Rejected

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain condition that is often overlooked by clinicians and typically occurs within an entire limb. There is considerable clinical variability in presentation among patients with CRPS. We report a case of extremely focal CRPS localized to the left small finger (LSF) following crush injury. A 48-year-old right-handed male presented with LSF stiffness and severe pain of three months' duration following crush injury. He endorsed severe allodynia and minimal flexion at the proximal interphalangeal and distal interphalangeal joints of the LSF. Physical examination was significant for overt shininess and edema isolated to the LSF. X-ray performed at the time of injury and three months after were devoid of any fracture or dislocation. Chronic focal pain syndrome (CFPS) may be a subset of CRPS that has yet to be documented in the literature.

Ultrasound-Guided Dorsal Penile Nerve (DPNB) Block was performed to provide surgical anesthesia for a 22 years old ASA II patient who had hemophilia A and was undergoing circumcision surgery. 20 ml of 0.25% bupivacaine was used for the DPNB. Surgery was completed under block without complication. Twenty-four hours of the analgesia was provided following surgery.

The risk of herpes zoster (HZ) increases with age and declining immune function. Increased oxidative stress and inflammatory conditions may cause negative impact on the immune responses. The present study aimed to assess the levels of oxidative/inflammatory stress biomarkers in HZ patients compared with the controls. This case-control study included 43 HZ patients and 47 age-matched controls. Melatonin (MLT), Indole-dioxygenase (IDO), Interleukin-18 (IL-18), Interleukin-6 (IL-6), ferritin, C-reactive protein (hsCRP), and total homocysteine (tHcy) levels were measured and compared in both groups. The significant high levels of IDO, IL-18, IL-6, ferritin, hsCRP, and tHcy, as well as low levels of MLT were found in HZ patients compared with the controls (p<0.001); these significant differences were also associated with rash and pain severity (p<0.001). The final logistic regression model with the AUC (0.99 [95%CI 0.98-1.00]) showed the association of HZ with decreased level of MLT (OR 0.95; 95%CI 0.92-0.98; p=0.007) and increased levels of tHcy (OR 1.53; 95%CI 1.06-2.19; p=0.02). The findings showed increased inflammation-associated oxidative stress in HZ patients. Elevated tHcy levels and reduced MLT levels may be associated with the manifestation of HZ. More investigations are required to confirm the results. This article is protected by copyright. All rights reserved.

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have a large negative impact on health-related quality of life (HRQOL). A reliable and validated measure of HS-specific HRQOL in clinical studies is needed.

The COVID-19 pandemic has emerged and has challenged us to look for alternatives to bring about a paradigm shift in interventional chronic pain management. As the disease lowers the body's immune system, the use of medications that suppress the immune system are not recommended during the COVID-19 pandemic.

Trigeminal neuropathy secondary to orthodontic tooth movement is reported as a rare occurrence. Risk assessment is possible to prevent or immediately treat these injuries and clinicians should be aware of the risk factors. Increasingly, orthodontics is provided by non-specialists and orthodontic therapists. This paper presents cases and a review of orthodontic-related nerve injuries, where early diagnosis of orthodontic nerve injuries was misdiagnosed, preventing early or immediate treatment that would have likely optimised neural recovery and prevented permanent sensory neuropathic pain in these patients. We present two cases of trigeminal neuropathy following orthodontic tooth movement that highlight some key issues relating to improving pre-orthodontic risk assessment during treatment planning and early identification of developing neuropathy requiring urgent cessation/reversal of orthodontic treatment. The cases presented demonstrate the importance of thorough pre-orthodontic assessment before treatment planning. Traditionally, two-dimensional imaging such as panoramic and periapical radiographs have been the gold standard for predicting the relationship of the dentition to the mandibular canal. However, cone beam computed tomography imaging is now accepted as providing a more accurate image of the position of the teeth in relation to vital structures, such as neurovascular supply.

Human infection with , or rat lungworm disease, manifests most commonly with neurologic symptoms that often include severe diffuse pain. While pain is reported by the majority of patients with rat lungworm disease, there are presently no published guidelines on the approach to pain management for these patients. Here we report a case of rat lungworm disease where severe refractory pain was the most prominent symptom and an intravenous lidocaine infusion was used as a successful treatment modality. Intravenous lidocaine has been shown to be safe and effective in neuropathic pain, refractory cancer pain, and peri-operative pain management. To our knowledge, this is the first case report on the use of lidocaine infusion for the management of refractory pain from rat lungworm disease, and among the first reports of any approach, to pain management for rat lungworm disease. We suggest that a lidocaine infusion protocol be considered when pain from rat lungworm disease fails to respond to first-line analgesics.

Obesity is a growing epidemic and it has been found to be an independent risk factor for a multitude of perioperative complications. We describe our experience with morbidly obese patients who underwent robotic ventral hernia repair (RVHR), examining factors affecting perioperative and mid-term outcomes.

Appendix intussusception is rare, can be responsible of chronic unexplained abdominal pain and is mostly associated with inflammatory changes or endometriosis. A 23-year-old woman with Crohn's disease was diagnosed invaginated appendix by CT-scan and colonoscopy after several acute atypical abdominal pain episodes. These episodes were suspected to be independent of the Crohn's disease and to be attributed to the intussusception itself. A resection combining ligation of the base by colonoscopy and cecectomy by laparoscopy was performed successfully. However, no argument for Crohn's disease was found on the pathologic examination.

A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood.