Rejected

Inflammatory Bowel Disease is considered incurable in allopathy. Medical professionals hardly advise nutritive-therapy or life-style management. This adds to the prevalence of chronic illness and may end into carcinoma. This case study is a success-story of a young student at 24 years of age who was diagnosed with IBS on colonoscopy. The only medicine advised was hydrocortisone-enema which did not benefit her. Stress related to father's demise and unhealthy-lifestyle and diet were the identified precipitating factors. History included off and on constipation, bloody-motion with mucus discharge, pain-free defecation, gaseous-abdomen with bloating and dull-pain. Life-style behavior included poor physical activity, disturbed sleep-wake cycle, compromised hostel diet and academic-deadlines related stress. The impact of Dietary variation was monitored in terms of variation in clinical features. Flare was observed with red-beans, chick-peas and black-lentil. Gluten and Lactose intolerance were ruled out by diet-variation. Probiotic-treatment and low FODMAP diet helped in remission. The specific algorithm that facilitated in recovery included figs, strawberries, cranberries, pomegranate, Salmon fish, Greek-yogurt, olive-oil, oatmeal, walnuts, dates and green-leafy-vegetables. Life-style modification included mindfulness meditation, walking/jogging, soul-cycling and counselling. Outcome was measured and compared. Remission was achieved within 4-5 months and the patient is recovered since last 1.5 years as evidenced by laboratory data. It includes CRP reduction within normal range, hemoglobin improvement (10.2 to 12.2 g/dl), MCV improvement (73 to 86.9 fL), MCH improvement (21.2 to 27.5 pg), MCHC improvement (29.1 to 31.7 g/dl), HCT improvement from 35% to 38.5%, Fecal Calprotectin reduction from 712.9 to 415.3 µg/g and total protein reduction from 8.39 to 7.48 g/dl. Hopefully continuous alternate treatment may normalize the calprotectin marker as well.

Parasitic flatworms (Phylum Platyhelminthes: Subclass Digenea) are scientifically important organisms in aquatic habitats because they represent potential human (i.e. Swimmer's Itch) and wildlife pathogens. Furthermore, larval stages (cercariae) released from snail intermediate hosts represent substantial biomass, contribute to energy flow in food webs, and potentially serve as biological indicators of ecosystem health. Identification of different cercariae is has traditionally been done by morphological traits or classical genotyping. These approaches are difficult, time consuming and expensive. This presents a barrier to researchers in the field working on non-model organisms. Matrix Assisted Laser Desorption Ionization – Time of flight (MALDI-TOF) mass spectrometric based identification of microorganisms has been successfully used to identify single- and multi-cellular organisms more quickly and accurately than traditional methods. Here we describe the protein extraction and MALDI-TOF identification of cercariae from four morphologically distinct parasite taxa. We have also assembled multiple cercariae MALDI-TOF spectra into individual Main Spectral Libraries (MSP) to differentiate each unique cercariae. Finally, we describe how these MSPs can be used to quickly and accurately identify unknown cercariae and thus remove a barrier to parasitic flatworm research progress.

Chronic stress is known to cause adverse physical and mental effects such as pain, chronic fatigue, and depression, and it is strongly related to many diseases and syndromes (e.g., fibromyalgia, chronic fatigue syndrome, and post-traumatic stress disorder). Evidence suggests that exercise and physical activity in leisure time are effective in improving stress-induced symptoms. Repeated cold stress (RCS), in which an animal is repeatedly exposed to alternating room and low temperatures, is one of the chronic stress models that induces chronic pain and depression. Mechanical hyperalgesia through thin muscle afferent fibers has also been reported to occur from RCS exposure. Since the muscle afferents have a dual modulatory function in nociception and cardiovascular reflex, we hypothesized that RCS augments the mechanical component of the exercise pressor reflex (the skeletal muscle mechanoreflex), i.e., skeletal muscle afferents-mediated increases sympathetic nerve activity (SNA) and arterial blood pressure (AP). [PURPOSE]: The purpose of this study was to clarify the impacts of RCS on sympathetic and cardiovascular responses to stimulation of the skeletal muscle mechanoreflex in decerebrated rats. [METHODS]: Male Sprague-Dawley rats (body weight: 410 ± 15 g, age: 12 weeks) were exposed to RCS using a homemade automated RCS device. The rats were alternately moved to room temperature (22°C) and cold temperature (4°C) compartments at 30-min intervals for 5 days. To assess the skeletal muscle mechanoreflex function, we measured mean AP (MAP), heart rate (HR), and renal SNA (RSNA) responses to 30-s static passive stretching of the hindlimb muscles by in vivo recording from unanesthetized decerebrated rats. Stretching was performed by tracing the maximum tension curve obtained from 30-s electrical stimulation. Changes (Δ) from baseline to peak values of the measured parameters between control and RCS rats were compared. [RESULTS]: Peak tension during the Achilles tendon stretch from baseline was not significantly different between groups (control: Δ929 ± 63 g [n = 6] vs RCS: Δ765 ± 66 g [n = 4], p = 0.17). Importantly, the peak RSNA response in RCS rats (Δ236.3% and Δ242.7%, n = 2) tended to be greater than that in control rats (Δ37.1% and Δ23.9%, n = 2). Moreover, RCS had a significantly (p < 0.05) greater HR response (RCS: Δ3.7 ± 1.0 bpm [n = 4] vs control: Δ0.6 ± 0.5 bpm [n = 6]), and MAP response tended (P = 0.07) to be higher in the RCS group (Δ23 ± 6 mmHg, n = 4) than in the control group (Δ8 ± 4 mmHg, n = 6). [CONCLUSIONS]: Our preliminary data demonstrate that RCS augments the skeletal muscle mechanoreflex. These results suggest that chronic stress can potentially cause exaggerated cardiovascular responses during physical activity.

Transcutaneous vagal nerve stimulation (tVNS) applied to the cervical branch of the vagus nerve is FDA-approved to treat migraine and cluster headache. tVNS applied to the auricle branch of the vagus nerve (tVNS ) reduces muscle sympathetic nerve activity and improves cardiac parasympathetic activity after one session in healthy participants. Given the use of tVNS to treat cerebral disorders and its effects on autonomic function, we postulated that tVNS might be beneficial for cerebral vascular function. We tested the hypotheses that tVNS will increase resting middle cerebral artery blood flow velocity (MCAv) and improve dynamic cerebral autoregulation (dCA) during a repeated squat-to-stand procedure.

Cannabis use may be helpful for symptom management in patients with chronic kidney disease (CKD). Knowledge, attitudes, and comfort with use of medical cannabis among kidney care providers may be limiting more widespread evaluation and use. We surveyed Canadian nephrologists regarding current prescribing habits, attitudes, and overall comfort level with cannabis products.

Thumb arthritis frequently is managed nonoperatively with activity modification, orthotic use, anti-inflammatory medications (oral and/or topical), and intra-articular injections. This article reviews the current literature and touches on novel modalities and future directions in the conservative treatment of thumb arthritis.

This study aimed to analyze the effects of transcutaneous electrical acupoint stimulation (TEAS) on the immune function in patients with pulmonary tuberculosis (PT) and the inflammatory response following one-lung ventilation surgery by comparing the levels of inflammatory mediators, such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 8 (IL-8); T lymphocyte subsets, including CD3, CD4, CD8, and CD4/CD8 cells; and natural killer cells (NK cells).

The precise mechanism of referred pain is not well understood; however, diaphragmatic irritation is a well-known etiology of referred pain. Left side referred pain due to diaphragmatic irritation is most commonly attributed to splenic laceration i.e. Kerr's sign. Here, we report an unusual case of left-sided referred pain that followed eating. An adult male presented vague and chronic left shoulder pain that followed eating. The pain was described as a deep boring type of discomfort that was poorly localized to the region deep to the acromion and extended superomedially along the upper fibers of the trapezius muscle. The pain was present immediately after eating heavy meals and always abated approximately 30 minutes later. There was no history of previous surgery and physical examination was unremarkable. CT examination of the abdomen and thorax did not show any pathology or anatomical variations that would result in such referred pain. Although the exact etiology of this case is unclear, the most likely cause would be left-sided diaphragmatic irritation from the stomach after eating. The current literature does not enclose reports pertaining to similar findings. Although unusual and seemingly rare, postprandial referred shoulder pain should be considered by clinicians alongside other causes of referred shoulder pain when presented with shoulder pain without an obvious musculoskeletal or neural etiology.

Urinothorax is a rare cause of pleural effusion, which is seen in patients with obstructive uropathy, blunt trauma, or ureteric injury during abdominal surgical procedures. Clinical symptoms may include dyspnea, chest pain, cough, fever, abdominal pain, and decreased urine output. Diagnosis is made by thoracentesis, which would reveal fluid with a urine-like odor, and pleural fluid analysis, which would show if fluid is transudative in nature with a pH lower than 7.30. Pleural fluid to serum creatine ratio of more than 1 is diagnostic for this condition. In our case, the patient underwent percutaneous nephrolithotripsy with a stent placement three days before presentation to the hospital. She was diagnosed with urinothorax, which led to further investigations, and she was found to have persistent hydronephrosis. Her condition improved after her underlying hydronephrosis was addressed with stent placement. She was discharged home in stable condition.

Background Dexmedetomidine, fentanyl, and tramadol as an adjuvant to local anesthetics improve postoperative analgesia when used in epidural anesthesia. We aimed to compare the efficacy of dexmedetomidine, fentanyl, and tramadol as an adjuvant to levobupivacaine in epidural anesthesia. Materials and methods This was a double-blinded randomized clinical trial (RCT). One-hundred twenty patients of either sex, aged 18-60 years, American Society of Anesthesiologists (ASA) physical status classification I and II, undergoing elective orthopedic procedures under epidural anesthesia were allocated into four groups of 30 each. The dexmedetomidine group received 15 ml of 0.5% levobupivacaine and 25 μg in 2 ml of dexmedetomidine, the fentanyl group received 15 ml of 0.5% levobupivacaine and 50 μg in 2 ml of fentanyl, the Tramadol group received 15 ml of 0.5% levobupivacaine and 100 mg of tramadol in 2 ml, and the control group received 15 ml of 0.5% levobupivacaine and 2 ml normal saline. Patients were monitored for the total duration of analgesia, time of first analgesic requirement, time to reach the T-10 level of sensory block, two-segment regression time of the sensory block, time to reach the motor block (Bromage 3), time to motor regression (Bromage 2), visual analog scale (VAS) scores at 0, 15 minutes, 30 minutes, and the first, second, sixth, twelfth, and twenty-fourth hours postoperatively, total analgesic consumption in 24 hours, and complications, if any, were recorded. Results During the inter-group comparison, VAS scores were lower, the duration of analgesia was longer, and the total analgesic consumption was less in the dexmedetomidine group compared to the fentanyl, tramadol, and control groups. The time to onset of sensory block to T-10 and the attainment of motor block up to Bromage 3 was lower in the dexmedetomidine group. Two segment regression and regression of motor block to Bromage score 2 was lowest for the dexmedetomidine group compared to the other groups. A lower incidence of hypotension and bradycardia was noted with dexmedetomidine. Conclusions Dexmedetomidine is the better alternative as an adjuvant to epidural anesthesia, with faster onset, good quality, and prolonged duration with no relevant adverse effects.