Rejected

To determine the characteristics and response to pegloticase of patients with chronic refractory gout with and without clinically apparent tophi.

Women who have continuous intrapartum support are more likely to have a shorter labor and spontaneous vaginal birth, and are less likely to need intrapartum analgesia than women who receive usual care without support. We aimed to determine what women in labor and midwives regard as the optimal number of labor supporters and whether they should be present during medical interventions.

ANCA-associated vasculitis is a life-threatening, systemic autoimmune disease. There is an increased risk of organ infarction but in many cases this is asymptomatic. We described here the first reported case of PR3 vasculitis presenting with symptomatic bilateral renal wedge infarction.

We present two patients who were treated for an intentional overdose of sodium nitrite. When ingested sodium nitrite leads to severe methaemoglobinaemia, resulting in severe hypoxia (as methaemoglobin does not transport oxygen), vasodilation and hypotension. Symptoms include cyanosis, headache, nausea, convulsions, coma and death. When measured by pulse oximetry, patients with a sodium nitrite intoxication and severe methaemoglobinaemia generally have an oxygen saturation of around 85%. This value is unreliable as the oxygen content of the blood is often extremely low – this can be confirmed by arterial blood gas analysis. Treatment of sodium nitrite intoxication consists of intravenous administration of methylthioninium chloride 1-2 mg/kg. Methylthioninium chloride converts the methaemoglobin back to haemoglobin. Due to the pharmacokinetics of methylthioninium chloride and sodium nitrite, a rebound effect is not to be expected. The only contra-indication for methylthioninium chloride is glucose-6-phosphate dehydrogenase deficiency, which is extremely rare in the Netherlands.

Pelvic inflammatory disease (PID) is a frequent cause of acute abdomen among sexually active females, although rarely seen in girls prior to their sexual debut. In this case report, a 12-year-old girl was hospitalised due to abdominal pain. She was virgo and premenarcheal. A laparoscopy showed a normal appendix but revealed pyosalpinx. A follow-up with ultrasound of the genitalia interna showed normal relations. PID should be considered in all females with compatible symptoms, irrespective of their age.

Integrative health is an expanding field that is increasingly called upon by conventional medicine to provide care for patients with chronic pain and disease. Although evidence has mounted for delivering integrative therapies individually, there is little consensus on how best to deliver these therapies in tandem as part of whole person care. While many models exist, few are financially sustainable.

The use of computed tomography (CT) in pediatric patients has decreased since the association between radiation and cancer risk has been reported. However, in adolescent patients being treated as adult patients, there has been a high incidence of CT use in emergency departments (EDs). Thus, this study aimed to evaluate the CT use in adolescent patients with complaints of headache or abdominal pain in the general and pediatric EDs of the same hospital.

An osteoid osteoma is a benign bone tumor that arises from osteoblastic dysfunction and usually presents as nonspecific, nocturnal pain located in the diaphysis of long bones, with <1% occurring in the ribs. It is most commonly treated with nonsteroidal anti-inflammatory drugs or merely observed; when these treatments do no prove efficacious, either open surgery or interventional ablation are pursued. Herein, we report a rare case of an osteoid osteoma located in the rib of a 19-year-old male that was histologically diagnosed through computed tomography (CT)-guided biopsy. Using CT guidance, the tumor was ablated by creating an artificial pneumothorax in order to induce a margin of space safe enough for cryoablation. It is important to be aware of the possibility that an osteoid osteoma may be present in the ribs, as the differential diagnosis includes costochondritis, pneumonia, osteoblastoma, enchondroma, osteosarcoma, cyst, and Brodie abscess. In addition, we have shown that CT-guided cryoablation can be an effective and less invasive treatment when compared to open en bloc resection, highlighting the role of interventional radiology in bone tumor ablation.

Anxiety disorders, depression and pain are highly prevalent pathologies. Their pharmacotherapy is associated with unwanted side effects; hence there is a clinical need to develop more effective drugs with fewer adverse reactions. Chalcones are one of the major classes of naturally occurring compounds. Chalcones and their derivatives have a huge importance in medicinal chemistry, displaying a wide range of pharmacological activities including anti-inflammatory, antimicrobial, antioxidant, cytotoxic and antitumor actions. The aim of this work was to evaluate chalcone effects on different targets involved in these pathologies. We have synthesized a series of simple chalcone derivatives taking common structural requirements described in literature related to their anxiolytic-like, antidepressant-like and/or antinociceptive properties into account. Furthermore, their potential effects towards different targets involved in these pathologies were evaluated. We have obtained twenty chalcones with moderate to high yields and assessed their ability to bind distinctive receptors, from rat brain homogenates, by displacement of labelled specific ligands: [H] FNZ (binding site of benzodiazepines/GABA), [H] 8-OH-DPAT (serotonin 5-HT) and [H] DAMGO (μ-opioid). Those compounds that showed the better activities were evaluated in mice using different behavioural tasks. results showed that 5'-methyl-2'-hydroxychalcone () exerted anxiolytic-like effects in mice in the plus maze test. While chalcone nuclei () revealed antidepressant-like activities in the tail suspension test. In addition, the novel 5'-methyl-2'-hydroxy-3'-nitrochalcone () exhibited antinociceptive activity in acute chemical and thermal nociception tests (writhing and hot plate tests). In conclusion, chalcones are thus promising compounds for the development of novel drugs with central nervous system (CNS) actions.

The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings.