Rejected

A 48-year-old man presented with persistent right knee pain 15 years after an arthroscopic partial meniscectomy. Right knee radiography was remarkable for a retained scalpel blade in the knee joint. The retained scalpel blade was completely removed from the affected knee arthroscopically; however, the patient's knee pain did not improve with 6 weeks of physically therapy.

The 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep guidelines from the Society of Critical Care Medicine recommend opioids as a first-line treatment option for non-neuropathic pain among critically ill adults and prioritize pain management optimization before the administration of sedatives. Although analagosedation is recommended, the downstream effects, such as intensive care unit (ICU)-acquired opioid dependence, are not well described. The purpose of this study is to determine the impact of continuous infusions of opioids for mechanically ventilated patients prescribed opioids on discharge.

Pilonidal sinus disease (PNSD) is considered as the challenging disease for surgeons since decades. The term pilo-nidal is derived from Latin meaning "nest of hair". It is a commonly occurring disease usually involved young male adults. It is considered as an acquired condition with unidentified aetiology and pathogenesis. The objective was to observe the results of Limberg's flap operation in patients with Pilonidal sinus disease..

Seronegative spondyloarthritis is a progressive inflammatory disease with a wide and varied range of symptoms. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by pain and structural changes. Ankylosing spondylitis is characterized by functional disorders such as reduced mobility and axial deformity, leading to a decrease in patient quality of life. The purpose of this article is to provide basic information on therapeutic options for exercise in the treatment of ankylosing spondylitis. Therapeutic exercise is the most important non-pharmacological intervention in patients. In addition to positive metabolic effects, exercise also plays an important role in improving spinal mobility and muscle strength. Maintaining proper postural posture appears to play a key role in patients with ankylosing spondylitis. Muscle contraction stimulates and promotes the secretion of cytokines called myokines. The best known is interleukin-6 (IL-6). This myokine also acts indirectly in the expression of tumor necrosis factor alpha (TNF-α). Exercise improves quality of life, physical condition, and symptoms associated with ankylosing spondylitis.

COVID-19 is highly transmissive and contagious disease with a wide spectrum of clinicopathological issues, including respiratory, vasculo-coagulative, and immune disorders. In some cases of COVID-19, patients can be characterized by clinical sequelae with mild-to-moderate symptoms that persist long after the resolution of the acute infection, known as long-COVID, potentially affecting their quality of life. The main symptoms of long-COVID include persistent dyspnea, fatigue and weakness (that are typically out of proportion, to the degree of ongoing lung damage and gas exchange impairment), persistence of anosmia and dysgeusia, neuropsychiatric symptoms, and cognitive dysfunctions (such as brain fog or memory lapses). The appropriate management and prevention of potential long-COVID sequelae is still lacking. It is also believed that long-term symptoms of COVID-19 are related to an immunity over-response, namely a cytokine storm, involving the release of pro-inflammatory interleukins, monocyte chemoattractant proteins, and tissue necrosis factors. Palmitoylethanolamide (PEA) shows affinity for vanilloid receptor 1 and for cannabinoid-like G protein-coupled receptors, enhancing anandamide activity by means of an entourage effect. Due to its anti-inflammatory properties, PEA has been recently used as an early add-on therapy for respiratory problems in patients with COVID-19. It is believed that PEA mitigates the cytokine storm modulating cell-mediated immunity, as well as counteracts pain and oxidative stress. In this article, we theorize that PEA could be a potentially effective nutraceutical to treat long-COVID, with regard to fatigue and myalgia, where a mythocondrial dysfunction is hypothesizable.

There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave.

Vestibular migraine is one of the most common vestibular disorders, which includes headache, photophobia, phonopobia and visual auras. Others as osmophobia are common but usually subregistered, and potentially would be involved in the vestibular migraine episodes. The aim of this study was to perform a search about the frequency and clinical interaction between vestibular migraine and osmophobia.

There is a paucity of clinical data on C1q nephropathy (C1qN) in children in India and Southeast Asia. This is the first detailed analysis conducted to elucidate the prevalence, clinicopathological profile, and response to different immunosuppressives in children with C1qN in India.

Pain due to rib fracture leads to respiratory impairment and bilateral fractures impact respiratory mechanics in the worst manner. Thoracic epidural analgesia is the gold standard for bilateral rib fractures but is technically difficult, entails potentially serious complications, and necessitates patient repositioning. Ultrasound-guided serratus anterior plane block (SAPB) has recently gained favor for alleviating thoracic pain and can be performed in patients lying supine, rendering it particularly useful in polytrauma patients who are unable to sit up or turn lateral for regional blocks on the back. Use of continuous bilateral SAPB for rib fractures has been underutilized. We report a case of a polytrauma patient who had bilateral multiple rib fracture along with vertebral and pelvic fractures due to which she was in severe pain and was unable to move to provide any kind of positioning for the blocks. Bilateral SAPB provided effective pain relief and facilitated early recovery and pulmonary rehabilitation of the patient.

Seizures are a rare, but documented, consequence of accidental dural puncture and epidural blood patch. They are also the cardinal feature of eclampsia. We present a postpartum patient who suffered a tonic-clonic seizure within 1 hour of an epidural blood patch procedure for a suspected post-dural puncture headache. Investigations also revealed hypertension, proteinuria and subdural collections. This case demonstrates the diagnostic dilemma associated with postpartum headache and late postpartum eclampsia. We illustrate the importance of a thorough clinical assessment of postpartum patients presenting with headache, highlighting the possibility of more than one underlying pathological cause. We also consider the role of epidural blood patch in both precipitating, and preventing, complications of accidental dural puncture.