Rejected

Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assesses the appropriate prescribing of opioids by dentists before guideline implementation.

Two protocols were developed to guide the use of subdissociative dose ketamine (SDDK) for analgesia and dissociative sedation ketamine for severe agitation/excited delirium in the emergency department (ED). We sought to evaluate the safety of these protocols implemented in 18 EDs within a large health system.

To investigate the effect of electroacupuncture (EA) at "Jiaji" (EX-B2) at different time points on the expression of OX-42 (a monoclonal antibody with specific expression of complement receptor-3 in spinal microglial cells) and purinergic receptor P2X4 (P2X4) in rats with chronic constriction injury (CCI) of the sciatic nerve, as well as the possible after-effect mechanism of EA analgesia in neuropathic pain.

Chronic pain usually accompanied by tissue damage and inflammation. However, the pathogenesis of chronic pain remains unclear.

BACKGROUND Corneal ulceration is caused by various corneal diseases, including infection, inflammatory disease, neurotrophic keratitis, dry-eye, autoimmune disease, and blepharitis. Treatment should be based on the etiology. In cases of infection, corneal scraping and pathogen culture should be carried out before treatment. Bacterial pathogens are the most common etiology, but it can be caused also by viruses, fungi, and protozoa. Quinolones are the first-line drug for bacterial keratitis, but the treatment should be changed according to the culture and drug sensitivity test results. The purpose of this case report is to show the resolution of a corneal ulcer case unusually treated with 0.66% povidone-iodine (PVP-I). CASE REPORT A 61-year-old man showed signs of pain, redness, watering, and photophobia in the left eye (oculus sinister; OS) over a 5-month period, starting as conjunctivitis and degenerating into keratitis. Clinical examination revealed an ulcer in the inferior cornea and biomicroscopy analysis confirmed this diagnosis. Previous therapies, starting with antibiotics first and then antiviral medications, were unable to control the signs and symptoms. Therefore, treatment with 0.66% PVP-I, based on its antiseptic activity, was administered 3 times a day for 4 weeks. CONCLUSIONS PVP-I 0.66%, an antiseptic with broad-spectrum activity against bacteria, fungi, viruses, and protozoa, was found to be effective in treating the signs and symptoms of the ulcer until its complete closure and resolution. It could be a useful therapeutic tool when the pathogen is unknown, as in this case. Its use for treatment of corneal ulcers warrants further investigation.

Patient Reported Outcomes Measurement Information Systems (PROMIS) scales are increasingly being used to measure symptoms in research and practice. The purpose of this study was to determine the minimally important difference (MID) and severity thresholds (cut-points) for the four fixed-length PROMIS depression scales.

Peripheral neuropathic pain is a common and disabling problem after traumatic brachial plexus injury with global plexopathy secondary to C5 rupture and avulsion of C6, C7, C8, and T1. The purpose of this paper is to evaluate restoration of sensation and pain levels before and after targeted muscle reinnervation to the hand using contralateral C7 nerve transfers in patients who have traumatic brachial plexus injuries with C5 rupture and avulsion of C6, C7, C8, and T1.

Population-level data on migraine hospital admission trends are unavailable. Changes in stroke care may have influenced these, since migraine is one of the most common stroke mimics. In this study, all hospital admissions on neurological, internal medicine, and pediatric wards in Finland with migraine as the primary diagnosis for persons at least 16 years of age in 2004-2014 were studied, resulting in an analysis of 6195 individuals with 7764 migraine discharges. The number of discharges increased by 4.2% annually ( = 0.000084), with no change in age of the admitted patients. Comorbidity burden was low but increased during the study period ( < 0.0001). The frequency of common vascular risk factors as comorbidities increased by 11-19% annually. Admission duration shortened by 2% annually ( < 0.0001). An intravenous thrombolysis was given in four admissions. It seems that migraine hospital admissions have become more frequent and the patients more often have cardiovascular risk factors, suggesting increased awareness and more aggressive acute evaluation of suspected stroke as the cause.

Due to the increasing rates of chronic diseases and an aging population, the use of assistive devices for ambulation is expected to grow rapidly over the next several years. Instrumenting these devices has been proposed as a non-invasive way to proactively monitor changes in gait due to the presence of pain or a condition in outdoor and indoor environments. In this paper, we evaluated the effectiveness of a multi-sensor cane in detecting changes in gait due to the presence of simulated gait abnormalities, walking terrains, impaired vision, and incorrect cane lengths. The effectiveness of the instrumented cane was compared with the results obtained directly from a shank-mounted inertial measurement unit. Results from 30 healthy participants obtained while simulating gait abnormalities and walking over different terrains demonstrated the ability of the cane to reliably and effectively discriminate among these walking conditions. Moreover, the results obtained while walking with impaired vision and incorrect cane lengths indicate the ability of cane to detect changes in gait during these scenarios as well.

Primary leiomyosarcomas of the central nervous system are extremely rare tumors, with few cases reported in the literature. In this article we report the case of a patient with an intracranial leiomyosarcoma of the cavernous sinus. This is the case of a 23-year-old man with a history of human immunodeficiency virus (HIV) and Epstein-Barr virus infection, with clinical picture of headache and left palpebral ptosis, who underwent nuclear magnetic resonance imaging that showed a lesion that occupied the cavernous sinus. Excisional biopsy reported fusocellular mesenchymal neoplasm with smooth muscle differentiation by immunohistochemistry compatible with low-grade leiomyosarcoma. The patient was initially taken to a partial resection, without treatment. Subsequently, the patient presented progression of his disease, so the area of neurosurgery considered that the lesion was unresectable due to its location and the risk of sequelae. It was then decided to treat the patient with intensity-modulated radiation therapy technique external radiotherapy. At six months of treatment, the patient continues asymptomatic with a stable disease.