Rejected

The opioid epidemic is a public health crisis in the United States (US) and is associated with devastating consequences, including opioid misuse and related overdose. In response to the opioid crisis, the US Department of Health and Human Services is advancing improved practices in pain management. Strategies to help mitigate opioid risks include physician safety programs, hospital- or practice-based initiatives, patient education, and harm reduction campaigns that include the use of naloxone. To date, little information is available regarding the use of these strategies among healthcare providers. A survey was conducted to identify the presence of opioid safety initiatives, prescribing patterns of opioids and naloxone, and perceived barriers to prescribing naloxone. The presence of these strategies was compared between different practice types (hospital-based/academic vs. private practice), practice scope (chronic pain vs. "other"), and practice location (in the US vs. outside the US) Regarding "outside the US," the actual geographical distribution of those countries was not captured by respondents.

Hydatid cyst is an important parasitic disease especially in endemic regions. Hydatid cysts are most commonly found in the liver and lungs and only 1% to 2% of the cysts reach the brain. Intracranial hydatid cysts are usually supratentorial and majority of cases are children and young adults. In this case report, a 55-year-old woman who lives in rural area in Turkey, admitted to our clinic with severe headache, neck pain, gait disturbance, and vomiting. Her neurological examination revealed cerebellar ataxia and left dysmetria. Radiological findings were compatible with hydatid cyst. On the 3rd of antihelmintic therapy, the patient underwent suboccipital craniotomy and epidural cyst was excised using Dowling technique without rupture of the cyst wall. Patient's symptoms improved postoperatively. Although hydatid cyst in posterior fossa is a very rare entity, it should be kept in mind in patients with intracranial cystic lesions who live in endemic regions.

Intrathecal morphine provides effective analgesia after cesarean birth, yet up to 90% of women who receive it experience excessive itching, an undesirable dose-dependent effect. Pruritis may increase nursing workload, delay breastfeeding, and decrease patient satisfaction. When 0.1 mg spinal morphine is given, pruritis is markedly reduced while analgesia is preserved.

Chronic subdural hematoma (CSDH) is one of the most prevalent neurosurgical disorders. Patients with CSDH commonly present with altered mental status, focal neurological deficit, and/or headache. The first-line treatment for CSDH is surgical evacuation. Although the surgical procedures for CSDH have been considered relatively "straightforward," they are not without any risk. The elderly are especially prone to show poor surgical outcomes. To make matters worse, many elderly patients are on anticoagulants and antiplatelet agents, increasing the risk of re-bleeding before and after surgery. These complications have led clinicians to search for nonsurgical alternatives. Dexamethasone should be used with caution for selected patients given its side effects. Tranexamic acid may be utilized as an adjunct therapy to surgery, but more randomized clinical trials are needed to evaluate its definitive efficacy. Interesting results of middle meningeal artery embolization (MMAE) have been reported from case studies. However, the risks associated with MMAE, including intracerebral hemorrhage, stroke, and vasospasm, have not been properly studied yet. The clinical benefits of atorvastatin and angiotensin-converting enzyme inhibitors are uncertain for CSDH. In conclusion, surgical intervention continues to be the first-line treatment while nonsurgical treatment options may be considered an adjunct therapy especially for recurrent hematoma or to reduce the volume of a hematoma.

Thoracic paravertebral block (TPVB) has become the gold standard to provide postoperative analgesia in breast surgery. Recently, ultrasound-guided (USG) pectoralis (PECS) block and serratus anterior plane (SAP) block have been described as an alternative to TPVB. The objectives were to compare TPVB, PECS, and SAP block in terms of analgesic efficacy and the spread of local anesthetic by ultrasound imaging, correlating it with the sensory blockade.

Background Brachial plexus block is popular choice for upper limb surgeries and offers good and relatively safe anesthesia. Among various approaches supraclavicular approach is the most consistent method for anaesthesia and postoperative pain management in surgery below the elbow joint. Many drugs are used as adjuvants in brachial plexus block for faster onset, denser block and for prolongation of postoperative analgesia. Dexmedetomidine also has been shown to prolong the sensory and motor duration when added as an adjuvant to local anaesthetic in nerve blocks. Objective To assess the effect of adding dexmedetomidine to ropivacaine in brachial block. Method Sixty patients, planned for upper limb surgeries under ultrasound guided brachial block were randomly allocated into two groups. Group RS (n=30) received 30 ml of 0.5% Ropivacaine + 1 ml Normal Saline and Group RD (n=30) received 30 ml of 0.5% Ropivacaine + 0.75 mcg/kg Dexmedetomidine diluted to 1 ml solution. The onset time to sensory and motor blockade were recorded. The duration of sensory and motor block and duration of analgesia were recorded. Result The mean time to onset of sensory block (12.60±2.67 min Vs 22.17±2.81 min) and motor block (14.20±3.22 min Vs 22.53±3.97) in Group RD was significantly faster in Group RD than Group RS. The mean duration of sensory block (838.70±164.11 min Vs 670.20±145.16 min), motor block (804.16±148.71 min Vs 594.93±53.89 min) and duration of analgesia (1193.80±223.11 min Vs 828.23±136.30 min) were significantly longer in Group RD compared to Group RS. The incidence of side effects in both groups were comparable. Conclusion From this study, it can be concluded that addition of Dexmedetomidine 0.75 mcg/ kg to 0.5% Ropivacaine results in early onset of sensory and motor blockade, prolongation of duration of sensory and motor blockade and duration of analgesia postoperatively without any significant side effects.

Aneurysms that occur anywhere in intracranial except where primary aneurysms develop, are called "de novo aneurysms". The risk factors and formation time of de novo aneurysms are not fully known. Congenital, environmental and hemodynamic factors can play a role in aneurysm development. The 43-year-old female patient was operated with the middle cerebral artery superior trunk aneurysm in our clinic. She came to us again after 17 months with a severe headache. In computed cranial tomography angiography, the middle cerebral artery superior trunk placement aneurysm was found to have a partial clip and "de novo aneurysm" was developed. She was re-operated for "de novo aneurysm". In this study, the risk factors in development of "de novo aneurysms" were discussed in the light of literature through this patient.

Lesser weever fish are saltwater fish that are found on the Mediterranean and European coasts, over sandy and muddy seabed areas, typically around the summer season. These bottom dwellers have envenoming dorsal spines that sting when stepped on. Severe pain is the main symptom. Initial treatment involves wound irrigation, removal of spines if they are visible and immediate hot water immersion (HWI). Tetanus prophylaxis, leg elevation and analgesia are recommended after pain subsides. HWI treatment is described as immersion of the affected area in hot, but not scalding, water to tolerance (upper limit 45 °C) for 30-90 min or until there is significant pain relief. While HWI is an effective therapy for the pain control of marine envenomation, it presents a potential risk of thermal burn injury in the untrained or unsupervised. Here, we present a case of an iatrogenic thermal burn after HWI for the treatment of a weever fish sting.

We present the case of a 51-year-old female complaining of persistent abdominal pain that started 5 months ago with recent bone pain. Abdomen-pelvic computed tomography (CT) showed a large pelvic mass raising the possibility of a malignant neoplasm. Bone scan was done to rule out bone metastases and showed extraskeletal abdominal tracer uptake with the single-photon emission CT/CT imaging showing the uptake to correspond to multiple calcified peritoneal deposits.

The aim of the present research is to evaluate and to compare various nutraceuticals and food supplements in the headaches prophylaxis.