Rejected

Alcohol consumption in the setting of chronic HCV is associated with accelerated progression towards cirrhosis, increased risk of hepatocellular carcinoma, and higher mortality. This analysis contextualizes how sociodemographic factors, chronic pain, and depression relate to the motivations of individuals with chronic HCV to consume alcohol. We conducted a secondary analysis of baseline data from the Hep ART trial of behavioral interventions on alcohol use among patients with HCV. Alcohol consumption was measured using the Drinking Motives Questionnaire and a novel 6-item measure of pain-related drinking motives. Statistical analyses performed included ANOVA for bivariate analyses and multivariable ordinary least squares linear regression. At study baseline, 181 participants had an average age of 55 years; the majority (66.7%) reported beyond-minor pain and a third (37%) met criteria for depression; drinking motives were higher for individuals with beyond-minor pain (means 9.9 vs 4.6, p<.001) and who met criteria for depression (means 10.9 vs 6.4, p<.001) when using the pain-related drinking motives items. Average pain(coef=1.0410067141<.001) was significantly associated with increased motives to drink to relieve pain in the full baseline model specification controlling for all covariates using ordinary at least squares; depression (coef=7.06; 95% CI 1.32, 12.81; p=.016) was significantly associated with increased non-pain-related motives to drink. From baseline to 3 months follow up, compared to participants who had mean average pain scores among the sample, motives to drink to relieve pain decreased in participants who had higher average pain scores (coef=-0.30; 95% CI -0.59, -0.01; p=.40). Physical pain and depression are associated with increased motives to consume alcohol. Patients with chronic liver disease should be screened for chronic pain and depression, and if present, referred to pain specialists or co-managed in partnership with pain specialists in hepatology clinics.

Magnetic resonance imaging (MRI) is currently the most accurate imaging tool used in axial spondyloarthritis regarding its diagnostic approach. MRI of the spine and sacroiliac joints (SIJ) might be relevant in the follow-up of axial spondyloarthritis for difficult cases, provided that its validity and correlation with clinical, biological and functional outcomes is ascertained. The aim of this study was to assess the effect of TNF alpha inhibitors (TNFi) on MRI scoring of inflammation on spine and SIJ and to evaluate their correlation with the parameters used in daily practice.

If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post-dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post-dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post-dural puncture headache. The level of evidence for these recommendations was low.

A 41 year-old woman presented to the Emergency department (ED), in October 2020, with holocraneal headache worsened by position changes and fever up to 37,7ºC, that started the 12 prior hours. She had no medical history of cephalea, visual loss or traumatic brain injury, not other secondary causes of CSF fistula. The patient had completed a nasal RT-PCR COVID-19 testing in March 2020 which came back negative. One week after, she developed unilateral continuous rhinorrhea with metallic taste. She was then diagnosed of allergic rhinitis by her general practitioner, who prescribed antihistaminics and a short-term antibiotherapy (Amoxicillin-Clavulanic), with no resolution of the symptoms. In July 2020 a nasal drainage tested positive for β2-transferrin and a head-CT was performed identifying a cerebrospinal fluid (CSF) fistula at the lamina cribrosa.

Breakthrough pain (BTP) is an important challenge in treatment and requires a rapid onset of action for pain control. BTP should be adequately controlled with a stable dose of a short-acting oral opioid. So far, no drug is available for the treatment of BTP in cancer patients in Iran, so we designed the first study in Iran to investigate the effect of sublingual fentanyl in relief of pain episodes in these patients.

One of the most common malignancies in women worldwide is breast cancer. Erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy for breast cancer. The duration of nerve block analgesia is limited if local anesthetic agents are used alone. The purpose of this study was to evaluate the effect of dexmedetomidine on postoperative analgesia during a single injection of local anesthetics.

Few treatments are available for patients with idiopathic hypersomnia (IH). Modafinil, an established treatment for narcolepsy, was tested for efficacy and safety in Japanese patients with IH without long sleep time.

Carotid artery dissection is an important cause of stroke, especially in the young. We present a 43-year-old lady, with a known background of headaches, who was referred to the Emergency Department with a headache, dilated pupil, and acute monocular blurring of vision. She was later found to have an internal carotid artery dissection (ICAD) with diffuse ipsilateral hemispheric involvement after being initially managed for atypical optic neuritis. This case report aims to provide further insight into an atypical presentation of a carotid artery dissection, with the intent of assisting the clinician in identifying such cases during the initial presentation.

Epiploic appendagitis is an unusual and very commonly overlooked source of acute abdominal pain. Its incidence is highest in middle-aged obese males. It presents clinically as a focal lower quadrant abdominal pain, usually in the absence of pyrexia, nausea, vomiting or change in bowel habit, and unremarkable laboratory markers. Due to its vague presentation, epiploic appendagitis may be mistaken for other more severe causes of acute abdominal pain like diverticulitis and appendicitis, thereby causing patients to undergo unwarranted management interventions and hospital stay. Epiploic appendagitis is usually diagnosed through imaging, most commonly computed tomography (CT). This condition is largely self-resolving and can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). Operative intervention is usually employed when symptoms persist or when complications arise. We present a case of epiploic appendagitis in a patient who presented with right lower quadrant pain initially misdiagnosed as acute appendicitis.