Rejected

Assisted calves are often born weak, injured, or oxygen deprived and have a higher risk of morbidity and mortality. The objective was to investigate the impact of using pain mitigation at birth in assisted beef calves on physiological indicators of pain and inflammation, passive immunity, health, and growth. Thirty-three primiparous cows and their calves requiring assistance at birth on 2 ranches located in southern Alberta were enrolled. Data collected at birth included: date and time of calving, calf sex, meconium staining, presentation of calf, and calving difficulty (easy assist: 1 person manually delivered the calf; difficult assist: delivery by 2 or more people, or mechanical assistance). Within 10 minutes of birth, calves were stratified by calving difficulty, randomized to a medication group, and received a subcutaneous dose of meloxicam (0.5 mg/kg body weight) or an equivalent volume of placebo. Cow-calf pairs were then placed in individual box stalls for observation and sampling. At birth, 1 hour, 4 hours, and 24 hours after birth, heart rate, respiratory rate, and rectal temperature were assessed and blood samples collected to measure indicators of pain and inflammation (cortisol, corticosterone, substance P, and haptoglobin). Serum immunoglobulin (IgG) concentration and failed transfer of passive immunity (serum IgG concentration less than 24 g/L) were assessed in the 24-hour blood samples. Preweaning treatment for disease and mortality information was collected and calves were weighed at 7 to 10 days of age and at weaning. Of the 33 calves enrolled, 17 calves received meloxicam and 16 calves received a placebo. Meloxicam-medicated calves had significantly greater average daily gain to 7 to 10 days of age (P = 0.05) (mean = 0.9 kg/d; SE= 0.10) compared to placebo-medicated calves (mean = 0.6 kg/d; SE = 0.12). There was no significant effect of meloxicam on physiological indicators of pain and inflammation, time to stand, time to nurse, passive immunity, health outcomes, or ADG to weaning (P > 0.1). Although this was a small sample population, meloxicam given to assisted calves at birth improved ADG in the first week of life, which may indicate an important production management tool for improving well-being in assisted calves.

Lower limb veins diseases belong to frequently occurring disease syndromes. It covers 62% of adult Poles. They are not only an aesthetic problem. They can cause a lot of subjective and objective ailments significantly reducing the quality of life – from asymptomatic spider veins to permanent pain in lower limbs, especially in standing, fixed edema, skin lesions and ulceration. Superficial chronic venous insufficiency is due to incompetence of the saphenofemoral junction and great or small saphenous vein. Conventional surgery involves high ligation, stripping and phlebectomy. Recently, at the beginning of XXI century, minimally invasive endovenous techniques which became as alternatives to conventional surgery. Currently, the number of possible methods of treatment of venous disease available for use exceeds ten.

Rectal adenocarcinoma is an uncommon finding in patients under the age of 40. However, epidemiological surveys have suggested that colorectal cancers are increasing in incidence among patients aged 20 to 39 years in the United States. Colorectal adenocarcinoma is often not considered in the differential diagnosis in this demographic because of age. Here, we present the case of an incidental finding of anemia during a preliminary evaluation of rheumatoid arthritis leading to the diagnosis of stage IV-B rectal adenocarcinoma in a 34-year-old male patient. A 34-year-old Caucasian male presented with the incidental finding of anemia during a preliminary evaluation for rheumatoid arthritis. The patient was asymptomatic with the exception of a three-month history of wrist and ankle joint pain. Past medical history was positive for only a three-year history of occasional spotty, painless rectal bleeding attributed to internal hemorrhoids. Physical exam findings were positive for mild extremity pallor and positive fecal occult blood test. Hematologic studies revealed a significant microcytic, hypochromic anemia with severe iron deficiency. Laboratory studies revealed no evidence of vitamin deficiency, hemolytic activity, hematuria, hypothyroidism, or clotting factor disorder. Erythrocyte sedimentation rate (ESR), rheumatoid factor, and cyclic citrullinated peptide 3 (CCP3) were elevated supporting the diagnosis of underlying rheumatoid arthritis. On further questioning, the patient revealed that he had been utilizing an average of 2000 mg of ibuprofen daily during the previous several months in an attempt to control his joint pain. The patient was evaluated for a potential upper gastrointestinal bleed by esophagogastroduodenoscopy (EGD), which found no evidence of active bleeding. As the patient continued to have decreasing hemoglobin levels, he was evaluated for a lower gastrointestinal source of bleeding by colonoscopy, which revealed an 8 cm circumferential mass at the anal verge. Pathological evaluation of biopsy samples revealed a moderately differentiated invasive adenocarcinoma. The patient had no family history of colorectal cancer or major associated risk factors, such as obesity, smoking history, heavy alcohol use, diabetes mellitus type 2, or a history of inflammatory bowel disease. Following discharge, positron emission tomography (PET) scan showed extensive metastatic disease to multiple regional lymph nodes as well as multiple suspicious hepatic lesions and bilateral pulmonary nodules. Due to the poor prognosis, recommended treatment consisted of folinic acid, 5-fluorouracil, oxaliplatin (FOLFOX-4) along with palliative radiation. The cause of the increase in the incidence rate of colorectal cancer in young adults remains unknown. Among this demographic, colorectal cancers appear to be more aggressive and present at later stages with more advanced disease. In young adults, the most common clinical sign at presentation is rectal bleeding. In young adults presenting with seemingly common gastrointestinal complaints, a high degree of suspicion for colorectal cancer may be warranted by clinicians.

Adverse Childhood Experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2-weeks to 3-months post injury. Demographics, burn, and hospital course data were also collected. Chi-square and student's t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs. LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (p < 0.04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (p ≤ 0.02) and more likely to screen positive for probable PTSD (p = 0.01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (p = 0.015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.

There are many empirical studies that demonstrate the associations between problematic internet use, psychopathological symptoms, and personality traits. However, complex models are scarce.

Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016.

This study examined the agreement between patient-reported chronic diseases and hospital administrative records in hip or knee arthroplasty patients in England.

Osteitis condensans ilii (OCI) is a benign cause of low back pain, which is self-limiting. Though OCI is still an orthopedic mystery, mechanical stress across the joint is a significant triggering factor according to the prevailing theories. The traditional location of involvement is around the ileum, and can be misinterpreted as sacroiliac joint (SIJ) involvement. We present a case of bilateral OCI with sclerosis based on radiological finding in a 30-year-old female presenting with chronic low back pain.

Neurogenic stunned myocardium (NSM) is a potentially fatal cause of sudden cardiogenic dysfunction due to an acute neurological event, most commonly aneurysmal subarachnoid hemorrhage in adults. Only two pediatric cases of hydrocephalus-induced NSM have been reported. Here the authors report a third case in a 14-year-old boy who presented with severe headache, decreased level of consciousness, and shock in the context of acute hydrocephalus secondary to fourth ventricular outlet obstruction 3 years after standard-risk medulloblastoma treatment. He was initially stabilized with the insertion of an external ventricular drain and vasopressor treatment. He had a profoundly reduced cardiac contractility and became asystolic for 1 minute, requiring cardiopulmonary resuscitation when vasopressors were inadvertently discontinued. Over 1 week, his ventricles decreased in size and his cardiac function returned to normal. All other causes of heart failure were ruled out, and his impressive response to CSF diversion clarified the diagnosis of NSM secondary to hydrocephalus. He was unable to be weaned from his drain during his time in the hospital, so he underwent an endoscopic third ventriculostomy and has remained well with normal cardiac function at more than 6 months' follow-up. This case highlights the importance of prompt CSF diversion and cardiac support for acute hydrocephalus presenting with heart failure in the pediatric population.