Rejected

An 87-year-old woman with grade IIIb follicular lymphoma treated with rituximab had presented with nausea, emesis, and chest pain of 1 day duration. She was found to have a contained abdominal aortic rupture secondary to follicular lymphoma invasion. She safely and successfully underwent emergent endovascular aortic repair. We have described a rare case of extranodal disease in follicular lymphoma associated with abdominal aortic pseudoaneurysms, likely due to a combination of malignancy-induced chronic inflammation and radiation therapy and chemotherapy side effects.

Circular RNAs (circRNAs) are a big group of members of the noncoding RNA family following long non-coding RNA and microRNA. They play a regulatory role in many biological processes. Analyzing their current research status and future development trends is conducive to a more comprehensive understanding of circRNAs and contributes to the dedication to the biological field.

Recently, peripheral nerve blocks are extensively applied for many patients undergoing surgical or nonsurgical analgesia. However, the effectiveness is limited by the duration of action of local anesthetics. Therefore, the application of adding local anesthetic adjuvants is evolved to prolong the duration of analgesia and decrease the concentration of local anesthetics in peripheral nerve blocks. There are many local anesthetic adjuvants available such as morphine, fentanyl, sufentanil, hydromorphone, and buprenorphine, dexmedetomidine, dexamethasone, midazolam, and magnesium sulfate. Most of them are safe and possess little adverse effects, while none of them is acknowledged by the food and drug administration. Therefore, this review is aimed to delineate benefits and adverse effects for clinical anesthesia.

COVID-19 vaccination is still a matter of concern among the public since its inception. Primary care physicians being in prime position can share accurate and ample information about COVID-19 vaccination so we estimated proportion and determinants of adverse events following immunization (AEFI) with Covishield vaccine, vaccination and reasons of non-vaccination.

The aim is to know if the presence of symptoms in children, adolescents, and young-aged are important for early diagnosis and therapy of hypertension.

The gut – brain axis plays a significant role in the pathophysiology of migraine. This interaction can be influenced by multiple factors, such as gut microbiota profiles. The aim of the study was to analyze the gut microbiome state in patients with migraine and healthy individuals, to assess possible correlations between the detected changes in patients with migraine and the frequency, intensity of headaches, their psycho-emotional state, and quality of life. In total, 112 patients-16.3% of men and 83.7% of women. Subjects were divided into 2 groups depending on the presence of migraine: the main – patients with chronic and episodic forms of migraine, the control – healthy individuals. The study of the intestinal microbiome was performed by chromato-mass spectrometry. The following scales were used: Visual Analogue Scale/VAS, Migraine Disability Assessment/MIDAS, Back Depression Inventory/BDI. In patients with migraine compared with healthy individuals, significant changes were noted in the quantitative composition of certain resident microorganisms including Alcaligenes spp (p=0.0061), Clostridium coccoides (p=0.0021), Clostridium propionicum (p=0.0287), Eggerthella lenta (p=0.0138), Pseudonocardia spp (p=0.0210), and Rhodococcus spp (p=0.0164). The number of microscopic fungi such as Candida spp (p=0.0079), Micromycetes spp (p=0.0011) and Micromycetes spp (p=0.0010) were increased in patients with migraine compared to the control group. In the main group, a negative correlation was found between the level of 16 Alcaligenes spp and the score on the BDI score, HARS score (respectively: r= -0.6226, p= 0.007; r= -0.509, p=0.03), the frequency of attacks (r=-0.4879, p=0.046) and the VAS score (r=-0.487, p=0.046). Significant negative correlation was found between elevated level of Clostridium coccoides and MIDAS score (r=-0.5123, p=0.03), BDI score (r=-0.54, p=0.025) in the patients with migraine. At the same time, in the main group a positive correlation was detected between Eggerthella lenta level of and VAS score (r=0.4830, p=0.049). In the main group negative correlations were found between slightly increased content of endotoxin in the main group, the BDI score, HARS score (respectively: r=-0.697, p=0.001; r=-0.557, p=0.02) the frequency of attacks (r=-0.547, p=0.023), on the VAS score (r= -0.531, p=0.028), as well as MIDAS score (r =-0.556, p=0.02). The revealed peculiarities of gut microbiome changes in patients with migraines need further clarification in order to identify the possible role of the gut microbiome in the pathogenesis, clinical picture, and therapy of migraine, and is a promising area of further scientific research.

Perampanel is approved for the adjunctive treatment of focal-onset seizures (FOS) with or without secondary generalized seizures. The FAME (Fycompa as first Add-on to Monotherapy in patients with Epilepsy; NCT02726074) study evaluated the efficacy and safety of perampanel added to monotherapy in patients with FOS with or without secondary generalized seizures (SGS). analyses of the FAME study assessed potential predictors of response and an in-depth evaluation of the safety and efficacy of perampanel.

Hypophosphatemic rickets can cause a variety of bone and joint symptoms, one of its rare presentations is sacroiliac joint involvement, which may be mistaken for inflammatory spondylitis. Here, we report the case of a 31-year-old African American woman who presented with a two-year history of lower back pain and morning stiffness, initially suspected to be due to inflammatory spondyloarthritis. Laboratory tests revealed negative inflammatory markers, normal serum calcium, vitamin D3, and parathyroid hormone levels; however, the alkaline phosphatase levels were elevated and serum phosphorus level was low. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed mild widening of the sacroiliac joint with periarticular sclerosis with no signs of osteitis or bone marrow edema. Her condition was attributed to a known diagnosis of X-linked hypophosphatemic rickets affecting her sacroiliac joints. Her symptoms gradually improved after conservative treatment with physical therapy, nonsteroidal anti-inflammatory drugs, phosphate, and vitamin D supplementations. Based on our literature review, we have come across only five rickets cases with similar presentations. Two patients had previously undiagnosed hypophosphatemic rickets at 15 and 35 years of age. One case was related to vitamin D-deficient rickets, and the final two cases were adult-onset vitamin D-resistant rickets misdiagnosed as ankylosing spondylitis. Radiological signs of sacroiliac joint involvement in these cases include narrowing of the sacroiliac joints, fusion of the sacroiliac joints, subchondral hypointense signal changes, and chondral surface irregularities. Vitamin D supplementation has significantly reduced the incidence of rickets; however, there are still cases of familial rickets that can present with a variety of symptoms, including signs and symptoms consistent with inflammatory spondylitis, which can be easily misdiagnosed or mistreated if this presentation is not recognized.

Portal vein thrombosis (PVT) is a heterogeneous entity often described as either an acute or chronic occlusion of the portal vein or its tributaries. The clinical presentation is highly variable, and it often mimics other more common causes of abdominal pain. In most patients, imaging studies such as doppler ultrasound, computed tomography, or magnetic resonance imaging are adequate for diagnosis. Occasionally imaging studies may be inadequate, and the diagnosis may not be made until complications such as bowel necrosis and perforation have occurred. We present a case of a morbidly obese 45-year-old female who was initially treated for suspected small bowel enteritis and discharged home on several occasions after nonspecific findings on abdominal imaging were seen and interval improvement in symptoms occurred with intravenous fluids and antibiotics. She then presented with worsening symptoms and was found on abdominal imaging to have a large fluid collection in the peritoneal cavity requiring exploratory laparotomy with peritoneal washout and partial small bowel resection due to perforation. She was diagnosed with PVT with mesenteric extension after samples of the resected mesentery were evaluated in the pathology laboratory. Her treatment included a prolonged course of antibiotics, total parenteral nutrition, and anticoagulation.

Fibromyalgia is a chronic illness that causes symptoms such as pain. In Japan, although pregabalin and duloxetine are the drugs of choice for fibromyalgia, they may be ineffective or may cause side-effects. Studies have reported on the efficacy of acupuncture against fibromyalgia. However, acupuncture is not always effective in clinical practice, and the reason for this is thought to be the dysfunction of the descending pain control system. This study aimed to determine whether the combined use of electro-scalp acupuncture and conventional electroacupuncture reduces fibromyalgia symptoms and drug dosage requirements.