Rejected

Elderly patients with pain and falls are commonly seen in family practice.

A 51-year-old male presented with intermittent chest pain for one month and productive cough with yellow sputum for seven days. He had a history of chronic kidney disease stage G3, depression, and polysubstance abuse. His chest X-ray revealed mild hazy opacity in the right lower lobe, followed by a chest computed tomography without contrast that indicated multiple nodular opacities in the left mainstem bronchus with clear lungs. The patient underwent flexible bronchoscopy where the left mainstem bronchus was found to be completely occluded by three clear plastic bags, about 1 x 0.5 cm in size containing whitish content consistent with the appearance of crack cocaine. A high index of suspicion is crucial in patients with suspected foreign body aspiration as prompt extraction of foreign bodies may prevent complications.

Introduction Gamification is a novel interventional approach to functional recovery and rehabilitation. A significant impact has been observed with the application of gamification on non-traumatic conditions and chronic neurological and musculoskeletal illnesses; however, the implication of gamification on the functional recovery of patients with distal radius fractures (DRF) is yet to be explored.  Methodology This pilot study included 20 post-DRF patients aged 18-65 years with unilateral DRF, managed with closed reduction and K-wire internal fixation. The patients were assigned to group A (gamification) and group B (conventional rehabilitation) in a 1:1 ratio. Group A patients played Racket: NX game, Until you fall game, and Holofit game on Oculus Quest head-mounted display (HMD) (Oculus, USA), while group B patients received a conventional rehabilitation program. Both groups underwent a rehabilitation program for 60 min/day, five days a week, for four weeks. The visual analogue scale (VAS), universal goniometer, Jamar dynamometer, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were used as outcome measures at baseline, at the end of the second week, and at the end of treatment. Results There were significant improvements in pain, range of motion (ROM), grip strength, and functional independence in both groups. However, improvements in hand function and functional independence were significantly greater in the gamification group than in the conventional physiotherapy rehabilitation group. Conclusion The study concluded that gamification appears to have a significant impact on post-DRF rehabilitation in terms of pain, ROM, grip strength, and functional independence. Further research with larger sample sizes is required to confirm the preliminary findings.

A 74-year-old woman visited our department for distally predominant unpleasant pain in the bilateral feet for several months. She had a history of chronic lumbago. Neurological examinations showed normal findings other than involuntary movements. A nerve conduction study, electroencephalography, and brain MRI revealed unremarkable findings, while spinal MRI revealed mild lumbar spinal stenosis. Given the typical unique movements, i.e., bilateral toe movements, which are asynchronous and consist of extension, flexion, and, rarely, abduction, she was diagnosed with painful leg moving toes syndrome. Administration of duloxetine produced partial pain relief and reduced movements. We considered that clinicians should be aware of this unique movement disorder in order to avoid misdiagnosis with psychogenic conditions.

The therapeutic significance of carbamazepine in individuals with trigeminal neuralgia, epilepsy, and bipolar disorder is well recognized. Although it has high effectiveness, it raises the patient's risk for some adverse effects. The relationship between carbamazepine usage and agranulocytosis is well-established. Agranulocytosis is characterized by an unusually low number of neutrophils. This disorder poses a grave hazard to the patient since they are more likely to get potentially lethal bacterial or fungal infections. Moreover, carbamazepine is one of the most common causes of Stevens-Johnson syndrome (SJS), a severe skin condition with a high mortality rate. In cases where agranulocytosis and Stevens-Johnson syndrome coexist, the prognosis is relatively poor. We report a rare case of a patient who developed agranulocytosis and Stevens-Johnson syndrome after taking carbamazepine. Neutrophils accounted for 2.1% of the patient's differential leukocyte count. Furthermore, Naranjo's scale found a score of 8 for Stevens-Johnson syndrome, placing it in the "probable" category, while a score of 9 for agranulocytosis indicated that it was a confirmed adverse reaction to carbamazepine.

Background and aims Peripheral neuropathy is a frequent complication of long-standing diabetes mellitus that adversely affects the quality of life. Pregabalin (anticonvulsant) and duloxetine (antidepressant) are often prescribed for diabetic peripheral neuropathic pain. This study aimed to determine and compare the efficacy and safety of pregabalin and duloxetine in patients with diabetic peripheral neuropathic pain. Materials and methods This prospective observational study was conducted at District Headquarter (DHQ) Hospital, Daggar, Buner district, Pakistan, from February 15 to July 15, 2022, after approval from the Institutional Research and Ethical Review Board. Confirmation of diabetic peripheral neuropathy was based on the history of diabetes mellitus and vibration perception threshold (VPT) using a biothesiometer. The cut-off was set at 15 volts. VPT of more than 15 volts was considered confirmatory for peripheral neuropathy. Patients were divided equally into two groups. Baseline visual analog scale (VAS) score was recorded for all patients. Tablet pregabalin 300 mg daily was administered for four weeks to one group, while tablet duloxetine in 60 mg strength daily was administered to the other group. VAS score after four-week treatment was recorded and compared. Adverse events experienced by the patient were also noted. Results A total of 86 patients were enrolled. The patient ages ranged from 30 to 80 years. Baseline characteristics, including mean age, mean BMI, and mean disease duration of duloxetine versus pregabalin group, were 50.30 ± 8.55 versus 48.20 ± 8.99 years, 23.47 ± 1.23 versus 23.10 ± 1.59 kg/m2 and 21.64 ±7.41 versus 20.04±6.37 months respectively. Duloxetine effectively controlled peripheral neuropathic pain in 81.4% of patients compared to pregabalin in 74.4% of patients. Severe drug-related adverse reactions were observed in 4.6% of patients with duloxetine compared to 0% with pregabalin. Conclusion Duloxetine and pregabalin effectively reduce diabetes-related peripheral neuropathic pain. However, duloxetine has slightly better outcomes than pregabalin. The safety profile of pregabalin is better than duloxetine.

Over the past few years, an integrated approach of palliative care (PC) to chronic and/or life-threatening conditions care has been widely used. Home-based PC (HBPC) service is developed to meet the needs of patients at home; however, it has not been used widely. This study is aimed at determining the benefits of integrated HBPC for the quality of life (QoL) and symptoms intensity in Indonesian children with malignancies.

and Importance: Nitrobenzenes are aromatic oxidizing nitrate compounds, acute ingestion of which can cause methemoglobinemia (metHb) that impairs oxygen transport. Clinical presentation ranges from cyanosis to asphyxia depending on the level of methemoglobin in the blood. Lack of improvement of hypoxia despite administration of oxygen can also be a clue to the diagnosis.

Although nefopam has been reported to have opioid-sparing and analgesic effects in postsurgical patients, its effectiveness in video-assisted thoracoscopic surgery (VATS) is unknown.

Human granulocytic anaplasmosis (HGA) is a bacterial infection caused by Anaplasma phagocytophilum and transmitted by the bite of the black-legged (deer tick) in North America. Its incidence is increasing. HGA can be transmitted after 24 to 48 hours of tick attachment. The incubation period is 5 to 14 days after a tick bite. Symptoms include fever, chills, headache, and myalgia. Complications include shock, organ dysfunction, and death. Mortality is less than 1% with appropriate treatment. Doxycycline is first line treatment for all ages. Start it empirically if symptoms and risk factors suggest HGA. PCR is the confirmatory test of choice.