Rejected

Marijuana and nonprescription opioids remain the two most commonly used illicit substances in the United States. They have commonalities, yet the use of both at the same time may have a greater impact on psychological and health outcomes. Research is needed to determine whether dual-use is associated with more negative outcomes than individual substance use.

Erythromelalgia is a rare disease that is associated with hemato-oncological diseases or after taking certain drugs and toxins, but it can also occur as an independent clinical picture, for example, due to mutations in the sodium channel Na1.7. Clinically, there is a characteristic triad of attack-like burning pain and skin redness in the area of the distal extremities, which can be alleviated by excessive cooling. The attacks are triggered by heat, exertion, and stress. The diagnosis is primarily made clinically and can be confirmed by genetic testing if a sodium channel Na1.7 mutation is present. Important differential diagnoses are complex regional pain syndrome, the non-freezing cold injury, and small fiber neuropathies. Therapy is multidisciplinary and has to be planned individually and include physical therapy and psychotherapy as well as drug therapy as integral components.

The causes of pain must always be clarified, as long as it can be justified. In dementia the placebo effect can be lacking. A treatment on demand is difficult to implement. Correctly applied nonmedicinal treatment has few unwanted effects but mostly needs constant support by personnel. Medications with anticholinergic effects should be used with caution due to the high risk of delirium and falling. With analgesics and coanalgesics the principles of geriatric treatment must also be adhered to: start low, go slow. Complaints that can be triggered by analgesics or coanalgesics should be recorded before starting treatment. Education and clarification by therapists are given priority. Multimorbidity and polypharmacy restrict the analgesic treatment. Strategies of self-efficacy and other psychological procedures have limited implementation. The course of treatment is difficult to monitor.

The assessment of comorbid physical illness and metabolic or cardiovascular risk factors as potential risk factors for onset of major depressive disorder (MDD) is crucial. We aimed to investigate potential risk factors for the development of MDD among individuals with chronic medical conditions and metabolic and behavioral risk factors using a large population-based retrospective cohort from the data of the National Health Insurance Service (NHIS) in South Korea.

Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality.

In this review, we discuss the changing landscape of sedation in mechanically ventilated children with pediatric acute respiratory distress syndrome (PARDS). While previous approaches advocated for early and deep sedation with benzodiazepines, emerging literature has highlighted the benefits of light sedation and use of non-benzodiazepine sedating agents, such as dexmedetomidine. Recent studies have emphasized the importance of monitoring multiple factors including, but not limited to, sedation depth, analgesia efficacy, opiate withdrawal, and development of delirium. Through this approach, we hope to improve PARDS outcomes. Overall, more research is needed to further our understanding of the best sedation strategies in children with PARDS.

We herein report a case of direct carotid-cavernous fistula(direct CCF)in a patient with masked hypertension caused by bilateral subclavian artery stenosis. A 74-year-old woman presented with headache, right-sided proptosis, double vision, and pulsatile tinnitus since past 10 days. The patient was diagnosed with direct CCF. Transarterial embolization in the region of the right internal carotid artery was performed, after which her symptoms resolved. However, additional interventions in the form of subclavian artery stenting were required, because of the complications of left subclavian artery occlusion and right subclavian artery stenosis. Satisfactory dilatations were achieved, and the angiographic 'steal' phenomenon disappeared. The patient had terminated antihypertensive treatment because of the normalization of her brachial blood pressure; however, this was merely pseudo-normalization due to subclavian artery insufficiency. We consider this a case of direct CCF occurring as a complication of masked hypertension caused by bilateral subclavian artery stenosis.

Chronic postsurgical pain (CPSP) following laparoscopic donor nephrectomy (LDN) is a disregarded topic. In this cross-sectional study, all consecutive patients who underwent a LDN at the Radboudumc (2003-2016) were approached for participation. Five hundred and twelve living kidney donors were included and asked to complete two questionnaires, including the Mc Gill Pain questionnaire and the RAND Short Form-36 Health Status Inventory (RAND SF-36) regarding their health-related quality of life (HRQoL). The mean prevalence of CPSP following LDN was 5.7% with a mean follow up time of 6 years. Possible predictors of CPSP following LDN are severe early postoperative pain, previous abdominal surgery and preexisting backache. The RAND SF-36 questionnaire revealed an impaired HRQoL in patients with CPSP when compared to those without CPSP. In conclusion, this study revealed that the prevalence of CPSP following LDN is substantial. Given the possible association between the presence of CPSP and impaired HRQoL scores, living kidney donors should be well informed in the preoperative phase about the risk of CPSP. This article is protected by copyright. All rights reserved.

Vascular complications in posterior fossa surgery, even in microvascular decompression (MVD) involving a small cranial opening, can have catastrophic consequences. This study analyzes these complications in order to determine the incidence, risk factors, prognosis, and preventive measures involved.