Rejected

The COVID-19 pandemic has challenged neurologists since its early days. Neurology consultation services were then overloaded by emergency department and intensive-care patients with acute neurological syndromes. These complications are better explained today, but the growing number of patients with reported longstanding neurological symptoms constitute an emerging, complex, and still poorly understood phenomenon.

Coronavirus disease 2019 (COVID-19) vaccination campaigns are trying to curb the pandemic by vaccinating as many individuals and as quickly as possible. The speed of immunization depends upon the availability of the vaccine and vaccine uptake by the communities, which in turn is related to vaccine hesitancy, the safety/efficacy profile of the vaccines, and adverse events following immunization (AEFI).

Thoracic epidural analgesia (TEA) is an effective analgesic technique for breast surgery, although it has many associated complications. Ultrasound (US)-guided erector spinae plane (ESP) block requires less technical expertise, is safe and may be an alternative to TEA. We aimed to compare the efficacy of TEA with US-guided continuous ESP block for post-operative analgesia in patients undergoing modified radical mastectomy (MRM) surgeries.

The initial electrocardiogram finding in the setting of acute myocardial infarction typically shows either persistent ST-segment elevation or non-ST-segment elevation. In young adults, when coronary angiography is performed, can further classify the patient with an occluded vessel and those with non-occluded coronary arteries. In these subgroups, myocardial infarction can be explained on the basis of coronary artery thrombosis, embolization, spontaneous coronary artery dissection, myocardial bridging, coronary aneurysms, ectasia, anomalous origin of coronary arteries coronary microvascular dysfunction, and vasospasm, or a combination of these factors. We describe a 37-year-old male with a history of chest pain and electrocardiographic evidence of acute myocardial infarction who worked many hours under the sun before being presented to the emergency department. The initial laboratory tests showed evidence of acute kidney injury. He underwent a rescue coronary angiogram due to failed initial medical reperfusion therapy with Tenecteplase, which revealed occluded of the distal left anterior descending (LAD) artery with a minor lesion in proximal LAD and right coronary artery. Our patient experienced acute myocardial infarction owing to severe dehydration. This case is important as it highlights that severe dehydration can be considered one of the triggering factors for acute myocardial infarction in young men who are at risk. Proper hydration could be a preventive measure.

Chronic neck pain is often multifactorial and is a leading cause of pain and disability. Cervical facet joint pain is a common cause of neck pain and, in addition to more conservative modalities, can be treated with radiofrequency ablation (RFA) of the respective medial branch nerves. Cervicogenic headaches are a frequent complaint in pain clinics in the United States and can be targeted via a similar procedural approach.

We are presenting a rare case of an acute complete external ophthalmoplegia with positive polymerase chain reaction (PCR) for SARS-CoV-2. Our case is the first case that depicts development of Tolosa-Hunt Syndrome (THS) following infection with COVID-19, with a challenging diagnosis and spontaneous improvement. A 65-year-old diabetic female presented with a complete external ophthalmopegia in the left eye and a severe left-sided headache. The PCR result for SARS-CoV-2 was positive. Brain and orbital computed tomography scan and magnetic resonance imaging were both unremarkable. We diagnosed the case as THS after ruling out other differential diagnoses. The patient refused to receive prednisone, so we had to observe her closely for 6 months during which period we recorded a spontaneous recovery. Acute ophthalmoplegia is a very challenging presentation. It needs full workup to exclude the wide range of differential diagnoses.

Primary retroperitoneal cavernous hemangioma is an extremely rare disease in clinical practice. It is classified as a vascular tumor. Only three cases have been reported in the literature. The diagnosis is uncommon due to the lack of specific radiological features. It becomes symptomatic as a consequence of its enormous size or complications like rupture or compression. We herein report a unique case of primary retroperitoneal cavernous hemangioma treated with conventional surgery in a 35-year-old male patient admitted to our department for chronic abdominal pain. Retroperitoneal cavernous hemangioma is an extremely rare vascular tumor in adulthood. Confirmation is made by histopathological examination after total surgical resection.

Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control.

Healthy functioning of the brain requires a precise autoregulation of cerebral blood flow, which in part is achieved by the pressure and flow sensitive vasomotor mechanisms. Traumatic brain injury (TBI) frequently occurs worldwide, resulting in brain diseases with high morbidity and mortality. Here, we hypothesized that TBI impairs the autoregulatory mechanisms, namely the pressure- and flow-induced constrictions of isolated rat middle cerebral arteries (MCAs).

Pain is a major symptom of many medical conditions with diverse etiologies. World Health Organization (WHO) indicates that 1 in 5 adults globally suffers from pain. Thus, there is a great demand on finding alternative interventions whether to be used alone or in combination with opioids or NSAIDs. In this preclinical study, we evaluated the antinociceptive effect of serratiopeptidase; a well-known proteolytic enzyme with proven anti-inflammatory effect and questionable analgesic effect; in the presence and absence of ibuprofen. Isobolographic analysis for drug combination was used to determine whether combination effects were synergistic. Intraperitoneal injection of 1.8 % of lactic acid and intraplantar injection of Complete Freund's Adjuvant (CFA) were used to assess acute and chronic inflammatory pain in adult male Sprague-Dawley rats. Both ibuprofen (10-32 mg/kg) and serratiopeptidase (1-3.2 mg/kg) showed a significant antinociceptive effect on lactic acid-induced stretching. Also, only ibuprofen (32 mg/kg) showed significant increase in the number of reward bottle activations using Orofacial Pain Assessment Device (OPAD) for the assessment of acid-depressed feeding behavior. Moreover, only ibuprofen (32 mg/kg) increased paw withdrawal threshold significantly in CFA-induced mechanical allodynia using von Frey filaments. Combination treatments of ibuprofen and serratiopeptidase resulted in a subadditive (antagonistic) interaction on lactic acid-stimulated body stretching behavior. However, synergistic interaction resulted by drug combination on lactic acid-depressed feeding behavior and on CFA-induced mechanical allodynia. In addition, the coadministration of serratiopeptidase with ibuprofen in showed a significant decrease in the duration of CFA-induced mechanical allodynia. These data suggest that the administration of serratiopeptidase with ibuprofen may produce synergistic antinociceptive effect in chronic inflammatory conditions and pain-depressed behaviors such as food consumption. Further clinical tests may be needed to assess this synergistic effect in human subjects.