Rejected

The progression of the otitic infectious process toward diseases of particular severity is often unpredictable, just as it is challenging to manage the patient over time, even after the apparent resolution of the disease. We aim to define a radiological reading key that allows us to correctly and promptly treat the disease, avoiding the possible severe complications.

The patients hope is closely related to his mental health, which is an important component of quality of life. In the context of the treatment of a serious illness, hope can be seen as the expectation of a future positive outcome that is personally valuable and realistically achievable. Research has shown that people with higher level of hope show better adaptation, lower stress levels, less anxiety and depression, and maintain an active approach to problem solving. Questionnaires and intervention methods have been empirically verified to assess and influence the level of hope in patients with advanced cancer. The sources and specific contents of the patients hopes, which change depending on the life situation and the severity of the disease, were also determined. It has been repeatedly found that the hopes of patients with advanced cancer do not relate solely to cure from the disease but are directed more towards the psychosocial aspects quality of life. The main sources of hope include the existence of a good relationship with a close person, the possibility of achieving partial meaningful life goals, a positively assessed life, a sense of self-worth, and spiritual support. On the other hand, the feeling of loneliness, persistent pain and reduced self-esteem have a negative effect on hope. It also shows that the patients hope is largely influenced by the quality of communication with doctors and other healthcare professionals. In an interview on unfavorable prognosis, patients most appreciate the empathic dialogue in which the sincerity and clarity of the message delivered by the doctor is balanced by the encouragement that leaves room for hope. Knowledge of the patients hope, wishes and life values can make a significant contribution to making optimal end-of-life care decisions.

Cystoscopy is a diagnostic and invasive procedure for treatment and follow-up of genitourinary system patients and could be performed with a variety of anesthesia techniques. The study aimed to assess the efficacy of dexmedetomidine-ketamine vs. fentanyl-ketamine on sedation and analgesia for cystoscopy. This double-blind randomized controlled clinical trial enrolled 60 patients undergoing cystoscopy in two groups. Patients were assigned randomly by block random allocation method into dexmedetomidine-ketamine group (1 μg/kg dexmedetomidine) and fentanyl-ketamine group (2 μg/kg fentanyl) receiving ketamine (0.5 mg/kg). Subsequently, mean blood pressure, heart rate, saturated oxygen, respiratory rate, pain intensity, Ramsay score for sedation level, cystoscopy duration, and urologic satisfaction were measured and compared between two groups. Both the groups were similar regarding age, sex and baseline hemodynamic parameters (P > 0.05). Lower heart rate and pain score were revealed in the dexmedetomidine-ketamine group at 25-50 and 30-60 minutes, respectively, after cystoscopy (P < 0.05). Moreover, repeated measure test showed that there was significant difference in trend of respiratory rate and pain score between two groups (P = 0.017) and was lower in dexmedetomidine-ketamine group. The dexmedetomidine-ketamine group relieves pain 30 minutes after cystoscopy with stable hemodynamic parameters during operation. Therefore, dexmedetomidine-ketamine is recommended to be employed for pain relief in subjects undergoing cystoscopy. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1397.108 on July 2, 2018, and registered in Iranian Registry Clinical Trial center with code IRCT20141209020258N105 on April 21, 2019.

With the 1-portal technique for endoscopic carpal tunnel release, the incision is less tender and patients have less postoperative need for analgesics, and return to activities of daily living and work seems to be earlier. The literature also confirms an earlier return to work. Surgical time can be shorter as less time is spent in making and closing the incision.

In patients with thunderclap headaches, reversible cerebral vasoconstriction syndrome (RCVS) should be considered as a differential diagnosis. However, RCVS diagnosis in the emergency department (ED) remains challenging. This report describes the clinical features and factors related to RCVS diagnosis and suggests diagnostic strategies for its management.

The coronavirus disease 2019 (COVID-19) pandemic has led to a declaration of a Public Health Emergency of International Concern by the World Health Organization. As of May 18, 2020, there have been more than 4.7 million cases and over 316,000 deaths worldwide. COVID-19 is caused by a highly infectious novel coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to an acute infectious disease with mild-to-severe clinical symptoms such as flu-like symptoms, fever, headache, dry cough, muscle pain, loss of smell and taste, increased shortness of breath, bilateral viral pneumonia, conjunctivitis, acute respiratory distress syndromes, respiratory failure, cytokine release syndrome (CRS), sepsis, etc. While physicians and scientists have yet to discover a treatment, it is imperative that we urgently address 2 questions: how to prevent infection in immunologically naive individuals and how to treat severe symptoms such as CRS, acute respiratory failure, and the loss of somatosensation. Previous studies from the 1918 influenza pandemic have suggested vitamin D's non-classical role in reducing lethal pneumonia and case fatality rates. Recent clinical trials also reported that vitamin D supplementation can reduce incidence of acute respiratory infection and the severity of respiratory tract diseases in adults and children. According to our literature search, there are no similar findings of clinical trials that have been published as of July 1st, 2020, in relation to the supplementation of vitamin D in the potential prevention and treatment for COVID-19. In this review, we summarize the potential role of vitamin D extra-renal metabolism in the prevention and treatment of the SARS-CoV-2 infection, helping to bring us slightly closer to fulfilling that goal. We will focus on 3 major topics here: 1. Vitamin D might aid in preventing SARS-CoV-2 infection: Vitamin D: Overview of Renal and Extra-renal metabolism and regulation. Vitamin D: Overview of molecular mechanism and multifaceted functions beyond skeletal homeostasis. Vitamin D: Overview of local immunomodulation in human infectious diseases. Anti-viral infection. Anti-malaria and anti-systemic lupus erythematosus (SLE). 2. Vitamin D might act as a strong immunosuppressant inhibiting cytokine release syndrome in COVID-19: Vitamin D: Suppression of key pro-inflammatory pathways including nuclear factor kappa B (NF-kB), interleukin-6 (IL-6), and tumor necrosis factor (TNF). 3. Vitamin D might prevent loss of neural sensation in COVID-19 by stimulating expression of neurotrophins like Nerve Growth Factor (NGF): Vitamin D: Induction of key neurotrophic factors. .

The opioid crisis presents many challenges for family practice providers in rural communities who treat patients with chronic non-cancer pain (CNCP). Unfortunately, evidence for effective opioid reduction strategies is sparse. We evaluated the effects of implementing a comprehensive opioid reduction protocol on overall opioid prescribing among patients with chronic non-cancer pain in our rural family medicine clinics.

Pain is one of the symptoms for which any man is willing not only to go to the doctor but also to resort to any means, including self-medication, to "get rid" of it. Self-medication is not only a current practice but also a public health problem, under the circumstances that it can influence the way in which a disease is diagnosed and/or treated in a timely manner, and, consequently, repercussions may occur on the cost of treatment, in the case of severe forms. Pain is a vital symptom, and the diminution until the disappearance of pain is a fundamental right of each individual; the analysis of ethical issues in the case of self-administration of analgesic medication has not been a major concern.

Roadside automobile mechanics are in the course of their work exposed to several hazards that put them at risk of severe debilitating health challenges. This group of workers, however, is reported not to know much about such hazards and to have little or no training on workplace safety.

A 14-year-old girl presented with chronic headache, recurrent episodes of vomiting, fever, and two episodes of generalized tonic clonic seizure in the past 2 months. Neuroimaging revealed herniation of the brain along with the dura through a defect in the left greater wing of the sphenoid. Left pterional craniotomy was carried out. Herniation of the dural sac along with its contents through the bony defect in the greater sphenoid wing was identified lateral to the V2 nerve passing through the foramen rotundum. The dural defect was repaired. Bony defect was covered with a circular titanium plate. The patient did not have cerebrospinal fluid rhinorrhea postoperatively. At 6-month follow-up, she was asymptomatic.