Rejected

 To compare the efficacy of quadratus lumborum (QL) block and intrathecal morphine (M) for postcesarean delivery analgesia.

Bilateral shoulder dislocations are a rare occurrence and can be categorized as either symmetric (both humeral heads dislocate in the same direction) or asymmetric (wherein the humeral heads dislocate in different directions). Shoulder dislocations may be overlooked if they are the result of systemic injury; if diagnosed >21 days after occurring, they are considered chronic dislocations. We describe the case of a 31-year-old male who presented with an eight-week history of bilateral shoulder pain. His onset of pain coincided with a seizure secondary to Chikungunya encephalitis. Clinical and radiological examination demonstrated bilateral symmetric anterior shoulder dislocation with associated greater tuberosity fractures and extensive callus formation bilaterally. Open surgical management was performed first on the left shoulder via the deltopectoral approach. The callus was removed, the greater tuberosity fragment lifted off, reattached to the original position, and held in place with sutures and proximal humeral locking plates. The right shoulder was reduced six weeks after the left shoulder due to patient preference; the reduction utilized the same approach as with the left shoulder. Post-operatively the patient was immobilized, and physiotherapy commenced. He achieved a satisfactory range of motion four months post-operation. Physicians should be cognizant that shoulder pain after a convulsive seizure may signify shoulder dislocation. Thorough clinical and radiological examinations are warranted in such an instance. There exists no consensus on the treatment of chronic shoulder dislocations, but it is recommended that closed reduction only be attempted up to six weeks post-dislocation due to the high risk of iatrogenic fractures and neurovascular damage beyond this time.

Post-COVID-19 conditions, also known as "long COVID", has significantly impacted the lives of many individuals, but the risk factors for this condition are poorly understood. In this study, we performed a retrospective EHR analysis of 89,843 individuals at a multi-state health system in the United States with PCR-confirmed COVID-19, including 1,086 patients diagnosed with long COVID and 1,086 matched controls not diagnosed with long COVID. For these two cohorts, we evaluated a wide range of clinical covariates, including laboratory tests, medication orders, phenotypes recorded in the clinical notes, and outcomes. We found that chronic pulmonary disease (CPD) was significantly more common as a pre-existing condition for the long COVID cohort than the control cohort (odds ratio: 1.9, 95% CI: [1.5, 2.6]). Additionally, long-COVID patients were more likely to have a history of migraine (odds ratio: 2.2, 95% CI: [1.6, 3.1]) and fibromyalgia (odds ratio: 2.3, 95% CI: [1.3, 3.8]). During the acute infection phase, the following lab measurements were abnormal in the long COVID cohort: high triglycerides (mean : 278.5 mg/dL vs. mean : 141.4 mg/dL), low HDL cholesterol levels (mean : 38.4 mg/dL vs. mean : 52.5 mg/dL), and high neutrophil-lymphocyte ratio (mean : 10.7 vs. mean : 7.2). The hospitalization rate during the acute infection phase was also higher in the long COVID cohort compared to the control cohort (rate : 5% vs. rate : 1%). Overall, this study suggests that the severity of acute infection and a history of CPD, migraine, CFS, or fibromyalgia may be risk factors for long COVID symptoms. Our findings motivate clinical studies to evaluate whether suppressing acute disease severity proactively, especially in patients at high risk, can reduce incidence of long COVID.

Pain is generally perceived as a sensory, emotional and cognitive aggression by the patient who suffers from it and as the enemy that must be defeated by the physician. It may become chronic, and the passage from the acute phase to the chronic phase cannot be explained in a single way. Indeed, multiple factors come into play: biological, psychological and socio-professional. The patient's quality of life then deteriorates and places him/her in a vicious cycle of pain. The assessment of the different components of pain (sensory, emotional, cognitive and behavioural) and its maintenance factors allow for the implementation of therapeutic strategies, both physical and psychological, adapted to every patient. Due to the complexity of chronic pain management, a multidisciplinary strategy is being developed, with a global approach according to the biopsychosocial perspective, including non-pharmacological approaches, with the objective of allowing the patient to be autonomous in the management of his/her symptoms.

We herein report a case of optic neuritis and ischemic optic neuropathy associated with herpes zoster ophthalmicus and decreased visual acuity.

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is an autoinflammatory bone disorder with predominantly paediatric onset. Children present with multifocal osteolytic lesions accompanied by bone pain and soft tissue swelling. Patients often exhibit extraosseous co-morbidities such as psoriasis, inflammatory bowel disease, and arthritis.

Cerebrospinal fluid (CSF) cutaneous fistula is an unusual but potentially serious complication of neuraxial procedures. While combined spinal-epidural (CSE) technique or spinal/epidural techniques alone are standard in obstetric anesthesia, subsequent persistent CSF leak is rarely reported in the obstetric population. Clinical presentation ranges from asymptomatic states and only abnormal leakage through the puncture site to severe cases with meningitis or subdural hematoma. Both conservative and invasive approaches are suitable for management, but no formal guidelines on how to diagnose and manage this condition are available, and hence clinicians have to rely on their experience. We present a case of a 35-year-old parturient scheduled for an elective cesarean delivery with a persistent CSF leak three days after epidural catheter removal. The leakage was managed with both suturing of the skin site and conservative methods such as hydration, bed rest, and oral analgesics, with no adverse effects for the patient.

Nerve injury of the saphenous nerve or infrapatellar branch seems to be a frequent complication following knee surgery or trauma. Denervation results vary, and in some cases, no pain relief is achieved. This might be due to anatomic variation. The purpose of this anatomical study is to identify the variation in the course of the infrapatellar branch and saphenous nerve. We dissected 18 cadavers from adult donors. Medial to the knee, the saphenous nerve and infrapatellar branch were identified and followed proximally to the point where the infrapatellar branch branched from the saphenous nerve. The location where the infrapatellar branch came off from the saphenous nerve relative to the knee joint and where it passed the knee joint were measured. A total of 23 infrapatellar branches were found. We identified 10 branches between 0-10 cm proximal to the knee joint, 3 branches at 10-20 cm, and 9 branches at >20 cm. Between the patella and semitendinosus tendon, the knee joint was crossed by 5 branches in the anterior, 15 in the middle, and 2 in the posterior one-third. The origin of the infrapatellar branch and the location at which it passes the knee are highly variable. This, in addition to people having multiple branches, might explain why denervation is frequently unsuccessful. Based on the anatomical findings, we propose a more proximal diagnostic nerve block to help differentiate between a distal-middle or proximal origin of the infrapatellar branch. Appropriate placement of the nerve block might help identify people who benefit from denervation.

Intracranial hypotension is a result of low Cerebrospinal fluid (CSF) pressure caused by either spontaneous or postoperative leakage. The classic presentation of spontaneous intracranial hypotension is acute orthostatic headache, but the diagnosis can sometimes be challenging as some patients may present with atypical initial presentations including cervical pain as well as cervical radiculopathy secondary to cervical spine venous engorgement. We described a 42-year-old female patient who presented initially with neuropathic pain symptoms as well as weakness involving both lower extremities for which she underwent diagnostic lumbar puncture with concern regarding demyelinating neuropathy. However, subsequently she developed postural headache as well as severe cervical pain which was attributed to cervical epidural venous engorgement in setting of intracranial hypotension based on cervical spine magnetic resonance imaging (MRI) findings. She was managed conservatively, and repeated cervical spine MRI 3 days later showed prominent improvement in the imaging findings. Spinal epidural venous engorgement can occur secondary to intracranial hypotension (mainly post lumbar puncture), and can present clinically with neck pain or even symptoms of radiculopathy. Since the findings can mimic more serious conditions, it is extremely important to consider this condition in the differential diagnosis of an enhancing epidural collection in the cervical spine, particularly when intracranial hypotension is suspected.