Rejected

Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids.

We present a rare case of extraskeletal para-articular osteochondroma (ESPAOC) in the ankle of a 9-year-old boy, which was causing pain and limiting the range of motion of the ankle joint. The lesion might have also contributed to the deformity of the medial aspect of the talus. Total resection resolved all of the symptoms, with no recurrence at 1-year postoperatively.

Despite its importance, no study from the Middle East has assessed the neonatal pain knowledge of health-care providers in neonatal intensive care units (NICUs).

The overarching goal of video games is to amuse the end-users by means of interactive systems that are now existent across numerous platforms such as personal computer, mobile phones, tablets and game consoles. Player Unknown's Battlegrounds (PUBG) is a multiplayer online game. The addiction of PUBG is soaring worldwide and it has thick user-base. It is suggested that inhuman attitudes such as lack of empathy and war-related sentiments are likely to emerge among children who play aggressive and violent games like PUBG. In 2018, World Health Organisation (WHO) acknowledged online gaming compulsion as a grave mental health problem. Some of the well-known repercussions of playing PUBG video game are eyes strain, exhaustion, headache, obesity, poor quality of sleep, insomnia, withdrawal symptoms (rage and irritability) and even drug abuse owing to compulsive disorder. This game craze is unfortunately triggering world's young population to invest their valuable time, money and effort in a no-return business, and therefore needs urgent measures.

Optic neuritis is an inflammatory demyelinating disorder of the central nervous system. Anti-NMDA receptor (NMDAR) antibodies encephalitis is also mediated by the inappropriate immunological response. We report a girl who was readmitted because of unilateral eye pain and vision impairment in the remission period of anti-NMDAR encephalitis. Based on the limited available literature on the treatment of optic neuritis associated with anti-NMDA receptor antibody, she was treated with a combination of corticosteroids and intravenous immunoglobulin with clinical improvement. Optic neuritis in the remission phase of anti-N-methyl-D-aspartate receptor encephalitis remains relatively uncommon. It is important to document and follow these patients to understand the pathogenesis of optic neuritis in the setting of anti-NMDAR encephalitis and formulate effective therapeutic strategies.

Using narcotics for pain management is an integral part of orthopaedic surgery, especially after traumatic injuries such as ankle fractures. Although narcotics are often necessary for adequate pain control, prolonged duration of opioid treatment is becoming more common, and the detrimental effects of opioid use are well known. To treat this epidemic, we need to better understand the factors that put patients at risk for increased narcotic requirements and potential opioid misuse after orthopaedic injuries. The purpose of this study was to retrospectively compare opioid use among ankle fracture patients in smokers versus nonsmokers to better elucidate whether tobacco use is a risk factor for increased opioid consumption. A retrospective review was conducted for all patients who presented with an ankle fracture (Weber A to C) to any of 8 institutions in a large mid-Atlantic regional hospital system and subsequently underwent surgery between the November 2013 and January 2017. Exclusion criteria included patients age <18 years, a diagnosis of a pilon fracture, polytrauma, history of substance abuse, chronic pain syndromes, and osteoporosis. This yielded a total of 130 patients (96 nonsmokers and 34 smokers). A repeated-measures analysis of variance was conducted to compare opioid consumption between the 2 groups. Model analysis demonstrated no difference between the 2 groups (p = .782). There was no difference in opioid consumption at 1 month (p = .838), 2 months (p = .569), or 3 months (p = .656) between smokers and nonsmokers. Our study revealed no significant difference in opioid consumption among smokers compared with nonsmokers in patients treated for ankle fractures.

Hip arthroplasty is a widely used and successful orthopedic procedure for the treatment of degenerative, inflammatory, or traumatic joint disease. The procedure promotes significant pain relief, as well as recovery of limb function, reduction of disability, and better quality of life. However, there are related complications, which have characteristic imaging aspects. In the present study, we review the literature and exemplify such complications using images obtained at our facility, illustrating the main radiological aspects of complications such as heterotopic ossification, periprosthetic fractures, osteolysis, infection, wear, and dislocation.

Primary central nervous system lymphoma (PCNSL) is a rare tumor that accounts for <1%-4% of primary CNS tumor. PCNSLs are class of non-Hodgkin's lymphomas which are primarily of diffuse large B-cell origin (90%), with remaining being T-cell lymphoma (10%). Author report a rare case of PCNSL presenting as an intracranial mass involving the entire ventricular system, in an immunocompetent 36-year-old male with severe headache, decreased vision, and unsteady gait. The diagnosis was obtained by histopathological and subsequent immunohistochemistry.

Non-neoplastic cysts localized in salivary glands are quite rare and represent approximately 2-5% of all salivary gland lesions. Salivary duct cyst, also known as sialocyst is a true cyst with the epithelium lining the inner side of its walls. It is generally observed in minor salivary glands and it rarely involves the parotid. Patients are mostly affected between the ages of 30 and 40 and the lesion is rarely seen in children. The current case is a rare report, as the patient was a child. The diagnosis has been difficult to ascertain due to the presence of pain, symptom characteristic for inflammatory lesions.

Botulinum toxin (BTX) is a popular cosmetic therapy administered by both dentists and physicians. The ability of the toxin to locally paralyze muscles has led to the use of BTX as a potential therapy for a variety of medical conditions. This article will discuss the current head and neck applications of BTX. In addition, a brief review of other potential clinical benefits is provided.