Rejected

Autoimmune hepatitis (AIH) is a chronic disease characterized by hepatocellular inflammation and destruction. Its pathogenesis remains unclear. Current evidence suggests that environmental factors, including viral infections, are implicated as possible triggers. We present a case of a 36-year-old lady with systemic lupus erythematosus who presented with abdominal pain, nausea, vomiting, and jaundice. She was initially diagnosed as acute hepatitis E virus (HEV) infection based on positive serology, but she did not improve with conservative management. Subsequently, she underwent liver biopsy that showed features characteristic of AIH. We discuss the role of HEV as a possible trigger of AIH. We also highlight the possibility of cross-reactivity between liver antigens and HEV as an explanation for the positive HEV serology in AIH. We explore the management options of cases in which both acute HEV infection and AIH coexist, which might be challenging as there is no current consensus whether to start immunosuppressive therapy or to manage such cases conservatively. Moreover, we discuss previous similar cases in which different lines of management were chosen.

Preventive analgesia in orthopedic surgery is becoming increasingly important because post-surgical pain management is more pleasant for the patient and allows them to initiate rehabilitation early. With this premise we consider the following hypothesis. The perception of post-surgical pain at two, 12 and 24 hours with local infiltration into the surgical wound with ropivacaine plus systemic analgesia will be less compared to patients who infiltrate with saline into the surgical wound plus systemic analgesia.

Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic.

Percutaneous nephrolithotomy (PCNL) a minimally invasive method for the removal of renal calculi and is associated with significant pain in postoperative period. Conventionally, intravenous opioids, local anesthetic infiltration, and regional blocks (intercostal/paravertebral blocks) have been tried with less efficacy to control postoperative pain. The present study is conducted to assess the effectiveness of erector spinae plane block (ESPB) performed under fluoroscopy guidance for postoperative analgesia during PCNL.

Pulmonary complications (PCs) are a major cause of poor prognosis in chest trauma. Evidence on the effectiveness of incentive spirometry (IS) in trauma is scarce. This study investigated the effectiveness of IS in preventing PCs in patients with chest trauma with rib fractures.

Though ilio-inguinal nerve block has been commonly utilised in male urologic surgery, a single injection ilio-inguinal nerve block alone has not previously been reported for analgesia of the vulva. In this report, we describe the case of a 14-year-old girl undergoing sclerotherapy of a venous malformation affecting the labia majora and minora. After induction of anaesthesia, we performed an ultrasound-guided ilio-inguinal nerve block using a total volume of 15 ml of ropivacaine 0.2% with 1 μg.ml dexmedetomidine which provided effective postoperative analgesia. Though the patient received intravenous analgesia intra-operatively and had an inpatient bed reserved in anticipation of severe postoperative pain, she required no further analgesia and was discharged home following 2 hours in the postoperative anaesthesia care unit. With the additional use of dexmedetomidine resulting in prolonged efficacy of the block, the patient reported effective postoperative relief for approximately 30 hours, solely using ibuprofen for pain relief. This case reminds clinicians that the ilio-inguinal nerve block may provide benefit not only for male urologic surgery but also for procedures involving the external female genitalia, with extended analgesia with the use of dexmedetomidine.

A 62-year-old female patient with a history of mastectomy surgery and sentinel lymphadenectomy in the context of breast cancer therapy was referred to our clinic for the treatment of refractory neuropathic pain. She reported a complex set of symptoms including burning and electrical-like sensations as well as profound hyperesthesia, hyperalgesia, and allodynia. The symptoms persisted chronically over months with a strong intensity and did not sufficiently respond to oral pain medication and co-analgetics, that is, tapentadol and pregabalin. As the patient could hardly move her right upper arm due to the pain, the quality of life was greatly reduced. In addition, the patient reported pain-related anxiety and depression. Therefore, a therapy with capsaicin 8% patch was initiated. Treatment with capsaicin 8% led to pain relief without tolerance development and improved flexibility in the affected body area. Despite significant pain relief, previous oral pain medications (tapentadol, pregabalin) as well as the anti-depressant amitriptyline were maintained to fully resolve pain symptoms, anxiety, and depression. In conclusion, capsaicin 8% may represent an effective therapeutic alternative for patients suffering from refractory neuropathic pain.

Muscle pain and fibromyalgia (FM) are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We recently demonstrated that during orthostatic stress testing, adults with ME/CFS reported increased pain. In the current study, we hypothesised that pain pressure thresholds (PPT) would decrease and temporal summation (windup) would increase after head-up tilt testing (HUT), and that the presence of co-morbid FM would be associated with greater change in both measures.

Increasing attention is being paid to the effects of organismic factors like age on pain sensitivity. However, very little data exist on this topic using modern algesiometric assays and measures in laboratory rodents.

This study aims to review, identify and study the determinations of the main orthopedic aspects in SCI patients.