Rejected

Infections after renal transplant are a common cause of morbidity and are commonly due to Cytomegalovirus (CMV), , , and . Concurrent infections with both cryptococcal and tuberculous aetiologies are rare within the central nervous system (CNS). We present a case of a 67-year-old male patient who presented with three weeks of headaches, confusion, unsteady gait, and seizures. He had type 2 diabetes mellitus and hypertension. He had a kidney transplant three years prior and was on three immunosuppressive agents. He was HIV-negative. He was evaluated and found to have cryptococcal meningitis and received appropriate treatment with liposomal amphotericin B, flucytosine, and serial lumbar punctures. He also had treatment for CMV viremia with valganciclovir. Three weeks later, after an initial good clinical response, he deteriorated with worsening confusion and persistent seizures. We re-evaluated him and found him to have brain imaging suggestive of tuberculosis. We started him on anti-tuberculous medication, and he improved significantly and was alert and seizure free at discharge home one month later. This case highlights that concurrent CNS infections with cryptococcus and tuberculosis do occur especially in patients who are severely immunosuppressed such as after a renal transplant. Failure to improve while on treatment for one CNS opportunistic infection should prompt one to investigate for other concurrent causes.

Interscalene nerve catheters have been proven to be effective in managing pain after rotator cuff repair (RCR) surgery. Liposomal bupivacaine is a newer approved therapy for use around the interscalene brachial plexus, but its analgesic efficacy has limited supporting data in various patient populations.

This study aimed to investigate whether the use of levonorgestrel intrauterine devices (LNG-IUD) in the perspective of traditional Chinese medicine (TCM) can improve the body constitution deviations and quality of life (QoL) in patients with chronic pelvic pain (CPP) and heavy menstrual bleeding (HMB).

In this study, we present a case of Behcet's colitis that caused acute inflammation in the gallbladder and mimicked the clinical picture of an acute abdomen: severe right-sided abdominal pain, nausea, fever, and tenderness in the right hypochondrium, right flank, right loin, and right iliac fossa (RIF), with severely elevated white blood cell (WBC) count. The picture of acute acalculous cholecystitis and acute abdomen was resolved after three days of antibiotic therapy. Then, the pain mainly was localized in the right flank and loin, with mild pain in the right iliac fossa, with positive Rovsing's and psoas signs. The pain in the right flank, loin, and RIF dramatically subsided after initiating a low dose of steroid injections. The colonoscopy, which was performed after the marked improvement of the patient's general condition, showed large, deep ulcers with severe colitis in the proximal transverse colon and the ascending colon. There was no cobblestone appearance. The histopathology of the colonoscopic biopsy showed surface ulceration with marked inflammatory infiltrates, mainly neutrophils, and no granulomas were found. The acid-fast bacillus (AFB) test was reported negative. Detailed history-taking, repeated clinical examinations, laboratory studies, and careful interpretation of ultrasound (US) and contrast-enhanced computed tomography (CECT) findings may prevent unnecessary surgical interventions in such fragile patients and lead to a better prognosis. A diagnosis of Behcet's colitis was made, taking into consideration the patient's past medical history, mucocutaneous lesions, and US, CECT, colonoscopic, and histopathology findings. Although there are no specific investigations and tests for Behcet's colitis, sparing of the rectosigmoid area, the absence of cobblestone appearance, the presence of deep, large round ulcers, patchy localization of the lesions, the absence of granulomas, and negative AFB are helpful for confidently excluding other specific colitis such as Crohn's disease, ulcerative colitis, intestinal tuberculosis (TB), diverticulitis, and ischemic colitis. In our view, in the differential diagnosis of the non-surgical cause of acute abdomen, Behcet's colitis must be considered among other rare causes, such as inferior myocardial infarction, diabetic ketoacidosis, sickle cell disease, familial Mediterranean fever, and acute intermittent porphyria, especially for the population of Mediterranean coast and Middle East countries.

We aimed to characterize the ocular phenotype of patients with ROSAH (Retinal dystrophy, Optic nerve edema, Splenomegaly, Anhidrosis, and Headache) syndrome and their response to therapy.

After studying this article, the participant should be able to: 1. Discuss the natural history and pathophysiology of sarcoma. 2. Summarize the most up-to-date multidisciplinary management of soft-tissue sarcoma. 3. Provide a synopsis of reconstructive modalities based on anatomical location. 4. Highlight some novel strategies for treatment of lymphedema and phantom limb pain that are common sequelae following treatment and resection of soft-tissue sarcomas.

The Food and Drug Administration has approved the Janus kinase inhibitor ruxolitnib (Opzelura) as topical treatment for nonsegmental vitiligo in children and adults ages 12 years and older.The most common adverse effects are application site acne, application site itching, common cold, headache, urinary tract infection, application site redness, and fever.

The relationship between autologous hematopoietic stem cell transplant (aHSCT) for multiple myeloma (MM) and anti-GABA receptor (GABAR) encephalitis is unknown. We aimed to describe the clinical features, diagnostic process, and outcome of 3 cases of anti-GABAR encephalitis in patients with a history of prior aHSCT for MM.

Objectives The objective of the study was to determine the effect of a single dose of IV dexamethasone on postoperative pain in patients after laparoscopic cholecystectomy. The outcome will be measured in the terms of mean pain score. Study design and setting This is a prospective study. We did a randomized control trial to compare the outcome in two groups. This study was conducted in the Department of Surgery, Benazir Bhutto Hospital, Rawalpindi, from December 2021 to May 2022. The total duration of the study was six months. Methodology A total of 160 patients were randomly divided into group A and group B. We performed laparoscopic cholecystectomies on all the patients under standard general anesthesia. In group A (control group), 5 mL of normal saline was injected intravenously at the time of induction of anesthesia. In group B, the dexamethasone group, the inj. dexamethasone with a dose of 0.1 mg/kg diluted in 5 mL normal saline was given intravenously at the time of induction of anesthesia. Postoperatively, the median pain score was measured using visual analog scale (VAS) at 2, 6, 12, and 24 h on a specially made proforma. The results were further stratified according to gender and age. Results The postoperative VAS in group B was significantly low compared with group A when measured at 2, 6, 12, and 24 h. It means that the median pain score was markedly less in the study group than in the placebo one, and it was statistically significant (p<0.05). Conclusion Administration of a single dose of dexamethasone preoperatively in laparoscopic cholecystectomy patients is effective to control postoperative pain.

Chronic pancreatitis represents an inflammatory condition occurring from repetitive pancreatic inflammation episodes ultimately causing patients intractable pain alongside pancreatic insufficiency and as a result, reduced quality of life. In addition to alcohol and smoking cessation, patients with chronic pancreatitis are treated conservatively with anti-depressants, anti-convulsant and analgesic medications including paracetamol and celecoxib – with limited success. Alternative to surgical resection, patients can opt for endoscopic treatment options including sphincterotomy or removal of calculi which have shown limited success. Celiac plexus blocks have had positive outcomes as well, however, are not long-lasting and carry significant risks, such as gastroparesis or organ damage. Evidence has shown alterations in the peripheral and central nervous system which causes these patients to often experience dysfunctional and neuropathic pain. The advent of this knowledge has introduced neuromodulation into the field with successful cases of spinal cord stimulation treating the pain associated with chronic pancreatitis. Dorsal root ganglion stimulation is similarly based upon the gate theory of pain but with more precision as it strictly targets the dorsal root ganglion. There have been no cases reported in the literature of this form of stimulation in treating chronic pancreatitis. We present a case of a patient with chronic pancreatitis who obtained 80% abdominal pain relief for two years after undergoing dorsal root ganglion stimulation.