Rejected

Fibrous dysplasia (FD) is a relatively rare osseous disease of unknown etiology, wherein the normal bone is replaced by collagen-rich tissue, comprising of fibroblasts and variably abundant immature woven bone. Clinically, it may involve a single bone or multiple bones. It commonly arises in the jaw bone, skull, rib, and proximal femur. Those arising in the skull and the jaw are together termed "craniofacial fibrous dysplasia." The differential diagnosis at this location includes meningioma and metastatic carcinoma. In this report, we highlight two diagnostically challenging cases presenting with orbital swelling and headache as the main complaints. Our first case was misinterpreted as meningioma on intraoperative squash smear, and paraffin sections revealed characteristic features of FD. The second case highlights the morphological feature of non-specific cystic degeneration occurring in FD. Radiographs in such cases show cystic swelling, which is indicative of a secondary aneurysmal bone cyst.

To study the effects of sevoflurane on reproductive function and its main mechanism of action in male rats. Forty adult male Sprague-Dawley rats were divided into 4 groups and exposed to 0, 50, 300 and 1800 ppm of sevoflurane, respectively. After 15 days, the serum levels of sex hormones and inflammatory factors were detected using enzyme-linked immunosorbent assay. Left testis was taken for conventional histopathological examination and TUNEL staining. Right testis was used for sperm production and daily sperm count were evaluated daily. Johnsen score was used to categorize the spermatogenesis. The expression of related genes in the hypothalamic-pituitary-gonadal axis were analyzed by quantitative real time polymerase chain reaction (qRT-PCR). Exposure to sevoflurane increased the levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein 1 (MCP-1), decreased the content of serum testosterone (T), reduced the concentration of testicular sperm, the production of daily sperm and Johnsen score, and damaged vas deferens in a dose dependent manner. In addition, chronic exposure to sevoflurane down-regulated transcription of gonadotropin-releasing hormone (GnRH) and kisspeptin (Kiss)-1 as well as its receptor GPR54 in hypothalamus, attenuated GnRH receptor and LH-β mRNA levels, but increased FSH-β mRNA in pituitary gland, and enhanced mRNA of LH receptor and FSH receptor, but decreased INH-α and INH-βA mRNA levels in testes. Sevoflurane induces disorders of spermatogenesis and causes testicular injury. The underlying mechanism may be related to the imbalance of sex hormones in the hypothalamic-pituitary-gonadal axis.

The assessment of patients likely to undergo lung resection surgery is a multidisciplinary approach involving pulmonologists, surgeons and anaesthesiologists. In thoracic surgery, medical operability is also a calculation of postoperative lung function. A mobile application – PreParAPP MSD – to calculate postoperative lung function has been developed with the endorsement of the Italian Society of Anaesthesia, Analgesia and Intensive Care and with the unconditional support of MSD Italia. Thanks to a simple graphic interface, the calculation becomes fast and intuitive, while the possibility of storing and sharing data in an analytical and computerised way with other clinicians might help with the full assessment of patients without forcing them to undergo several medical examinations. These simple calculated parameters are performed by a minority of clinicians, generally anaesthesiologists. In our facility, there is a team involved in the perioperative evaluation of lung resection surgery (13 pulmonologists, 9 surgeons and 5 anaesthesiologists). In order to evaluate the possible Awareness towards postoperative lung function calculation better, we organised an internal survey with 27 clinicians who are members of such a team before and after the introduction of the PreParAPP MSD. It was found that after the introduction of PreParAPP MSD, the percentage of clinicians involved in postoperative lung function calculation rose from 18% to 70%. The implementation of a digital tool may help to improve guideline adherence, in accordance with other experiences in which such tools represented the start for various quality improvement purposes throughout the medical field.

Chronic pain is common in terminally ill patients with cancer and affects their quality of life. In this study, we wanted to evaluate pain severity and the adequacy of prescribed analgesics in terminally ill patients with cancer in North Palestine.

Sixty-five-year old male patient applied to our clinic with nonspecific complaints such as tinnitus, otalgia, headache, halitosis, and persistent globus pharyngeus which had been continued for 5 years. His complaints persisted despite different extensive treatments. In nasoendoscopy, a yellow-colored mass with purulent discharge around was observed in eustachian tube opening in left fossa of Rosenmüller. Computed tomography scan showed a mass of 6 × 6 mm size in left fossa of Rosenmüller. After excision of the mass under local anesthesia, significant reductions were observed in patient's symptoms. Histopathology of the mass was reported as rhinolith. Although fossa of Rosenmüller is a quite rare localization for rhinoliths, it needs to be considered in differential diagnosis of patients with nonspecific symptoms such as halitosis, globus pharyngeus, and otalgia. This report represents a patient with rhinolith localized in fossa of Rosenmüller as the 2nd report in the literature.

The purpose of the study is to evaluate the most effective analgesic route of magnesium sulfate (MgSO) either intravenous (i.v.) or pectoralis interfascial plane block.

To describe marijuana's clinical role for urologic symptoms.

The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.

Blood or marrow transplantation (BMT) is increasingly offered to older adults with hematologic malignancies; however, their risk for severe pain is poorly understood. Using the Bone Marrow Transplant Survivor Study, the current study investigated the prevalence and predictors of pain after BMT (allogeneic or autologous) as well as its association with physical performance impairments and frailty.

A ketogenic diet may be a therapeutic option for approximately one third of patients with epilepsy. These patients continue to have seizures despite suitable pharmacological treatment. Regardless of the diet's therapeutic potential regarding seizure control, adverse events may coexist. This requires constant monitoring of the patient as comorbidities may emerge. A prospective, nonrandomized and uncontrolled study was conducted to evaluate the effect of a ketogenic diet on cardiometabolic parameters (lipid profile, glycemic profile and body composition variables) and seizure control in adult patients with pharmacoresistant epilepsies. Patients followed the Modified Atkin's Diet (MAD), with a restriction of 20 g of carbohydrates per day, adequate protein amounts and fats ad libitum for 24 weeks. Fourteen eligible patients were enrolled in the study, however, only eight completed the treatment (four women with an average age of 33.5 ± 9.9 years and four men with an average age of 27.5 ± 9.0 years; p = 0.386). The median of focal impaired awareness seizures decreased from 9.0 (interquartile range [IQR] 4.0-28.0) seizures per month pre-diet to 4.0 (IQR 0.5-11.2) seizures per month in 12 weeks (p = 0.028), i.e. a 55.5% reduction. Total cholesterol (19,711 ± 1373 mg/dL to 28,427 ± 2545 mg/dL; p = 0.016), LDL (131.47 ± 1319 mg/dL to 194.85 ± 20.41 mg/dL; p = 0.037), and non-HDL (140.20 ± 13.04 mg/dL to 219.75 ± 28.53 mg/dL; p = 0.028) levels increased progressively over the intervention period, being significant at 24 weeks (n = 6). A significant reduction in blood glucose (89.70 ± 2.20 mg/dL to 82.62 ± 1.45 mg/dL at week 24, p < 0.001, n = 6), insulin (11.02 ± 1.78 μUI/mL to 6.20 ± 0.71 μUI/mL at week 12, p < 0.001, n = 6) and HOMA-IR index was observed (1.46 ± 0.29 to 0.91 ± 0.23 at week 24, p < 0.001, n = 5). The estimated cardiovascular risk after treatment was low for all patients (less than 10 %). A significant reduction in body weight (76.28 ± 6.62 kg to 69.14 ± 5.63 kg; p < 0.001), body mass index (26.41 ± 1.79 kg/m² to 24.05 ± 1.58 kg/m²; p = 0.001), and waist (87.40 ± 4.98 cm to 78.61 ± 3.94 cm; p < 0.001) and arm circumferences (32.12 ± 1.97 cm to 28.98 ± 1.30 cm; p < 0.001) was observed (n = 8), as well as reduction in fat mass (26.85 ± 3.15 g to 21.54 ± 2.64 g; p < 0.001) and fat free mass (48.01 ± 2.75 g to 46.60 ± 2.29 g; p < 0.001), n = 7. Adverse events were generally mild and treatable, with the following being the most common: headache (50 %), weakness (50 %), and gastrointestinal symptoms (37.5 %). Potentially atherogenic lipid profile changes were observed; however, improved glycemic control and reduced body weight and waist circumference demonstrated an improvement in cardiometabolic parameters. Framingham score and the QRISK3 showed lower cardiovascular disease risk for some of the patients. Our data suggests MAD could be an appropriate therapeutic choice for adults with pharmacoresistant epilepsies.