Rejected

The risk of treating psoriasis with biologic drugs in patients treated with topical corticosteroids over prolonged periods requires careful attention to their underlying adrenal insufficiency because the development of adrenal insufficiency symptoms frequently occurs after cessation of the topical corticosteroids: the dose and duration of topical corticosteroid therapy and etretinate use correlate with risk. In this case report, we present a 65-year-old man with psoriatic erythroderma who developed arthralgia, joint pain, muscle pain, fatigue, and headache after starting brodalumab and a reduction of topical potent corticosteroid doses in the treatment of psoriasis. Because his plasma cortisol levels were decreased and the levels and various signs recovered by administration of physiological doses of hydrocortisone replacement, we concluded that these clinical signs observed after starting brodalumab could be clinical manifestations of adrenal insufficiency secondary to an abrupt reduction in the amount of a topical corticosteroid, but not adverse effects of brodalumab. We found another 2 cases with psoriatic erythroderma who developed secondary to adrenal insufficiency after starting biologic drugs and a reduction of topical corticosteroid doses in the literature. Notably, the side effects of brodalumab include arthralgia, headache, and fatigue, and suspicion of side effects may include the clinical manifestations of adrenal insufficiency. Clinicians have to predict adrenal insufficiency secondary to an abrupt reduction of topical corticosteroids after remarkable improvement of psoriasis by biologics. The routine monitoring of plasma cortisol levels is necessary for all erythrodermic psoriasis patients treated with topical corticosteroids over prolonged periods before starting biologics.

Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE.

The outcomes of plexus and peripheral nerve blocks depend on needle-nerve contact and the spread of local anesthetic (LA) around the plexus or nerve. Needle-nerve distance and spread of LA could be visualized during US-guided lumbar plexus block (LPB).

To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment.

Recent studies have supported the use of quadratus lumborum block (QLB) for postoperative analgesia for patients undergoing renal surgery.

Laparoscopic colectomy is a procedure which is being performed for three decades and is gaining popularity continuously over the traditional open colectomy. This study was conducted in order to compare postoperative and oncologic results based on several factors in laparoscopic and open right colectomy for right colon cancer.

Our aim was to examine the utility of the HIV Disability Questionnaire (HDQ), a patient-reported outcome measure for use in clinical practice from the perspectives of people living with HIV (PLWH) and healthcare providers. We conducted a qualitative descriptive study. Fifteen PLWH and five healthcare providers participated in an interview, of which ten PLWH participated in a follow-up focus group discussion. The HDQ has value in clinical practice, including its role in assessing disability, facilitating communication, tailoring treatments, and guiding referrals. Strengths of the HDQ included its comprehensiveness, relevance of domains, and importance of specific items. Concerns related to length of the HDQ, the potential for some items to trigger emotional response, and negative connotations with the term 'disability.' Recommendations for HDQ implementation included the importance of score interpretability, shortening the questionnaire, and tailoring administration to the individual. Results suggest the HDQ possesses clinical utility with PLWH and healthcare providers.

To determine the prevalence, risk factors, and elaborate our experiences with diagnosis and treatment of patients with mucormycosis, enabling a better understanding of the disease and its management. This is a case series of patients with Covid-19 associated with Rhino-orbital-cerebral mucormycosis, managed in our tertiary care center from April 2021 to June 2021. Six cases of Covid-19 associated with Rhino-orbital-cerebral mucormycosis have been analyzed in the study. The mean age of patients was 40.67 years with a male preponderance (83.3%). The most common complaint was headache (100%), while a minority (33%) came with ocular complaints. All the patients either had a previous history of diabetes mellitus or developed increased blood sugar levels following Covid infection, and were kept on insulin to control their blood sugar levels. 4 patients (66.67%) had a history of corticosteroid use during Covid-19 hospitalization. Treatment included intravenous liposomal Amphotericin B (100%), functional endoscopic sinus surgery (66.67%), maxillectomy (33.33%) and transcutaneous retrobulbar liposomal Amphotericin B (33.33%). Amphotericin B induced nephrotoxicity, which was seen in 1 patient (16.67%). Mortality occurred in only one patient (16.67%), 25 days following successful surgery. Diabetes Mellitus is the most important predisposing factor for the development of Covid-19 associated Rhino-orbital-cerebral mucormycosis. Early presentation, prompt diagnosis and timely initiation of treatment with liposomal Amphotericin B and surgical debridement along with strict blood sugar control can lead to a favorable outcome. However, regular follow-up and monitoring of serum electrolytes and kidney profile must be ensured for such patients.

Fibromyalgia is a chronic pain syndrome which occurs in the absence of an organic damage, whom causes is still unclear. Aims of this pilot study were to investigate the neural correlates of fibromyalgia in response to pain-related visual stimuli and explore the psychological differences among fibromyalgia, chronic low back pain (CLBP) and healthy conditions.