Rejected

Osteoid osteoma is a rare benign bone lesion that is often confused with the osteoblastoma. The osteoid osteoma comprises of 3% of all the primary bone tumours usually found in the long bones and vertebrae with the facial skeleton being the most infrequent site. The lesion usually presents with the swelling and pain that resolves with non-steroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of osteoid osteoma of retromolar trigone, the site which has not been reported in the literature, in a 50-year male patient with a complaint of hard swelling on retromolar trigone associated with the mild intermittent localised pain that aggravated at night and on mastication. Excision of the lesion was carried out with chisel and mallet under local anesthesia with uneventful recovery and no recurrence at the 6 months follow-up. Key Words: Benign, Osteoid osteoma, Retromolar trigone.

Irritable Bowel Syndrome (IBS) is one of the most prevalent chronic gastrointestinal diseases, which is characterized by recurrent abdominal pain and altered bowel habits. The pathophysiological mechanisms are not completely clear for IBS, multiple factors such as genetic, psychosocial, environmental, visceral hypersensitivity, low-grade inflammation, gastrointestinal motility changes, food components, and intestinal microbiota are thought to play a role in the disease process of IBS. The rapid progression of recent microbiome research using advanced microbiological technologies has shed light on dysbiosis related to the pathophysiology of IBS. We used PubMed, PubMed Central, and Medline as our primary databases to search for articles using keywords and medical subject heading (MeSH) keywords on April 30, 2022, to render a total of 4062 articles. Then, a total of 10 articles were selected following a quality assessment. Despite the variable findings in different studies, most studies have concluded that IBS patients have a reduction in bacterial diversity and an increase in the temporal instability of the microbiota. IBS is known as a and the gut-microbiome-brain axis has been associated with the pathogenesis of the disease. Additionally, the potential of dietary manipulation of gut microbiota and the use of probiotics, prebiotics, and synbiotics in the treatment of IBS has been studied in recent years and shown promising results. We concluded that the gut microbiome plays a substantial role in the pathophysiology of IBS.

Intracystic hemorrhage is a rare complication of multiple hepatic cysts and can lead to hemorrhagic shock. Hence, measures should be taken to prevent the rupture of cysts. The incidence of intestinal perforation is high in patients undergoing hemodialysis. The diagnosis can be difficult in a patient without typical symptoms. We report the case of a woman in her late 60s with multiple renal and hepatic cysts, which caused chronic renal failure managed with dialysis. She presented with abdominal pain and was diagnosed with intrahepatic cystic bleeding. Continuous intravenous fentanyl was administered for pain management, which temporarily alleviated pain, but abdominal pain recurred with increased intensity when she resumed feeding. Subsequently, a contrast-enhanced computed tomography revealed perforation of the lower gastrointestinal tract. Therefore, in cases of intrahepatic cystic hemorrhage that require administration of analgesics, the complications of other diseases that may also cause acute abdominal pain should also be considered.

Adhesive capsulitis (frozen shoulder) may result from any injury to the shoulder. The main signs and symptoms are pain, decreased range of motion, and stiffness of the joint. A patient could have additional causes that can include muscle spasm, rotator cuff tear, or weakness of the upper extremities, which could make treatment decisions more complicated. Multiple therapeutic and surgical approaches exist. Successful outcomes for adhesive capsulitis are due to timely diagnosis and effective treatment options. In our case report, a 58-year-old female developed acute sharp pain in her shoulders, decreased range of motion, as well as bilateral weakness in her upper extremities. The symptoms developed after doing repetitive overhead arm motion while swimming without proper conditioning. The pain was debilitating and prevented the patient from completing simple daily maneuvers. Significant weakness in the upper extremities made it impossible for her to independently dress herself. Initially, the patient's symptoms were attributed to the chronic effects of osteoarthritis and rotator cuff tear. One orthopedic surgeon recommended replacement of the right shoulder. As a second opinion, another orthopedic surgeon recommended bilateral shoulder replacement. The orthopedic surgeons' decisions were based on physical examination and reading the MRI, which confirmed total rotator cuff tear and osteoarthritis. Before proceeding with surgical treatment, the patient was evaluated by an osteopathic specialist. The osteopathic specialist's decision was based on osteopathic principles that the body is a unit capable of self-regulation and that structure and function are reciprocally interrelated. Observation and palpation are particularly important means of uncovering information. After the first examination, the osteopathic physician diagnosed and successfully restored cervical spine mobility problems (cervical somatic dysfunctions) and relieved a trapezius muscle spasm. The patient's upper extremities gained strength after the first treatment and she was able to dress herself (which is a task she was unable to do in over a year with continuous physical therapy treatment). At this point, surgical treatment became an alternative option. The patient preferred to continue osteopathic manipulation and osteopathic manipulation under anesthesia. The patient experienced a resolution of her symptoms over time. A stepwise approach to management is necessary for patient assessment and diagnosis, especially when the alternative recommendation is surgery.

When influenza (flu) season arrives, it is easy for emergency department clinicians to anchor on the diagnosis of flu, sending patients on their way with or without anti-influenza medication. It is important not to miss the outlier – the patient who seems to have typical symptoms of influenza but with certain subtleties that should make one consider expanding the differential diagnosis.

Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear associated with tympanic membrane rupture and purulent discharge for at least 6 weeks. Owing to the proper use and easy availability of antibiotics, these types of cases are rare in developed regions, but they are still occasionally seen in the developing world with poor hygiene and a lack of availability of antibiotics and immunizations.

To characterise the prevailing pharmacological and non-pharmacological pain management strategies among adults with chronic pain, comparing these against the newly published NICE guidelines NG-193, and examine these pre-NG-193 pain management strategies in relation to pain severity, pain interference, sleep quality and mental health outcomes.

Brachioradial pruritus (BRP) is a rare chronic neuropathy of the skin of the arms and forearms that presents with itching, burning or tingling, with no associated dermatological features. Sun exposure and cervical spine pathology have been described as causes for BRP; however, the exact aetiology is often unclear. Herein, we discuss the case of a 63-year-old female patient who presented with BRP with a C5-C6 distribution. Physical examination excluded skin conditions, thus magnetic resonance imaging was done and revealed a C5-C6 disc protrusion. Anterior cervical discectomy and fusion were performed leading to the resolution of symptoms. The case emphasizes the beneficial role of anterior cervical discectomy and fusion as a last resort in patients with refractory pruritus of discogenic cause.

Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) is associated with permanent neurologic deficit and decreased survival. Prophylactic cerebrospinal fluid (CSF) drainage (CSFD) in TEVAR is controversial. We evaluated the usage of CSFD in TEVAR at our tertiary aortic center.