Rejected

Transition from originator biological medicines to their biosimilar equivalents is now part of routine clinical practice, but there is little understanding of patient experiences, which influence adherence and overall satisfaction with care. Understanding this will help ensure future switches adequately address patients' concerns and expectations leading to better outcomes for all stakeholders.

Fatty Liver, one of the most common liver diseases worldwide, usually emerges due to lipid accumulation, mostly triglycerides in hepatocytes. Fat exists in the liver naturally, but if it surpasses 5-10% of the liver's total weight, it can result in fatty liver. In this case, report effect of Ayurveda intervention in grade II fatty liver is reported. Thirty-five-year-old obese male with grade II fatty liver presented with fatigue, abdominal pain, heaviness, and incomplete bowel evacuation to the National Institute of Ayurveda hospital, Jaipur, Rajasthan, India. On examination, there was no significant clinical abnormality except a high body mass index (BMI = 30.2). Hematological examinations revealed altered Alanine transaminase, fasting blood glucose, total cholesterol, low-density lipoprotein, and triglycerides. The patient was diagnosed sonologically with a grade II fatty liver. The patient was given Ayurveda treatment for two months with three treatment regimens. The patient was assessed for improvement in signs and symptoms, hematological parameters, and quality of life using a chronic liver disease questionnaire (CLDQ). After two months, significant improvement was observed in signs and symptoms, BMI (24.7), and CLDQ. No fatty tissue was reported sonologically, and all altered biochemical parameters were within normal limits. Present case highlights the potential of Ayurveda interventions in managing non-alcoholic fatty liver disease and obesity.

BACKGROUND There are several reports of atlantoaxial subluxation caused by upper respiratory tract infections. Although, there are many known non-pulmonary complications COVID-19 infection, to date there have been no reported cases of orthopedic complications in the peer-reviewed literature. Diagnosis and management of atlantoaxial subluxation is currently limited. Therefore, it is important to explore other methods of identifying and treating patients suffering from atlantoaxial subluxation. CASE REPORT Our patient was an 86-year-old man with right-sided neck pain and reduced range of neck motion for the past 6 months, shortly after a mild case of COVID-19. Autoimmune and inflammatory workup was unremarkable. Patient's symptoms persisted despite 3 weeks of conservative therapy with analgesics, cervical collar, and physical therapy. He received low-frequency kinetically directed impulse wave (al-Kindi wave) treatment administered by the KKT device after 3-dimensional digital X-ray analysis of the atlas. After receiving the treatment over a period of 13 days, patient showed significant improvement in symptoms and follow-up X-rays. CONCLUSIONS For patient's having neck stiffness or pain with COVID-19, it is important to consider atlantoaxial subluxation as a potential cause, especially if the patient requires intubation, as the technique should be adjusted to reduce spinal injury. Atlas X-ray analysis with Spinalytics provides very precise measurements of the atlas in relation to the skull and cervical spine, and improvement in angles were seen before and after treatment. The al-Kindi wave treatment was also effective in reducing the patient's symptoms and improving cervical X-ray results, but further studies are required for confirmation.

An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.

Sepsis and related complications lead to high morbidity and mortality in humans and animals. Olmesartan medoxomil (OLM), a nonpeptide angiotensin II type 1 receptor blocker, has antiinflammatory and antioxidative effects in various experimental animal models. The present study aimed to investigate whether OLM protects against sepsis in a clinically relevant model of polymicrobial sepsis induced by cecal ligation and puncture (CLP).

: Migraine occupies the first position regarding to the disability caused in female working population (15-49 years). Research in the field of prophylaxis of this pathology has made enormous strides in recent years.

Quadratus lumborum block (QLB) is a new fascial plane block that may be helpful for laparoscopic surgeries. In this present study, we aim to evaluate the analgesic efficacy of QLB in laparoscopic living related donor nephrectomy (LLRDN) applied continuously via a catheter that was placed under laparoscopic vision by the surgeon. Following the approval of the Clinical Research Ethics Committee of Istanbul University, Istanbul Medical Faculty (2019/1552), 9 study (Group QLB) and 26 control (Group M) patients that underwent LLRDN were enrolled in this retrospective study. All donors underwent left nephrectomy via transperitoneal laparoscopic approach. An epidural catheter was placed between the QL and psoas major (PM) fascial plane intraoperatively by the surgeon under laparoscopic direct vision, and bupivacaine 0.25% 20 mL was injected through the catheter. After the operation, for group QLB, we used a continuous infusion of bupivacaine 0.1% 7 mL/h over 24 hours. Group M patients received intravenous morphine patient controlled analgesia for 24 hours, postoperatively. Pain scores, total morphine consumption, and complications during the first 24 hours after surgery were recorded. During the first postoperative 24 hours, morphine requirement decreased by more than 70% in Group QLB (Group QLB: 5.11 ± 1.16 mg vs Group M: 16.8 ± 7.1 mg) (P < .0001). Postoperative Numeric Rating Scale (NRS) values at the 45th minute and first hour were both significantly lower in Group QLB than Group M (P < .01). This preliminary report showed that QL catheter placement technique provides good postoperative analgesia in patients undergoing LLRDN. However, further randomized controlled studies with extended patient numbers are required to test the efficacy of the technic.

Given limited efficacy and potential harms of long-term opioid therapy, it is patient-centered and guideline-concordant to offer patients the opportunity to engage in a supportive, patient-centered tapering program. The goal of this study was to develop and pilot an interactive web-based program designed to support patients willing to consider an opioid taper; this manuscript describes the development and the protocol for a pilot randomized trial of Summit.

Holospinal epidural abscess (HEA) is a rare condition which can cause extensive cord compression, necessitating prompt neurosurgical intervention for evacuation and drainage. Here we report the case of a 74-year-old male with HEA due to Cutibacterium acnes infection leading to headache, neck stiffness and decreased mental acuity, successfully treated using segmental laminectomies in the cervical, thoracic and lumbar spine.

Spinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies have indicated that epidural spinal cord stimulation (eSCS) is a promising therapy to improve motor control and autonomic function for patients with chronic SCI. The aim of this study is to assess the effects of tonic eSCS after chronic SCI on quantitative outcomes of volitional movement and cardiovascular function. Our secondary objective is to optimise spinal cord stimulation parameters for volitional movement.