Rejected

Radiation esophagitis, the most common acute adverse effect of radiation therapy, leads to unwanted consequences including discomfort, pain, an even death. However, no direct cure exists for patients suffering from this condition, with the harmful effect of ingestion and acid reflux on the damaged esophageal mucosa remaining an unresolved problem. Through the delivery of the hydrogel with stent platform, we aimed to evaluate the regenerative capacity of a tissue-specific decellularized extracellular matrix (dECM) hydrogel on damaged tissues. For this, an esophagus-derived dECM (EdECM) was developed and shown to have superior biofunctionality and rheological properties, as well as physical stability, potentially providing a better microenvironment for tissue development. An EdECM hydrogel-loaded stent was sequentially fabricated using a rotating rod combined 3D printing system that showed structural stability and protected a loaded hydrogel during delivery. Finally, following stent implantation, the therapeutic effect of EdECM was examined in a radiation esophagitis rat model. Our findings demonstrate that EdECM hydrogel delivery via a stent platform can rapidly resolve an inflammatory response, thus promoting a pro-regenerative microenvironment. The results suggest a promising therapeutic strategy for the treatment of radiation esophagitis.

Traumatic ruptures of the subscapularis tendon in children are rare and often missed. In this case report, a 70 kg person landed on a 13-year-old boy with his arm abducted and rotated, causing pain and restricted motion. An MRI showed a total rupture of the subscapularis with avulsion of the minor tubercle and subluxation of the biceps tendon. The avulsion was fixed to the foot print and the biceps tendon in the bicipital groove, by delto-pectoral approach, using three anchors. It is important to avoid missing these injuries. They may cause chronic shoulder pain and decreased motion if left untreated.

Palliative care is an essential component of emergency medicine, as many patients with terminal illness will present to the emergency department (ED) for symptomatic management at the end of life (EOL).

Lyme disease, spread by the Ixodes tick, is typically associated with a single "bull's eye rash" that emergency physicians are comfortable recognizing and treating during the summer months when this disease is most prevalent. However, Lyme disease can also present in disseminated forms that are more difficult to diagnose.

An intense itching localized to dermatomes is a rare symptom of multiple sclerosis (MS). Herein, we report a case of a 45-year-old female who presented with severe itching and tingling sensation, gait disturbance, and bilateral paresthesia for one week. She also had a history of multiple admission in the hospital due to recurrent walking abnormalities and numbness and tingling of both hands associated with intermittent psychiatric symptoms. The neurological examination revealed spastic quadriparesis with lower limb muscles affected more than the upper limbs, numbness, and sensory loss in the upper extremities in the glove and stocking pattern. Magnetic resonance imaging (MRI) revealed multiple small rounded periventricular plaques in both hemispheres and along the long axis of the corpus callosum (fluid-attenuated inversion recovery/FLAIR sequence), and cerebrospinal fluid analysis revealed the presence of oligoclonal bands, suggestive of MS. She was commenced on methylprednisolone and carbamazepine, leading to progressive resolution of her signs and symptoms. She was discharged with monthly natalizumab, and she was doing well on her follow-up.

Erector spinae plane block (ESPB) is a fascial plane block that targets the dorsal and ventral branches of the primary dorsal root ganglion. We report a case of a 76-year-old woman who presented for percutaneous posterior interspinous decompression spacer at the L3-L4 level in the setting of neurogenic claudication from severe spinal stenosis. We describe the novel performance of bilateral ESPBs under ultrasound guidance for postprocedural analgesia. Throughout the recovery period, the patient experienced sustained pain relief. ESPB may be a useful adjunct for periprocedural analgesia and recovery in patients undergoing interspinous spacer placements.

A 20-year-old female presented to the emergency department with fever, anorexia, headache, and neck stiffness for two weeks with recent onset of diplopia and ptosis. She was found to have bilateral symmetrical and complete oculomotor palsy. The diagnosis of tubercular meningitis (TBM) was established on magnetic resonance imaging of the brain and cerebrospinal fluid examination. The oculomotor palsy was attributed to tubercular exudates along the ventral surface of midbrain. Although cranial nerves palsies are common in TBM, such a pattern is rarely seen and has been reported only in the context of tuberculoma in midbrain. She was treated with anti-tubercular therapy for nine months, but there was only partial recovery of the oculomotor function.

Missed or chronic bilateral anterior shoulder dislocation is a rare presentation, usually secondary to epileptic attack. We present herein an exceptional case of this injury pattern, associated with bilateral displaced fracture of the coracoid process, and unilateral rupture of the long head of biceps. Treatment consisted of open reduction through osteotomy of the lesser tuberosity, with additional stabilization of the glenohumeral joint, using the Latarjet procedure by transposition of the coracoid fragment with its attached conjoint tendon to the antero-inferior glenoid rim. Rupture of the long head of the biceps required tenodesis. Temporary glenohumeral pin transfixation was performed for residual instability at the end of the procedure. Patients with postictal shoulder pain, discomfort, or disability should be investigated with adequate radiographs, in addition to CT scan or MRI when needed. Early diagnosis allows for safe closed reduction, and helps avoid late and more complex surgical treatment required for missed or chronic dislocations.

Background Migraine is amongst the top 10 most disabling conditions, and the disease burden is highest in young and middle-aged women. Another variant of the migraine headache, menstrual migraine (MM) is experienced by this cohort of patients. Former studies have done comparisons between various demographic and clinical features of MM versus menstrual-unrelated migraine (MUM) in patients presenting to various clinics with the primary complaint of headaches. We aimed to compare symptoms of migraine in women attending gynecology outpatient clinics, regardless of their presenting complaint. This would help lessen the selection bias and produce more generalizable results. Methods and materials A cross-sectional study was conducted in the outpatient gynecology clinics at a tertiary care hospital over six months. The clinic attendees were screened for sufferers of a primary headache of the migraine type. The migraineurs were then stratified into groups A, MM patients, and group B, MUM patients, using the International Headache Society (HIS) criteria. They were then questioned for the presence of various symptoms associated with their migraine attacks for comparison. Results One-hundred eighty-one women (between 12 years to 55 years) were found to have primary headaches; amongst these, 126 patients met the inclusion criteria and consented to participate; from these, 62 (49.2%) patients had MM and 64 (50.8%) patients had MUM. The symptoms of nausea (p=0.00269), photophobia (p=0.000088), and phonophobia (p=0.0281) were statistically higher in MM patients while vomiting was not a significant feature. Both groups had a predominantly unilateral headache. The average days of the attack had a significant difference between the two groups (p=0.000019), where the duration was longer for MM patients. Conclusions It was observed that patients with MM tend to experience more features associated with migraine headaches, including a longer duration of attacks, and have a worse experience overall.