Rejected

Headache is a common problem with great effect both on the individual and on the society. Recent studies raised the possibility of increasing rate of specialty referrals, inappropiate treatment and advanced imaging for simple headache. The aim of our study was to analyze the characteritics of patients (including duration of symptoms, headache type, brain imaging, treatment) referred to our specialized headache clinic between 01/01/2014 and 01/01/2015 by their general practitioners and primary care neurologists due to chronic/treatment-resistant headache syndromes. 202 patients (mean age 53.6 ± 17.6 years) were evaluated in our clinic (102 females, mean age 50.14 ± 16.11 years and 100 males, mean age 57 ± 18.1 years). Migraine (84/202) and tension-type (76/202) were the most common syndromes. 202 plain brain CT, 60 contrast-enhanced CT and 128 MRI were carried out by their general practitioners or other healthcare professioners including neurologists before referral to our headache centre. Despite of extensive brain imaging appropiate treatment was started less than 1/3 of all patients and significant proportion received benzodiazepines or opioid therapy. Furthermore, more than 10% of referred patients presented with secondary headache including one meningitis. The management of headache is still a challenge for primary care physicians leading to medical overuse. Vast majority of our patients should not be referred to our specialized headache clinic as they had uncomplicated headache or other underlying conditions than pain.

Intrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with postoperative pulmonary complications such as delayed respiratory depressionPatients with obstructive sleep apnea may be at higher risk of these complications, especially if intrathecal morphine is used for analgesia WHAT THIS ARTICLE TELLS US THAT IS NEW: Low-dose intrathecal morphine, in conjunction with multimodal analgesia, was not associated with increased risk of postoperative pulmonary complications in patients with obstructive sleep apnea BACKGROUND:: Intrathecal morphine is commonly and effectively used for analgesia after joint arthroplasty, but has been associated with delayed respiratory depression. Patients with obstructive sleep apnea may be at higher risk of postoperative pulmonary complications. However, data is limited regarding the safety of intrathecal morphine in this population undergoing arthroplasty.

Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS).

To examine the value of data obtained outside of regular healthcare visits (clinical communications) to detect problematic opioid use in electronic health records (EHRs).

To assess the adverse drug reactions (ADR) of tetracaine among patients referred to an eye emergency department in the southeast of Iran.

The Tactical Combat Casualty Care (TCCC) card has undergone several changes since its first introduction in 1996. In 2013, updates to the card included more data points to increase prehospital documentation quality and enable performance improvement. This study reviews the proportions of data collected before and after the implementation of the new TCCC card.

After periodontal surgery, in most cases, the surgical area is covered with a surgical pack. It has been suggested that these packs might minimize complications. This study aimed to compare the effects of Diplen LX membrane and Coe-Pak on pain, wound healing, and patient preference after a periodontal flap surgery in patients with moderate to severe chronic periodontitis. In this randomized clinical trial, 26 patients were evaluated. Pain scores were assessed using visual analog scale (VAS) on the 3rd and 7th days postoperatively and compared between the two dressings. On the 7th and 14th days after both flap surgeries, surgical site healing was evaluated using the wound healing index (WHI). The mean age of the patients was 31. It was observed that the severity of pain in the studied patients on the 3rd and 7th days postoperatively was significantly lower in the intervention group than in the control group. It was also observed that the value of WHI in the studied patients on the 7th and 14th days postoperatively was significantly higher in the intervention group than in the control group. The pain was less severe in both groups using periodontal dressing and also lower in the Diplen LX membrane group. In addition, based on WHI, wound healing score in patients was also higher and more favorable in the Diplex LX membrane group. Due to the above factors, the majority of patients preferred the use of the Diplen LX membrane.

 Duodenal polyps are rare in patients undergoing upper gastrointestinal endoscopy. The present study is an experience of the histopathological spectrum of the duodenal polyps and its correlation with the clinical and endoscopic findings in a tertiary care centre.