaches 75%. We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care. Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP.

With their potent anti-inflammatory effects, corticosteroids are popular adulterants in illicit health products for allergies, dermatitis and pain control. Their illegal supply over the counter is also a common practice for similar conditions. Prolonged, unsupervised usage of corticosteroids often leads to severe adverse effects including Cushing syndrome, adrenal insufficiency and immunosuppression. Confirming clinical suspicion of unsupervised corticosteroid usage is challenging. Apart from evaluating the adrenal function, identifying the concerned drug is the most direct proof of its consumption. While detecting corticosteroids or their metabolites in biological specimens is convincing evidence of their usage, such approach is analytically difficult. More importantly, this approach would not be useful if the patient has stopped taking the drug for some time-a situation that is often encountered clinically. We advocate a more direct approach by measuring corticosteroids in suspicious medicinal products. In the current study, a liquid chromatography-tandem mass spectrometry method for simultaneous detection of 28 corticosteroids in pharmaceutical and proprietary Chinese medicine products was developed and validated for the purpose. The method was applied to 388 cases of suspected unsupervised corticosteroids usage. Among 1,000 products tested, corticosteroids were found in 276 of them and confirmed the clinical suspicion.

Cholesteatomas are benign tumors mainly composed of cholesterol crystals that rarely arise within the orbit. However, orbital cholesteatomas require a complete surgical resection due to their recidivating potential. Transcranial approaches offering a broad surgical exposure of the orbital cavity have been scarcely used for the management of these tumors. Here, we provide evidence of the benefits of the pterional craniotomy for the surgical resection of orbital tumors by sharing our experience in the surgical management of a cholesteatoma of the superotemporal orbital wall.