Rejected

Migraine is a chronic disease that reduces health-related quality of life. Little is known about the burden of migraine in individuals who are potential candidates for preventive treatment with ≥ 4 monthly headache days currently using migraine medications.

Objectives To explore the clinical, pathological, and imaging characteristics of allergic fungal sinusitis (AFS) and to analyze the correlation of disease duration with imaging and histopathology findings. Methods We reviewed all cases of AFS managed at the otorhinolaryngology department of King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Demographic and clinical features were collected, as well as imaging and histopathological findings, which were analyzed by time from onset. Results Forty-six patients were diagnosed AFS, representing 11.8% of total sinusitis cases; 25 (54.3%) were female, with mean (SD) age=33.57 (11.76). Patients presented with multiple symptoms of chronic rhinosinusitis (43, 93.5%), chronic headache (14, 30.4%), and hyposmia (2, 4.3%), and 36 (78.3%) were diagnosed late (≥5 years after onset). AFS involved all four sinuses in 32 (69.6%) patients and was bilateral in >53.5% of infected sinuses. Imaging showed increased intrasinus attenuation (88.2%-95.3%), complete opacification (74.4%-85.3%), sinus expansion (35.3%-51.2%), remodeling (20.6%-37.2%), wall thinning (41.2%-58.1%), and involvement of adjacent soft tissue (11.8%-25.6%), depending on the sinus type. Histology evidenced eosinophilic mucin (45.7%), eosinophils (91.3%), fungal hyphae (93.5%), and Charcot-Leyden crystals (6.5%). Patients who were diagnosed late had a higher percentage of imaging and pathological lesions, principally, the expansion and wall thinning of involved sinuses (p<0.050). Conclusion AFS represents a significant proportion of chronic sinusitis cases treated in the otorhinolaryngology department and is often diagnosed late with extensive forms. Major efforts should be made to improve the early diagnosis and management of such disease, including raising awareness about this entity among general practitioners and family physicians to enhance clinical suspicion and detection rate.

The functional impairment associated with migraine can cause physical, emotional, and economic ramifications that can affect occupational, academic, social, and family life. Understanding the relationship between headache-free days (HFDs) and the disease burden of migraine may help with decisions regarding treatment and management of migraine.

For geriatric patients with chronic pain, a comprehensive well-coordinated pain management is pivotal to ensure the best possible pain relief and to minimize as far as possible preventable negative side effects of treatment.

Chronic neuropathic perineal pain syndrome is a collective term that encompasses several diagnoses. In patients where the neuropathic pain syndrome is caused by pudendal or cluneal nerve entrapment, surgical release can be proposed if other measures have failed. The aim of this study is to evaluate the clinical outcome of patients suffering from pudendal and/or cluneal nerve entrapment at 1 year after this minimal invasive surgery, which is based on the open trans gluteal approach who has proven its efficacy compared to medical treatment in a randomized control trial.

Janus kinase (JAK) is a signal transducer and activator of a protein transcription system that transduces signals from cell surface cytokine and growth factor receptors to the nucleus. Recently developed JAK inhibitors (JAKinibs) inhibit JAKs non-selectively or selectively and down-regulate the effects of corresponding ligands (i.e. cytokines and growth factors). JAKinibs are efficacious against rheumatoid arthritis and other immune-mediated inflammatory diseases and are being increasingly prescribed clinically. Regarding safety, JAKinib use is associated with common or unique changes in laboratory parameters; however, incidence rates of serious adverse drug reactions (ADRs) associated with these changes are low. Opportunistic and other infections, including tuberculosis, are the most critical ADRs of treatment with JAKinibs, and screening and monitoring of patients should be carefully performed. Incidence rates of herpes zoster (HZ) in patients receiving JAKinibs are high in Japan and Korea, and modestly high in other countries. Filgotinib may not be associated with an elevated risk for HZ, but long-term safety data are lacking. Data from clinical development programmes and post-marketing surveillance have indicated no increased risk for malignancy or serious cardiac events; however, long-term observational studies are necessary. Despite the non-elevated risk of gastrointestinal perforations, patients with older age and/or a history of diverticulitis or receiving non-steroidal anti-inflammatory drugs should be carefully evaluated to determine the risk-benefit balance. The incidence rates of venous thromboembolism with all approved doses are similar to that expected in the population, although there are discrepancies in the placebo-controlled portion of the baricitinib clinical development programmes. Regulatory agencies in the USA and Europe suggested a higher risk for thrombotic events in patients receiving JAKinibs. Pharmacokinetic studies demonstrated that dose adjustment should be considered for JAKinib use in patients with moderate-to-severe renal or hepatic dysfunction, depending on the metabolism of each drug. Long-term observational studies enrolling patients with diverse clinical backgrounds are required to strike a risk-benefit balance in clinical settings.

Neurotuberculosis is among the most severe type of tuberculosis with high mortality and morbidity in all age groups. Various sociodemographic and disease-/treatment-related factors have emerged over the years that can affect clinical and radiologic features of neurotuberculosis.

Patients with inflammatory bowel disease are commonly prescribed opiates for pain. We sought to determine the incidence of opiate use disorder after inflammatory bowel disease (IBD) admission over a 1-year period as well as its impact on mortality and hospital resource utilization.

Acute respiratory failure associated with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide and presents critical challenges for the public health and medical communities. The World Health Organization (WHO) has declared SARS-CoV-2 a public health emergency of international concern, with a global estimate of over 7 million human infections and more than 400000 deaths worldwide as of June 12, 2020. A 2020 report by the China Medical Treatment Expert Group for Coronavirus disease 2010 (COVID-19) (2) showed that the clinical spectrum of the viral infection is dominated by fever (up to 88.7% of patients during hospitalization) and cough (67.8% of patients) followed by symptoms such as headache, fatigue, or shortness of breath.

Measurement of CSF opening pressure (CSFOP) is valuable and much used in the investigation of several neurological conditions. However, there are different opinions regarding reference values and influence of age, gender and body mass index (BMI). We have, in a previous study, noted possible differences in CSFOP between gender and age groups. Here the aim was to collect information regarding normal distribution of CSFOP in an out-patient sample and also include BMI.