Rejected

We report a young woman with malignant hypertension (HTN) and multiorgan damage due to microangiopathy.

Cyclodestructive procedures, which target the nonpigmented epithelium of the ciliary body, have been utilized to treat recalcitrant glaucoma since the early 1930s. There are now various types of cyclophotocoagulation (CPC) available. The authors provide a retrospective description that details the histopathologic findings in 2 patients who underwent CPC for uncontrolled uveitic and neovascular glaucoma (NVG) with subsequent enucleation.

Postoperative pain is a major concern in surgical patients and is often challenging to treat. Studies have shown that carboxytherapy may be helpful in some cases of persistent pain, as it increases tissue oxygenation. This report describes the case of a patient who received carboxytherapy after three years of persistent postoperative neuropathic facial pain and successfully had her symptoms reduced.

Migraine is a neurological disorder that strongly relates to psychiatric conditions like depression. Lately, the increased prevalence of depression in migraineurs has come to attention. This article compiled various literature to explore the association between migraine and depression. Genetic overlap of various gene segments was studied, and heritability patterns were explored. Shared mechanisms such as serotonergic dysfunction, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and hormonal effects were investigated, and commonalities like comorbidities, stress, and environmental factors were analyzed. Migraine with comorbid depression (MID) affects various aspects of life and its clinical impact on migraine disability, quality of life (QOL), progression, and medication overuse was investigated. We further inspected several types of research in order to provide options on various treatment modalities. Pharmacotherapy such as antidepressants and anti-Calcitonin Gene-Related Peptide (CGRP) monoclonal antibodies like fremanezumab were studied. Alternative treatment options such as onabotulinumtoxinA (OBTA) injections, cognitive behavioral therapy (CBT), and vagal nerve stimulations (VNS) were also appraised and the efficacies of each were compared.

Pathogenic free-living amoebae (FLA), namely Acanthamoeba sp., Naegleria fowleri and Balamuthia mandrillaris are distributed worldwide. These neurotropic amoebae can cause fatal central nervous system (CNS) infections in humans. This review deals with the demographic characteristics, symptoms, diagnosis, and treatment outcomes of patients with CNS infections caused by FLA documented in India. There have been 42, 25, and 4 case reports of Acanthamoeba granulomatous amoebic encephalitis (GAE), N. fowleri primary amoebic meningoencephalitis (PAM), and B. mandrillaris meningoencephalitis (BAE), respectively. Overall, 17% of Acanthamoeba GAE patients and one of the four BAE patients had some form of immunosuppression, and more than half of the N. fowleri PAM cases had history of exposure to freshwater. Acanthamoeba GAE, PAM, and BAE were most commonly seen in males. Fever, headache, vomiting, seizures, and altered sensorium appear to be common symptoms in these patients. Some patients showed multiple lesions with edema, exudates or hydrocephalus in their brain CT/MRI. The cerebrospinal fluid (CSF) of these patients showed elevated protein and WBC levels. Direct microscopy of CSF was positive for amoebic trophozoites in 69% of Acanthamoeba GAE and 96% of PAM patients. One-fourth of the Acanthamoeba GAE and all the BAE patients were diagnosed only by histopathology following autopsy/biopsy samples. Twenty-one Acanthamoeba GAE survivors were treated with cotrimoxazole, rifampicin, and ketoconazole/amphotericin B, and all eleven PAM survivors were treated with amphotericin B alongside other drugs. A thorough search for these organisms in CNS samples is necessary to develop optimum treatment strategies.

Diabetic neuropathy is a clinical condition that can have a significant impact on quality of life, presenting as numbness, tingling, and burning in the extremities. Current treatment options focus on symptom alleviation and reducing exposure to risk factors as treating the pathophysiological causes of diabetic neuropathy remains a significant challenge. Novel studies have proposed that the use of antioxidants, including alpha-lipoic acid (⍺-lipoic acid), may represent a beneficial intervention for treating neuropathic pain in diabetic patients. This study aims to evaluate the effect of ⍺-lipoic acid in the treatment of diabetic neuropathy and determine its effectiveness in reducing the symptoms of diabetic neuropathy. To achieve our objective, PubMed, Scopus, and Web of Science databases were screened on March 3, 2022. Randomized controlled trials that investigated ⍺-lipoic acid treatment in diabetes mellitus patients with neuropathic pain and made an appropriate comparison were included. The reduction of neuropathic symptoms was the primary outcome, and the secondary outcome was the incidence of adverse events. Eight studies comprising 1,500 diabetic patients were evaluated in this systematic review. The findings were inconsistent among the literature concerning the effectiveness of ⍺-lipoic acid in the treatment of diabetic neuropathy, with three trials (37.5%) observing significant improvements in symptoms and five trials (62.5%) not observing any notable results. All studies found ⍺-lipoic acid to be a safe and tolerable intervention, with no reported adverse effects. The administration of ⍺-lipoic acid may result in symptom reduction and offers a safe and tolerable treatment option. However, there is limited evidence to support the beneficial outcomes of this approach. Further trials are warranted to corroborate or contradict the hypothesis that ⍺-lipoic acid is an effective intervention for the treatment of diabetic neuropathy.

Since the start of the COVID-19 pandemic in early 2020, pericarditis has been identified as a COVID-19 complication. We report a case where the development of pericarditis was unusually delayed after the initial COVID infection. The reported onset of pericarditis and pericardial effusion is anywhere from a few days to a few months after infection. Our case surmises that a latent complication of COVID-19 can manifest more than one year after the initial infection. A forty-three-year-old male with a past medical history of SARS-CoV-2 infection in September 2020 presented in September 2021 and January 2022 with recurrent sharp chest pain and shortness of breath. During both admissions, he was diagnosed with acute pericarditis, and his workup was significant for elevations in D-dimer and CRP as well as pericardial and pleural effusions. Recurring pericardial symptoms and persistent elevations in D-dimer and CRP point toward a COVID etiology, particularly in the absence of other factors associated with pericarditis. Our case highlights the importance of recognizing this latent complication one year after the initial infection and how the symptoms can persist beyond the one-year period.

The sacroiliac joint (SIJ) is affected in 14% to 22% in individuals presenting with chronic low back or buttock pain. This percentage is even higher in patients who underwent lumbar fusion surgery: 32% to 42%. Currently, there is no standard treatment or surgical indication for SIJ dysfunction. When patients do not respond well to nonsurgical treatment, minimally invasive sacroiliac joint fusion (MISJF) seems to be a reasonable option. This systematic review and meta-analysis evaluates the current literature on the effectiveness of MISJF compared to conservative management in patients with SIJ dysfunction.

Multimodal analgesia is nowadays a recognized method to reduce postoperative pain. Infiltration of the surgical site with local anesthetic is one of the methods widely used for its effectiveness and its lower risk of toxicity, particularly in orthopedic surgery. We present here a case of local anesthetic systemic toxicity (LAST) that occurred on two different occasions to the same patient after total knee replacement surgeries. The clinical presentation of the syndrome was not typical for this 74-year-old patient who presented with respiratory distress associated with impaired consciousness. After the elimination of the most common diagnoses, it was finally the administration of Intralipid that followed with clinical improvement.

Treatments of Achilles tendinopathy continue to evolve. The body of literature is inadequate to provide a comprehensive guide to evaluation and treat failed surgeries. Issues related to failed surgical treatment may be divided into infection/wound issue, mechanical failure, and persistent pain. Awareness of the potential problems described in this article will allow surgeons to have a foundation in clinical assessment and making accurate diagnoses. Various surgical treatment options are available and should be executed carefully to treat individualized patient conditions.