Rejected

Individuals with chronic low back pain (CLBP) may lack coordination between the stabilising and respiratory functions of trunk muscles. The trunk stabilisers compromise breathing to maintain spinal stability, leading to breathing dysfunctions. Maximal voluntary ventilation (MVV) is indicative of the respiratory muscle endurance and strength whereas end-tidal carbon dioxide (PETCO) gives an estimate of breathing patterns that closely reflect the arterial measurement of CO. CLBP has been shown to have a significant effect on respiratory functions. However, the impact has not yet been quantified. Further, there is a dearth of literature comparingrespiratory functions between CLBP and healthy individuals. This study investigates respiratory functions in participants with and without CLBP.

Nontraumatic chylous pleural effusions (chylothorax) and pericardial effusions (chylopericardium) are rare. They can, however, accompany intrathoracic malignancies and, most commonly, lymphomas. An association of chronic lymphocytic leukemia (cll) with chylopericardium has rarely been reported. A 68-year-old woman with cll, previously treated with single-agent fludarabine in the community, developed pleuritic chest pain and a new pericardial effusion. Computed tomography (ct) imaging of her chest revealed a large pericardial effusion with progressive lymphadenopathy. Pericardiocentesis identified a chylous effusion, and complete evacuation was achieved by catheter drainage. The cll was not treated. An asymptomatic pericardial effusion subsequently recurred. Pericardiocentesis was not repeated. Lymph node biopsy and flow cytometry revealed no evidence of large-cell lymphoma transformation. The patient was treated with 6 cycles of chlorambucil and obinutuzumab. Imaging of her chest by ct between cycles 2 and 3 revealed a marked resolution of the intrathoracic lymphadenopathy, with complete disappearance of the pericardial effusion. Repeat imaging at 5 months and again at 3 years after completion of chemotherapy demonstrated no recurrence of either the lymphadenopathy or the pericardial effusion. The mechanism of production and the treatment of chylous effusions are poorly defined. In this case, resolution of the pericardial effusion with effective chemotherapy is postulated to have alleviated obstruction of anterograde lymphatic flow facilitating drainage into the systemic venous system and allowing for spontaneous complete resolution of the pericardial effusion without surgical intervention.

Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. However, recurrent aseptic meningitis, reported as the most uncommon initial symptom, was the presenting feature in our case. We present the case of a 19-year-old female with recurrent episodes of aseptic meningitis. She presented with fever, headache, vomiting and photophobia. Neurological examination showed neck stiffness. Fundoscopy was normal. On two previous occasions her cerebrospinal fluid analysis was consistent with meningitis; however, it was normal at this presentation. Review of system revealed history of fatigue and sicca symptoms since early childhood. Autoimmune workup showed antinuclear antibodies with a titer of 1:400 and positive anti SSA (Ro) antibodies that led to the diagnosis of Sjogren's syndrome. She responded well to intravenous steroids, followed by oral prednisolone and hydroxychloroquine. To conclude, diagnosis of Sjogren's syndrome may also be considered in a patient presenting with recurrent aseptic meningitis.

Allergic rhinitis is one of important risk factor for developing asthma and sometimes it appears before developing full-blown asthma in affected patients. This is a socially embarrassing condition for the patients. Current estimates are that allergy in one form or another affects some 30% or more of general population. Otolaryngologists may expect about 50% of patients encountered in their daily practice to have allergy as a major or at least a contributing cause of presenting problems. Allergy has been called "The great masquerader", because of its ability to mimic an immense variety of other conditions. Objective of the study is to determine the association of allergic rhinitis with asthma. This cross sectional study was conducted at Green Life Hospital, Dhaka, Bangladesh from January 2018 to July 2018. Ultimately 250 interested patients were enrolled in the study. 50.8% of the participants were male and 49.2% were female. Among the 250 allergic rhinitis patients 92% presented with nasal discharge, 64.8% presented with nasal blockade, 84% presented with bouts of sneezing, 27.6% presented with hyposmia, 8.8% presented with Ocular redness, 48.8% presented with headache, 18.0% presented with epistaxis. Among them 43.2% patients were previously diagnosed as asthma by competent physicians; 39.2% patients had previous history of breathlessness that relieved with asthma medication in last 12 months. At least more than one symptom like wheeze, shortness of breath, chest tightness and cough in last 12 months were experienced by 51.6% patients. Among the 250 patients 51.2% had Rhonchi on chest examination, 54.8% had some form of shortness of breath, 43.2% had chest tightness, 59.6% had dry cough during the time of history taking & physical examination. The current study found strong association between allergic rhinitis and asthma.

MINI: Lumbar disc herniation always generates radicular pain and mechanism is not clear. In this study, we found spinal SFKs contributed to radicular pain by activating of p38 MAPK and increasing pro-inflammatory cytokines expression in rats with NP implantation. Targeting SFKs/p38 pathway may be helpful for alleviating radicular pain.

To characterize the clinical symptoms and magnetic resonance imaging (MRI) findings of unilateral cortical FLAIR-hyperintense Lesions in Anti-MOG-associated Encephalitis with Seizures (FLAMES).

Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications.

Complex mechanisms involved in neuropathic pain that represents a major health concern make its management complicated. Because neurosteroids are bioactive steroids endogenously synthesized in the nervous system, including in pain pathways, they appear relevant to develop effective treatments against neuropathic pain. Neurosteroids act in paracrine or autocrine manner through genomic mechanisms and/or via membrane receptors of neurotransmitters that pivotally modulate pain sensation. Basic studies which uncovered a direct link between neuropathic pain symptoms and endogenous neurosteroid production/regulation, paved the way for the investigations of neurosteroid therapeutic potential against pathological pain. Concordantly, antinociceptive properties of synthetic neurosteroids were evidenced in humans and animals. Neurosteroids promote peripheral analgesia mediated by T-type calcium and gamma-aminobutyric acid type A channels, counteract chemotherapy-induced neuropathic pain and ameliorate neuropathic symptoms of injured spinal cord animals by stimulating anti-inflammatory, remyelinating and neuroprotective processes. Together, these data open interesting perspectives for neurosteroid-based strategies to manage/alleviate efficiently neuropathic pain.

Changes in different regions of the brain due to postural disturbances were found in patients with chronic low back pain (LBP). The aims of the current study were to investigate the short- and long-term enhancing effects of concurrent postural training and primary motor cortex (M1) anodal transcranial direct current stimulation (a-tDCS) on balance, postural stability and pain in chronic LBP patients with postural impairment. In this clinical trial study, thirty eight patients with chronic LBP were randomly assigned to a-tDCS and training, sham a-tDCS and training,and training only groups. All groups received identical postural training for 20 min, three sessions per week for two weeks. The length of stimulation, which used concurrent with postural training in the active a-tDCS group was also 20 min. Before, immediately and one-month after the interventions, postural stability, balance and pain were assessed using Biodex Balance System, Berg Balance Scale (BBS) and Visual Analog Scale (VAS), respectively. The postural stability indices, BBS and VAS scores significantly improved immediately and one-month after the intervention in the a-tDCS and training group (P < 0.001), while there were significant differences between active a-tDCS and other two groups (P < 0.001). Postural stability indices, the BBS and VAS scores were not significantly different between the sham and training only groups after the interventions (P > 0.05). M1 a-tDCS significantly improves the effects of postural training on postural stability, balance and pain in patients with chronic LBP. Two-week postural training alone cannot improve postural impairment in patients with chronic LBP.