Rejected

Kounis syndrome is defined by the occurrence of an acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity or anaphylactic condition. Degranulation of mast cells and platelet activation leading to the release of multiple inflammatory mediators are thought to make the arterial circulation susceptible to acute cardiac events. It is an often underdiagnosed entity in the emergency setting, due to lack of awareness among emergency providers. Identifying Kounis syndrome is critical, since managing ACS differs from that of a classical acute myocardial infarction. We present the case of a 72-year old male patient with a history of stable coronary disease who presented to the emergency department with a diffuse pruritic rash and chest pain. Electrocardiogram showed ST elevation myocardial infarction. Urgent coronary angiography revealed total occlusion of the mid left anterior descending coronary artery which was treated with a drug eluting stent with an excellent outcome. The pruritic rash responded to treatment with intravenous corticosteroids and antihistamines; No allergens were identified. The patient's symptoms resolved and he had an uneventful hospitalization. The diagnosis of Kounis syndrome can complicate the management of acute allergic reactions. Special precautions should be taken by emergency physicians with regards to the administration of beta blockers, morphine and vasodilators, which may be detrimental in this setting.

Interacting with social robots, such as the robotic seal PARO, has been shown to improve mood and acute pain for people with dementia. Little attention has been paid to the effect of PARO on people with dementia and chronic pain.

The Colloid Cyst Risk Score (CCRS) was devised to identify symptomatic colloid cyst patients and stratify risk of hydrocephalus. The CCRS considers patient age, presence of headache, colloid cyst diameter, fluid-attenuated inversion recovery (FLAIR) hyperintensity, and location within the third ventricle.

How variations of treatment time affect the safety/efficacy of Gamma Knife (GK) radiosurgery is a matter of considerable debate. Due to the relative simplicity of treatment planning for trigeminal neuralgia (TN) this question has been addressed in a group of these patients. Using the concept of biologically effective dose (BED) the effect of the two key variables, dose and treatment time have been taken into account.

This study aimed to identify the best procedure for addressing inguinal hernias by comparing results after transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), and Lichtenstein repairs using a network meta-analysis.

Prospective cohort study.

Pain is the most common reason endorsed by patients seeking medical cannabis. Given the nature of chronic pain, it is particularly important to understand consumption patterns for patients who use cannabis for chronic health conditions to evaluate how frequency of use might impact overall health and functioning. This analysis examines whether levels of chronic pain were associated with cannabis consumption patterns, after controlling for patient-level differences in demographics.

Inadequate pain management in EDs is a worldwide problem, yet there has been little progress in understanding how pain management can be improved. There is only weak evidence and limited rationale to support interventions to improve pain management. We used naturalistic, qualitative methods to understand the factors that influence how pain is managed within the adult ED.

Self-medication refers to self-prescription which includes diagnosing and treating one's own illness and prescribing for one's self. Though appropriate self-medication relieves acute symptoms, is time saving and economical, it should not be advocated because of more risks than benefits. Self-medication practices were found to vary in medical students of Nepal and India. This study was aimed to determine the prevalence of self-medication among medical students.