Rejected

Gastrointestinal pythiosis is a severe, progressive and often a fatal disease, which is caused by the aquatic pathogen Pythium insidiosum. Treatment is challenging due to the disease's resistance to antifungal drugs. Surgical resection is frequently attempted in cases of pythiosis; however, it can be technically challenging. This report presents two dogs with decreased appetite, abdominal pain, progressive haematochezia, tenesmus and significant weight loss. With the medical histories of both being young canines, living in areas with access to natural water resources and with the main chronic gastrointestinal symptoms having not responded to symptomatic treatment, pythiosis was taken into consideration. Abdominal ultrasound revealed severe, diffuse thickening and loss of normal layering of the colonic wall. These findings led to a differential diagnosis between intestinal neoplasia and fungal disease. Full-thickness biopsies were later performed, and immunohistochemistry staining was suggested for colonic pythiosis. Medical treatment for pythiosis was successful with a combination of oral terbinafine and prednisolone. However, therapy with itraconazole in case 1 did not improve the clinical signs, and in case 2, itraconazole was used after all clinical signs have improved for clinical control. Since then, there has been no recurrence of clinical signs until the time of preparing this report (19 months for case 1, 11 months for case 2 since the cessation of treatment). The treatment was successful based on clinical signs and ultrasonographic data, and the disease remission was not confirmed by advance imaging, monitoring of pythiosis enzyme-linked immunosorbent essay concentration or repeat sampling.

Determine the incidence, recurrence rate and clinical associations of status migrainosus in care-seeking residents of Olmsted County, Minnesota.

Lappaconitine (LA) is a C-18 diterpene alkaloid isolated from Nakai that has been shown to relieve mild to moderate discomfort. Various researchers have tried to explain the underlying mechanism of LA's effects on chronic pain. This article uses metabolomics technology to investigate the metabolite alterations in the dorsal root ganglion (DRG) when lappaconitine hydrobromide (LAH) was injected in an inflammatory pain model, to explain the molecular mechanism of its analgesia from a metabolomics perspective. The pain model used in this study was a complete Freund's adjuvant (CFA)-induced inflammatory pain model in rats. There were two treatment groups receiving different dosages of LAH (4 mg/kg LAH and 8 mg/kg LAH). The analgesic mechanism of LAH was investigated with an analgesic behavioral test, tissue sections, and metabolomics. The results of the analgesic behavioral experiment showed that both 4 mg/kg LAH and 8 mg/kg LAH could significantly improve the paw withdrawal latency (PWL) of rats. The tissue section results showed that LAH could reduce the inflammatory response and enlargement of the paw and ankle of rats and that there was no significant difference in the tissue sections of the DRG. The metabolomics results showed that retinol metabolism and glycerophospholipid metabolism in the CFA-induced inflammatory pain model were significantly affected and may exacerbate the inflammatory reactions and initiate persistent pain; in addition, the linoleic acid metabolism, arachidonic acid metabolism, and alanine, aspartate, and glutamate metabolism were also slightly affected. Among them, the alpha-linolenic acid metabolism was up-regulated after LAH treatment, while the retinol metabolism was down-regulated. These results suggest that LAH could effectively reduce inflammatory pain and might achieve this by regulating the lipid metabolism in the rat DRG.

The cause of the piriformis-related pelvic and extra-pelvic pain syndromes is still not well understood. Usually, the piriformis syndrome is seen as extra-pelvic sciatica caused by the entrapment of the sciatic nerve by the piriformis in its crossing through the greater sciatic foramen. However, the piriformis muscle may compress additional nerve structures in other regions and cause idiotypic pelvic pain, pelvic visceral pain, pudendal neuralgia, and pelvic organ dysfunction. There is still a lack of detailed description of the muscle origin, topography, and its possible relationships with the anterior branches of the sacral spinal nerves and with the sacral plexus. In this research, we aimed to characterize the topographic relationship of the piriformis with its surrounding anatomical structures, especially the anterior branches of the sacral spinal nerves and the sacral plexus in the pelvic cavity, as well as to estimate the possible role of anatomical piriformis variants in pelvic pain and extra-pelvic sciatica.

Few reports on clinical factors, treatment, and survival in children and adolescents with Central nervous system tumors in low-income and middle-income countries in Latin America exist. We retrospectively reviewed such data in all cases of patients younger than 18 years with brain tumors diagnosed in a single tertiary care center in Peru from 2007 through 2017. Variables were analyzed for association with overall survival and event-free survival by using the Kaplan-Meier method and the Cox hazards ratio regression. Seventy-five patients' data were analyzed (40 boys, 35 girls; mean age=7.7 y). The main clinical symptoms were headache, vomiting, difficulty walking, and visual disturbances. The most frequent clinical signs were hydrocephalus, cerebellar signs, visual abnormalities, and focal motor signs. The median time to diagnosis was 12 weeks. Tumor resection was performed in 68 patients, and 37 patients received postoperative radiotherapy. The most frequent histologic subtypes were low-grade gliomas and medulloblastomas. Overall survival rates at 1 and 5 years of disease were 78% (CI 95%, 0.67 to 0.86) and 74% (CI 95%, 0.62 to 0.82), respectively, and the 5-year event-free survival rate was 62% (CI 95%, 0.47 to 0.73). Although diagnosis occurred late in our cohort, the survival rate was higher than that in other Latin American countries.

: Numbness, one of the complications after knee replacement (KR), has been studied far less than other complications, and there are few studies on this topic. Without comprehensive research on numbness, there is a need to design a study that includes all relevant parameters. This study investigated the relationship between numbness and pain and neuropathic pain and its impact on functional and emotional life and the functioning of the knee. : The 105 knees with KRs were divided anteriorly into six regions. Numbness was determined with a pinprick test. Douleur Neuropathique 4 (DN4) and a painDETECT questionnaire (PD-Q) were tested for neuropathic pain. Patients' physical, emotional, and social status and functional knee abilities were assessed with the Short Form (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) test. The relationships between numbness and gender, age, bilaterality, postoperative follow-up time, and incision measures were examined. The binomial logistic regression model was applied to investigate the effects of age, gender, bilaterality, incision length, and postoperative follow-up time on numbness. : A total of 88.6% of the patients were female, half had bilateral KRs, and the mean age was 68.3 years. Numbness occurred more frequently in the L3 and L2 areas than in other regions. There was no association with gender, bilaterality, and age, but there was a weak association with postoperative follow-up time. There was a positive correlation between numbness and neuropathic pain. It has been found that there is a significant relationship between numbness and physical function, and it has a negative effect. Emotional health was not significantly associated with numbness. The effect of numbness on social functioning was statistically significant. Knee functioning was measured with the WOMAC, and significant differences were found in the numbness group. : According to the results, numbness is considered to be a complication that affects social and physical life and has a negative impact on functional outcomes of the knee. The results show that it should be considered a statistically significant complication. Numbness and its indirect effects should be considered in patients whose follow-up parameters are normal over one year but whose symptoms do not resolve.

Surgeries are a crucial medical intervention that has saved countless lives from time immemorial. To reduce pain during surgeries patients are administered with anesthetic drugs, which cause loss of sensation and thus reduce the pain involved. However, anesthetists control the effects of the drug by depending on pharmacokinetic calculations, which may vary from patient to patient, thus leading to a reduction in the quality of anesthetic care and adverse effects. To avoid these adverse effects, it is highly necessary to implement a real time monitoring of plasma drug concentration, which will adjust the drug infusion and maintain the levels of drug within therapeutic levels. To implement such a system, it is highly essential to analyze current advances in electrochemical sensor systems for different types of anesthetic drugs like opioids, intravenous anesthetics, and neuromuscular blockers. This review focuses on the present strategy of electrochemical sensors implemented for the detection of anesthetic drugs and it helps towards developing a real time drug dispensing system with respect to the plasma concentration of the drug. This analysis will contribute towards establishing highly effective real time drug dispensing systems like the total intravenous anesthesia technique and patient-controlled analgesia. Such systems will lead to better usage of anesthetic drugs and improve the quality of anesthetic care thus making surgeries safer and more painless.

Films based on carrageenan, alginate and poloxamer 407 have been formulated with the main aim to apply prepared formulations in wound healing process. The formulated films were loaded with diclofenac, an anti-inflammatory drug, as well as diclofenac and curcumin, as multipurpose drug, in order to enhance encapsulation and achieve controlled release of these low-bioavailability compounds. The obtained data demonstrated improved drug bioavailability (encapsulation efficiency higher than 90%), with high, cumulative in vitro release percentages (90.10% for diclofenac, 89.85% for curcumin and 95.61% for diclofenac in mixture-incorporated films). The results obtained using theoretical models suggested that curcumin establishes stronger, primarily dispersion interactions with carrier, in comparison with diclofenac. Curcumin and diclofenac-loaded films showed great antibacterial activity against Gram-positive bacteria strains ( and , inhibition zone 16.67 and 13.67 mm, respectively), and in vitro and in vivo studies indicated that curcumin- and diclofenac-incorporated polymer films have great potential, as a new transdermal dressing, to heal wounds, because diclofenac can target the inflammatory phase and reduce pain, whereas curcumin can enhance and promote the wound healing process.

The transversus abdominis plane (TAP) block is an ultrasound guided regional anaesthetic technique used to provide analgesia to the abdominal wall. Research in humans and cats has demonstrated that TAP blocks reduce pain and post-operative opioid requirements after abdominal surgery. To date TAP blocks have not been described in rats. The optimal technique to employ when performing TAP blocks is controversial with single point injection techniques failing to reliably provide adequate coverage of the cranial abdominal wall. It has been suggested that performing a two point injection may provide more reliable coverage of the cranial abdominal wall.The objective of this study was to determine the feasibility of performing ultrasound guided TAP blocks in rat cadavers and to evaluate whether performing a two point technique provides greater spread of injectate than a one point technique when administering the same total volume of methylene blue solution.Twenty-three, four-month-old, female Sprague Dawley rat cadavers weighing 506 ± 78 g were used. TAP blocks were performed using a total of 1 ml/kg of methylene blue solution.Overall success rates for injections were 21.7% (13.6-32.8%). Single point injection area of spread was 87.8 ± 32 mm compared with 102.4 ± 17 mm for the two point injection technique.Due to the low success rate the use of TAP blocks using the current technique cannot be recommended. Two point injection technique appears to provide greater spread; however, additional data is required to draw meaningful conclusions.

Postoperative pulmonary complications (PPCs) represent the most frequent complications after lung surgery, and they increase postoperative mortality. This study investigated the incidence of PPCs, in-hospital mortality rate, and risk factors leading to PPCs in patients undergoing open thoracotomy lung resections (OTLRs) for primary lung cancer. The data from 1426 patients in this multicentre retrospective study were extracted from the German Thorax Registry and presented after univariate and multivariate statistical processing. A total of 472 patients showed at least one PPC. The presence of two PPCs was associated with a significantly increased mortality rate of 7% ( < 0.001) compared to that of patients without or with a single PPC. Three or more PPCs increased the mortality rate to 33% ( < 0.001). Multivariate stepwise logistic regression analysis revealed male gender (OR 1.4), age > 60 years (OR 1.8), and current or previous smoking (OR 1.6), while the pre-operative risk factors were still CRP levels > 3 mg/dl (OR 1.7) and FEV1 < 60% (OR 1.4). Procedural independent risk factors for PPCs were: duration of surgery exceeding 195 min (OR 1.6), the amount of intraoperative blood loss (OR 1.6), partial ligation of the pulmonary artery (OR 1.5), continuing invasive ventilation after surgery (OR 2.9), and infusion of intraoperative crystalloids exceeding 6 mL/kg/h (OR 1.9). The incidence of PPCs was significantly lower in patients with continuous epidural or paravertebral analgesia (OR 0.7). Optimising perioperative management by implementing continuous neuroaxial techniques and optimised fluid therapy may reduce the incidence of PPCs and associated mortality.