Rejected

Given no consensus on optimal timeframe of periarticular multimodal drug injection (PMDI) in knee osteoarthritis patients undergoing total knee arthroplasty (TKA), this study was aimed to compare the postoperative pain and the functional recovery in patients who underwent simultaneous bilateral TKA (SBTKA) and received PMDI at the different intraoperative time points.

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm derived from tissue of mesenchymal origin. This tumour occurs predominantly in the lung, though extrapulmonary sites have been documented throughout the body.1 Presentation can be variable depending on location of the tumour and can include constitutional symptoms (fever, weight loss), thrombocytosis, hypergammaglobulinemia, anemia, and mass effect on local structures.2 Majority of patients with intrapulmonary IMT remain asymptomatic but can have symptoms including chest pain, dyspnoea, cough or haemoptysis.3 Most cases of IMT present in younger individuals (under age 40).4 Although the aetiology of IMT is unclear, current hypotheses suggest an inflammatory response to infection or an underlying malignancy could promote such cellular changes. Alternatively, the inflammatory component itself may be a consequence of the development of these mesenchymal tumours.

Random pattern skin flaps are applicable to reconstruct any defects in plastic surgery. However, they are limited to apply due to necrosis. Sumatriptan, a selective 5HT 1b/1d agonist, routinely use to subset acute migraine attack. Recent studies suggested Sumatriptan may induce vasodilation in lower concentration. Our aim is to investigate the effect of sumatriptan on skin flap survival and the role of nitric oxide in this phenomenon.

When styloid process elongation or stylohyoid ligament calcification can lead to various symptoms, such as dysphagia, facial pain, globus sensation, and headache, it is termed Eagle's syndrome. It may be unilateral or bilateral. Though the overall prevalence in adults is 4%, only 0.16% of patients are symptomatic. Since the symptoms mimic several other orofacial pains and neuralgia, the diagnosis must be made through a detailed history, clinical examination, and various imaging modalities. The case of facial pain in a 22-year-old female patient who was diagnosed to have a unilateral elongated styloid process is discussed in this paper.

Moyamoya disease (MMD) is a rare, chronic vaso-occlusive disease affecting the arteries of the Circle of Willis, leading to the development of characteristic collateral vessels. In this paper, we present a case of a 35-year-old Hispanic male who presented to the emergency department with new onset headaches. On examination, Glasgow Coma Scale score was 3T. The patient was investigated with head CT scan and cerebral angiogram, diagnosed as MMD, and treated with emergent ventriculostomy. Ultimately, the patient underwent extracranial-intracranial (EC-IC) bypass surgery for treatment of Moyamoya.

Area postrema syndrome (APS) is considered to be one of the most specific clinical presentations of neuromyelitis optica spectrum disorders (NMOSDs). In sub-Saharan Africa, NMOSDs and even more so those revealed by an APS, are rarely reported. However, studies among mixed populations have shown that NMOSDs disproportionately affect black people with relatively more frequent encephalic involvement. We report a case of APS revealing an NMOSD associated with central nervous system (CNS) tuberculosis in a young Togolese woman residing in Togo (West Africa).

Neovascularizing retinopathy is a significant complication of sickle cell disease (SCD), occurring more frequently in HbSC than HbSS disease. This risk difference is concordant with a divergence of angiogenesis risk, as identified by levels of pro- vs anti-angiogenic factors in the sickle patient's blood. Because our prior studies documented that morphine promotes angiogenesis in both malignancy and wound healing, we tested whether chronic opioid treatment would promote retinopathy in NY1DD sickle transgenic mice. After 10 to 15 months of treatment, sickle mice treated with morphine developed neovascularizing retinopathy to a far greater extent than either of the controls (sickle mice treated with saline and wild-type mice treated identically with morphine). Our dissection of the mechanistic linkage between morphine and retinopathy revealed a complex interplay among morphine engagement with its μ opioid receptor (MOR) on retinal endothelial cells (RECs); morphine-induced production of tumor necrosis factor α and interleukin-6 (IL-6), causing increased expression of both MOR and vascular endothelial growth factor receptor 2 (VEGFR2) on RECs; morphine/MOR engagement transactivating VEGFR2; and convergence of MOR, VEGFR2, and IL-6 activation on JAK/STAT3-dependent REC proliferation and angiogenesis. In the NY1DD mice, the result was increased angiogenesis, seen as neovascularizing retinopathy, similar to the retinal pathology occurring in humans with SCD. Therefore, we conclude that chronic opioid exposure, superimposed on the already angiogenic sickle milieu, might enhance risk for retinopathy. These results provide an additional reason for development and application of opioid alternatives for pain control in SCD.

Vertebral artery dissection (VAD) sometimes has no specific symptoms and is difficult to differentiate from other forms of headache.

Corneal abrasions can have potentially sight-threatening consequences if not accurately diagnosed and managed appropriately in the acute period. Simple corneal abrasions can be managed with antibiotic and tetanus prophylaxis, analgesia, and next-day follow up with ophthalmology. However, if there is any suspicion for penetrating eye injury, corneal ulcer, a sight-threatening infection such as bacterial keratitis, or ophthalmic zoster, an emergent referral is imperative. In this report, we present a case of classic corneal abrasion and discuss the acute management of this common problem.

Cerebral venous thrombosis (CVT), while rare, is a challenging diagnosis. It can be easily missed as the presenting symptom can be just a mild headache. However, if missed and left untreated, it can lead to multiple complications, even death. There are certain risk factors that should make one suspect CVT, such as pregnancy, puerperium, use of oral contraceptive pills (OCPs) or known underlying hypercoagulable disorder, to name a few. Imaging is required for diagnosis. Anticoagulation, typically long term, is the standard treatment. We present a case of a 25-year-old male who was initially discharged after an emergency department visit with symptomatic treatment for migraine headaches, and was later found to have extensive cerebral venous sinus thrombosis. It is worth emphasizing the importance of having a broad differential diagnosis and a low threshold to obtain imaging studies when patients present with persistent headaches, even in the absence of any obvious risk factors.