Rejected

The use of Spinal Cord Stimulation (SCS) system to treat medically refractory neuropathic pain is increasing. Severe neuropathic pain can be found in giant chest wall arteriovenous malformations (AVMs), exceedingly rare and debilitating abnormalities, rarely reported during pregnancy.

To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?"

Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. Most patients with lung cancer that are symptomatic have hemoptysis, coughing, shortness of breath, chest pain and persistent infections. Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding.

Hemidesmus indicus (L.) R. Br. ex Schult. (Apocynaceae) is widely used in traditional medicine in the different parts of the Indian subcontinent due to the various biological activities attributed to its different parts, especially the roots. It has traditionally been used for treating snakebites, scorpion stings, diabetes, urinary diseases, dyspnea, menorrhagia, oligospermia, anorexia, fever, abdominal colic and pain, dysentery, diarrhea, cough, rheumatism, pain including headache, inflammation, pyrosis, skin diseases, leprosy, sexually transmitted diseases and cancer. In Ayurveda, the plant is used in the treatment of bone-loss, low body weight, and fever, stress, topical wound and psoriasis. Besides, Ayurvedic literature also depicts its use as anti-atherogenic, anti-spasmodic, memory enhancing, immunopotentiating and anti-inflammatory agents.

Minimally invasive surgery for inguinal hernia repair is advantageous in terms of return to usual activities and lower rates of chronic pain; however, it requires general anesthesia. This study sought to analyze the benefits of ultrasound guided locoregional anesthesia of the quadratus lumborum muscle (QL block) as a single anesthetic technique for endoscopic totally extraperitoneal (TEP) inguinal hernia repair with regard to postoperative pain, length of hospital stay, and hospital cost. A total of 46 patients, aged 18 to 80 years, with unilateral inguinal hernia, one group that received general anesthesia and one that received sedation and QL block for TEP inguinal hernia repair. In the 46 patients the median pain score 6 hours after surgery was significantly lower (2 versus 4) among the QL block group than among the group receiving general anesthesia. Consequently, the former group showed a briefer median hospital stay (6 versus 24 hours, respectively). The anesthesia and hospital costs were also lower for the QL block group, with median reductions of 64.15% and 25%, respectively. QL block is a safe and effective option for patients undergoing TEP inguinal hernia repair, given the observed reduction in early postoperative pain, briefer hospital stay, and decreased anesthesia and hospital costs.

Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.