Rejected

This phase 1/2a study (NCT02737475) evaluated the safety and activity of BMS-986178, a fully human OX40 agonist immunoglobulin G1 monoclonal antibody, ± nivolumab and/or ipilimumab in patients with advanced solid tumors.

Total intravenous anesthesia (TIVA) with propofol may improve acute postoperative pain control compared to inhalational anesthesia. The objective of this review was to comprehensively update and evaluate the existing literature on the analgesic efficacy of propofol TIVA. A systemized literature search for randomized controlled trials in adult patients was conducted in the PubMed and Cochrane CENTRAL (EMBASE source) databases up to August 2019. Clinical trials included compared propofol TIVA against inhalational isoflurane, sevoflurane, or desflurane. Only clinical trials that studied acute postoperative pain scores or analgesic consumption as a primary outcome were included. Sixteen randomized controlled trials were included. Surgical procedures evaluated included: radical gastrectomy, open vein stripping, breast cancer surgery, laparoscopic cholecystectomy, inguinal herniotomy, abdominoplasty, bariatric surgery, lumbar spine surgery, emergency neurosurgical operations, open and laparoscopic gynecological surgeries, and dental surgery. Propofol TIVA was associated with reduced postoperative pain scores and/or decreased opioid consumption in 9 out of 16 clinical trials. There was no difference in 5 clinical trials, and propofol TIVA was associated with worse analgesic outcomes in 2 trials. Propofol TIVA may improve acute postoperative analgesia after surgery, but different factors such as surgical procedures and anesthetic/analgesic techniques may influence its effectiveness.

Patients undergoing total hip replacement (THR) experience severe postoperative pain. The advantage of pain relief by continuous epidural anesthesia (CEA) is offset by various adverse effects. Ultrasound guided (USG) continuous lumbar plexus block (LPB) has emerged as an alternative approach for postoperative analgesia in patients undergoing THR, especially where epidural is difficult or contraindicated.

Fever is a widely recognised presenting symptom of COVID-19. Consequently, other febrile illnesses may be difficult to distinguish from COVID-19-leading to delays in diagnosis and treatment. One such illness is murine typhus, a fleaborne illness with worldwide distribution caused by It often presents with fever, headache and myalgia, all of which have been commonly reported with COVID-19. Although the disease is usually mild with a good prognosis, there have been reports of severe illness and death. I present a case of murine typhus in a young male who had 2 weeks of headaches and daily fevers during the COVID-19 pandemic. He was ultimately tested for murine typhus when his occupation as a dog trainer was queried, and he experienced resolution of symptoms after treatment with doxycycline. During this pandemic, clinicians must be vigilant of other febrile illnesses whose symptoms overlap with COVID-19.

Bernhardt-Roth syndrome (BRS) is a neurological condition characterised by pain, burning or numbness in anterolateral thigh due to entrapment of the lateral femoral cutaneous nerve (LFCN). The possible aetiologies can be mechanical, iatrogenic, neuropathic or idiopathic. After consent for possible publication, we are discussing a case of pain management in a 38-year-old patient with BRS secondary to diabetes. The coherent history, uncontrolled glycaemic status and reduced nerve conduction velocity for LFCN helped reach the diagnosis. Initial treatment with pharmacotherapy, steroid LFCN block and conventional pulsed radiofrequency (PRF) provided moderate temporary pain relief. Extended PRF over 8 min provided significant analgesia without any complications. Physical therapy, adequate glycaemic control and extended PRF provided complete pain relief and improved function over 6 months of follow-up duration. Hence, a cautious multifaceted approach targeting the basic aetiology with extended PRF helped achieve significant analgesia in our refractory case of BRS.

A 65-year old man presented with 6-week history of bilateral knee pain and swelling, with difficulty mobilising. He had bilateral total knee arthroplasties in situ performed 5 years prior complicated by postoperative wound infection. Bilateral synovial fluid cultures were positive for , and extensive investigations had not identified an extra-articular source of infection. Failing debridement antibiotic and implant retention procedure, the patient underwent a simultaneous bilateral 2-stage revision with articulated cement spacers impregnated with vancomycin and gentamycin. The patient received 6 weeks of intravenous antibiotics after each stage. is a nutritiously fastidious organism, posing a challenge for clinical laboratories to isolate and perform antimicrobial susceptibility testing, yet prosthetic joint infections caused by are scarce in literature and present atypically with subacute signs of chronic infection. This poses a diagnostic and therapeutic challenge, and two-stage revision is the only documented treatment that successfully eradicates the infection.

A 48-year-old man who worked in mining in remote, northern Australia was transferred from a rural hospital 5 days after the onset of headaches, subjective fevers and flaccid paralysis of the left upper limb. Initial investigations demonstrated inflammatory cerebrospinal fluid (CSF) changes and a longitudinally extensive cervical cord lesion. Given two serial negative blood and CSF cultures, he was treated as inflammatory myelitis with intravenous methylprednisolone. Despite the initial improvement in pain and left arm power, the patient's neurological deficit plateaued and then deteriorated with worsening neck pain, diaphragmatic dysfunction and dysphagia requiring intubation and respiratory support. A third CSF culture isolated confirming a diagnosis of neuro-melioidosis. Repeat imaging revealed the rostral extension of the original spinal cord lesion into the medulla and pons. Over the next 4 weeks, the patient's neurological deficits slowly improved with continued intravenous antibiotic therapy with meropenem and oral trimethoprim/sulfamethoxazole.

Joannesia princeps (SOJP) has been used in folk medicine as anthelmintic treatment and cutaneous wound healing.

We report here a case of human envenoming by Thamnodynastes hypoconia, a common and abundant non-front-fanged snake belonging to the subfamily Dipsadinae. The case was registered in the municipality of Tapes, Rio Grande do Sul state, Brazil, in a 27-year-old female. The snakebite was on the wrist of the left arm while handling the snake in a field outing. No pain sensation was noted during the bite, and after 20 minutes edema developed along the hand and forearm with a slight sensation of numbness and mild pain when moving the fingers. After 15 hours, the victim began to develop erythema, paraesthesia, and a sensation of warmth at the bite site. After 30 hours, ecchymosis occurred on the fingers and forearms, and the edema began to decrease. After 70 hours from the time of the bite ecchymosis along with pruritus and mild pain were still evident. The patient was treated with prescribed medications, and after 7 days no further symptoms were observed. This is the first reported case of envenoming by T. hypoconia.

Women often complain of symptoms of fatigue and generalized aches and pains around menopause. Even though fibromyalgia is more prevalent in midlife women, not all women presenting with aches and pain and disrupted sleep meet diagnostic criteria for fibromyalgia. This Practice Pearl addresses the distinction between chronic fatigue syndrome and fibromyalgia and the management of fibromyalgia in perimenopausal and postmenopausal women.