Rejected

The purpose of this article is to systematically review the use, efficacy, differences between botulinum toxin type A doses and side effects of botulinum toxin type A therapy in patients with trigeminal neuralgia.

Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known.

The neurotransmitter Substance P, and its neurokinin-1 receptor (NK-1R) are involved in the regulation of many pathophysiological processes including emesis, inflammation and nociceptive processing. This review provides a brief summary of the anti-inflammatory and analgesic properties of experimental NK-1R antagonists followed by a systematic review and meta-analysis on maropitant, the only NK-1R antagonist with a label indication for emesis in veterinary patients. There is very limited evidence based information on the putative clinical utilisation of maropitant for pain and inflammation. The aim of this systematic review and meta-analysis was to evaluate published reports on anti-inflammatory, analgesic and anaesthesia-sparing effects of maropitant. Medline, Pubmed, Science direct and Web of Science were searched to identify all published studies on maropitant, followed by a meta-analysis. Fourteen studies with 128 animals receiving maropitant and 127 controls met the inclusion criteria. Overall, maropitant had a significant inhalation anaesthetic-sparing effect (SMD -0.92, 95% CI -1.30, -0.54; P < 0.00001). However, treatment with maropitant had no effect on pain (SMD 0.06, 95% CI -0.37, 0.48; P = 0.80), or leukocyte cell infiltration in different inflammatory conditions (SMD -0.60, 95% CI -1.31, 0.11; P = 0.10). Based on all eligible studies for this review, it can be deduced that maropitant significantly reduced the minimum alveolar concentrations for isoflurane and sevoflurane for many different surgical procedures but it had no clearly proven effect on inflammation and pain.

Pain-related memory biases have been frequently explored in individuals with chronic pain, and along with attentional and interpretation biases are hypothesised to contribute to the onset and/or maintenance of chronic pain. The aim of this review is to provide a systematic review and synthesis of studies exploring memory recall biases for pain-related information in individuals with chronic pain relative to healthy controls and the recall of neutral information. Studies were identified through a search of Medline, PsychINFO, Web of Science, CINAHL, Cochrane Library, and Open Grey databases. Search terms were memory, recall, recognition, and bias*, intersected with pain. Eighteen studies meeting the inclusion criteria were included. Subset meta-analyses are also reported from 12 studies with relevant between-groups data (comparing recall in chronic pain vs healthy control groups) and 12 studies with relevant within-groups data (eg, comparing recall of pain-related/emotional vs neutral words). Between-groups analysis revealed significantly weaker recall bias for affective-pain words in individuals with chronic pain relative to healthy controls, but only when nondepressed chronic pain individuals were included. No significant differences were found between groups in the recall of sensory-pain, illness-related, or depression-related words. Within-groups analysis revealed individuals with chronic pain show a significant recall bias favouring sensory-pain words relative to neutral and affective-pain words, and a bias for illness-related words relative to depression-related words. A recall bias favouring neutral words was found in healthy individuals. Evidence for the presence of pain-related memory biases in patients with chronic pain is inconclusive. Further methodologically rigorous research is required.

X-linked hypophosphatemia (XLH) is a rare X-linked dominant metabolic bone disease, often diagnosed in childhood but causing increasing physical debilitation and pain in adulthood. Physical comorbidities of XLH in adulthood include pervasive and early-onset degenerative arthritis, mineralizing enthesophytes and osteophytes, osteomalacia and pseudofracture, dental abscesses, and hearing loss.

On February 22, 2017, Hospital X-Kampala and US CDC-Kenya reported to the Uganda Ministry of Health a respiratory illness in a 46-year-old expatriate of Company A. The patient, Mr. A, was evacuated from Uganda to Kenya and died. He had recently been exposed to dromedary camels (MERS-CoV) and wild birds with influenza A (H5N6). We investigated the cause of illness, transmission, and recommended control. We defined a suspected case of severe acute respiratory illness (SARI) as acute onset of fever (≥38°C) with sore throat or cough and at least one of the following: headache, lethargy, or difficulty in breathing. In addition, we looked at cases with onset between February 1 and March 31 in a person with a history of contact with Mr. A, his family, or other Company A employees. A confirmed case was defined as a suspected case with laboratory confirmation of the same pathogen detected in Mr. A. Influenza-like illness was defined as onset of fever (≥38°C) and cough or sore throat in a Uganda contact, and as fever (≥38°C) and cough lasting less than 10 days in a Kenya contact. We collected Mr. A's exposure and clinical history, searched for cases, and traced contacts. Specimens from the index case were tested for complete blood count, liver function tests, plasma chemistry, Influenza A(H1N1)pdm09, and MERS-CoV. Robust field epidemiology, laboratory capacity, and cross-border communication enabled investigation.

Anesthetic management of patients with pericardial tamponade is challenging. A 65-year-old man diagnosed with small-cell lung carcinoma and bilateral malignant pleural effusion in the lungs and pericardial effusion was scheduled for pericardial-window-opening surgery. The severely compromised lung function of the patient led to an anesthetic plan of ultrasound-guided serratus anterior plane block combined with an intercostal block. Although serratus plane block was initially developed for postoperative analgesia, we have shown here that it can be used under deep sedation in combination with an intercostal block for anesthesia for surgeries involving the hemithorax; the block may be promising in high-risk cases.

Clostridium difficile colitis has been the most recognized bacterial enterocolitis for years and other bacteria such as Staphylococcus colitis has been relegated. Staphylococcus enterocolitis following antibiotics had been one of the most frequent complications in surgical patients in the 1950s and 1960s and now reappear with more resistance such as methicillin-resistant(MRSA) colitis which brings a new challenge. A 32-year-old Hispanic female with a history of type I diabetes mellitus presenting with altered sensorium and a 2-day history of watery, nonbloody diarrhea, intractable emesis, and diffuse crampy abdominal pain. About a month before the presentation, the patient had a soft-tissue laceration on the left foot requiring a 7-day course of cephalexin and clindamycin that healed appropriately. On physical examination, she was tachycardic with heart rate of 110 bpm and tachypneic with respiratory rate of 28, somnolent but arousable with the Glasgow Coma Scale >12. The abdomen was soft, tender diffusely to palpation without rebound or guarding. On the biochemical analysis, her blood glucose was 968 mg/dL with anion gap metabolic acidosis (AG 46). In the intensive care unit, she initiated on intravenous (IV) fluids, insulin, and IV antibiotics for suspicion of colitis. Clostridium difficile testing was negative, but stool cultures grew MRSA for which she was started on vancomycin and TMP-SMX. Due to continued abdominal pain on antibiotics, computed tomography of the abdomen with contrast showed acute appendicitis with inflammatory debris and without perforation or abscess requiring laparoscopic appendectomy. Our case presented with diabetic ketoacidosis (DKA), which complicates the etiology of abdominal pain on admission for the clinician masking-MRSA colitis associated with a rare complication of appendicitis double challenge and difficult to diagnose as most DKA patients present with abdominal pain. This is the first case report describing MRSA enterocolitis in patient with DKA complicated by acute appendicitis.

We report a case of a young woman with no cardiac history who presented with out-of-hospital cardiac arrest and ST-segment elevation on the electrocardiogram. The cardiac arrest initially was suspected to be secondary to coronary artery disease. Further history was taken from a relative who said that the patient had a severe headache before the cardiac arrest. It was subsequenly found on computed tomography of the head that the patient had infratentorial subarachnoid hemorrhage and diffurse brain edema. The management of course was totally different from what was contemplated initially. This case illustrates that ST-segment elevation can be caused by other conditions besides on occlusive thrombus in the coronary arteries.

Mucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy.