Rejected

Clavicle fracture fixation is commonly performed under general anesthesia due to the complex sensory innervation in this region which poses a challenge for anesthesiologists applying regional anesthetic (RA) techniques. In part 1 of this two-part study, we summarized the current literature describing various RA approaches in clavicle fractures and surgery. In our earlier scoping review, we surmised that a superficial or intermediate cervical plexus block (CPB) may provide analgesia for this procedure and, when combined with an interscalene brachial plexus block (ISB), can provide anesthesia to the clavicular region for surgical fixation. We performed a retrospective study, consolidating assumptions that were based on the results of our earlier scoping review. A retrospective study was conducted on 168 consecutive patients who underwent clavicle fixation surgery at a tertiary healthcare system in Singapore. We used a standardized to collate perioperative data from the electronic health records of both hospitals, including anesthetic technique, analgesic requirements, pain scores, and adverse events, up to the second postoperative day or up until discharge. In our study, patients who received RA had significantly reduced pain scores and opioid requirements, compared to general anesthesia (GA) alone. Through subgroup analysis, differences were found in postoperative pain scores and opioid requirements in the following order: GA alone > GA with local infiltration analgesia > CPB > CPB plus ISB. All patients who received combined CPB and ISB had upper limb weakness in recovery, compared to none with CPB alone ( < 0.001). Of those who received an ISB either in isolation or combined with a CPB, four (9.3%) were reported to have dyspnea (within 24 h) and motor weakness that persisted beyond 12 h, compared to none for patients that received CPB alone. Addition of a CPB to GA for clavicle fracture fixation surgery is associated with reduced pain scores in the early postoperative period, with a lower opioid requirement compared to GA alone. In patients undergoing GA, the combination of a CPB with an ISB was associated with a small, although statistically significant, reduction in pain scores and opioid requirements compared to a CPB alone.

Familial Mediterranean fever (FMF) is one of the most common inherited autoinflammatory diseases. Angiogenesis is a feature of inflammatory activation and part of pathogenic processes in autoimmune diseases. Therefore, this study aimed to investigate the role of the Vascular endothelial growth factor () gene insertion/deletion (I/D) functional variant in FMF Turkish patients. gene mutations were detected in all patients. The FMF patients (N:105) and the healthy controls (N:100) were genotyped for the I/D variant using PCR followed by agarose gel electrophoresis. The results were statistically analyzed by calculating the odds ratios (OR) and their 95% confidence intervals (95% CI) using the χ-tests. The mean age of patients was 25.46 ± 10.09. Fifty-nine patients (56.2%) had two or more gene mutations. The most common mutation was M694V/M694V. The I/D variant genotype distribution exhibited a statistically significant difference between the patients and the controls. I/D genotype was higher in controls compared to patients, while D/D genotype was higher in patients compared to the controls , , respectively). When we examined the clinical findings, joint pain was more common in patients with D/D and I/D genotypes compared to I/I genotype (). Although not statistically significant, the most common genotype in patients with two or more mutations was D/D (28.6%). The results provided evidence supporting that the D/D genotype of the I/D variant is associated with an increased risk of FMF in a group of Turkish populations.

Alzheimer's disease (AD) is considered a chronic and debilitating neurological illness that is increasingly impacting older-age populations. Some proteins, including clusterin ( or ) transporter, can be linked to AD, causing oxidative stress. Therefore, its activity can affect various functions involving complement system inactivation, lipid transport, chaperone activity, neuronal transmission, and cellular survival pathways. This transporter is known to bind to the amyloid beta (Aβ) peptide, which is the major pathogenic factor of AD. On the other hand, this transporter is also active at the blood-brain barrier (BBB), a barrier that prevents harmful substances from entering and exiting the brain. Therefore, in this review, we discuss and emphasize the role of the transporter and -linked molecular mechanisms at the BBB interface in the pathogenesis of AD.

Some individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID).

The clinical behaviors, prognosis, and appropriate treatments of papillary tumors of the pineal region (PTPR) are not fully defined due to the rarity of these tumors. At diagnosis, PTPR may present with clinical symptoms, including headache with obstructive hydrocephalus, diplopia, vomiting, and lethargy, as well as neurological signs, including Argyll Robertson pupils and Parinaud's syndrome due to compression of the dorsal midbrain, specifically the periaqueductal region with horizontal nystagmus. Radiological assessment of pineal region lesions is challenging, with a wide range of potential differential diagnoses. PTPR typically presents as a heterogeneous, well-circumscribed mass in the pineal region, which might contain cystic areas, calcifications, hemorrhages, or protein accumulations. Here, we report three female pediatric patients with PTPR treated in King Fahad Medical City (KFMC) in Saudi Arabia. Histological and immunohistochemical diagnosis was confirmed by analysis of genome-wide DNA methylation profiles. This case series expands on the available reports on the clinical presentations of PTPR and provides important information on the responses to different treatment modalities.

Transient osteoporosis of the hip is described as an uncommon, self-limiting condition that typically affects middle-aged men and pregnant women in their third trimester. Transient osteoporosis most commonly affects the hip, but cases have been described in the knee, ankle, and foot. Symptoms include pain, limited range of motion, and antalgic gait. A greater level of awareness of transient osteoporosis of the hip as a differential diagnosis for hip pain will obviate unnecessary, inefficient, or unproductive interventions and treatments. Transient osteoporosis of the hip is a self-limiting disease process that requires only symptomatic treatment such as basic analgesia, physical therapy, and activity modification. On average, recovery is seen within 6-12 months.

Henoch-Schönlein purpura (HSP) is a disease commonly manifesting purpura, joint pain, and gastrointestinal symptoms. It can lead to glomerulonephritis (Henoch-Schönlein purpura nephritis, HSPN), which is directly associated with mortality and progression to chronic kidney disease (CKD). While HSP occurs more commonly in children, deadly outcomes occur at a higher rate in adult patients. Previous studies have not reported effective treatment of HSPN by Western or traditional medicine. Here, we report two cases of adult HSPN patients treated with the herbal medicine Jarotang (JRT, modified Sipjeondaebo-tang, modified SJDBT).

The objective was to determine whether an erector spinae plane (ESP) block could provide additional postoperative analgesic benefits compared with a transversus abdominis plane block. 78 patients were separated into two groups (n = 39 per group). Both groups received bilateral injections of 266 mg Exparel (20 ml) and 60 ml of 0.125% bupivacaine. Patients undergoing a transversus abdominis plane block received these injections intraoperatively, while patients undergoing an ESP block received these preoperatively. Outcomes were measured based on scores in opioid usage; pain (visual analog scale) at rest and with movement; nausea; sedation and patient satisfaction. There were no significant intergroup differences in any category (all scores had p > 0.05). No additional analgesic benefits were found using the ESP block procedure.

A 25-year old male presented with chest pain and elevated troponin following COVID-19 vaccination. Despite initial response to nonsteroidal anti-inflammatory drugs, he developed a recurrent and relapsing course requiring multiple readmissions. Cardiac magnetic resonance imaging confirmed myocarditis. Due to progressing macrocytic anemia, he was eventually diagnosed with acute myeloid leukemia, thought to be the underlying cause of driver of his recurrent and persistent myocarditis.