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Gender Disparities in Outpatient Management of Postlaminectomy Syndrome.

Postlaminectomy syndrome (PLS), also known as failed back surgery syndrome, is the persistence of radicular pain in the face of surgical intervention. Despite its prevalence in 10 to 40% of spine surgery patients, outpatient pharmacologic and interventional management remains poorly characterized.

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To Study the Association between Sick Euthyroid State and the Incidence of ACS.

The low T3 syndrome, the most common type of Sick Euthyroid syndrome, once believed to be a beneficial adaptive mechanism under conditions of stress, has emerged as a strong prognostic determinant in chronic systolic heart failure. Sick Euthyroid Syndrome is frequently observed in Chronic Heart Failure, Acute Myocardial Infarction. Acute myocardial infarction (AMI) may be associated with a number of endocrine alterations, including those of the SES which reflect the acute hormone response to stress and trauma. It is known from several studies that several cytokines can be found elevated in patients with cardiac ischemia or AMI. From in vitro studies it is of particular interest that ischemic myocytes produce cytokines such as interleukin-6 (IL-6) and its synthesis is accelerated by reperfusion. Interleukin-6 seemed to be an important cytokine produced by the injured myocytes in patients with AMI, and strong negative correlation between serum IL-6 concentration and left ventricular ejection fraction (LVEF) has been demonstrated. Similar observations have been made by studying tumor necrosis factor-a (TNF-a), IL-1a and soluble IL-2 receptor (sIL-2-R) which were found to be significantly elevated in AMI, with the highest levels noted in the most severe and complicated cases of myocardial infarction.

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Two-Week Cervical Vagus Nerve Stimulation in Chronic Pancreatitis Patients Induces Functional Connectivity Changes of Limbic Structures.

Noninvasive vagus nerve stimulation (nVNS) has not only shown antinociceptive effects, but also demonstrated anti-inflammatory and antidepressant effects. These effects could be beneficial in chronic pancreatitis (CP) patients suffering from chronic abdominal pain, even though the underlying central mechanisms remain unclear. The aim was to investigate the effect of cervical nVNS in patients with painful CP on brain functional connectivity and cerebral metabolites.

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Opioid and analgesic use before and after revision knee arthroplasty for the indications “pain without loosening” versus “aseptic loosening” – a Danish nationwide study.

It is uncertain if patients undergoing revision knee arthroplasty for "pain without loosening" are relieved of pain. This study aimed to compare pre- and postoperative analgesic consumption by patients undergoing revision for "pain without loosening" versus "aseptic loosening" and to determine predictors for postoperative long-term opioid use.

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Laboratory and clinical predictors of focal involvement and bacteremia in brucellosis.

Early diagnosis of organ involvement and bacteremia in brucellosis increases treatment success and may prevent poor clinical outcomes. This study aimed to investigate the predictors of focal involvement and bacteremia in patients with brucellosis. A total of 139 brucellosis patients aged 16 years and older were included in the study. Patients with and without organ involvement and bacteremic and non-bacteremic patients were compared separately. Low back pain, lymphadenomegaly, absence of fever on admission, ESR, AST, and neutrophil-lymphocyte ratio (NLR) were predictors of focal involvement (OR: 2.604; 3.167; 7.224; 1.039; 1.032; 1.738, respectively). The AUC value of ESR was 0.669 (0.573-0.765, p = 0.002) with the cutoff point > 30 mm/h (sensitivity 89.74% and specificity 37.00%) in predicting focal involvement in patients with brucellosis. Myalgia and headache (OR: 2.970; 2692) were defined as clinical predictors of Brucella bacteremia. Focal involvement should be considered in patients with brucellosis in the absence of myalgia and fever, presence of low back pain, and sedimentation > 30 mm/h. Brucella bacteremia should be considered regardless of fever, especially in patients with myalgia and headache in endemic areas.

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Continuing Medical Education Questions: April 2022.

Article Title: Percutaneous Tibial Nerve Stimulation vs Sham for Fecal Incontinence in Women: Neuromodulation for Accidental Bowel Leakage Randomized Clinical Trial.

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New Drugs Update: Finerenone, Difelikefalin, and Avacopan.

Three drugs are discussed in this article: finerenone, difelikefalin, and avacopan. Finerenone (Kerendia™) is FDA-indicated to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end stage kidney disease (ESKD), cardiovascular (CV) death, non-fatal myocardial infarction (MI), and hospitalization for heart failure (HF) in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Difelikefalin (Korsuva™) is FDA-indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP) in adults undergoing hemodialysis (HD). Avacopan (Tavneos™) is FDA-indicated as an adjunctive treatment of adult patients with severe active anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]) in combination with standard therapy including glucocorticoids.

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A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery.

The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.

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Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial.

Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session.

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The effectiveness of conventional radiofrequency ablation for chronic plantar heel pain due to heel spur.

The purpose of this study was to investigate the effectiveness of conventional radiofrequency (CRF) ablation treatment on chronic plantar heel pain due to heel spur.

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