Rejected

: Herein, we aimed to investigate the impact of FM in migraine patients and the specific features and discriminations of this group of migraineurs with FM according to patients without FM. : 102 consecutive migraine patients among 18-50 years old who accepted to involve in the study were included. All patients were asked to complete the following self-report questionnaires for the assessment of pain-related disability, migraine-related disability, anxiety, depression, sleep disturbance and quality of life. All statistical analyses were performed using the SPSS statistics 20 program. : 92% of the patients were diagnosed with episodic migraine, whereas 8% of them was diagnosed with chronic migraine (CM). Comorbid FM which was detected to present in 30.3% of the patients. FM was more frequent in CM patients and in migraine patients with aura. The analyses comparing FM (+) and FM (-) migraineurs revealed that headache frequency, migraine disease duration, headache impact test, MIDAS scores were significantly higher in FM (+) migraineurs. Furthermore, the vitality and role-emotional domains of the SF-36 resulted in worse scores in the group of FM (+) migraineurs. : The results of our study may suggest the presence of FM as a clinical sign of a more severe migraine. However, the long-term prospective studies including these group of patients are needed to understand the prognostic impact and importance of the comorbid FM in migraine. FM: Fibromyalgia; MIDAS: Migraine Disability Assessment.

This study aimed to investigate the antinociceptive effect of allopurinol, a xanthine oxidase inhibitor, in the chronic constriction injury (CCI) to sciatic nerve rat model of neuropathic pain.

Risk for prescription opioid addiction is an endemic public health concern, especially for adults with chronic pain. This study examined craving as a mediator from pain to opioid use outcomes during prescription opioid addiction treatment and tested whether counseling in pain coping skills moderated the effects of craving on treatment outcomes.

Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20ml of solution administered at the level of the transverse process of L4 in a cadaver model.

Headache is a common complaint in children at a pediatric emergency department (PED). The primary objective of this analysis is to describe the outcome of patients presenting with headache to the PED and discharged with neurology follow up. The secondary objective is to describe the diagnostic evaluation children with headache underwent in the PED and to evaluate headache characteristics which are more likely associated with serious, life-threatening conditions.

Overlapping surgery, performed by the same primary attending surgeon asynchronously, has gained significant attention from the government and media as potentially harmful to patients. Therefore, the goal of this study was to evaluate the outcomes and safety of overlapping versus nonoverlapping microvascular decompression (MVD) operation.

The aim of the study was to investigate the influence of Hp on clinical and biochemical course of chronic hepatitis C (CHC). The study included 150 patients with a confirmed diagnosis of chronic hepatitis C, who for various reasons did not receive specific antiviral therapy. Helicobacter pylori (Нр) was determined using a quick urease test (CLO-test) and a coprological test (CITO TEST, manufactured by Pharmasco LLC), interleukin (IL) levels: IL-1β, IL-6, tumor necrosis factor α (TNF-α) and neopterin by ELISA. Two groups were formed: the 1st (n=52) – patients with chronic hepatitis C infected with Hp and the 2nd (n=98) – patients with chronic hepatitis C without Hp. It was found that in patients with chronic hepatitis C infected with HP, dyspeptic syndrome (94.2% versus 52.0%, p<0.05), pain and severity in the right hypochondrium (65.4% versus 20.4%, p<0.05); and periodic itching of the skin (57.7% versus 12.4%, p<0.05) were significantly more often recorded, compared with patients with chronic hepatitis C without HP. Levels of total bilirubin, alkaline phosphatase and gammaglutamyltranspeptidase are significantly higher in patients with chronic hepatitis C combined with Hp, compared with patients without Hp (p<0.05), which indicates the predominance of cholestasis syndrome in them. Also, in patients with chronic hepatitis C combined with Hp, higher levels of hepatic enzyme activity (AlAT, AsAT) were detected compared with patients with chronic hepatitis C without Hp (82.3% versus 22.9%, respectively; p<0.001). More pronounced disregulatory changes in the cytokine link of the immune system, characterized by an increase in the levels of proinflammatory cytokines: IL-1β, IL-6, TNF-α and neopterin were registered in patients with chronic hepatitis C infected with Hp, than in patients without Hp. High levels of hepatic enzyme activity (AlAT, AsAT, GGTP), as well as the predominance of cholestasis syndrome in patients with chronic hepatitis C combined with Hp, require the development of a comprehensive eradication therapy of Hp considering the results of clinical and laboratory features of the course of CHC.

The current literature supports static progressive stretch (SPS) orthoses as the consensus modality to treat joint stiffness as an adjunct to manual therapy. Over 50 published studies prove the efficacy and safety of this modality as an adjunct to therapy to improve range of motion (ROM) as well as decrease stiffness and pain. Data from a large prospective study on SPS effectiveness identified a 90% improvement in ROM, 84% reduction in stiffness and swelling, 70% reduction in pain, and no reports of complications or injury. Another 13 studies evaluating patients with knee stiffness have shown excellent results with SPS, and a reduced need for manipulation under anesthesia or additional surgeries. The bidirectional SPS device allows for ROM therapy in both flexion and extension, uses short, 5-minute incremental stretches for up to a 30-minute session applied 1 to 3 times per day for 8 weeks, though treatment might be needed for longer durations (8 to 12 weeks) in cases with chronic stiffness/contracture, to improve motion and significantly reduces need for manipulation or surgery for treatment of knee fibrosis. Earlier application of SPS therapy, even immediately postoperative following corrective surgery for motion loss, can greatly improve the results for patients who have limitations in knee motion.

Silent corticotroph adenoma (SCA) is an unusual type of nonfunctioning pituitary adenoma (NFA) that is silent both clinically and biochemically and can only be recognized by positive immunostaining for ACTH. Under rare circumstances, it can transform into hormonally active disease presenting with severe Cushing syndrome. It might often produce diagnostic dilemma with difficult management issue if not thoroughly investigated and subtyped accordingly following surgery. Here, we present a 21-year-old male who initially underwent pituitary adenomectomy for presumed NFA with compressive symptoms. However, he developed recurrent and invasive macroadenoma with severe clinical as well as biochemical hypercortisolism during post-surgical follow-up. Repeat pituitary surgery was carried out urgently as there was significant optic chiasmal compression. Immunohistochemical analysis of the tumor tissue obtained on repeat surgery proved it to be an aggressive corticotroph adenoma. Though not cured, he showed marked clinical and biochemical improvement in the immediate postoperative period. Anticipating recurrence from the residual tumor, we referred him for cyber knife radio surgery.

Morphine is a common analgesic often used to manage chronic pain, especially for patients with pain due to malignancies. Since UGT2B7 plays an important role in the metabolism of morphine, UGT2B7 gene mutation may influence the efficacy of morphine in patients with cancer being treated by this medication.