Rejected

Good handover creates a common understanding of responsibility and patients' status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams.

Acute pancreatitis is the most common gastrointestinal-related reason for hospitalization in the United States. It is diagnosed based on the revised Atlanta classification, with the presence of at least two of three criteria (upper abdominal pain, serum amylase or lipase level greater than three times the upper limit of normal, or characteristic findings on imaging studies). Although computed tomography and other imaging studies can be useful to assess severity or if the diagnosis is uncertain, imaging is not required to diagnose acute pancreatitis. Based on limited studies, several scoring systems have comparable effectiveness for predicting disease severity. The presence of systemic inflammatory response syndrome on day 1 of hospital admission is highly sensitive in predicting severe disease. Treatment of acute pancreatitis involves goal-directed fluid resuscitation, analgesics, and oral feedings as tolerated on admission. If oral feedings are not tolerated, nasogastric or nasojejunal feedings are preferred over parenteral nutrition. Cholecystectomy is recommended during the initial admission for patients with mild acute biliary pancreatitis. Medical management is usually sufficient for necrotizing pancreatitis; however, if surgical intervention is needed, a minimally invasive approach is advised over direct endoscopic or open surgical debridement (necrosectomy) because of lower complication rates.

Retrospective review of prospectively collected data.

Chronic pain after cardiac surgery, whether or not related to the operation, is common and has negative impact on health related quality of life (HRQL). Frailty is a risk factor for adverse surgical outcomes, but its relationship with chronic pain after cardiac surgery is unknown. This study aimed to address the association between frailty and chronic pain following cardiac surgery.

Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are part of the trigeminal autonomic cephalalgia (TAC) group of headache disorders. Attacks present with repeated, severe, sharp, stabbing, or throbbing pain. Patients may experience a single attack, recurrent attacks with pain-free interictal periods, or a sawtooth pattern background pain with superimposed stabs. Although SUNCT typically presents as a primary headache disorder, it may be secondary to an underlying pathology, such as pituitary tumors or posterior fossa lesions, both intra and extra-axial (vascular lesion, tumor, or bony abnormalities). Multiple Myeloma (MM) with central nervous system involvement (CNS MM) most commonly presents with visual changes (36%), radiculopathy (27%), headache (25%), confusion (21%), dizziness (7%) and seizures (6%). Secondary SUNCT cases have been sparsely described (less than 60), and CNS MM presenting as SUNCT has not been previously described in the literature. Our case describes a previously unreported clinical presentation of CNS MM. The report highlights the need for a timely and thorough diagnostic work-up of headache in patients with risk factors for a secondary etiology, which in this case included new-onset, autonomic features, older age, and history of malignancy. A misdiagnosis will preclude a potentially life-extending or saving targeted therapy for the underlying illness. We also aim to remind practitioners of the variability in the clinical symptoms of SUNCT, which are known to occur in a significant number of cases, including migrainous features and dull interictal pain.

We describe a case of a 2-year-old girl with congenital megaureter presenting as intraabdominal cystic masses. The patient presented with a lump in abdomen that has been getting bigger since birth accompanied by pain. Ultrasonography that was taken when the patient was 2 years old showed a cystic mass with thick septation and pelvocaliectasis of the left kidney. One month after US, patient underwent 3D CT Scan which showed cystic masses in the upper to lower abdomen with no visualization of the normal structure of the left kidney and ureter. Non-contrast MRU that was taken 3 month after the CT Scan showed a thick-walled cystic mass resembling a tortuous tubular mass associated with the pelvocalyceal system without any distal obstruction. VCUG examination that was taken 2 weeks after the non-contrast MRU showed no reflux. This case reports can help clinicians to confirm persistent urinary tract dilatation, exclude the presence of VUR and differentiate primary megaureters from other causes of hydronephrosis including obstruction of the VUJ, posterior urethral valves, and ureterocele from radiological studies.

Ischium is one of the rare sites to be involved by mycobacterium tuberculosis. The incidence is generally not more than 0.2% in any of the large series. We report an unusual case of extrapulmonary tuberculosis of the ischial tuberosity presenting with chronic gluteal pain of 6 months duration.

Surgical excision of the problematic mandibular third molars causes substantial tissue damage and an inflammatory response. Discomfort and edema are common postoperative signs and symptoms caused by the latter. To find out whether dexamethasone may help with the edema and pain that come along with the surgical removal of impacted mandibular third molars, researchers have performed clinical studies.

We report the case of a 23-year-old parturient who received epidural analgesia and was subsequently diagnosed with Evans syndrome (ES). The diagnosis was made after a complete blood count (CBC) resulted in severe anemia and a platelet count of less than 10K/µL. To further complicate this case, the patient developed post-delivery pleuritic chest pain and pulmonary emboli (PE), and a chest computed tomography (CT) scan showed bilateral ground-glass lung opacities. This prompted a COVID-19 testing and ultimately confirmed infection.