Rejected

Published Lyme meningitis treatment studies are limited by outcome measures that cannot capture day-to-day differences in clinical improvement. Our goal was to use expert consensus to develop a daily measurement instrument for assessing clinical improvement in children with Lyme meningitis. We assembled a panel of 24 nationally recognized Lyme disease experts to develop a pediatric daily symptom measurement instrument. Experts responded to four rounds of surveys, receiving feedback about the previous round prior to each subsequent round with anonymity for participants and responses. Using modified Delphi methods, we established a novel Lyme meningitis outcome instrument. The final Pediatric Lyme Meningitis Symptom Measurement instrument includes five items: headache (Likert scale), neck pain/stiffness (Likert scale), fever (yes/no), light sensitivity (yes/no) and vision problems (yes/no). We defined three consecutive days with a symptom score of zero as the minimum to define clinical improvement. Using expert consensus, we developed a novel Pediatric Lyme Meningitis Symptom Measurement instrument to measure treatment response daily for children with Lyme meningitis enrolled in clinical studies.

The incidence of undiagnosed diabetes mellitus (DM) is high among patients with herpes zoster (HZ) due to complex immune defects. The DM and HZ affect each other's course aggressively. We introduced three cases of HZ for two men and one woman who were nondiabetic at presentation. Later on, their treating physicians diagnosed them with DM with different degrees of severity of hyperglycemia. They referred the three patients to us for a second opinion and for managing their DM in the presence of HZ. We managed them according to their glycemic figures. The patients were asymptomatic at different follow-up visits. The innate immune responses are lower in patients with DM, which is not enough for cutaneous protection during the reactivation of the dormant varicella-zoster virus (VZV). HZ and post-herpetic neuralgia (PHN) show an aggressive course in patients with DM and reduce the patient's quality of life. We illustrated three quiescent risk factors for our patients, in addition to undiagnosed DM, prior statin use, and comorbidity with coronary artery disease (CAD) and thyroid disease. These risk factors might affect the immunomodulatory responses and proinflammatory cytokines in various degrees. The management of patients with HZ and underlying DM is challenging. The therapy relies on antiviral medications for infection control, pain control, and a specific management plan for DM in which premixed insulin and metformin are the main components. Nondiabetic patients with acute HZ infection, whatever the severity, need to be screened for diabetes and/or hyperglycemia at the baseline interview and on frequent intervals thereafter to diagnose possible underlying DM.

Many patients and their families are hesitant to consult a palliative care (PC) team. In 2014, approximately 6,000,000 people in the United States could benefit from PC, and this number is expected to increase over the next 25 years.

Acute pancreatitis (AP) in pregnancy and post-partum period is a rare event and can have a lethal effect on the mother and the fetus. Gallstone disease is thought to be the most common causative factor of AP; however, in many cases the cause remains unclear. Here, we present a case of severe AP occurring in late pregnancy which aggravated in the early postpartum period. A 32-year-old multiparous woman, para 7, presented with severe abdominal pain, abdominal distension and multiple episodes of vomiting. The pain was localized to the upper abdomen and radiating to the back, aggravated by food and bending forward. She had neither a history of chronic alcoholism nor any evidence of viral infection was found. The patient was diagnosed with idiopathic severe AP on contrast-enhanced computed tomography, which was managed conservatively and recovered within several days. She did not have any recurrence thereafter and had a good clinical recovery. Therefore, it is important to consider AP when a woman presents with upper abdominal pain, nausea and vomiting in pregnancy and during the postpartum period to improve the maternal outcome for patients with AP.

The annulus fibrosus-one of the two tissues comprising the intervertebral disc-is susceptible to injury and disease, leading to chronic pain and rupture. A synthetic, biodegradable material could provide a suitable scaffold that alleviates this pain and supports repair through tissue regeneration. The transfer of properties, particularly biomechanical, from scaffold to new tissue is essential and should occur at the same rate to prevent graft failure post-implantation. This study outlines the effect of hydrolytic degradation on the material properties of a novel blend of polycaprolactone and poly(lactic acid) electrospun nanofibers (50:50) over a six-month period following storage in phosphate buffered saline solution at 37 °C. As expected, the molecular weight distribution for this blend decreased over the 180-day period. This was in line with significant changes to fiber morphology, which appeared swollen and merged following observation using Scanning Electron Microscopy. Similarly, hydrolysis resulted in considerable remodeling of the scaffolds' polymer chains as demonstrated by sharp increases in percentage crystallinity and tensile properties becoming stiffer, stronger and more brittle over time. These mechanical data remained within the range reported for human annulus fibrosus tissue and their long-term efficacy further supports this novel blend as a potential scaffold to support tissue regeneration.

Introduction The management of the chronic pilonidal disease is variable and the principles of treatment are aimed to eradicate the sinus tract, promote wound healing, prevent disease recurrence, and improve the quality of life of the patient. This study aims to compare the effectiveness of excision and primary closure, and Bascom's technique in the management of pilonidal sinus disease. Methods  The study was performed at a tertiary hospital from April to October 2011. All patients with chronic pilonidal sinus were included in the study (n=60) and randomly allocated into Group A – undergoing excision and primary closure (n=30) and Group B – undergoing Bascom's repair. Comparative outcomes of interest were duration of hospital admission, post-operative pain, wound infection, wound-healing and disease recurrence.  Results The mean age of presentation was 24.18±5.6 years. A higher number of patients in Group A were discharged within 24 hours compared to Group B (p = 0.001). Group B had significantly less post-operative pain by the first postoperative week (p = 0.049). Group B had lower infection rates with clean wounds observed in 28 (93.3%) patients compared to 23 (76.7%) in Group A by the first postoperative week (p = 0.07). Recurrence rate during 12-week follow-up was observed in one (3.3%) patient in Group B, and five (16.7%) in Group A (p= 0.085). Conclusions Patients who underwent Bascom's operation had less postoperative pain, lower infection rates and disease recurrence, and better wound healing. Therefore, in our patient cohort, we conclude Bascom's repair appears to be superior to primary excision and repair in reducing patient morbidity.

To investigate the clinical features and outcome of treatment for novel coronavirus pneumonia. Literature on novel coronavirus pneumonia was retrieved from PubMed and EMBASE databases. The relevant data was extracted and a meta-analysis was performed using StatsDirect statistical software V.2.8.0 to calculate the combined odds ratio. Seven studies were included, consisting of 1594 cases. The meta-analysis result showed that the most common clinical symptoms of the novel coronavirus pneumonia were fever (91.6%) and cough (64.5%), followed by dyspnea (32.8%) and sputum (28.1%). Headache (10.5%), sore throat (11.2%), hemoptysis (3.2%), diarrhea (6.6%) and the other symptoms were relatively rare. Aspartate aminotransferase (29%), alanine transaminase (22.7%), and total bilirubin (11.7%) levels were elevated, except for serum albumin levels (80.4%). The common therapeutic agents used were antibiotics (87.7%), antiviral drugs (75.5%), and glucocorticoids (26.6%), while antifungal agents (7.7%) were used in few. Mechanical ventilation (13.4%), extracorporeal membrane oxygenation (1.9%), and continuous renal replacement therapy (3.8%) were used in severe cases. The rate of mortality in hospital was 7.7%, respectively. Heterogeneity between studies was significant; however, subgroup and sensitivity analysis had failed to identify clear sources of heterogeneity. Fever, cough and liver dysfunction are the main clinical manifestations of this disease and the mortality rate is low.

Analgesics, particularly opioids, have been routinely used in the emergency treatment of ischemic chest pain for a long time. In the past two decades; however, several studies have raised the possibility of the harmful effects of opioid administration. In 2014, the American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) changed the guidelines regarding the use of opioids from class IC to class IIb for non-ST elevation acute coronary syndrome. And in 2015, the European Society of Cardiology (ESC) guidelines incidentally noted the side effects of opioids. In ST-segment elevation myocardial infarction, both ESC and AHA/ACCF still recommend the use of opioids. Given the need for adequate pain relief in ischemic chest pain in the emergency setting, it is necessary to understand the adverse effects of analgesia, while still providing sufficiently potent options for analgesia. The primary purpose of this review is to quantify the effects of analgesics commonly used in the prehospital and emergency department in patients with ischemic chest pain.