Rejected

Septic emboli induce two insults – firstly, the infectious insult, which causes inflammation and increases the potential for abscess formation, and secondly, the early embolic/ischemic insult brought on by arterial blockage and infarction. Pulmonary embolism is the second leading cause of cardiovascular disease-associated death, right after cardiovascular events. The sequelae of venous thromboembolism include post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension (CTEPH). The pathophysiological characteristics of inflammation, hypercoagulability, and endothelial damage are the three components of Virchow's triad, which are mirrored by the risk factors for both diseases. The screening of patients for whom venous thromboembolism can be ruled out with a positive plasma D-dimer test result is made easier by clinical probability evaluation. To confirm the diagnosis, compression ultrasonography that displays deep vein thrombosis or a chest CT that reveals pulmonary embolism have been frequently employed. We report a case of a young male who presented with sudden onset pain and swelling in the left lower limb and chest following an intramuscular injection which further resulted in pulmonary thromboembolism.

Introduction Inflammatory bowel diseases (IBD) (Crohn's disease (CD) and ulcerative colitis (UC)) are considered among the commonest gastrointestinal (GI) tract diseases manifesting with chronic, recurring episodes of gut inflammation, especially in the colon. Each disease has its pattern, symptoms, severity of pain, extension, management, and prognosis. However, these diseases share most of the various complications, including the GI tract and extending it to other systems such as musculoskeletal, skin, liver, and pulmonary systems. Objectives We aim to identify the demographic data, prevalence, risk factors, clinical presentation, and management (medications given and investigations ordered) of thromboembolic events (TEE) among inflammatory bowel disease patients at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim, Saudi Arabia. Materials and methods This is a retrospective, cross-sectional study. All included patients with IBD who meet the inclusion criteria between January 2020 and January 2022 in KFSH were reviewed, and data were analyzed using the Statistical Package for the Social Sciences (SPSS) Statistics version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 187 participants were included in the current study. The mean age of the participants ± standard deviation (SD) was 28.7 ± 10.8 years old. Of the participants, 107 (57.2%) were males. A total of 121 (64.7%) participants were diagnosed with Crohn's disease (CD), 56 (29.9%) with ulcerative colitis (UC), and 10 (5.3%) with both CD and UC. In 156 (83%) participants, the duration of the disease was 1-5 years. Among the IBD patients, two (1.1%) had TEE in the interval resolution middle and left portal vein, as well as the inferior mesenteric vein. The majority of the participants (73.3%) were with no history of comorbid conditions. The most reported clinical symptoms were chest pain as reported by 3.2% of the participants. Abdominal computed tomography (CT) was the most reported method of diagnosis as reported by 35.8% of the participants. Of the participants, 8.6% used heparin prophylactically, 0.5% used heparin as a treatment, and 0.5% used enoxaparin as a treatment. Moreover, 20.3% of the participants used prophylactic treatment, whereas about 79.7% did not use prophylactic treatment. Old age, extensive disease, colorectal surgery, and pregnancy were not found to be associated with thromboembolic events (p = 1.000, 0.400, 0.164, and 0.053, respectively). Age, gender, and nationality were not significantly associated with thromboembolic events (p = 0.915, 1.000, and 1.000, respectively). Conclusion Despite IBD being one of the emerging health concerns in the Kingdom of Saudi Arabia, records showed that the prevalence of thromboembolic events was found to be lower when compared to the prevalence reported in the relevant multinational studies. The was no difference in factors affecting the development of thromboembolic events between IBD patients and the general population. Recommendations We should stress raising awareness of IBD patients about their condition, the increased risks of developing thromboembolic events, and the proper prevention methods.

Hyponatremia is defined as a serum sodium concentration of less than 135 mEq/L. Severe hyponatremia is defined as a serum sodium concentration of less than 125 mEq/L and is a life-threatening complication that must be managed promptly to avoid irreversible neurological damage. One particular cause of hyponatremia is the ingestion of recreational drugs, such as 3,4-Methylenedioxymethamphetamine (MDMA), also known as Ecstasy. Another drug with limited understanding of its adverse effects on specific individuals and is widely available to purchase legally is Kratom (). Here, we present the case of severe hyponatremia secondary to the ingestion of Kratom. Kratom is believed to act on various pain-modulating receptors and may explain its role in causing hyponatremia. Unfortunately, Kratom remains poorly understood and underreported. Our case illustrates the need for further in-depth studies to determine the complete toxic profile of Kratom, providing awareness to clinicians in anticipation of severe complications that may develop.

To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL).

Intensive interdisciplinary pain treatment (IIPT) is a promising approach for youth with complex, disabling, refractory pain conditions. However, youth and families who initiate IIPT without sufficient acceptance of its focus on functional rehabilitation or readiness to adopt a self-management approach to their pain may face challenges in IIPT and/or experience suboptimal outcomes. Motivational interviewing (MI) techniques have been shown to enhance readiness to make a number of health behavior changes for adults and youth, but it has not been systematically examined in the context of pediatric IIPT. The authors developed an MI telehealth intervention protocol explicitly designed to prepare youth and families for admission to IIPT.

Preclinical studies have shown that local anesthetics may modify the growth and invasion of cancer cells. However, few clinical studies have evaluated their impact on cancer outcomes after tumor resection.

[Purpose] We aimed to examine the effects of pain-related catastrophic thoughts and anxiety/depression on pain intensity and quality of life (QOL), and how these effects (relationships) vary with pain location, in outpatients with chronic pain. [Participants and Methods] We recruited 14 participants with low back pain (2 males and 12 females) and 14 with knee joint pain (3 males and 11 females). We used the following evaluation tools: the visual analog scale (to evaluate pain intensity), pain catastrophizing scale (in which scores are categorized into helplessness, rumination, and magnification), Hospital Anxiety and Depression Scale (for psychodynamic evaluation), and a questionnaire for QOL evaluation. [Results] There was no difference in pain intensity between the groups. The "low back pain" group showed a positive correlation between pain intensity and anxiety, while the "knee pain" group showed a positive correlation between pain intensity and helplessness. The "low back pain" group showed a negative correlation between health in QOL assessment items and helplessness, and between health and magnification. However, in the "knee pain" group, there was a negative correlation between health and rumination, between health and anxiety, and between positive mental attitude and magnification. [Conclusion] Mental status varied depending on the pain location, regardless of the intensity of the pain. This suggests that a psychological approach dependent on pain location is needed during physical therapy.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) triggers the development of numerous pathologies and infection-linked complications and exacerbates existing pathologies in nearly all body systems. Aside from the primarily targeted respiratory organs, adverse SARS-CoV-2 effects were observed in nervous, cardiovascular, gastrointestinal/metabolic, immune, and other systems in COVID-19 survivors. Long-term effects of this viral infection have been recently observed and represent distressing sequelae recognised by the World Health Organisation (WHO) as a distinct clinical entity defined as post-COVID-19 condition. Considering the pandemic is still ongoing, more time is required to confirm post COVID-19 condition diagnosis in the COVID-19 infected cohorts, although many reported post COVID-19 symptoms overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19.