Rejected

Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood.

Debilitating headache persists after acute aneurysmal subarachnoid hemorrhage (SAH). Despite high prevalence, little is known regarding optimal treatment strategies for SAH-related headache. Nonpharmacologic adjunctive therapies are emerging as tools to help treat pain and limit opioid exposure in the hospital. Virtual reality (VR) is an immersive audiovisual experience that has been shown to reduce pain perception in other patient populations. The role of VR in acute brain injury is unknown. Here we report a patient with SAH who suffered from persistent headache during her hospitalization despite escalation of analgesic pharmacotherapy. A trial of VR was used as an adjunct to medication over four days. The patient reported subjective improvement in pain and anxiety. VR may provide additional analgesia and anxiolysis over pharmacologic measures alone and warrants further study in patients with acute brain injury.

Epipericardial fat necrosis (EPFN) is a rare, benign cause of acute chest pain imitating symptoms of life-threatening diseases, such as acute coronary syndrome. Here We report a 37-year-old, healthy male presented to the emergency department (ED) with sudden-onset pleuritic chest pain after an isometric physical training. Initial cardiac workup included ECG, echocardiography was unremarkable, but diagnosis of an inflammatory process that involved the epipericardial fat tissue surrounding the heart was made by showing encapsulated fatty lesion, enhanced adjacent parietal pericardium using of contrast-enhanced magnetic resonance imaging (MRI). Magnetic resonance imaging would help physicians to differentiate EPFN from severe and life-treating conditions.

Nonalcoholic fatty liver disease (NAFLD) is one of the major and prevalent liver diseases from the national and global perspectives. It appears that considerable numbers of the general population have been suffering from NAFLD. When a patient with NAFLD also exhibits inflammation of the liver, the condition is regarded as nonalcoholic steatohepatitis (NASH). Nonalcoholic steatohepatitis is a pathological entity that may progress to cirrhosis of the liver (LC) and hepatocellular carcinoma (HCC). It is acceptable by all that the health burden of NAFLD and NASH is tremendous. Due to the increased prevalence of these pathologies, extensive research has been conducted regarding pathogenesis, diagnostic tools, and staging of the diseases. However, adequate and approved pharmacotherapy for these pathologies is lacking. The farnesoid receptor (FXR) is a bile acid-activated receptor. It regulates lipid, glucose, bile acid metabolism. Farnesoid receptor is also endowed with anti-inflammatory and anti-fibrotic properties on the liver. Obeticholic acid (OCA), a potent and selective FXR ligand, may become a promising molecule to combat NASH and advanced fibrosis. The present review briefly discusses the current recommendation of NASH management with available pharmacological treatments. The scope of OCA with a focus on recent data of major randomized controlled trials (RCTs) is discussed. On the basis of current data and recent interim analysis, OCA seems to improve insulin resistance, steatohepatitis, levels of alanine transaminase (ALT) and fibrosis in NASH. Dose-related adverse effects like pruritus and dyslipidemia may limit its usage. Also, its usage may be restricted in patients with NASH cirrhosis. More adequately powered RCTs that would contain NASH patients with different and heterogeneous properties would be required to develop consensus about these issues. The safety profile of different doses of OCA needs to be established in these patients as well as there remain considerable queries about these.

The analgesia after the C-section is a very challenging condition to the anesthetist. Various combinations of the agents have been proposed for a successful analgesia. Hence, in our study, we aimed to compare the intrathecal bupivacaine 0.5% with intrathecal bupivacaine 0.5% and 60-microgram buprenorphine for postoperative analgesia in elective C-section patients.

Sildenafil citrate is a specific phosphodiesterase type 5-enzyme blocker that can enhance the indirect impacts of nitric oxide on vascular smooth muscle and permeability via the guanosine monophosphate (c-GMP) route in the penis erectile tissue. Though the medication is well taken, particular side effects such as flushes, headache, indigestion, and retinal abnormalities have indeed been reported. Liver toxicity caused by sildenafil use is thought to be quite infrequent. There have been few studies that looked at a potential link between sildenafil usage and liver problems, and the underlying cause involved for liver toxicity is still unknown. We report a unique instance of acute severe hepatitis with fulminant hepatic failure in a 38-year-old male patient after taking sildenafil citrate.

-lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) and an uncommon cause of proctitis. The diagnosis requires a high index of clinical suspicion, since the clinical, imaging, endoscopic, and histological findings can mimic multiple benign or malignant conditions like inflammatory bowel disease and rectal neoplasms.

Malaria is an infection caused by the Plasmodium malaria (PM) parasite. There are still cases of malaria that are reported in the United States on an annual basis. All these cases were a result of travelers who did not receive or follow their prescribed chemoprophylaxis, recommendations for avoiding mosquito bites while traveling, or relapsed dormant plasmodium. The malaria parasite can be transmitted by the bite of an infected female mosquito, through contact with infected blood products, or from mother to child during pregnancy through the placenta. It can take anywhere from 12 to 20 days for symptoms to appear, but there are cases of delayed development and/or relapse that can occur up to 13 years after the infection. We report a 31-year-old female with a history of malarial infection in Liberia, which had been treated ten years prior to her arrival in the United States. She presented to the hospital with abdominal pain, fever, and headache. She was eventually diagnosed with plasmodium malaria infection relapse and treated with a 14-day course of primaquine 300 mg daily, with the symptoms resolving a few days after. We believe her malarial infection was caused by a dormant malarial parasite that evaded the immune system and relapsed without having a risk factor for relapse or re-infection 10 years after her original infection.

Runners are most commonly attributed to the shin splint, which is showing commonly the symptom of leg pain. It may be misdiagnosed as compartment syndrome as well. This case report depicts the standard condition of medial tibial stress syndrome in a long-distance runner, which is an acute condition with worsening symptoms in many authors' opinion. Patients with accurate symptoms of the conditions may be diagnosed with shin splints for medical usage. Only pain along the posterior medial border of the tibia at the origin of the posterior tibialis muscle should be referred to as shin splints. The chronic form of anterior compartment syndrome may attribute to the runner if they ignore the symptoms of leg pain that occurs in shin splints. Anterior tibial pain during activity is frequent in athletes. It has been linked to various disorders, including periostitis from improper stretching and muscular conditioning, as well as exertional compartment syndromes.