Rejected

Intracranial aneurysm (IA) is a devastating cerebrovascular disease characterizing with a potential rupturing risk. In previous studies, the formation of IA was considered to be in a chronic manner, and the ruptured aneurysms might merely derived from the already formed unruptured IA. A 61-year-old male presented to the hospital complaining of a headache. The patient received neuroimage tests, including head computed tomography and digital substraction angiography, to examine the underlying cerebrovascular diseases. Interestingly, we found a newborn ruptured IA with 9-day intervals between 2 whole-cerebral digital subtraction angiography examinations. In summary, the case in our report provides a clue for the natural course that the IA is probably in a "rapid formation, acute rupture" manner.

Acquired reactive perforating collagenosis (ARPC), rare disorder characterized by transepidermal elimination (TEE) of collagen fibers, is seen in adult diabetics. Genetic predisposition, familial aggregation, trauma, bites and scratching are implicated. Diabetics develop microvascular diseases leading to intense pruritus causing repeated micro trauma leading to necrosis of connective tissue of dermis, causing TEE. Isolated papules, plaques and nodules with central keratotic plugs, are mostly seen on extensor surfaces of limbs but trunk and face may be involved. Histopathology shows extrusion of abnormal collagen fibers through epidermis. Multiple treatment modalities show variable response. A 52 year old diabetic female had multiple, itchy, well defined, erythematous papules and plaques with central adherent crusting on lower back since 1 month. Histopathology showed cup shaped epidermal depression filled with plug of altered collagen, acanthotic epidermis with hyperkeratosis and parakeratosis. Underlying epidermis was thin with fine slits through which vertically oriented basophilic collagen fibers were extruded.

Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound-guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy.

Spinal subarachnoid block (SAB) is the first choice anesthesia in lower abdominal and lower limb surgeries. It produces a varying degree of sensory analgesia, motor blockade, and sympathetic blockade depending on the dose, concentration, and volume of the local anesthetic given. This study was undertaken to assess the degree of sensory and motor block with 150 μg of oral versus intramuscular clonidine as an adjuvant to bupivacaine for spinal anesthesia.

Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions: ketamine, propofol, and midazolam. For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.

The prevalence of chronic pain and its links to the opioid epidemic have given way to widespread aims to improve pain management care and reduce opioid use, especially in rural areas. Pain Management Specialty Care Access Network-Extension for Community Health Outcomes (VA-ECHO) promotes increased pain care access to rural Veterans through knowledge sharing from specialists to primary care providers (PCPs). We explored PCP participants' experiences in VA-ECHO and pain management care.

Managing patients with chronic pain with long-term opioid therapy can be challenging for the prescribers, as the development of treatment complications such as addiction and opioid-induced hyperalgesia has to be considered. There is a paucity of information on the use of opioid detoxification protocols in patients with chronic pain on a long-term opioid therapy who have developed opioid-induced complications.

Morvan's syndrome (MoS) is a rare, complex neurological disorder characterized by neuromyotonia, neuropsychiatric features, dysautonomia, and neuropathic pain. The majority of MoS cases have a paraneoplastic etiology, most commonly thymoma, usually occurring before the diagnosis of the underlying tumor and showing improvement following surgery. We present a case of 60-year-old patient presenting with suspicious of MoS and autoimmune encephalitis (AE), F-18 fluorodeoxyglucose positron emission tomography/computed tomography as single imaging modality detected and confirmed both AE and thymoma.

Itching along with other problems can be one of the factors exacerbating the sufferings and disturbing the comfort of patients with chronic renal failure. The present research aimed to study the effects of omega-3 on the treatment of uremic pruritus in hemodialysis (HD) patients. In this crossover randomized clinical trial study, 52 HD patients with pruritus were evaluated. After the random assignment of the participants to Group 1 (treatment mode A) (omega-3 plus cetirizine) and Group 2 (treatment mode B) (cetirizine), they received the treatments for six weeks and then after one week washout period, treatments were changed between the two groups. The pruritus severity was measured using the Yosipovitch pruritus questionnaire before the intervention and at the end of each treatment period. The obtained data were analyzed using descriptive statistics, analysis of variance with repeated measures, and Pearson correlation coefficient. The results of this study showed that pruritus severity reduced in both groups, but it was more significant in Group 1 (omega-3 plus cetirizine). The study findings indicated that omega-3 is effective in the reduction of uremic pruritus. Therefore, this supplement can be used as a convenient method for reducing pruritus in HD patients.