Rejected

Autoimmune pancreatitis (AIP) is a rare chronic pancreatitis and the incidence is increasing recently. However, the formal report of this disease is still rare in literatures. Here, we reported a rare case of IgG4 positive autoimmune pancreatitis to make the awareness of this type of disease. The patient was a 58-year-old Chinese male who was suffered from epigastric pain accompanied by nausea and vomiting. An occupying lesion was detected in the body of the pancreas tail with the ultrasound examination. The serum IgG4 levels, white blood cells, blood amylase and the γ-globulin fraction were all increased. After operation, the following pathological detection with immunochemistry test confirmed the diagnosis of autoimmune pancreatitis.

The objective of this study was to investigate in a real-life context the effectiveness of long-term opioid therapy for reducing pain intensity and interference and improving health-related quality of life (QOL) in patients with chronic noncancer pain.

We aimed to investigate the efficacy and safety of combination of sofosbuvir with ombitasvir, paritaprevir, and ritonavir ± ribavirin as a retreatment option for experienced Egyptian patients who failed previous sofosbuvir, daclatasvir ± ribavirin therapy. A total of 75 treatment-experienced patients were allocated for the completion of their treatment period according to criteria formed by the national committee for control of viral hepatitis. The enrolled patients were followed up throughout treatment, at the end of treatment and 3 months after the end of the treatment by clinical evaluation and laboratory investigations. 27 patients were treated with sofosbuvir with ombitasvir, paritaprevir, and ritonavir plus ribavirin for 12 weeks while 48 patients were treated with sofosbuvir with ombitasvir, paritaprevir, and ritonavir without ribavirin for 24 weeks. The per-protocol sustained virological response at week 12 (SVR12) rate was 100% in both groups while the intention-to-treat SVR12 was 93.4% in all patients, 97.9% in the 24 weeks group and 85.2% in the 12 weeks group. The regimen was well tolerated and the most common adverse effects observed across treatment and during follow-up period included fatigue (38.6%) and headache (29.3%), withdrawal due to adverse effects occurred in 6.6%. We can conclude that retreatment with sofosbuvir with ombitasvir, paritaprevir, and ritonavir ± ribavirin is well tolerated and achieved high SVR12 rates in chronic HCV Egyptian patients with previous sofosbuvir plus daclatasvir treatment failure. Ribavirin free regimen for 24 weeks exerted significant lesser adverse effects.

Bloody stool with fever may always be considered as inflammatory bowel disease or intestinal tuberculosis. Epstein-Barr virus (EBV) infection is common. But EBV-positive lymphoproliferative disease (EBV-LPD) involvement of gut is pretty rare and is hardly taken into consideration. A 34-year-old woman was admitted to our hospital for bloody stools over one month and fever over one week with multiple black brown nodular erythema on face. With the electronic colonoscope, intestinal tuberculosis was considered firstly, but Crohn's disease and lymphoma cannot be ruled out. So the patient received diagnostic anti-tuberculosis therapy on Aug. 2, 2012. After 8 months of antituberculosis therapy and drug withdrawal for 4 months, the patient developed symptoms of umbilicus pain accompanied with vomit, diarrhea and hyperpyrexia up to 40.3°C. The discomfort didn't get complete remission after symptomatic treatment. And on Apr. 20, 2015, colonoscopy showed multiple ulcers in colon, so inflammatory bowel disease was considered firstly. As a result, the patient was treated with Mesalazine. However, there was little symptomatic improvement and more black brown nodular erythema occurred on her face. Then on Jun. 11, 2015, she underwent colonoscopy again and the immunohistochemical of intestinal tissue suggested EB virus infection. What's more, we found serum EB virus IgM: – S/CO, serum EB virus IgG: + 12.5 S/CO, blood EBV-DNA: 5.71*10E5/mL (0-500). Furthermore, on Jun. 25, 2015, skin biopsy showed (forehead) T lymphocytes hyperplasia and focal necrosis, according with characteristics of EBV related T lymphocyte proliferative disease (EBVT-LPD). Ultimately, we got definitive diagnosis of the patient: 1. EBV-LPD, hydroa vacciniforme-like lymphoma. 2. Multiple ulcers in small intestine and colon: according with EBV-LPD. And she was treated with definitive therapy. This case shows we must consider rare disease for patients accompanied by gastrointestinal symptoms with conventional treatment ineffectively.

Despite the epidemic of nonmedical analgesic use (NMAU) in North America, there is a scarcity of research quantifying the effect of pain on NMAU.

Visceral pain, a common characteristic of multiple diseases relative to viscera, impacts millions of people worldwide. Although hundreds of studies have explored mechanisms underlying visceral pain, it is still poorly managed. Over the past decade, strong evidence emerged suggesting that microRNAs (miRNAs) play a significant role in visceral nociception through altering neurotransmitters, receptors and other genes at the posttranscriptional level. Under pathological conditions, one kind of miRNA may have several target mRNAs and several kinds of miRNAs may act on one target, suggesting complex interactions and mechanisms between miRNAs and target genes lead to pathological states. In this review we report on recent progress in examining miRNAs responsible for visceral sensitization and provide miRNA-based therapeutic targets for the management of visceral pain.

Retroperitoneal fibrosis is a connective disease of the auto-inflammatory/auto-immune type of the retroperitoneum with unknown etiology and pathological mechanism. The manifestations of the pathology can be local or systemic. Amongst the local symptoms, the dull and constant pain in the hips, back or abdomen is the most frequent. We report here a case of a 47-year-old woman, whose pathogenic mechanism could be related to an "IgG4-related disease" disorder as suggested by an increased serum level of this subclass of IgG and the positive immunohistochemistry. The diagnosis is not easy, because this pathology generates masses; adenomegalies with retro peritoneal development, that makes it similar to lymphomas or metastases from ovarian tumors.

Access to face-to-face cognitive behavioral pain management programs is very limited. Internet-delivered cognitive behavioral pain management has potential to improve client access to care but is not readily available in Canada.

Posterior reversible encephalopathy syndrome with stroke is very rare in puerperal women. A 36-year-old nulliparous woman with both rheumatoid arthritis and recurrent pregnancy loss, probably due to a high titer of anti-phospholipid IgM antibody, was referred at 10 weeks of gestation. Low-dose aspirin at 100 mg/day and heparin calcium subcutaneous injection at 10,000 units/day were started before pregnancy and stopped at 35 and 40 weeks, respectively. She transabdominally delivered a male infant weighing 3,344 g at 40 weeks. A tonic-clonic seizure abruptly occurred without either hypertension or proteinuria 5 days after delivery. Intracerebral hemorrhage involving an area of 2 cm in diameter in the right frontal lobe and subarachnoid hemorrhage with PRES were confirmed. Seizure recurred 2 days after the initial episode. She showed severe headache and mild disturbance of consciousness but no neurological findings. We suggested that a high titer of anti-phospholipid IgM antibody might be associated with stroke.

Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique.