Rejected

Headache is a commonly encountered symptom in urgent care and the emergency department. Headache syndromes are classified a primary headache and do not require neuroimaging; however, patients should be assessed at each encounter for changes in their headache symptoms. This case highlights a patient who was suffering from a new headache type, characterized as different from her previous attacks and unyielding to her current acute and preventive treatment methods. The patient was sent for neuroimaging and found to have a mass within her sella turcica that required surgical intervention and removal. Assessing headache patients for red flag symptoms can uncover significant alterations in the patient's symptomatology and indicate a need for further evaluation. By evaluating for red flag symptoms, clinicians can ensure the delivery of high-quality care and better health care outcomes for patients with headache disease.

To evaluate the clinical efficacy of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis.

A 52-year-old woman presented with a tender swelling in the right axilla, fever, a headache, nausea, and general weakness. On examination, she was found to have lymphangitis on the right arm and red papules on the 1 and 2 fingers of the right hand. She had had prepared wild rabbit stew 5 days before disease onset. Serology and an ultrasound of the right axilla confirmed the diagnosis of ulceroglandular tularemia. The lymphadenitis did not resolve after streptomycin treatment so an incision was made and 30 cc of purulent fluid drained. Over the course of the next 3 months, the fluid continued to drain. A radiographic fistulography was performed and it revealed a short main channel with a few long channels of varying caliber branching out from it, all terminating in a conglomerate of necrotic axillary lymph nodes. The lesions healed spontaneously and completely over the following 12 months without additional antibiotic therapy. Radiographic fistulography can help plot the course of the fistula/fistulas and demonstrate the anatomic features of the lesion in resource poor settings.

COVID-19 patients, especially immunocompromised or severely ill, have a higher probability of suffering from invasive fungal infections.

Noise in intensive care units (ICUs) has always been a problem, but noise above the recommended range affects not only the patient but staff as well. It is clear that some noise in the ICU is inevitable, but exceeding the normal range brings various physiologic and psychologic changes, which directly affect health. This review presents a synthesis of noise sources in the ICU and the potential interventions designed to attenuate noise and protect patients.

Intraventricular pilocytic astrocytomas are a rare occurrence, accounting for approximately 4% -15.6% of all pilocytic astrocytomas .The aim of the study was to describe the radiology, surgical management and outcome in 15 patients with histopathologically proven intraventricular pilocytic astrocytoma(IVPA).

Prospective observational cohort study. To determine whether biofilms exist on spinal instrumentation recovered during revision surgery in which microbial cultures were negative. Biofilm bacteria are extremely difficult to detect by conventional culture methods used in the standard hospital setting. Chronic infections in which bacteria form biofilms have been demonstrated to slow healing and prevent bony fusion. These slime encased microbial communities serve to isolate the bacteria from the body's immune responses, while simultaneously providing metabolic resistance to antimicrobial therapy. Traditional debridement wound cultures were taken from each specimen and sent for microbiological analyses. Bacterial DNA testing was performed using polymerase chain reaction (PCR) electrospray ionization-mass spectrometry (ESI-MS). Based on the PCR/ESI-MS results, specific crossed immune electrophoresis was used to detect the bacterial species within biofilms observed on the removed instrumentation. In addition, fluorescent hybridization (FISH) probes corresponding to the bacterial species identified by PCR/ESI-MS were used with confocal microscopy to visualize and confirm the infecting bacteria. Fifteen patients presented for surgical revision of thoracolumbar spinal implantation: four for clinical suspicion of infection, six for adjacent segment disease (ASD), one with ASD and pseudoarthrosis (PA), three with PA, and one for pain. Infections were confirmed with PCR/ESI-MS for all four patients who presented with clinical infection, and for five of the patients for whom infection was not clinically suspected. Of the presumed non-infected implants, 50% demonstrated the presence of infectious biofilms. Half of the revisions due to pseudoarthrosis were shown to harbour biofilms. The revisions that were performed for pain demonstrated robust biofilms but did not grow bacteria on traditional culture media. Culture is inadequate as a diagnostic modality to detect indolent/subclinical biofilm infections of spinal instrumentation. The PCR/ESI-MS results for bacterial detection were confirmed using species-specific microscopic techniques for both bacterial nucleic acids and antigens. Biofilms may contribute to pseudoarthrosis and back pain in postoperative wounds otherwise considered sterile.

Onychomykose (OM) und Tinea pedis (TP) sind häufige Pilzinfektionen der Haut. Aktuell basiert die Diagnose vornehmlich auf mikroskopischem Direktnachweis und/oder Kultur. Beide Methoden haben jedoch eine geringe bis mäßige Sensitivität und benötigen teilweise mehrere Wochen, bis endgültige Laborergebnisse vorliegen. Um die Diagnose kutaner Pilzinfektionen zu verbessern, wurden PCR-basierte Methoden entwickelt. Hier haben wir hier die Sensitivität und Spezifität einer Chip-basierten Multiplex-PCR mit mikroskopischen Direktnachweis und verglichen.

Cluster headaches are a series of short, excruciating, and unilateral pain that happens for a short period at a time over days, weeks, or months and may awake people from sleep. It is situated behind, in, or around one eye only with possible radiation to the forehead at the same side. Cluster headache is characterized by many ocular features. However, extraocular muscle involvement is unusual in this type of headache. We present a case of chronic cluster headache associated with diplopia due to oculomotor nerve palsy in a 24-year-old man, which responded successfully to oral steroid. This presentation is rare. Therefore, ophthalmologists and neurologists should consider it in their list of a differential diagnosis. A short course of oral prednisolone has a role in the management of patients in such cases.

This study measured the prevalence and impact of nonadherence to clinical practice guidelines (CPGs) that recommend using nonpharmacological and nonopioid treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) before considering opioids in patients with chronic low back pain.