Rejected

Exit-site (ES) infection is a common complication in peritoneal dialysis (PD). . is particularly difficult to treat, and catheter removal should be considered in persistent infections. The authors present a chronic ES infection resistant to directed antibiotic therapy in which catheter salvage was not possible. Removal was very difficult due to the presence of white sponge-like tissue with petrous consistency surrounding the catheter, all the way into the peritoneum. Histology revealed well-differentiated adenocarcinoma infiltrates. Abdominal computed tomography scan revealed a solid pancreatic (tail) lesion, nodular images on the greater epiploon, an adnexal lesion and a hepatic solid lesion, consistent with metastasis. The patient was referred for palliative care but maintained PD until untreatable pain and deterioration of general status aroused. Somewhere along the course of a chronic ES infection, the peritoneal catheter (and inflammation) was the metastatic path of an unknown pancreatic cancer, with neoplastic tissue reaching the skin. Catheter removal was crucial for diagnosis.

Current Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) literature focuses on improving outcomes through careful patient selection, diligent catheter placement, and expeditious definitive hemorrhage control. However, the detection and treatment of post-REBOA ischemia-reperfusion injury (IRI) remains an area for potential improvement. Herein we provide a review of the metabolic derangements that we have encountered while managing post-REBOA IRI in past swine experiments. We also provide data-driven clinical recommendations to facilitate resuscitation post-REBOA deflation that may be translatable to humans.

Approximately 20% of patients undergoing surgery develop persistent lower extremity pain following total knee arthroplasty. Animal studies have confirmed that prolonged tourniquet time increases the risk of endoneural ischemia and can mediate or modulate the development of chronic pain. The use of Near InfraRed Spectroscopy (NIRS) adjacent to nerve tissue, previously described as ONG has been shown to detect early neural compromise and has demonstrated clinical utility in carpal tunnel diagnosis.

Histoplasma capsulatum is a dysmorphic fungus distributed worldwide commonly associated with pulmonary histoplasmosis. We report the case of an unusual presentation of gastrointestinal histoplasmosis leading to the obstruction of the intestinal lumen in a 30-year-old female, HIV positive, admitted to the hospital due to chronic abdominal pain and constipation. An initial abdominal CT revealed a mass in the sigmoid colon. A further colonoscopy showed an infiltrating, friable mass obstructing 80% of the lumen staining positive for H. capsulatum. The unspecific nature of the patient's symptoms along with the unusual presentation of the infection raises awareness about the importance of including new pathologies to differential diagnoses when treating AIDS patients.

Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment.

We performed this study and associated review to examine whether a one prognostic block is sufficient to proceed with radiofrequency ablation.

This study identifies patterns of simultaneous polysubstance use (SPU) in partygoers, their associated characteristics, and their differences in terms of acute effects experienced. We used a web-based survey with 1345 partygoers who reported using at least one substance during the past year, collecting information on drug use and drug-related acute effects experienced at the last party attended. Latent class analysis identified three SPU profiles according to the use of nine substances: (67.7%), (11.6%), and (20.7%). These profiles differed in their sociodemographic characteristics and were associated with different odds of experiencing adverse drug-related effects. Compared with participants with a profile of or , those in the group were at higher odds of experiencing memory impairment, tachycardia, and bad mood after drug use. The only differences between the and groups were in terms of hangover and headache experiences, which were less likely in the latter group (who consume less alcohol). Knowledge regarding the acute adverse drug-related effects experienced by partygoers who use multiple drugs can help to develop interventions for reducing drug-related risks in this population.

Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life ( = 1.8 in physical component summary), catastrophism ( = 1.7), kinesiophobia ( = 1.8), central sensitization ( = 1.4), disability ( = 1.4), pain intensity ( = 3.3), and pressure pain thresholds ( = 2). Differences between the groups ( < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.