Rejected

Idiopathic intracranial hypertension (IIH), called pseudotumor cerebri, could cause postpartum headaches. Generally, this diagnosis is idiopathic and treatment is mainly medical to avoid serious complications of possible vision loss. In this paper, we report the case of a 24-year-old lady who developed a similar constellation of symptoms and was diagnosed with this condition. Postpartum, the patient demonstrated symptoms of headache and vision disturbances. Workup ruled out infectious processes and intracranial pathologies. Normal cranial magnetic resonance imaging (MRI) and high cerebrospinal fluid (CSF) pressure during lumbar puncture led to a diagnosis of IIH. Initiation of medication allowed rapid improvement of symptoms and evaded imminent morbidity. Further discussion in light of the latest findings of the literature is held after the presentation of the case. This case sheds light on the importance on importance of fundoscopy in patients demonstrating new-onset headaches especially postpartum with the absence of intracranial pathologies.

To review clinical data regarding the newly approved drug setmelanotide, an injectable melanocortin 4 receptor (MC4R) agonist, for chronic weight management in adults and children aged 6 years and older with monogenic obesity. A literature review was performed by searching MEDLINE, SCOPUS, and EMBASE for all relevant English-language articles published between January 1, 1996, and November 30, 2021, using search terms obesity, setmelanotide, Imcivree, and MC4R agonist. This review included two phase 2, two phase 3, and one ongoing clinical trial evaluating the efficacy and/or safety of setmelanotide. Setmelanotide demonstrates statistically significant weight loss with at least a 10% decrease in body weight after 1 year and decreased appetite in phase 2 and phase 3 clinical trials. The most common adverse effects included injection site reaction (96%), skin hyperpigmentation (78%), nausea (56%), headache (41%), and diarrhea (37%). Setmelanotide is the first and only Food and Drug Administration-approved medication for the treatment of proopiomelanocortin, proprotein convertase subtilisin/kexin type 1, and leptin receptor deficiency in patients with obesity. It may be used in children and adults who have received genetic testing and exhibited extreme obesity before age five. Setmelanotide is a daily subcutaneous injection and may be difficult to afford for patients. Setmelanotide is an effective treatment in patients with obesity and indicated genetic disorders.

Although clinical improvement after stenting for symptomatic iliofemoral venous obstruction has been demonstrated in multiple large studies, a small proportion of patients will experience persistent quality of life-impairing symptoms. Swelling in such a setting represents the concomitant presence of lymphedema and will respond to treatment directed at the lymphedema. In contrast, persistent pain likely arises from venous hypertension in the lower leg, leading to the development of chronic compartment syndrome. Evaluation of intracompartmental pressures in such patients can help confirm the diagnosis, and fasciectomy combined with fasciotomy will treat the issue. In the present series, we evaluated six patients (six limbs) who had undergone fasciectomy combined with fasciotomy and their outcomes.

To estimate long-term efficacy and safety for maxillary trigeminal neuralgia (TN) using radiofrequency thermocoagulation (RFT) targeted on Gasserian ganglion, and to identify the factors which may influence outcomes after procedure.

Traditional Chinese medicine (TCM) prescriptions have multiple bioactive properties. "Gui Zhi-Shao Yao" herb pair is widely used to treat chronic pain (CP), as well as anxiety and depression. However, its related targets and underlying mechanisms have not been deciphered.

The ongoing 2022 multicountry monkeypox epidemic has drawn worldwide attention. Human monkeypox is a virus that spreads from animals to humans. It is an endemic disease in the rain forests of Central and West Africa. However, the disease recently emerged in India, and also in United States through imported wild rodents from Africa, even though the world is still struggling to escape from the clutches of the COVID-19 pandemic. Monkeypox is one of the contagious zoonotic diseases caused by the monkeypox virus (MPXV), transmitted to humans by direct contact with an infected person or animal or contact with virus-contaminated material. Its lesions are similar to smallpox in humans with various medical complications including flu-like symptoms, fever, malaise, back pain, headache, and a characteristic rash. Public health experts around the world are very concerned about the rapid spread of the infection, which has intensified efforts to find the source and cause of this phenomenon. Several viral infections with epidemic potential threaten global health security. Early recognition of cases and timely intervention of potential transmission chains are necessary to contain further outbreaks. At this early stage of monkeypox outbreaks, the current review provides updated information on the current worldwide monkeypox outbreak status, disease aetiology, clinical presentation, therapy, and preventive measures worldwide. Our review will also provide useful information to health professionals and the general public.

Small bowel diaphragm disease is a rare condition that is characterized by the presence of diaphragm-like strictures that causes intermittent or complete small bowel obstruction. Most cases are asymptomatic until presented with severe abdominal pain due to small bowel obstruction or diagnosed during anemia workup as a cause of occult gastrointestinal bleeding. Small bowel diaphragm disease is usually associated with long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). Here, we present the case of a 50-year-old male with no history of NSAID use who presented with abdominal pain and iron deficiency anemia. He was postoperatively diagnosed with idiopathic small bowel diaphragm disease.

Streptococcal toxic shock syndrome is a serious complication of group A infection with a high mortality rate. Rapid detection, early intensive care support, and surgical management are paramount in treating these patients. We present a case of a 65-year-old male, with a documented medical history of hypertension, type 2 diabetes mellitus, and peripheral arterial disease. The patient was evaluated in the emergency department with a chief complaint of pain, swelling in his left leg, and fever. Physical examination showed tachycardia, hypotension, and clear inflammatory signs in the left leg. After initial clinical and laboratory evaluation, the patient was admitted with a diagnosis of cellulitis and urinary tract infection. He presented progressive worsening with multi-organ dysfunction, requiring vasopressor support, invasive mechanical ventilation, and renal replacement therapy. was isolated in blood cultures, and a streptococcal toxic shock syndrome was considered. Appropriate antibiotic therapy, immunoglobulins, hemoperfusion, and corticosteroid therapy were administered, with clinical improvement. During hospitalization, there was a progressive improvement in the skin lesion. Once clinically stabilized the patient was discharged with follow-up. The case presented shows the rapid evolution of cutaneous streptococcal infection with multiorgan dysfunction. Although these types of infections have an associated high mortality rate, this patient survived. The use of immunoglobulin and hemoperfusion technique, in this case, might have contributed to this positive outcome. Therefore, we highlight the need for high suspicion of this syndrome, especially in diabetic patients presenting with skin lesions. Once the diagnosis is established, these infections require close surveillance and rapid and intensive treatment.

Background Acute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. Methodology A total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. Results In detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. Conclusions The diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.

Vaccine adverse event reporting system (VAERS) was established in the United States (U.S.) as an early warning system with a main purpose of collecting post-marketing Adverse events following immunizations (AEFIs) reports to monitor the vaccine safety and to mitigate the risks from vaccines. During the coronavirus diseases 2019 (COVID-19) pandemic, VAERS got more attention as its important role in monitoring the safety of the vaccines. The aim of this study was to investigate VAERS patterns, reported AEFI, vaccines, and impact of different pandemics since its inception.