Rejected

Acute acalculous cholecystitis accounts for only 5-10% of cholecystitis cases and is often associated with severe trauma, critical illness, or chronic disease. Our case describes an otherwise healthy 25-year-old female presenting with acute abdominal pain. After undergoing a magnetic resonance cholangiopancreatography and cholescintigraphy she was diagnosed with acute acalculous cholecystitis. Her symptoms resolved following laparoscopic cholecystectomy which highlights the importance of prompt diagnosis and treatment of acalculous cholecystitis even in the absence of trauma or critical illness.

We present a 58-year-old left hand-dominant woman with right glenohumeral osteoarthritis and anterior instability in the setting of a congenital residual limb at the level of the mid-humerus. She had persistent pain and dysfunction despite trying conservative treatments and elected for a stemless or "canal-sparing" hemiarthroplasty with anterior capsular reconstruction. At the 2-year follow-up, there was significant improvement in her pain, motion, and function without signs of radiographic loosening.

Collet-Sicard syndrome is a unilateral palsy of the lower cranial nerves IX, X, XI, and XII, resulting from lesions at the skull base that affect the jugular foramen and hypoglossal canal. Common causes of the lesions include basilar skull fractures, carotid artery dissections, and malignancy. Infectious and inflammatory etiologies have also been reported. A 63-year-old male with a history of uncontrolled diabetes was admitted for dysphagia, right ear pain, drainage, and right-sided facial droop after recent local trauma and surgical instrumentation of the right ear. Culture of the external auditory canal grew . Triple phase bone scan demonstrated osteomyelitis at the skull base due to complications from otitis externa. The patient's presentation was consistent with Collet-Sicard syndrome, and he was subsequently treated with a six-week course of ciprofloxacin. This patient demonstrates a unique case since his malignant otitis externa spread locally and led to skull base osteomyelitis and subsequently developed Collet-Sicard syndrome. His uncontrolled diabetes likely played a role in his disease progression.

A four-year-old previously healthy child presented with new-onset, diffuse, severe headache, and left sixth nerve palsy. The child was evaluated at several acute care facilities, at which the symptom of "crossing eyes" was not addressed specifically. At our emergency department, on day 6 of symptoms, a left cranial nerve 6 palsy was diagnosed; on brain MRI scan, there was evidence of increased intracranial pressure (distended optic nerve sheaths, flattened posterior sclerae), which was confirmed by lumbar puncture, which showed an opening pressure of >36 cm HO. Idiopathic intracranial hypertension (IIH) was diagnosed, and all symptoms abated with two months of treatment with acetazolamide. IIH should be considered in a child with headache and abnormal eye movements.

The Harlequin syndrome is an idiopathic, autonomic disorder. It typically presents with unilateral sweating and flushing of the face. It could be caused not only by autonomic dysfunction or space-occupying central neuropathy, but by some clinical interventions as well. Although iatrogenic Harlequin syndrome is rare, clinicians should be aware of this condition to diagnose correctly and provide suitable assistance.

Celiac disease is an enteropathy characterized by malabsorption related with gluten intolerance and immune-mediated pathogenesis. It may manifest with gastrointestinal features like diarrhea, abdominal pain, weight loss, and anemia. Besides, it can manifest with various extraintestinal features like ataxia, neuropathy, stroke, or sometimes venous sinus thrombosis. Being of autoimmune origin, relation with systemic lupus erythematosus has also been reported. Herein, we present a rare case of a young patient with celiac disease who presented with fever, headache, and altered sensorium and was found to have meningitis with deep cerebral venous sinus thrombosis.

Posterior reversible encephalopathy syndrome encompasses a spectrum of disorders with a constellation of clinical symptoms and neuroradiological features. It is commonly encountered in organ transplant where it poses a challenge in the diagnosis and treatment in the absence of strong evidence. The underlying pathophysiology of posterior reversible encephalopathy syndrome is the loss of cerebral autoregulation following elevated blood pressure and/or endothelial dysfunction. It is more likely to happen in patients treated with cyclosporine versus with tacrolimus. Posterior reversible encephalopathy syndrome manifests as headache, visual disturbances, seizure, and abnormal mentation. The characteristic radiological features are the result of posterior- circulation vasogenic edema secondary to blood-brain barrier disruption. Treatment varies based on the etiology of the condition. In addition to the symptomatic management of hypertension and seizure disorders, switching or replacing the calcineurin inhibitor with another immunosuppressant or decreasing the dose of the calcineurin inhibitor is the key in calcineurin inhibitor-associated posterior reversible encephalopathy syndrome. Here, we have reviewed the terminology, pathogenesis, clinical features, diagnosis, and treatment of posterior reversible encephalopathy syndrome with special reference to its presence in the posttransplant period.

Torus (buckle) fractures of the wrist are the most common fractures in children involving the distal radius and/or ulna. It is unclear if children require rigid immobilisation and follow-up or would recover equally as well by being discharged without any immobilisation or a bandage. Given the large number of these injuries, identifying the optimal treatment strategy could have important effects on the child, the number of days of school absence and NHS costs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease (COVID-19) were reported to originate from Wuhan, China, in December 2019, spreading rapidly worldwide. With the emergence of this pandemic, an increasing number of cases of Guillain-Barré syndrome (GBS) have been reported following this infection. Most patients had a demyelinating subtype of GBS. The time interval between infectious and neuropathic symptoms, absence of cerebrospinal fluid pleocytosis, and negative polymerase chain reaction test result support a postinfectious mechanism. Skeletal muscle injury presents as muscle pain and elevated serum creatine kinase level in patients with COVID-19. Some patients developed several myopathic manifestations, including new-onset inflammatory myopathy. Muscle injury is caused by direct SARS-CoV-2 infection or through parainfectious mechanisms such as type I interferonopathy.

Chronic rhinosinusitis refers to the non-specific inflammation that occurs in the nasal mucosa and sinuses, with clinical manifestations of mucopurulent nasal discharge, nasal congestion, hyposmia or anosmia, and head and face swelling pain.This disease has a long course and is prone to recurrence, which seriously affects the physical and mental health and quality of life of patients.Xiangju Capsules, prepared from infructescence of Platycarya strobilacea(without seeds), Prunellae Spica, Magnoliae Flos, Chuan-xiong Rhizoma, Angelicae Dahuricae Radix, Chrysanthemi Indici Flos, Astragali Radix, etc., are effective in dispelling wind by pungency and dispersing, clearing heat, and relieving orifices, and has good efficacy and safety in the clinical treatment of acute and chronic rhinosinusitis and rhinitis.From the perspective of the health system, an economic evaluation model was constructed based on the Meta-analysis of the effectiveness of Xiangju Capsules in the treatment of chronic rhinosinusitis to discuss the economic efficiency of Xiangju Capsules in combination with conventional treatment or conventional treatment alone in patients with chronic rhinosinusitis.The model simulation results showed that 53 days(average course of treatment) after treatment, Xiangju Capsules combined with conventional treatment had higher cost and higher output, with an incremental cost-effectiveness ratio of CNY 263.71, about 0.82% of per capita disposable income.As revealed by sensitivity analysis results, the research results were robust.As indicated by the findings of this study, Xiangju Capsules combined with conventional treatment for chronic rhinosinusitis patients were more economical than conventional treatment alone based on the assumption that the per capita disposable income of Chinese people in 2020 was the threshold of patients' willingness to pay.