Rejected

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome, which is presented with headache, seizures, altered mental consciousness, and visual disturbances, and is characterized by white matter vasogenic edema, predominantly affecting the posterior occipital and parietal lobes of the brain. This clinical syndrome is increasingly recognized due to the improvement and availability of brain imaging and, more specifically, magnetic resonance imaging.

Allopregnanolone and pregnanolone-neurosteroids synthesized from progesterone in the brain, adrenal gland, ovary and testis-have been implicated in a range of neuropsychiatric conditions including seizure disorders, post-traumatic stress disorder, major depression, post-partum depression, pre-menstrual dysphoric disorder, chronic pain, Parkinson's disease, Alzheimer's disease, neurotrauma, and stroke. Allopregnanolone and pregnanolone equipotently facilitate the effects of gamma-amino-butyric acid (GABA) at GABA receptors, and when sulfated, antagonize N-methyl-D-aspartate receptors. They play myriad roles in neurophysiological homeostasis and adaptation to stress while exerting anxiolytic, antidepressant, anti-nociceptive, anticonvulsant, anti-inflammatory, sleep promoting, memory stabilizing, neuroprotective, pro-myelinating, and neurogenic effects. Given that these neurosteroids are synthesized de novo on demand, this review details the molecular steps involved in the biochemical conversion of cholesterol to allopregnanolone and pregnanolone within steroidogenic cells. Although much is known about the early steps in neurosteroidogenesis, less is known about transcriptional, translational, and post-translational processes in allopregnanolone- and pregnanolone-specific synthesis. Further research to elucidate these mechanisms as well as to optimize the timing and dose of interventions aimed at altering the synthesis or levels of these neurosteroids is much needed. This should include the development of novel therapeutics for the many neuropsychiatric conditions to which dysregulation of these neurosteroids contributes.

Midfoot arthritis causes chronic foot pain and significant impairment of daily activities. Although post traumatic arthritis and primary osteoarthritis are the most common pathologies encountered, surgeons need to rule out inflammatory causes and neuropathic aetiology before starting treatment. Steroid Injections are invaluable in conservative management and have diagnostic value in guiding surgical treatment. For the definitive surgical option of fusion there are a variety of fixation devices available. A successful union is linked to a satisfactory outcome which most authors report to be in the range of 90% following the key principles of careful patient selection, pre-operative planning, adequate joint preparation and a stable fixation.

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumors are a rare group of tumors usually affecting children and young adults. They occur in various anatomic locations, with most common being the lung accounting for almost 95% of the cases. We present a case of a 4-year-old girl who presented with fever and dull abdominal pain for 6 months with a clinically palpable left hypochondrium mass. On suspicion of mesenteric/gastric neuroendocrine tumor, Ga-DOTA-NOC positron-emission tomography-computed tomography was done; however, the biopsy revealed IMT.

Many patients with pulmonary sarcoidosis experience reduced quality of life. Although oral corticosteroids are the most common agents used in sarcoidosis, very little is known on the effects on quality of life.

Altitude chamber exposures are used for training to allow aircrew to experience their hypoxia and pressure effect symptoms. Decompression illness (DCI) can occur subsequent to altitude chamber training or in operational aircraft when the cabin altitude is at least 18,000 feet. Definitive emergent treatment is hyperbaric oxygen (HBO2) to decrease bubble size, dissipate excess nitrogen, hyperoxygenate tissue and reduce inflammation.

Tympanoplasty is performed to close the tympanic membrane perforation and recover the hearing level of patients with non-suppurative chronic otitis media. Endoscopic tympanoplasty has recently been increasingly preferred by ear nose and throat surgeons to treat tympanic membrane perforations.

Chronic postsurgical pain (CPSP) is a possible complication of various surgical procedures, which can impair patients' quality of life while also contributing to chronic opioid use. Multiple biopsychosocial factors put patients at risk for CPSP. Multimodal analgesia with the use of various pharmacologic and regional anesthetic techniques can help reduce the incidence and severity of CPSP. However, the relationship between various perioperative analgesic strategies and the development of CPSP is not fully understood. Although the use of multimodal analgesia will not automatically prevent CPSP and/or prolonged opioid consumption, there is potential to do so, especially by means of regional techniques.

This study examined the development and effect of an online hypnosis program for the treatment of migraines. Forty-three participants were randomly assigned to a wait-list control or a treatment group. The treatment group received hypnosis mp3s developed for the study. Pain catastrophizing (PCS), headache disability (HDI), migraine frequency, duration, severity, and medication usage were measured. There was a 48% reduction in mean HDI score in the treatment group and 2% reduction in the control group. There was a 60% reduction in mean PCS score in the treatment group. There were no significant between-group differences in the proportion of subjects experiencing decreased frequency or severity of migraines. There was a significant between-group difference in the change in migraine duration. This study demonstrated that a hypnosis intervention delivered online was effective in reducing headache symptoms in migraine sufferers.