Rejected

Introduction Neck pain is a common and debilitating ailment that places a significant burden on the healthcare system. No practical protocols have been published utilizing a portable, commercially available, and affordable device that significantly reduces acute and chronic neck pain. Methods Forty-six young adults with or without mild-to-moderate neck pain completed a six-week neck stretching and strengthening protocol with a portable cervical stretching and strengthening device. The primary outcome was changes to pericervical muscle endurance. Secondary outcomes were changes to cervical range of motion (ROM), neck length, circumference, and subjective pain, flexibility, and strength. Measurements were obtained on study days 0, 21, and 42. Results A significant increase in pericervical muscle endurance was demonstrated across all planes of cervical motion, ranging from 84% to 105%. Cervical ROM improved across all planes of motion but was only significant in right-side bending (5.3°), left rotation (6.2°), and right rotation (7.8°). Subjective pain evaluated via the Numeric Rating Scale (NRS) saw statistically significant improvement as well (1.33 to 0.51). Subjective assessment of participant cervical pain, strength, and flexibility improved 61.3%, 95.7%, and 97.8%, respectively. Conclusions A six-week pericervical muscle stretching and strengthening program increased pericervical endurance and ROM in young adults. Decreased cervical pain was seen using the NRS and modified pain scale across most participants.

The advent of laparoscopic techniques in repairing inguinal hernia has significantly improved outcomes of inguinal hernia surgery. However, acute and chronic postoperative pain after fixation of mesh with tacks and the cost of tacking devices are major hindrances to the widespread use of laparoscopic transabdominal preperitoneal (TAPP) repair in resource-poor settings. This study sought to introduce a method of mesh fixation that will reduce the cost of laparoscopic TAPP repair and might help reduce postoperative pain.

Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be encountered during epidural needle placement, with catheter advancement, or subsequently during infusion of local anesthetic agents. We present the rare occurrence of a persistent cerebrospinal fluid (CSF) leak following inadvertent dural puncture (wet tap) during attempted placement of an epidural catheter in a 6-year-old child. Potential adverse effects of epidural anesthesia in children are discussed, and options for treatment of a persistent CSF leak after inadvertent dural puncture are reviewed.

The herpes zoster infection occurs in the United States, particularly targeting those who are immunocompromised, and can present with many manifestations including encephalitis. Instances of varicella zoster virus (VZV) encephalitis in immunocompetent patients have been rarely reported, but such diagnoses are becoming more frequent as detection of VZV has improved with the adoption of molecular diagnostic panels such as the BioFire Film Array meningitis panel (Salt Lake City, USA). Here, we present an interesting case of acute meningoencephalitis in an immunocompetent adult female without dermatomal neuralgia or cutaneous lesions attributable to VZV. Given many inconsistencies between the patient's presentation and the positive polymerase chain reaction (PCR) result for VZV, we suspected our patient was infected with an undetected organism while possibly simultaneously shedding previously acquired VZV. As molecular diagnostic panels are increasingly used and have greatly improved detection of rarer etiologies of disease, we encourage clinicians to interpret results with caution.

In peripheral nerve surgery, the presence of psychiatric diagnoses and medications may affect outcomes and perioperative neuropathic pain management. The purpose of this study was to determine the prevalence of psychiatric diagnoses and chronic pain in patients referred to a peripheral nerve surgery clinic.

Spleen's Littoral Cell Angioma is a rare benign vascular tumor. The main clinical presentation is isolated splenomegaly.

Chronic recurrent multifocal osteomyelitis is a rare noninfectious inflammatory bone disease diagnosed based on the synthesis of clinical, radiological, and pathological findings. The differential diagnostic considerations are led by multifocal infectious osteomyelitis and multifocal neoplasms. We report a case of a 9-year-old girl who emergently presented with worsening back pain, inability to walk, and normal vital signs. C-reactive protein and erythrocyte sedimentation rate were elevated, whereas the white blood cell count was normal. Initial radiographs and MRI of the spine showed multiple edematous vertebral body lesions. Subsequent whole-body MRI demonstrated multiple additional edematous bone lesions in the right half of the body, including the scapula, femur, and tibia. The lack of symmetrical bone lesion distribution indicated image-guided percutaneous core biopsy to exclude neoplastic disease. Pathological examination of an osseous core biopsy specimen showed a noninfectious osteomyelitis pattern with no findings of Langerhans cell histiocytosis, malignancy, or infectious osteomyelitis. The synthesis of clinical, radiological, and pathological findings was diagnostic of asymmetric right-sided chronic recurrent multifocal osteomyelitis, representing an atypical presentation that deviates from the typically symmetrical bilateral chronic recurrent multifocal osteomyelitis pattern.

Several studies have shown the effectiveness of trans-muscular quadratus lumborum block (TQLB) in analgesia after cesarean delivery. However, the influence of anterior QLB at the lateral supra-arcuate ligament (QLB-LSAL) in this surgery is unclear. This study aimed to compare the analgesic efficacy of bilateral TQLBs with bilateral QLBs-LSAL following cesarean delivery. Ninety-four parturients scheduled for cesarean delivery under spinal anesthesia were enrolled and randomly allocated to undergo either bilateral TQLBs or bilateral QLBs-LSAL with 0.375% of ropivacaine (20 mL each side) following cesarean delivery. Intravenous sufentanil was administered for patient-controlled analgesia (PCA). The primary outcome was postoperative sufentanil consumption during the initial 24 h post-surgery. Secondary endpoints included pain scores, time to the first PCA request, postoperative rescue analgesia, satisfaction scores, and nausea/vomiting events. Sufentanil consumption was significantly reduced in the QLB-LSAL group in the first 24 h compared with the TQLB group after surgery (29.4 ± 5.7 μg vs. 39.4 ± 9.6 μg, < 0.001). In comparison with TQLB, the time to the first PCA request in the QLB-LSAL group was significantly longer (10.9 ± 4.1 h vs. 6.7 ± 1.8 h, < 0.001). No differences were observed between two groups regarding pain scores, rescue analgesia after surgery, satisfaction scores, or nausea/vomiting incidence. The significant reduction in opioid consumption in the first 24 h and prolongation in time to first opioid demand in parturients receiving QLB-LSAL compared with TQLB suggest that the QLB-LSAL is a superior choice for multimodal analgesia after cesarean delivery.

Despite affecting approximately 1.8 billion individuals worldwide, until recently, a pharmacologic treatment for presbyopia was not available. This special commentary reviews the treatment of presbyopia with a focus on the recently approved medication Vuity (pilocarpine 1.25%, Allergan, an AbbVie Company).