Rejected

Reversible cerebral vasoconstriction syndrome (RCVS) typically manifests with acute-onset, recursive, severe headache that continues for a month; it rarely manifests as seizures. Development of RCVS following thyrotoxicosis has not been previously reported in detail.

Rib fractures are a common thoracic injury that is encountered in 20% to 39% of patients with blunt chest trauma and is associated with substantial morbidity and mortality. Traditionally, the majority of patient with rib fractures have been managed nonoperatively. Recently, the utilization of surgical stabilization of rib fractures has increased considerably because the procedure has shown improved outcomes.

Stratification of patients according to the individual sensory phenotype has been suggested a promising method to identify responders for pain treatment. However, many state-of-the-art sensory testing procedures are expensive or time-consuming.

The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.

Medication therapy emerged as a theme for this issue-from many perspectives and for different conditions. We have several articles on opioids, including for pain/noncancer pain; use by older drivers and their reported driving; and the advantages of family medicine treatment sites. A related article explores chronic widespread pain and concurrent low back pain. In addition, this issue covers the gamut of prescribing inappropriate medications for older individuals and prescribing antibiotics when a CT scan of the abdomen would not have found an indication for such treatment. Other included topics include social complexity and impact on primary care physician income.

When the entire hepatic pedicle is invaded by a tumour, the treatment of cholestasis represents a challenge both for choosing the best drainage possibility and for performing the liver haemostasis during a surgical procedure. Case Report: A patient with progressive jaundice resulting from a remaining gastric tumour that invaded the gallbladder and the hepatic pedicle was successfully treated with biliary decompression using the omega hepaticojejunal shunt. The minor parenchymal bleeding was achieved with the electrocautery greased with lidocaine gel. When burned by the electrocautery, the lidocaine gel made a sealing crust that recovered all the liver parenchyma. Efficacious and stable haemostasis was immediately achieved. The patient had an uneventful early postoperative follow-up, and all cholestasis manifestations, including jaundice and pruritus, decreased since the first day. The patient survived nine months with asymptomatic low jaundice. Conclusion: In the presence of general involvement of the bile ducts, the omega hepaticojejunal shunt reduces the manifestations of cholestasis and improves the patient's quality of life. The electrocautery greased with lidocaine gel is inexpensive, easily available and efficacious method to achieve immediate hepatic haemostasis.

Trigeminal neuralgia is a common neuropathic pain in the head and face. The pathogenesis of trigeminal neuralgia is complex, and so far, the pathogenesis of trigeminal neuralgia involving peripheral and central nervous inflammation theory has not been explained clearly. The loss of dopamine neurons in striatum may play an important role in the development of trigeminal nerve, but the reason is not clear. C-Abl is a nonreceptor tyrosine kinase, which can be activated abnormally in the environment of neuroinflammation and cause neuron death. We found that in the rat model of infraorbital nerve ligation trigeminal neuralgia, the pain threshold decreased, the expression of c-Abl increased significantly, the downstream activation product p38 was also activated abnormally and the loss of dopamine neurons in striatum increased. When treated with imatinib mesylate (STI571), a specific c-Abl family kinase inhibitor, the p38 expression was decreased and the loss of dopaminergic neurons was reduced. The mechanical pain threshold of rats was also improved. In conclusion, c-abl-p38 signaling pathway may play an important role in the pathogenesis of trigeminal neuralgia, and it is one of the potential targets for the treatment of trigeminal neuralgia.

Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a thorough understanding of inciting medications and treatment pitfalls to be avoided.