Rejected

Hypercalcemia is commonly encountered in the clinical setting. Although primary hyperparathyroidism resulting from a single parathyroid adenoma is the most common cause, in patients who undergo total thyroidectomy, especially when there is no history of radiation exposure nor parathyroid autotransplantation, it becomes an even more unexpected diagnosis. Because the majority of patients are asymptomatic, the diagnosis often is made incidentally. However, with long-standing disease, as parathyroid hormone and blood calcium levels rise, symptoms become more noticeable, and its clinical manifestations can affect nearly every organ system in the body. We present the case of a 79-year-old woman with a history of surgical hypothyroidism secondary to total thyroidectomy, hypertension and chronic kidney disease, who was admitted to the Emergency Department after an episode of syncope. She mentioned abdominal pain and vomiting in the previous week and paresthesia of both hands and feet over the last months. The initial testing identified a first-degree auriculoventricular block, a worsened renal function and severe hypercalcemia caused by primary hyperparathyroidism. The mainstay of treatment was aggressive fluid therapy, intravenous bisphosphonate and calcimimetic. Definitive treatment was achieved by the surgical removal of a mass located in the left thyroidectomy bed, compatible with a parathyroid adenoma. No further therapy was needed, as calcium levels gradually returned to normal.

Pediatric burn injury is a traumatic experience for affected children and their families. Burn pain is frequently undertreated and may adversely affect patient experience and outcomes. The aim of this study was to investigate the current practice of initial pediatric burn pain assessment and management at a major trauma center in Riyadh, Kingdom of Saudi Arabia.

We report a case of transurethral resection of the prostate (TURP) syndrome with mild hyponatremia, severe lactic acidosis, and hypotension. A 73-year-old man with benign prostatic hyperplasia underwent monopolar TURP. Two episodes of hypotension occurred during the operation. These were corrected after injection of a bolus of ephedrine. After the operation, the hypotension persisted and lactic acidosis worsened. Abdominal distension was evident postoperatively. Abdominal ultrasound and computerized tomography revealed a large amount of fluid in the abdominal cavity. We suspected the leakage of sorbitol-containing irrigating fluid. After percutaneous drainage, the lactic acidosis resolved and hypotension stabilized.

Masticatory myofascial pain disorders (MMPD) are a common group of orofacial pain conditions affecting the muscles of mastication, with headache and cervical disorders as well as chronic widespread pain and psychosocial disorders being common comorbid conditions. As their pathophysiology is multifactorial in nature, a multimodal and interdisciplinary approach should be considered. Overall treatment goals include decreasing pain and disability, increasing mandibular range of motion, and improving quality of life. This article describes a complex case exhibiting common characteristics of MMPD while additionally reviewing the literature on classification, pathophysiology, and evidence-based treatment planning.

Limited information on the analgesic efficacy and safety of even clinically commonly used analgesic drugs in guinea pigs and chinchillas is available. Buprenorphine and meloxicam are currently the most common analgesics routinely used to treat painful conditions in guinea pigs and chinchillas. Hydromorphone has also shown to be an effective analgesic drug in these species, with limited adverse effects. Tramadol in chinchillas does not provide analgesia even at high doses, and no information is available on the efficacy of this drug in guinea pigs. Multimodal analgesic protocols should be considered whenever possible.

Painful neuromas commonly cause neuropathic pain, in up to 1 in 20 cases of traumatic or iatrogenic nerve injury. Despite the multiple surgical treatment types that reduce pain, no type has been universally accepted.

Chronic pain is a complex phenomenon. Understanding its multiple dimensions requires the use of a combination of several patient-reported outcome measures (PROMs). However, completing multiple PROMs is time-consuming and can be a burden for patients. The objective of our study was to simultaneously reduce the French versions of the Pain Catastrophizing Scale (PCS) and Tampa Scale for Kinesiophobia (TSK) questionnaires to enable their use in an ambulatory and clinical settings.

After admission to hospital, COVID-19 progresses in a substantial proportion of patients to critical disease that requires intensive care unit (ICU) admission.

Oncolytic virus V937 showed activity and safety with intratumoral administration. This phase 1 study evaluated intravenous V937±pembrolizumab in patients with advanced solid tumors.