Rejected

The distribution of individual heart disease differs among women and men and, parallel to this, among particular age groups. Women are usually affected by cardiovascular disease at an older age than men, and as the prevalence of comorbidities (like diabetes or chronic pain syndromes) grows with age, women suffer from a higher number of symptoms (such as pain and breathlessness) than men. Women live longer, and after a husband or partner's death, they suffer from a stronger sense of loneliness, are more dependent on institutionalized care and have more unaddressed needs than men. Heart failure (HF) is a common end-stage pathway of many cardiovascular diseases and causes substantial symptom burden and suffering despite optimal cardiologic treatment. Modern, personalized medicine makes every effort, including close cooperation between disciplines, to alleviate them as efficiently as possible. Palliative Care (PC) interventions include symptom management, psychosocial and spiritual support. In complex situations they are provided by a specialized multiprofessional team, but usually the application of PC principles by the healthcare team responsible for the person is sufficient. PC should be involved in usual care to improve the quality of life of patients and their relatives as soon as appropriate needs emerge. Even at less advanced stages of disease, PC is an additional layer of support added to disease modifying management, not only at the end-of-life. The relatively scarce data suggest sex-specific differences in symptom pathophysiology, distribution and the requisite management needed for their successful alleviation. This paper summarizes the sex-related differences in PC needs and in the wide range of interventions (from medical treatment to spiritual support) that can be considered to optimally address them.

A 63-year-old male receiving hemodialysis for renal insufficiency developed severe and widespread pruritus, which was unresponsive to antihistamines and severe depression with insomnia, agitation, and anxiety. The oral administration of 7.5 mg mirtazapine daily alleviated his severe pruritus after 4 days and severe depression after 14 days. Mirtazapine has potential as a therapeutic option for patients receiving hemodialysis with depressive disorder and severe pruritus unresponsive to antihistamines.

Chronic low back pain patients have been observed to show a reduced shift of thorax-pelvis relative phase towards out-of-phase movement with increasing speed compared to healthy controls. Here, we review the literature on this phase shift in patients with low back pain and we analyze the results presented in literature in view of the theoretical motivations to assess this phenomenon. Initially, based on the dynamical systems approach to movement coordination, the shift in thorax-pelvis relative phase with speed was studied as a self-organizing transition. However, the phase shift is gradual, which does not match a self-organizing transition. Subsequent emphasis in the literature therefore shifted to a motivation based on biomechanics. The change in relative phase with low back pain was specifically linked to expected changes in trunk stiffness due to 'guarded behavior'. We found that thorax-pelvis relative phase is affected by several interacting factors, including active drive of thorax rotation through trunk muscle activity, stride frequency and the magnitude of pelvis rotations. Large pelvis rotations and high stride frequency observed in low back pain patients may contribute to the difference between patients and controls. This makes thorax-pelvis relative phase a poor proxy of trunk stiffness. In conclusion, thorax-pelvis relative phase cannot be considered as a collective variable reflecting the orderly behaviour of a complex underlying system, nor is it a marker of specific changes in trunk biomechanics. The fact that it is affected by multiple factors may explain the considerable between-subject variance of this measure in low back pain patients and healthy controls alike.

Scabies is a common parasitic skin infestation characterized by severe itch and a heterogenous clinical presentation. Itch, as the cardinal symptom of scabies, is imposing a high burden on affected patients and is often difficult to manage. Decreased life quality and secondary complications, caused by an itch-related disruption of the epidermal barrier and subsequent superinfections, illustrate the need to treat scabies and to understand the underlying mechanisms of itch in respective patients. This review summarizes available data on itch in scabies with a special focus on the clinical aspects and its underlying pathomechanisms.

is an organism occasionally isolated in humans but rarely causes bacteremia. We report the first case of cellulitis with bacteremia due to in a patient undergoing mantle-cell lymphoma. A 51-year-old man presented with a two-month history of fever and bilateral leg pain and redness. Despite oral ciprofloxacin administration, his symptoms had not improved. The blood culture sample in the anaerobic bottle yielded positive results and was identified by mass spectrometry. The bacteremia did not initially respond to oral azithromycin but responded to intravenous meropenem and amikacin for five days followed by oral minocycline. This report indicates that bacteremia may be treated with oral minocycline following short-term intravenous antimicrobial therapy even among patients undergoing hematological malignancies.

The acute scrotum is defined as a new-onset pain of the intrascrotal contents. The differential diagnosis of acute scrotum includes a variety of etiologies. We report a case of an 18 years old presented with acute scrotal pain with scrotal ultrasound suggestive of testicular torsion, underwent bilateral orchiopexy for suspected testicular torsion. The patient came later with persistent testicular pain. A computerized tomography (CT) scan of the abdomen and pelvis was done and showed a retroperitoneal mass. We suggest that patients with atypical presentation of the acute scrotum should undergo CT scan of the abdomen and pelvis to rule out retroperitoneal pathologies and referred pain.

To determine the prevalence of neuropathic pain among terminally ill patients with cancer admitted to a general ward, using the International Association for the Study of Pain algorithm.

Uterine fibroids (leiomyomas or myomas) are the most frequent benign tumors in women. Heavy menstrual bleeding with resultant anemia, dysmenorrhea, chronic pelvic pain, infertility urinary symptoms and constipation are generally associated with uterine fibroids (UFs). Although strategies mainly resort to surgical intervention, medical treatments are considered the first-line treatment to preserve fertility and avoid surgery. The aim of this review is to offer available and newest medical treatment options for symptomatic UFs. Various medical therapies are now available for women with uterine fibroids, although each therapy has its own advantages and disadvantages. Our topic specifically explores gonadotropin-releasing hormone (GnRH) analogs and selective progesterone receptor modulators (SPRMs), but also provides the reader with useful advice on the therapies for fibroids available after the recent European Medicines Agency (EMA) warning (EMA/160220/2020). The treatment options depend on the personal treatment objectives of the patients, in addition to treatment effectiveness and necessity for recurrent interventions.

The present investigation explored the therapeutic actions of oleuropein along with the possible signaling pathway involved in attenuating neuropathic pain in chronic constriction injury (CCI) and vincristine-induced neuropathic pain in male rats.

Muscle strengthening exercise is suggested to beneficial for patients with knee osteoarthritis (OA) and electrical muscular stimulation is reported to be effective in improvement of muscle strength. This study examined whether isometric exercise combined with whole body-electromyostimulation (WB-EMS) can improve serum cytokine levels, muscle strength, and knee function in elderly women with early knee OA. This randomized controlled study included 75 participants assigned into three groups: the control group (CON), isometric exercise group (ISOM), and isometric exercise and electromyostimulation group (ISOM + EMS). The two exercise groups performed their respective programs for 8 weeks, 3 days a week, 30 min a day. The main exercises for both groups were performed continuously during the 20 min in an alternation of a 6-s contraction with a 4-s break. At pre- and post-intervention, anthropometric variables, muscle strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and blood sampling for biomarkers including interleukin-6, tumor necrosis factor-α, C-reactive protein, and resistin were performed. All variables at pre-intervention showed no significant differences among the three groups. However, there were significant differences between groups for body composition, muscle strength, KOOS subscale scores, and biomarkers. ISOM + EMS group resulted in a significant reduction in body weight, fat mass, fat percentage, inflammatory cytokine levels, and increased muscle strength. An ISOM + EMS group had the best KOOS score among all groups. Isometric exercise combined with WB-EMS resulted in the best overall improvements in knee function and alleviating the pain and symptoms of patients with early knee OA. Further, reduced levels of inflammatory cytokines were observed. These non-pharmacologic, non-invasive interventions should be considered by healthcare specialists for elderly patients with early knee OA.