Rejected

The old definitions of fever are based on cross-sectional surveys of the population without analyzing the associated symptomatology as fever is a sign, not symptom. Therefore, a longitudinal follow-up study is the need of hour to analyze associated symptoms with fever.

Ramsay Hunt syndrome, a late manifestation of varicella-zoster virus infection, occurs when the virus reactivates, infects, and produces an inflammatory reaction in the seventh cranial nerve geniculate ganglion. The detection is made clinically on the basis of the following three features: facial nerve palsy, the presence of characteristic herpetic vesicles around the mouth, and pain in the ear. However, it is often diagnosed quite late and sometimes even missed, increasing the chances of complications that have long-term effects. The two significant complications following the development of Ramsay Hunt syndrome are facial nerve palsy and hearing impairment. Ramsay Hunt syndrome is among the principal causes of facial nerve palsy, implicated in around 2-10% of all cases. While hearing loss though prevalent, is a less common complication than facial palsy. This review aimed to analyze the clinical presentation and prognostic features of the complications of Ramsay Hunt syndrome mentioned above, that is, hearing loss and facial nerve palsy. It was seen that while the association of Ramsay Hunt syndrome with facial nerve palsy has been studied quite extensively, the literature on hearing loss as a sequela is quite lacking. The course and outcome of facial nerve palsy is determined by the early clinical picture, while the otological symptoms rely on the extent of nerve involvement. Early diagnosis and treatment go a long way in preventing these complications and increasing the chances of complete recovery. Treatment options most commonly studied included antiviral drugs such as acyclovir, steroids, and anti-inflammatory agents.

To find out the anatomic variations of nose/paranasal sinuses and how they affect the sinuses in chronic rhinosinusitis (CRS). This observational cross-sectional study included adults with CRS, refractory to optimum medical management, planned for functional endoscopic sinus surgery (FESS). Pre-operative naso-endoscopy and computed tomography (CT) were utilized to estimate the extent of CRS, and to note the anatomic variations of the sinuses. The findings were corroborated within the practical scope of FESS. The anatomic variations were evaluated to establish how they affected the related sinus(es). Most of the 53 patients were young adults presenting with nasal obstruction (77%), discharge (76%) and headache (68%). On diagnostic naso-endoscopy, prominent agger bulge (83% of the nasal sides), prominent uncinate (18%), inferior turbinate hypertrophy (34%), concha bullosa (38%), mucopus and polyp in the middle meatus (51%, 19%; respectively), and gross septal deviation (55%) were noted. The spheno-ethmoid and frontal recesses were predominantly unremarkable. CT revealed inferior turbinate hypertrophy (38% of the nasal sides), agger (100%), and lateralized/collapsed uncinate (8%). Ethmoids and maxillary sinuses were diseased in 50% and 65% respectively, with blocked ostiomeatal complex in 32% and prominent bulla in 48%. Frontal and sphenoid sinuses were least involved (10%, 2%; respectively). Enlarged agger caused maxillary sinusitis (87%), whereas anterior ethmoiditis resulted from enlarged agger (100%), bulla (89%) and frontal cells (51%). Identification of the anatomic variations of the nose/paranasal sinuses through CT and naso-endoscopy (diagnostic, per-operative) is crucial to understand the pattern, extent and severity of the involvement of sinuses in CRS.

This study aimed to investigate the relationships of lumbar spine-hip discoordination during sit-to-stand (STD) and stand-to-sit (SIT) with pain and functional disability in chronic nonspecific low back pain (CNLBP) patients.

Abdominal tuberculosis is an uncommon clinical entity, and it can involve the gastrointestinal tract but also the peritoneum, lymph nodes, and solid organs. Its prevalence is higher among individuals from endemic regions for tuberculosis. Epidemiological risk factors associated with typical symptoms and complementary exams should prompt early treatment. We describe the case of a 47-year-old man, originally from India, residing in Portugal for approximately a year. He presented to our emergency department with a three-week-long history of diarrhea, diffuse abdominal pain, more intense on the left quadrants of the abdomen, anorexia, asthenia, and loss of nearly 10% of his body weight. Abdominal and pelvic imaging showed diffuse circumferential thickening of the distal ileum and adjacent mesentery with associated lymphadenopathies. A colonoscopy confirmed the presence of an ulcerated deformative lesion of the cecum with the involvement of the terminal ileum. Initial suspicion of infectious colitis versus inflammatory bowel disease led the team to prescribe antibiotics and corticosteroid therapy, which was associated with bronchoalveolar lavage and sputum samples negative for , delaying the diagnosis of intestinal tuberculosis. The lack of improvement after weeks of the initial medical therapy, and with histopathological examination of cervical lymphadenopathy showing the presence of granulomatous lymphadenitis with necrosis, led the medical team to start antituberculostatic therapy. The patient showed significant clinical and laboratory improvement, but after two months of adequate treatment a cavitated nodule appeared on the upper lobe of the left lung, and a   was identified in the bronchoalveolar lavage. Timely diagnosis and adequate treatment are essential to lower mortality rates of intestinal tuberculosis, and epidemiological risk factors have a great deal of importance on this matter and must always be taken into account.

Trigeminal trophic syndrome (TTS) is an unusual complication that occurs secondary to trigeminal nerve injury. The insult to the nerve can lead to anesthesia, hypoesthesia, and paresthesias producing sensations such as burning or itching. The combination of both leads to repeated self-inflicted skin trauma in an attempt to alleviate these sensations, eventually leading to ulceration of the skin. We report a case of a 71-year-old male patient with a scalp ulcer who had an episode of herpes zoster ophthalmicus four months prior to presentation.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that prevails mainly in western countries. Due to the unknown etiology of UC, the purpose of treatments has predominantly comprised symptomatic and pain relief. With extensive research focusing on the pathogenesis of UC, various novel treatments have emerged, although their efficiency has remained unsatisfactory. (HMM), a crucial constituent of traditional Chinese medicine, has a broad application in many diseases and has been found beneficial for UC patients.

Microscopic polyangiitis (MPA) is a type of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis linked to myeloperoxidase (MPO), usually accompanied by pulmonary and renal lesions. MPA sometimes causes central nervous system (CNS) involvement such as cerebral infarction. Herein, we report a case of a 72-year-old man with a headache. He had an unknown cause of the elevated inflammatory response. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions in the small vessel region in the right basal ganglia with multiple cerebral microbleeds (cMBs). After admission, his left hemiparesis and consciousness disturbance gradually deteriorated. A follow-up MRI on day 18 showed increased multiple cerebral infarctions in small vessel regions with increased cMBs. Additional blood tests revealed positive MPO-ANCA. Although there were no findings suggestive of active renal or pulmonary involvement or peripheral neuropathy, we diagnosed him as having MPA-associated CNS-restricted vasculitis. CNS involvement of MPA is relatively rare but is associated with a high small vessel disease (SVD) burden. In addition to the unknown cause of inflammatory response, the multiple cMBs increase and a short-term recurrence of cerebral infarctions in the bilateral thalamus and basal ganglia was the clue for the diagnosis of CNS-restricted vasculitis. It is difficult to diagnose MPA vasculitis when lesions are restricted to the CNS. In the absence of lesions other than SVD, MPA-associated CNS vasculitis should be suspected in patients with progressive SVD burden and elevated inflammatory response.

Although several randomized controlled trials (RCTs) have reported the efficacy of scrambler therapy (ST) for the management of chronic pain, those findings remain inconsistent.

The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients.