Rejected

The provision of health services has been transforming from a largely top-down, paternalistic model into a construct in which patients play a substantive role in decision making over their care. Two articles in this month's issue of Anesthesia & Analgesia and an accompanying editorial address the growing momentum behind transparency in health care. Firstly, Quinonez et al consider the increasing expectation of family presence during surgical procedures and resuscitation of loved ones. They entertain the valid merits of family presence, such as the anxiolytic effect it may have as well as increased understanding of procedural goals and enhanced staff professionalism. Conversely, family members may not be psychologically prepared to bear witness to more invasive clinical environments and may serve as a source of distraction to providers. The impact of family presence on medical litigation is unclear. There have been long standing precedents set by way of obstetric and pediatric populations as seen in this infographic. In conjunction with the increased desire for physical presence of loved ones during clinical procedures, so too is there a demand for complete access to all medical records, including even the arcane hieroglyphics of an anesthesia record as detailed by Ramaswamy et al. As federal law now mandates such access, questions naturally arise as to their utility and medicolegal implications. The reader is strongly encouraged to review the concepts elaborated in these articles for in depth appreciation of their considerations.

Fibrocystic change is the most common benign lesion in breasts of a woman in her reproductive age. It is an outcome of estrogen excess due to sex hormone imbalance. Cyclical pain as the most common symptom worsens life quality, compels patient to seek health care support continuously, and imposes large amounts of expense to both patient and health system. Current study aims to evaluate effects of N-acetyl cysteine on decreasing pain and changes in plasma biochemistry.

These unique agents may be the answer when other treatments fail or are intolerable for patients with asthma, atopic dermatitis, hyperlipidemia, osteoporosis, or migraine headaches.

Coronavirus disease-2019 (COVID-19) is the most challenging health problem of our century, but our knowledge about the disease is limited. Most individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, have mild symptoms such as headache, sore throat, joint pain, loss of sense of taste and smell. However, infection also causes significant morbidity and mortality, especially in individuals over 65 years of age with comorbidities. However, it is not known exactly which patients will have a poor prognosis. In this study, it was aimed to determine serum Pentraxin-3 (PTX3) and soluble urokinase plasminogen activator receptor (suPAR) levels in COVID-19 patients, and to evaluate the relationship between PTX3 and suPAR levels and the clinical status of the disease. This study was conducted with 150 patients who were confirmed to have COVID-19 by microbiological or clinical/radiological methods between April 1 and December 31, 2020. Thirty people with no known history or symptoms of COVID-19 and negative reverse transcription-polymerase chain reaction (RT-PCR) results also constituted the control group. Patients admitted to inpatient services due to COVID-19 constituted the service group (n= 75) and patients admitted to the intensive care unit (ICU) constituted the ICU group (n= 75). Serum PTX3 and suPAR levels were analyzed by enzyme-linked immunoassay (ELISA) and the results were compared between the three groups. The patients' leukocyte, neutrophil, neutrophil/lymphocyte ratio (NLR), troponin, procalcitonin (PCT), D-dimer, C-reactive protein (CRP), lymphocyte and ferritin results were included in the analysis. The mean age of the patients was 67.2 ± 11.8, and 62.0 ± 8.4 in the control group. There was no significant difference between the groups in terms of female/male ratio (p= 0.582). The PTX3 and suPAR levels of the patients were higher than the controls (p= 0.001, p= 0.023, respectively). PTX3 and suPAR levels were higher in the service group than the ICU group (p<0.001, p= 0.004, respectively) and the control group (p<0.001, p= 0.001, respectively). However, PTX3 (p= 0.291) and suPAR (p= 0.411) concentrations did not differ between ICU and control groups. The most determining parameters in ICU admission were found to be leukocytes (AUC= 0.840), neutrophils (AUC= 0.840), and NLR (AUC= 0.835), respectively. The most predictive parameters for mortality were PCT (AUC= 0.712), NLR (AUC= 0.708) and D-dimer (AUC= 0.695), respectively. In our study, serum PTX3 and suPAR concentrations were found to be high in COVID-19 patients. In patients admitted to the ICU, PTX3 and suPAR levels were observed at low levels. Low levels of PTX3 and suPAR in COVID-19 patients were thought to be clinically important.

Mucoceles are benign, encapsulated, expansible, locally invasive masses within a paranasal sinus filled with mucus and lined by epithelium. Sphenoid sinus mucoceles are relatively rare, accounting for only 1% of all paranasal sinus mucoceles. Usually presenting with headache but can rarely result in visual defect, diplopia and at times, ptosis. We present two cases of sphenoid sinus mucocele where patient presented with ophthalmoplegia, ptosis and/or sudden onset vision loss. With the help of imaging studies like CT scan and MRI of paranasal sinus diagnosis was made and immediate surgical intervention was planned which resulted in acceptable improvement of symptoms and vision.

Background Acute postoperative pain after breast cancer surgery adversely affects recovery and is an independent predictor of chronic postsurgical pain in these patients. Serratus plane blocks have been found to provide analgesia to the anterior hemithorax. However, trials comparing superficial serratus plane block and deep serratus block in breast cancer surgery patients are sparse. Methodology A total of 74 female patients with American Society of Anesthesiologists physical status I and II scheduled for elective modified radical mastectomy for breast cancer were randomized into two groups. Group A patients received a superficial serratus plane block with 30 mL of 0.25% bupivacaine, and group B patients received a deep serratus plane block with 30 mL of 0.25% bupivacaine. Postoperatively, the Numerical Rating Scale (NRS) score was measured during the immediate postoperative period, after 30 minutes and at one, four, eight, 16, and 24 hours, as well as on the second and third day. After discharge, the NRS scores were recorded in the second and third weeks and then monthly once for three months. All patients received patient-controlled analgesia with intravenous (IV) morphine. The duration of analgesia, pain scores, and 24-hour morphine consumption were also noted. Results In group A, the mean duration of analgesia (hours) was 5.51 ± 1.42, whereas in group B the mean duration of analgesia (hours) was 6.69 ± 1.18 (p < 0.01). NRS scores for pain during rest at 12 and 16 hours and NRS scores for pain during cough at eight, 12, and 16 hours, as well as at the third month were significantly lower in group B. However, morphine consumption was comparable between the groups. Conclusions Deep serratus plane block was associated with better NRS scores for pain on rest and coughing and prolonged duration of analgesia after a modified radical mastectomy. We conclude that the deep serratus plane block provides superior and extended analgesia than the superficial serratus plane block after a modified radical mastectomy.

 Acute pancreatitis is a significant challenge to health services. Remarkable progress has been made in the last decade in optimizing its management.  This review is a comprehensive assessment of 7 guidelines employed in current clinical practice with an appraisal of the underlying evidence, including 15 meta-analyses/systematic reviews, 16 randomized controlled trials, and 31 cohort studies.  Key tenets of early management of acute pancreatitis include severity stratification based on the degree of organ failure and early goal-directed fluid resuscitation. Rigorous determination of etiology reduces the risk of recurrence. Early enteral nutrition and consideration of epidural analgesia have been pioneered in recent years with promising results. Indications for invasive intervention are becoming increasingly refined. The definitive indications for endoscopic retrograde cholangiopancreatography in acute pancreatitis are associated with cholangitis and common bile duct obstruction. The role of open surgical necrosectomy has diminished with the development of a minimally invasive step-up necrosectomy protocol. Increasing use of endoscopic ultrasound-guided intervention in the management of pancreatic necrosis has helped reduce pancreatic fistula rates and hospital stay.  The optimal approach to surgical management of complicated pancreatitis depends on patient physiology and disease anatomy, in addition to the available resources and expertise. This is best achieved with a multidisciplinary approach. This review provides a distillation of the recommendations of clinical guidelines and critical discussion of the evidence that informs them and presents an algorithmic approach to key areas of patient management.

To establish a metabonomics research technique based on the combination of H-NMR and multivariate statistical analysis, so as to explore the metabolic regulation mechanism of extract (ARCE) in rat tissues and serum.

Idiopathic intracranial hypertension (IIH) is a syndrome mostly affecting young, overweight women, which characteristically causes headaches, transient visual obscuration or double vision, tinnitus, nausea and vomiting. Severe disease may cause irreversible visual loss. IIH may be primary, or it may be secondary to various medications and diseases. We hereby present a case study of a patient with ulcerative colitis and uveitis, who presented with blurred vision, headache and tinnitus and was diagnosed as IIH. We discuss the differential diagnosis with relation to her underlying disease and treatments.