Rejected

The discoid meniscus is a congenital abnormality, with the vast majority occurring in the lateral meniscus. More commonly seen in pediatric populations, patients present with acute or chronic knee symptoms such as joint line pain, audible or palpable mechanical symptoms, and the inability to achieve terminal extension. The classic discoid classification system by Watanabe excludes anterior and horizontal instability and tearing that commonly occur with this pathology. A comprehensive classification, the Pediatric Research in Sports Medicine (PRiSM) Discoid Meniscus Classification, was developed to include these characteristics. To complement this classification system, we describe a complete arthroscopic examination of the discoid meniscus, assessing meniscal width, height, instability, and tearing. For thorough anterior assessment, the importance of medial portal viewing with lateral portal probing is highlighted. Assessment of the meniscus for tearing and instability should be performed before and after saucerization. Consistent use of a comprehensive classification system and a diagnostic arthroscopic exam will improve the understanding, treatment, and quality of research in the discoid meniscus.

Sphenopalatine ganglion block (SPGB) is a well-known technique of anesthesia used for the treatment of many types of facial pain syndromes. Its utility in the treatment of headaches due to cerebrospinal fluid hypotension, caused by dural breach or not, seems established but the lack of strong studies proving its efficacy or its superiority compared to epidural blood patch doesn't allow it, for now, to be a part of the official treatment algorithm. We report the case of a patient presenting idiopathic cerebrospinal hypotension (Schaltenbrand syndrome) treated effectively with a sphenopalatine ganglion block using the intranasal approach.

The complex and uncertain causes of sick building syndrome (SBS) have become one of the most challenging and hot issues worldwide. Studies on the correlation between indoor environment and SBS based on local characteristics are relatively limited in China. We studied typical SBS risk factors related to the indoor environment and lifestyle in two northern Chinese cities. The study population was drawn from parents of pre-school children in randomized daycare centers in Taiyuan, Shanxi, and Urumqi, Xinjiang, China (N = 6838). Data on SBS and indoor environment were obtained from cross-sectional questionnaires. Odds ratios (OR) were estimated by multilevel logistic regression and adjusted using gender, atopy, own smoking, home size, and dampness index. Results showed that location, homeownership, year of construction completion, changes in the indoor environment (new furniture and decorations), and changes in indoor air (smoking, burning mosquito repellent and incense, cooking fuels including electricity, natural gas, coal, and wood) might contribute to different levels of SBS in Chinese adults, including eye, nasal, throat, dermal symptoms, and headache and tiredness. The results of the subgroup analysis suggest city and gender differences in susceptibility. Daily cleaning, window opening, and improved ventilation effectively improved SBS. People should improve their indoor environment and lifestyles based on sensitivity factors, gender, and geographic characteristics to reduce SBS risks.

We conducted a systematic review to determine the efficacy and safety of cannabidiol (CBD) for chronic pain. The systematic review is according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist. Five databases (PubMed, PubMed Central, Medline, Cochrane Library, and ScienceDirect) were searched using cannabidiol, CBD, hemp, and chronic pain. Inclusion criteria used were studies on adult populations >18 years old; pain symptoms >three months duration; all available preparations of CBD; human studies only; publication in English in the past five years. A total of 2298 articles were found. Inclusion criteria were applied, and quality assessments were done, resulting in 12 publications eligible for the review. CBD and tetrahydrocannabinol (THC), both from Cannabis plants with almost identical chemical structures, attach to the CB receptor, eliciting different effects like the psychoactivity seen on THC but less or none in CBD. Regulations of CBD worldwide differ from each other due to the insufficiency of solid evidence to establish its benefit versus the risks. However, a few studies are showing the benefits of CBD not only for chronic pain but also for sleep improvement and quality of life. In conclusion, CBD is an excellent alternative to an opioid in chronic pain because CBD is non-intoxicating in its pure form. More clinical trials should be done to prove CBD's significance clinically and statistically.

Pain is the most common symptom of cerebral palsy and spina bifida (CP/SB). The objective of this study was to compare the opioid prescription patterns for differing pain types and overlapping pain among adults living with and without CP/SB.

A 29-year-old woman without history of cardiac disease or risk factors sought treatment for sudden onset of chest pain radiating down the back, jaw, and arms, complicated by discomfort in the orthostatic position and severe headache. She had a history of epistaxis since childhood as well as familial history of epistaxis via her mother. BMI was 22 kg/m, and electrocardiography showed ST segment depression in V1V2 precordial leads and T-wave inversion in inferior leads. Troponin was elevated at 3,700 ng/L (normal, < 34 ng/L), with a peak of 11,115 ng/L.

Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders.

Hemidiaphragmatic paresis after ultrasound-guided supraclavicular brachial plexus block is reported to occur in up to 67% of patients. We tested the hypothesis that an injection outside the brachial plexus sheath reduces the incidence of hemidiaphragmatic paresis compared with an intrafascial injection while providing similar analgesia.

The COVID-19 pandemic started to affect Turkey in March 2020. In this study, we retrospectively investigated spontaneous rectus sheath hematoma (S-RSH) in patients with COVID-19 presenting with acute abdominal pain during the ongoing pandemic.

Aseptic meningitis is a rare immune-related adverse event (irAE), which occurs during treatment with immune checkpoint inhibitors (ICIs). This condition has non-specific symptoms and exhibits no clear signs on magnetic resonance imaging (MRI). There are only a few reports of aseptic meningitis caused by pembrolizumab treatment for non-small cell lung cancer (NSCLC). The present study includes a report of such a case and a review of the related literature. A 67-year-old Japanese man received first-line pembrolizumab treatment for NSCLC and subsequently developed severe nausea and vomiting. No significant findings were observed following a computed tomography (CT) scan, MRI of the brain and upper gastrointestinal tract, or upper gastrointestinal endoscopy. Cerebrospinal fluid analysis revealed lymphocyte infiltration and elevation of the IgG index, without indications of metastasis or infection, which suggested the presence of aseptic meningitis. The symptoms immediately improved following prednisolone treatment, and aseptic meningitis was diagnosed as an irAE related to pembrolizumab treatment. Given that aseptic meningitis can cause non-specific symptoms, including headache and nausea, the possibility of an irAE should be considered in patients with non-specific symptoms who are receiving ICIs, and a cerebrospinal fluid examination should be performed.