Rejected

Posterior circulation strokes account for 20% of ischaemic strokes, but may present differently to their anterior circulation counterparts. Patients may not exhibit unilateral facial weakness, speech disturbances and unilateral limb weakness, but instead present with more vague symptoms of sudden headache, dizziness, loss of balance and visual problems. This case describes a patient displaying signs and symptoms of a posterior stroke, but who eluded the FAST (face, arm, speech, time) test.

Rhino-orbitol-cerebral mucormycosis (ROCM) is seen as a common post-coronavirus disease (COVID-19) fungal infection in India. It is a lethal, opportunistic infection of the paranasal sinuses and brain caused by fungi of the Mucorales, most commonly with Rhizopus spp. Early diagnosis and timely management are essential. Other studies have shown high mortality up to 25-60%. However, in this study, the recovery rate is very high. We aimed to present six post-COVID mucor cases and to review the literature in terms of prevention, diagnosis, and management of this fatal infection. We carried out a retrospective case series of six patients with a confirmed diagnosis of ROCM presenting to a single tertiary-level hospital during the second wave of covid 19 pandemic. Clinical details for each case was obtained from the hospital information system. A total of six patients (five males and one female) were diagnosed with ROCM during this period. Out of six patients, four had diabetes mellitus and all were on steroid treatment during COVID-19 infection. The most common presenting features were headache (100%), facial pain (80%), orbital swelling (80%), and earache (20%). Most of the patients had sinusitis as a predominant finding in preop magnetic resonance imaging (MRI) at presentation. All patients received liposomal amphotericin B (LAmB) as the first line of treatment and subsequently shifted to posaconazole. The overall recovery rate was 100% and patients were discharged. ROCM infection is very hard to treat. The studies have shown cases with late presentation spreading beyond paranasal sinuses. Early intervention and treatment with antifungals and extensive surgical debridement resulted in the full recovery of all six cases.

To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis.

Uraemic pruritus is a common and burdensome symptom in patients undergoing haemodialysis. Though a significant negative impact of chronic itch on patient's quality of life is proved, this problem is still often underestimated in clinical practice. Various instruments describing itch are in use, however only recently a specific instrument for uraemic itch – Uraemic Pruritus in Dialysis Patient (UP-Dial) – questionnaire has been created.

This case report presents the failure of retrograde intramedullary (IM) nailing in a supracondylar distal femur fracture in a 72-year-old female after a fall from standing. Multiple medical comorbidities are a known risk factor for fracture nonunion. With the rising incidence of patients having osteoporosis and multiple medical comorbidities, orthopedic surgeons need to be prepared for the treatment of hardware complications. The patient is a 72-year-old severely obese female with multiple medical comorbidities including cardiac valvular disease, hypertension, type II diabetes mellitus, hypothyroidism, acute on chronic blood loss anemia, rheumatoid arthritis, and lupus arthritis. She presented after a fall from standing where she sustained a closed displaced left supracondylar distal femur fracture with intercondylar extension. Open reduction and internal fixation (ORIF) was performed on the left distal femur intercondylar split and retrograde intramedullary nailing for the left supracondylar distal femur fracture. Three-month follow-up X-rays revealed no osseous formation of the supracondylar distal femur fracture and catastrophic failure of the implants with two broken screws and a broken condylar bolt consistent with hardware failure. Treatment options included either non-weight-bearing for three months to evaluate for callus formation, which would require her to be in a wheelchair, or surgical referral for implant removal and distal femur replacement. The patient elected to undergo revision surgery consisting of distal femoral replacement. Following revision surgery, the patient was discharged with physical therapy referral. She disclosed a decrease in pain and increased range of motion (ROM) compared to the preoperative state. This case demonstrates an elderly, obese patient with multiple comorbidities including type II diabetes mellitus and autoimmune conditions that placed the patient at high risk for hardware failure following surgery. Due to pain and quality of life concerns, patients with such injuries may be forced into a situation with limited options. This case highlights the need for optimal surgeon-to-patient communication to ensure that patients and all members of their healthcare team are knowledgeable when certain clinical situations are considered high risk for failure. Moving forward, risk factor consideration and medication adjustments are preoperative topics of discussion that should be discussed at length with the patient in order to provide the best opportunity for a successful surgery.

Neuropathic pain after nerve root or plexus avulsion injury is disabling and often refractory to medical therapy. Dorsal root entry zone (DREZ) lesioning is a neurosurgical procedure that disrupts the pathological generation and transmission of nociceptive signaling through the selective lesioning of culprit neurons within the dorsal horn of the spinal cord.

 Persistent and prolonged symptoms, termed as long COVID (coronavirus disease), have been reported in several patients who recovered from the acute phase at different intervals. However, there has been largely unclear data regarding the full range of long-term sequelae of coronavirus disease 2019 (COVID-19) patients. This study aims to evaluate the prevalence of long COVID syndrome.

To establish an evidence-based role for acupuncture as a safe and effective treatment for managing Long COVID in the integrative medical setting.

Background and objective Hair-thread tourniquet syndrome (HTTS) is a rare and potentially dangerous condition that occurs when a hair strand or fabric thread is wrapped around the penis, clitoris, toes, fingers, or other appendages, leading to focal edema, ischemia, and necrosis. This study aimed to examine the cases of six female patients with isolated clitoral hood HTTS. Methods This was a retrospective study involving six female patients (age range: two to six years) with isolated clitoral hood tourniquet who presented to the outpatient department (OPD) and emergency room (ER) of the pediatric and adolescent gynecology service at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2010 and December 2021. Data related to patients' clinical presentation, symptom duration, and management were recorded. Results The most common symptom of isolated clitoral hood HTTS in all six cases was pain, followed by redness, itching, discomfort while sitting, and dysuria. Local signs included edema in three cases, tight hair tourniquet around a portion of the clitoral hood in four cases, and loose hair tourniquet around a portion of the clitoral hood in two cases, one of which was during the first episode in a patient who had recurrence (Case 1). Sedation and local anesthetic were used in five cases involving the local removal of four hairs and a strangulated skin. This was followed by local care and antibiotic ointment application. The edges were closed by interrupted stitches in two of the cases as the resulting wounds were broad. Limited clitoral unhooding was performed under general anesthesia in one patient, who had repeated bouts of autoamputation of parts of the hood tissue with resulting disfiguration of the remaining redundant hood, to avoid the additional risk of organ loss. Only two patients experienced recurring episodes. Conclusions A high index of suspicion should be maintained when encountering these patients, which can facilitate a prompt resolution to save the affected tissue. HTTS should be suspected in all females presenting with a prominent clitoral hood, genital pain, structural abnormality, swelling, or discomfort. This is the first study to report isolated clitoral hood HTTS; it describes the presentation, manifestation, and management of patients with HTTS. It also addresses preventive strategies to alert mothers and treating physicians of the pediatric and adolescent-age group females to the defect and its underlying causes, particularly when patients have genital structural abnormalities such as excessive clitoral hood labial hypertrophy or ambiguous genitalia.

Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder worldwide, but research regarding this disease is rare in Bangladesh. This study aimed to assess the prevalence of IBS and its associated risk factors among university students in Bangladesh.