Rejected

Nonsteroidal anti-inflammatory drugs are an effective nonopiate option for pain control. However, the antiplatelet aggregation of cyclooxygenase-1 (COX-1) inhibitors presents a concern in that they may exacerbate bleeding in patients with solid organ injuries.

The purpose of this study was to investigate the impact of a family caregiver training program on care provision to burn patients. A quasi-experimental study was conducted with 96 family caregivers of burn patients admitted to a burn hospital in Iran. The caregivers' knowledge and training needs were measured at baseline. Four training sessions were provided for the experimental group and caregivers' practices were measured 6 weeks after discharge. Comparing the scores of knowledge and total care with its subdomains (i.e., diet and medication, wound care, itch decrease, wound scar healing, pain management, use of mobility assistive devices, and follow-up considerations) revealed a significant difference between the two groups of caregivers after the intervention (p < 0.01). The caregivers' practices regarding provision of care to burn patients were improved after attending the training program. Receiving sufficient and continuous information from admission to discharge can empower family members.

Hoffa's disease is anterior knee pain presumably stemming from inflammatory fibrous hyperplasia of the infrapatellar fat pad (Hoffa's pad). The etiology and pathogenesis are unclear, however, and no genetic information about the disease has been published. We report the genetic findings in cells from the fat pad of a patient with Hoffa's disease.

Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.

We present the case of a 40-year-old male, who presented to the ophthalmology emergency department with pain and visual loss in his left eye 10 days after an intravitreal injection of a split medication. At the exploration, we found an intense corneal edema in the left eye with endothelial dusting and ciliary hyperemia. LE fundus was impracticable due to anterior chamber opacity. Because of the corneal edema, we performed an anterior segment optical coherence tomography (AS- OCT), visualizing a cyclitic membrane with pupillary block and inflammatory cells in the anterior chamber. There are different treatments to lyse the cyclitic membrane; in this case, we managed the cyclitic membrane with 0,05 ml of intracameral recombinant tissue plasminogen activator (rtPA), a highly potent fibrinolytic protein. We disinfected the eyelids and the conjunctival sac with Povidone Iodine solution, applied topical anesthesia with double anesthetic, and injected 0,05 mL rtPA solution into the anterior chamber using an insulin syringe with a 30-gauge needle. Intracameral rtPA was prepared under sterile conditions using 50 mg vials of rtPA diluted with 50 mL of sterile water to create a 1 mg/ mL solution. Four hours after rtPA treatment, the cyclitic membrane lysed, obtaining pupillary mydriasis. The AS OCT before and after the treatment with intracameral rtPA was of high utility as it allowed the visualization of the cyclitic membrane and its removal.

Liposomal bupivacaine (LB) is a local analgesic that may be used at the time of surgery to limit postoperative pain around the surgical site. Its efficacy in decreasing pain, decreasing narcotic consumption, decreasing length of stay, and improving mobility is an area of intense research. The purpose of this study was to determine whether LB use was associated with improved patient-reported pain scores in the first 72 h following posterior spinal surgery, decreased postoperative narcotic need, and decreased length of stay.

Syringomas commonly occur in women over the face, neck, and chest. They are usually asymptomatic and mainly of cosmetic concern. The vulva is an uncommon site for syringomas. A 45-year-old woman had asymptomatic lesions over the face, of 28 years duration and presented with vulvar papules, associated with severe pruritus for the past 2 months. Clinical and histopathological examination confirmed them to be syringomas. Coexistent facial and vulvar syringomas are rare. Further, vulvar syringomas presenting as pruritus vulvae is still rarer. We report a case with severe pruritus vulvae causing sufficient distress to seek medical care, which is remarkably unusual.

To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI).

Hydration and hydroxyurea (HU) can modify sickle cell disease (SCD) severity. Optimal nutrition and L-glutamine (Gln) may provide further amelioration.

Atopic dermatitis (AD) is a common skin disorder with symptoms including severe pruritus and eczematous lesions. AD affects between 5 and 20% of people in their life. Silymarin (SM) is a polyphenolic flavonoid from  L. and has several therapeutic characteristics including antiallergic, anticancer, and anti-inflammatory properties. is a small plant that has a high antioxidant power and modulating effects on the immune system. Therefore, the current study intended to examine the influence of these two herbs extract on severity and symptoms of AD in patients.