Rejected

Saccadic intrusions such as opsoclonus and ocular flutter are often due to a paraneoplastic or a parainfectious condition. Toxins/drugs may rarely cause them. Herein, we report a rare case of ocular flutter/opsoclonus due to phencyclidine (PCP) toxicity. Our patient is a 21-year-old male who presented with a 3-day history of headache, generalized ill health, and aggressive behavior. He was admitted with reduced level of consciousness following generalized seizures. He had features of sympathetic overactivity with ocular flutter and opsoclonus. Urine toxicology was positive for PCP. Despite supportive care, he succumbed to complications of rhabdomyolysis. Several drugs including cocaine, phenytoin, lithium, and amitriptyline are known to cause ocular flutter/opsoclonus rarely. It is poorly described with PCP. This case highlights PCP as a rare cause of toxin-induced saccadic intrusions and attempts to postulate its pathogenesis. Moreover, our report is the first case of PCP intoxication in Sri Lanka and one of the few documented reports in the South Asian region. Therefore, it represents a significant worrisome alarm about the spread of this substance in this region.

Osteoarthritis (OA) is the most common form of arthritis, affecting 1 in 3 people over age 65 and women more so than men. The prevalence of OA is rising due, in part, to the increasing prevalence of OA risk factors, including obesity, physical inactivity, and joint injury. OA-related joint pain causes functional limitations, poor sleep, fatigue, depressed mood and loss of independence. Compared to age and sex-matched peers, OA patients incur higher out of pocket health-related expenditures and substantial costs due to lost productivity. Most people with OA (59-87%) have at least one other chronic condition, especially cardiometabolic conditions. Symptomatic OA may impair the ability of people with cardiometabolic conditions to exercise and lose weight, resulting in increased risk for poor outcomes. People with OA and other chonic conditions are less likely to receive a diagnosis or recommended treatment. Further, in these individuals the most effective and safest treatment is physical activity/exercise coupled with self-management strategies, which is only moderately effective. Given the already high, and growing, burden of OA, enhanced effort is required to identify better – more effective and safe – treatments for the majority of people with OA who are living with other chronic conditions.

Butorphanol and tramadol, the synthetic opioid analgesics, have been used alone or in combination with a local anesthetic in supraclavicular brachial plexus block.

The management of paediatric femoral fractures continues to spark debate in published literature, with poor quality evidence guiding current guidelines on the optimum treatment in children. Many centres report excellent results for both elastic intramedullary nailing and plate fixation of diaphyseal femoral fractures. This study aimed to investigate the outcomes of femoral fractures treated with elastic nail fixation versus those treated with plate fixation in a tertiary children's trauma unit, and discuss the advantages and disadvantages of each technique.

Cough is one of the most common complaints encountered in every setting, however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. Reported cough-induced pathology ranges from rare (the majority) to common and from trivial (e.g. lightheadedness, subconjunctival hemorrhage) to severe and life-threatening (e.g. cervical artery dissection, rupture of a normal spleen). Other seemingly benign entities may mask a serious underlying pathology (e.g. cough headache, cough syncope). A substantial proportion of patients experience anxiety, insomnia and their quality of life is affected. Thus, the wide spectrum of cough-induced pathology need to be recognized and considered in patients complaining of cough. Suppression of cough must not be neglected in patients at risk, and areas of uncertainty need to be clarified by future prospective studies.

Medical necessity of stereotactic radiosurgery (SRS) is non-uniform across insurance policies. American Society for Radiation Oncology (ASTRO) created a model policy based on the consensus of the radiation oncology community to communicate "medically necessary" indications for SRS. We compared current insurance policies for SRS with ASTRO model policy.

Cryoneurolysis of peripheral nerves uses localised intense cold to induce a prolonged block over multiple weeks that has the promise of providing potent analgesia outlasting the duration of postoperative pain following surgery, as well as treat other acute and chronic pain states. However, it remains unclear whether persistent functional motor deficits remain following cryoneurolysis of mixed sensorimotor peripheral nerves, greatly limiting clinical application of this modality. To help inform future research, we used a rat peroneal nerve injury model to evaluate if cryoneurolysis results in persistent deficits in motor function.