Rejected

Health equity for all patients is an important characteristic of an effective healthcare system. Bias has the potential to create inequities. In this study, we examine emergency department (ED) throughput and care measures for sex-based differences, including metrics such as door-to-room (DTR) and door-to-healthcare practitioner (DTP) times to look for potential signs of systemic bias.

The treatment of trigeminal neuralgia remains a challenging issue. Stem cells from human exfoliated deciduous teeth (SHED) provide optimized therapy for chronic pain. This study aimed to investigate the mechanisms underlying the attenuation of trigeminal neuralgia by SHED.

Pancreaticoduodenectomy is a highly invasive procedure associated with high morbidity. Several preoperative variables are associated with postoperative complications. The role of perioperative factors is uncertain. The use of perioperative epidural analgesia is potentially associated with fewer postoperative surgical complications. We hypothesize that perioperative epidural analgesia might be associated with fewer surgical complications.

Cerebral venous sinus thrombosis (CVST) is a rather uncommon disorder. CVST is potentially lethal, therefore early detection and treatment is critical. CVST has been linked to pregnancy and puerperium, while COVID-19 infection has been linked to a hypercoagulable state. CVST can be difficult to detect and treat due to the wide range of neurological manifestations, especially in patients with hypercoagulability. The goal of this study is to conduct a literature review and present a unique case of a pregnant woman with CVST who had left hemiplegia and headache. After 6 months of treatment in the hospital, the patient's hemiplegia was fully resolved. Here, we discuss the treatment of CVST in pregnant women who have a suspected past COVID-19 infection.

To determine the association of body mass index with various primary headache disorders.

Metronidazole is an antibiotic commonly prescribed for anaerobic and protozoan infections. Despite its good safety profile, this drug frequently causes a series of well-known side effects (nausea and intestinal transit disorders, dysgeusia, headaches, and alcohol intolerance). However, there are few data in the literature, mainly case reports and case series, about the onset of peripheral neuropathy with a generally self-limiting course after drug withdrawal. Thus, we herein describe two cases of peripheral neuropathy due to treatment with metronidazole. A 69-year-old woman treated with a total of 55 g of metronidazole for diverticular disease and a 52-year-old male patient on a long course of antibiotic therapy for hepatic abscesses (a cumulative dose of 168 g) developed peripheral neuropathy. The suspicion of metronidazole side effects was raised after the exclusion of other causes. After the suspension of the drug, different degrees of improvement were observed. Metronidazole is an effective antibiotic for treating infections caused by anaerobic or protozoan pathogens, and it has a good pharmacological and economic safety profile. However, in the existing literature, prolonged therapy regimens (>4 weeks of treatment and/or 42 g cumulative dose) may increase the risk of developing neurological complications, in particular peripheral polyneuropathy.

A middle-aged female presented with lower abdominal pain associated with nausea and vomiting and was admitted to the acute hospital. She was thoroughly investigated and treated presumably as having a urinary tract infection. However, she was admitted again shortly after discharge with persistent symptoms. A careful evaluation and review were done, and she was diagnosed with nutcracker syndrome based on the clinical assessment, computed tomography (CT), and ultrasound (US) findings.

To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (< 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.

The purpose of this case report was to benefit the clinical recognition and conservative management of giant cell arteritis (GCA) in temporal arteries associated with jaw claudication. Giant cell arteritis is a systemic inflammatory vasculitis that affects medium-to-large-sized arteries. Primarily affecting arteries in heads, especially in temples, chronic GCA can result in secondary headaches and even polymyalgia rheumatica. This is a case report of a 68-year-old female with a 10-year history of GCA. The patient presented jaw claudication, headache, and joint stiffness over 6 months. The left palpable superficial temporal artery was thickened and tendered. A full-spine radiograph revealed uneven shoulders, imbalanced jaws, and moderate lumbar scoliosis. After nine months with conservative management, the patient was completely recovered from the symptoms with significantly improved radiographic parameters. Patients with GCA can present with jaw claudication. Physiotherapy and chiropractic collaborations are options for patients with GCA who suffer from the chronic adverse effect of medicines. Clinicians should be aware of the common clinical findings associated with GCA when rehabilitation treatment is planned.

Background Lateral epicondylitis or 'Tennis elbow' is a common cause of elbow pain in the middle-aged group caused by tendinosis of the common extensor origin of the forearm muscles. Though no obvious aetiology is identified in most cases, it could be attributed to repetitive overuse of wrist extensors or supinator muscles. This condition is generally self-limiting but may become persistent in a few cases. Radiofrequency microtenotomy (RFM) is a minimally invasive surgical procedure for recalcitrant lateral epicondylitis of the elbow. This involves targeted coblation of pathological tissue at significantly lower temperatures. Objectives The aim of this study was to evaluate the therapeutic efficacy and report long-term results and recurrences in patients treated with RFM. Methods We present long-term results with a mean eight-year follow-up in a case series of 19 patients. All patients had a minimum of six months (mean 23.25 months and range: 6-36 months) of conservative management which included steroid injections prior to being offered RFM. This was a retrospective case series of 20 elbows (in 19 patients) who underwent RFM. The majority of patients (65%) were females. The operation was carried out in the dominant arm in 55% of patients. Results Results were analysed by comparing pre-operative and post-operative QuickDASH scores (Disabilities of the Arm, Shoulder and Hand Score) obtained at one year and eight years post-operatively. We found an improvement in QuickDASH scores from a mean of 61.7 pre-operatively to 18.9 (p-value < 0.0001) and 8.5 (p-value < 0.0001) at one year and eight years, respectively. The mean pain component of the QuickDASH scores decreased from 4.8 to 2.0 and 1.5, respectively, at one year and eight years (p-value < 0.0001). More than 83% of the patients had excellent to good functional improvement. Conclusion RFM is a reliable modality for treating recalcitrant lateral epicondylitis of the elbow with excellent long-term results.