Rejected

 Neurology is a high-demand specialty with long waiting lines. Some pathologies require rapid decision-making. Through technology, telemedicine can allow neurological patients to have faster access to specialized assessment. In store-and-forward telemedicine, the specialist physician evaluates data collected by a general practitioner and optimizes screening.

Osteitis condensans ilii (OCI) is a rare self-limiting low back pain syndrome. It is an incidental imaging discovery around sacroiliac joints with distinctive sclerotic lesions. We present three case reports as a series. In the first case, a 38-year-old female presented with unresolved chronic low back pain for eight years. She had bilateral triangular sclerosis of the ilium abutting sacroiliac joints and other causes of back pain were ruled out. Non-operative management was successful. In the second case, a 38-year-old female presented with acute exacerbation of low back pain for one year. She suffered low back pain during her pregnancy and postpartum period 16 years ago and intermittently after that. Bilateral radiodensity around sacroiliac joints was noted in the radiograph and she had successful remission with non-operative management. In the third case, a 45-year-old female presented with chronic low back for six years. On radiographs, she had bilateral sclerotic lesions around sacroiliac joints and responded well to non-operative management. OCI is a benign, idiopathic cause of axial low back pain. It is a diagnosis of exclusion and the pelvic radiographs classically show areas of sclerosis in the ilium adjacent to sacroiliac joints bilaterally. Treatment for OCI is essentially non-operative.

Objectives The primary goal of this study is to explore demographic and comorbid factors that increase the hospitalization risk of acute myocardial infarction (AMI) in patients with vasculitis along with the utilization rate of percutaneous coronary intervention (PCI)/angioplasty. Additionally, we aim to study the prevalence of AMI in vasculitis inpatients based on geographical distribution. Methods We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) in 2019 involving 33,210 inpatients hospitalized on emergency-based admissions with a co-diagnosis of vasculitis, subdivided into cohorts without AMI (N = 31,790) and with AMI (N = 1,420) as the primary diagnosis. A binomial logistic regression model was used to evaluate the odds ratio (OR) of predictors associated with AMI in patients with vasculitis compared to the non-AMI cohort. Results The prevalence of AMI in the total inpatient population with vasculitis was 4.28%, with a majority of patients being in the older age group of 51-65 years (63%), males (59.2%), and white (59%). Inpatients with vasculitis having pre-existing co-morbid conditions were at greater risk for AMI, such as obesity (OR 2.84, 95%CI 2.78-2.89), metastatic cancer (OR 1.73, 95%CI 1.26-2.37), complicated hypertension (OR 1.64, 95%CI 1.46-1.85), and arthropathies (OR 1.48, 95%CI 1.30-1.68). The in-hospital mortality rate was significantly higher in the AMI cohort compared to the non-AMI cohort (13% vs 2.9%). The utilization rate of PCI/endovascular angioplasty was 13.02% (185 out of 1,420) and had a lower in-hospital mortality rate compared to those managed by medical treatment (8.1% vs 13.8%). Conclusion AMI is an important differential diagnosis to consider in vasculitis patients admitted into the hospital with chest pain. Due to the low prevalence of vasculitis and diagnostic challenges, these primary conditions can be often missed. There is a greater risk of inpatient mortality among vasculitis patients with AMI. Therefore, a higher index of suspicion should be exercised, especially in elderly males with risk factors. Vasculitis patients with chronic comorbidities such as arthropathies, obesity and hypertension are at a greater risk for suffering from AMI. Careful screening and management of cardiovascular risk factors is mandatory in vasculitis patients.

Osteoarthritis (OA) is the most common form of arthritis associated with ageing. Vitamin D has diverse biological effect on bone and cartilage, and observational studies have suggested it potential benefit in OA progression and inflammation process. However, the effect of vitamin D on OA is still contradictory. Here, we investigated the therapeutic potential of vitamin D in OA. Six-week-old male Wistar rats were injected with monosodium iodoacetate (MIA) to induce OA. Pain severity, cartilage destruction, and inflammation were measured in MIA-induced OA rats. Autophagy activity and mitochondrial function were also measured. Vitamin-D (1,25(OH)D3) and celecoxib were used to treat MIA-induced OA rats and OA chondrocytes. Oral supplementation of vitamin D resulted in significant attenuations in OA pain, inflammation, and cartilage destruction. Interestingly, the expressions of MMP-13, IL-1β, and MCP-1 in synovial tissues were remarkably attenuated by vitamin D treatment, suggesting its potential to attenuate synovitis in OA. Vitamin D treatment in OA chondrocytes resulted in autophagy induction in human OA chondrocytes and increased expression of TFEB, but not LC3B, caspase-1 and -3, in inflamed synovium. Vitamin D and celecoxib showed a synergistic effect on antinociceptive and chondroprotective properties . Vitamin D showed the chondroprotective and antinociceptive property in OA rats. Autophagy induction by vitamin D treatment may be a promising treatment strategy in OA patients especially presenting vitamin D deficiency. Autophagy promoting strategy may attenuate OA progression through protecting cells from damage and inflammatory cell death.

Schwannomas are mostly benign tumors arising from the nerve sheath. These tumors can be found anywhere in the body. Depending on their locations, they may cause compressive symptoms as well as cosmetic or functional defects. Ancient schwannomas, the rare variant of schwannomas, are the slow-growing tumors characterized with cystic necrotic degeneration areas in the neoplastic tissue. Ancient schwannomas rarely occur in the spinal canal, they are particularly unusual in the thoracic spine. Herein we present a 66-year-old woman with chronic back pain who is detected a cystic mass in her thoracic spine by magnetic resonance imaging and is diagnosed with ancient schwannoma by histological examination.

Systemic mastocytosis is a rare disease resulting from infiltration of atypical mast cells in multiple organ systems and present with variety of symptoms. Primary appendiceal and cecal mass with isolated abdominal pain as a presenting feature in systemic mastocytosis have not been reported in literature up to now.

To address the management of complications after temporal bone fractures and the outcomes. A prospective clinical study of 100 patients from the Department of Trauma (Surgery + E.N.T.), P.D.U. Medical College, Rajkot between the time period of 2017-2019. Among 100 patients, 79 were males and 21 were females. The most affected age group was 16-45 years (72). The longitudinal fracture (90) is the most common type of fracture, in which non-petrous type is the most prevalent (88) as low impact injuries are more common. The most common presentations of temporal bone fracture are ear bleed (59) and decreased hearing (59), mostly over the side of trauma. The most common clinical finding is hearing impairment (59), followed by haemotympanum (20) and facial palsy (15), more common over the side of trauma. Facial palsy had been easily managed conservatively by steroids and physiotherapy in most of the cases. 12 out of 15 patients had good recovery i.e. upto grade I and II by conservative management, 3 had undergone facial nerve decompression, following which 1 had recovered completely, i.e. grade 1; 1 upto grade II while 1 did not show any improvement. Other complications included giddiness (18), trigeminal neuralgia (1) and abducens nerve palsy (1). The temporal bone is more prone to injury and complications following trauma like hearing impairment, cerebrospinal fluid leak and facial palsy resolve either spontaneously or with conservative management. Surgeries must be undertaken only if adequate conservative treatment fails and after proper investigations.

Atogepant is a selective oral, small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist that has been approved for preventive treatment of migraine. CGRP is a neuropeptide involved in vasodilation and cerebrovascular regulation. CGRP is the most potent vasoactive constituent of the cerebrovascular trigeminal neuronal system and has a key role in migraine. Medications targeting CGRP are being used as migraine preventive and abortive treatments.

Meloxicam is a commonly prescribed non-steroidal anti-inflammatory drug for backyard poultry that has demonstrated pharmacodynamic efficacy at a single high dose of 5 mg/ kg. This study characterized the adverse effects of meloxicam administered in chickens at an approximate dose of 5 mg/kg orally twice daily for 5 days. Twenty-one adult Rhode Island Red hens (), judged to be healthy based on an external physical examination, complete blood count (CBC), and plasma biochemistry panel, were recruited for this study. The subject birds were randomly assigned to a treatment (n = 11) or control group (n = 10) and received a 15-mg tablet of meloxicam or a nonmedicated feed pellet, respectively, orally twice daily. Physical examinations and body weight measurements were performed daily, and observation for clinical signs occurred twice daily. Following completion of the 5-day treatment course, an external physical examination, blood collection for a CBC and plasma biochemistry panel, euthanasia, necropsy, and measurement of meloxicam tissue residues were performed. During the treatment course, 1 hen from the treatment group died with peracute clinical signs, 2 hens from the treatment group died suddenly with no clinical signs, and 1 hen from the treatment group became acutely lethargic and was euthanized. Within the meloxicam group, 7 out of 11 hens had gross and histologic evidence of varying levels of renal acute tubular injury and gout. Plasma uric acid concentrations were above the species reference intervals in all affected hens in the treatment group that were still available for testing. The control group had no evidence of renal injury or gout based on postmortem examinations. Based on the results of this study, repeated oral dosing of meloxicam in chickens at 5 mg/kg twice daily is not recommended.

Phase 1/2 dose-escalation and expansion study evaluating varlilumab, a fully human agonist anti-CD27 mAb, with nivolumab in anti-PD-1/L1 naïve, refractory solid tumors.