Rejected

The history of glomangiopericytoma began in 1924 when it was initially diagnosed by Stout and Murray. It is a rare tumour of the respiratory mucosa, with a prevalence of less than 0.5% among all sinonasal tumours. Literature shows female predominance among patients who develop glomangiopericytoma. So far, no accurate aetiology has been discovered, but there are certain risk factors, including trauma, use of corticosteroids and high blood pressure, which are believed to cause glomangiopericytoma. Patients usually present with a history of epistaxis or nasal blockage, though symptoms can get worse if the tumour is not resected timely and can lead to visual disturbance, chronic sinusitis and headache. It has reddish polypoidal appearance on examination. The best modality for the treatment of glomangiopericytoma is endoscopic surgical resection via trans-nasal approach. We present the case of a 70-year-old man, with nasal blockage and epistaxis who underwent endoscopic sinus surgery for this condition.

Mucormycosis involves life-threatening rapidly progressive angioinvasion with infiltration across tissue planes, resulting in necrosis and thrombosis, most commonly seen in the setting of immunocompromised states. We describe 2 cases of isolated cerebral mucormycosis in immunocompetent adults and describe this syndrome in detail in the context of a systemic literature review.

In their working life, airline pilots are exposed to particular risk factors that promote nonspecific low back pain (LBP). Because of the varying incidence internationally, we evaluated the point prevalences of acute, subacute, and chronic nonspecific LBP, as well as the current prevalences in German airline pilots. Furthermore, we compared the prevalence to the general German population and to European counterparts. An anonymous online survey of 698 participating German airline pilots was evaluated. The impairment between groups was analyzed. Prevalences from our data were compared to existing data. The following point prevalences were found: 8.2% acute, 2.4% subacute, 82.7% chronic LBP; 74.1% of all individuals were suffering from current LBP when answered the questionnaire. A total time spent flying greater than 600 h within the last 12 mo was significantly related to acute nonspecific LBP. Individuals with any type of LBP were significantly impaired compared to those unaffected. It was found that German airline pilots suffer more often from current LBP than the general population and have a higher point prevalence of total LBP than their European counterparts. The evaluation showed a surprisingly high, previously unidentified, prevalence of nonspecific LBP in German airline pilots. Why German airline pilots suffer more often from LBP remains uncertain. The number of flying hours appears to have a negative effect on developing acute low back pain, but causation cannot be concluded. Other risk factors could not be confirmed.

In this study, we synthesised the zinc oxide nanoparticles from and evaluated its anti-inflammatory and antinociceptive potentials against the different inflammation and pain induced mice model. The synthesised zinc oxide nanoparticles were characterised by UV, SEM, XRD and FTIR techniques. The anti-nociceptive effects of were examined by different stimuli e.g. acetic acid, glutamate, capsaicin, and formalin-induced nociception in mice. The anti-inflammatory effects of synthesised zinc oxide nanoparticles were assessed by air sack assessment and the level of inflammatory cytokines were studied. The muscle tension of animals were studied through open field assessment. The present study exhibited proficient antinociceptive and anti-inflammatory actions of the synthesised Zinc oxide nanoparticles from . The sormulated zinc oxide nanoparticles were appreciably reduced the acetic acid, glutamate, capsaicin, and formalin-induced nociceptive responses in mice. Further the zinc nanoparticles were exhibited the potent anti-inflammatory actions reducing the inflammatory response and pro-inflammatory cytokines level in the mice. In conclusion, the findings of this study proved the beneficial effects of zinc oxide nanoparticles from against the different pain and inflammation-induced mice. Hence, it was clear that the zinc nanoparticles from could be promising antinociceptive and anti-inflammatory agent in the future.

The first descriptions on medial talar tubercle fractures are attributed to Cedell. He described avulsion fractures of the insertion of the posterior talotibial ligament. However the true etiology has not been established. Since little is known about these fractures, they are easily misdiagnosed as simple ankle sprains. Untreated, these fractures may lead to chronic ankle pain. To improve the understanding of the etiology and outcome of these fractures a systematic review was conducted of all cases of isolated fractures of the medial tubercle of the posterior talar process. In addition we present the first series of competitive athletes treated by means of the two-portal hindfoot approach for isolated medial talar tubercle fractures.

Objective Silicosis is one of the common occupational lung diseases caused by crystalline silica respiration. Pneumothorax is one of the most common and morbid complications of silicosis involving lung pleura. It is commonly seen unilaterally in chronic silicosis and can often be lethal. The purpose of this study is to report secondary spontaneous pneumothorax (SSP) in critically ill patients with silicosis. Methods A cross-sectional study was done between January 2019 and June 2019 at Sawai Man Singh (SMS) Medical College in Jaipur, India. A cohort of 50 patients with dyspnea and a history of silicosis were studied. A chest X-ray and sputum for acid fast bacilli were checked on all suspected cases. Results The present study showed that the mean age of patients was 38.7 years, all silicosis patients had dyspnea, and 96% of patients had severe chest pain. The results of chest X-rays concluded the evidence of silicosis. Bilateral pneumothorax was seen in three cases, right-sided pneumothorax in eight cases, and left-sided pneumothorax in 11 cases. The rate of pneumothorax incidence in silicosis patients was about 44%, which is higher than the current evidence. Six patients were managed conservatively with oxygen and bronchodilators, and 16 patients underwent through tube thoracostomy. Conclusion This study highlights the importance of considering spontaneous pneumothorax in patients who are presenting with shortness of breath and/or chest pain especially with a known history of silicosis, as the timely diagnosis can alter the management of this morbid condition which carries a high mortality rate if left untreated, compromising the lung expansion, venous return, cardiac output, oxygenation and eventually leading to death.

Inflammatory myofibroblastic tumors (IMFTs) are rare solid mesenchymal tumors frequently noted in children and young adults. It is characterized by variable clinicopathological and etiopathogenetic features. They are commonly reported in the lungs and occurrence in the colon is extremely rare. Here, we report a case of IMFT in the sigmoid colon confirmed histopathologically after surgical resection. A 40-year-old lady presented with abdominal pain, vomiting, and constipation for four days. On abdominal examination, there was tenderness in the left iliac fossa region with localized guarding. Contrast-enhanced computed tomography (CECT) showed a sigmoid colonic mass lesion with few enlarged perilesional lymph nodes. Colonoscopy demonstrated circumferential ulceration with irregular margin associated with luminal narrowing noted 55 cm from the anal verge and scope could not negotiate beyond, biopsies were taken. Later, the biopsy came as descriptive in nature. Hence, we proceeded for surgery and intra-operatively we have found there was circumferential thickening in the sigmoid colon for about size 8 cm of which was abutting the left lateral parietal wall. We have done sigmoid colon resection with adequate margins and postoperatively patient did well. Finally, the histopathology report suggested an IMFT sigmoid colon.

Morbidly obese obstetric patients undergoing anesthesia present many unique challenges. Previous caesarean sections (CSs) further complicate their management. We present the successful anesthetic management of a super morbidly obese obstetric patient with body mass index (BMI) of 109 kg/m who underwent her fourth CS. As per our review, this patient has the highest recorded BMI in the obstetric anesthesia literature. A 27-year-old female, G4P3003, presented for fourth repeat CS at 38 weeks' gestation. She had obstructive sleep apnea, hypertension, atrial fibrillation, and type 2 diabetes. Her first CS was emergent under general anesthesia (GA), and the other two were performed under neuraxial anesthesia, with the most recent one complicated by intraoperative cardiac arrest requiring cardiopulmonary resuscitation. Preoperative preparation involved multidisciplinary preparation, planning, and risk stratification. Although neuraxial anesthesia is preferred over GA for CS, she refused neuraxial anesthesia due to her prior traumatic experience and the potential that it caused her prior cardiac arrest. In addition, her inability to position for a block or lay flat, poor anatomical landmarks, unknown length of surgery, plan for periumbilical incision, uncertain placental status, and risk of massive hemorrhage convinced us to consider GA. Surprisingly, her airway examination was reassuring. Two 18G peripheral intravenous lines and an arterial line were obtained prior to induction. With optimum patient positioning and preoxygenation, modified rapid sequence induction with mask ventilation and endotracheal intubation with direct laryngoscopy were performed. A healthy baby was delivered without significant intraoperative complications. Intraoperative lung-protective strategy with recruitment maneuvers, multimodal analgesia, and elective postoperative continuous positive airway pressure aided in successful extubation. Postoperatively, pulmonary toilet, early mobilization, physical therapy, and venous thromboembolism prophylaxis were employed. Her postoperative course was complicated by severe preeclampsia and pulmonary embolism, which were managed successfully in the intensive care unit. She was discharged initially to outpatient rehabilitation followed by home. This case highlights the complexities and significance of an individualized approach in managing super morbidly obese obstetric patients.

High-grade glioma is also called a malignant glioma because it is fast-growing and spread rapidly through brain tissue. Due to the rarity of high-grade glioma, its diagnosis and management are multi-faceted. We present a case of a 10-year-old girl presented with headache, seizure, and right-sided weakness of upper and lower limbs. Neurological exam revealed reduced power in both upper and lower right limbs with reduced sensation and reflexes. Magnetic resonance imaging revealed an ill-defined altered signal intensity mass involving the left temporal lobe with parenchymal involvement and surrounding perilesional vasogenic edema. Biopsy of the lesion confirmed high-grade glioma. The patient underwent external beam radiation therapy with concomitant daily temozolomide treatment, followed by adjuvant standard temozolomide. However, progressive neurological worsening and an increased lesion size led to partial tumor resection through a craniotomy to remove intracranial hypertension, which was unsuccessful, and the patient could not survive after the procedure.

Falls and fall-induced injuries in elderly people are common worldwide. However, few reports have examined the association between body pain and fall in middle-aged and older Chinese adults. The objective of this study is to access the association between pain and fall among middle-aged and older Chinese.