Rejected

We report an unusual case of primary gastric synovial sarcoma in a young woman who presented with chronic abdominal pain. Esophagealgastricendoscopy showed a gastric fundus mass measuring 2 cm × 3 cm. Biopsy confirmed a primary synovial sarcoma. Staging work-up was negative for metastasis. The patient underwent surgery, and the histopathology results did not suggest the need for adjuvant chemotherapy.

Technical errors in electrocardiography acquisition can deviate from the correct diagnosis, ensuing in unnecessary workups and hospital billings. A keen understanding of lead placement concepts and the Einthoven triangle helps avoid these unwanted paths. Here, we presented the case of a 57-year-old woman with a history of hypertension and chronic kidney disease who came to the hospital due to chest pain. Initially, ischemic changes in her electrocardiogram (ECG) were noted. However, the correct placement of ECG leads confirmed the "counterclockwise lead placement" of this patient. This case report highlighted the underrecognized types of ECG lead reversals.

Chronic pain in painful post-traumatic trigeminal neuropathy, formerly called trigeminal deafferentation pain (TDP) or anesthesia dolorosa, is virtually incurable neuropathic pain. In severe cases, no effective method has yet been established. A 58-year-old woman presented with chronic dysesthetic pain in the right side of her face that had persisted for 8 years. It was caused by percutaneous balloon compression for an unexplained, persistent right gingival pain. The TDP did not respond to any medications or radiosurgery. Considering the typical occipital neuralgia that occurred later, the incomprehensible gum pain was interpreted as referred trigeminal pain from occipital neuralgia. Decompression of the greater occipital nerve improved occipital neuralgia; however, TDP did not respond to internal neurolysis or invasive brain stimulation. The last attempt was made to administer an intrathecal opioid because of pain sufficiently severe to cause suicidal ideation. Trial administration of intrathecal opioids had some effect on pain relief. Although incomplete, the effects of intrathecal morphine infusion were maintained up to 1 year later. Invasive neurosurgical interventions should be cautiously performed for continuous pain in persistent idiopathic facial pain and referred facial pain cases that do not show typical neuralgic pain in primary trigeminal neuralgia because of the risk of TDP.

Dynamic lumbar motor control training (MCT) is frequently used in low back pain management; however, whether it affects lumbar proprioception remains unclear. Objectives The purpose of this study was to investigate the effect of dynamic lumbar MCT on lumbar proprioception and to determine the effectiveness of dynamic lumbar MCT in patients with low back pain.

To investigate whether deep neuromuscular blockade (NMB) improves surgical conditions and postoperative pain compared to moderate block, in patients undergoing gynecologic laparoscopic surgery.

Navi Mumbai Municipal Corporation, Covid-19 DCHC and ICU, Navi Mumbai COVID- 19 pandemic has become a leading cause of morbidity and mortality worldwide since the emergence of novel coronavirus SARS-CoV-2 in December 2019. The patterns of imaging abnormalities and data from prior coronavirus outbreaks suggest that patients with severe COVID-19pneumonia are at increased risk of progression to interstitial lung disease and chronic pulmonary vascular disease.We have devised an effective,inexpensive approach for Covid-19 recovering patients to reduce the incidence and severity of these pulmonary complications.

Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients' level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool.

Sternoclavicular (SC) joint inflammatory arthritis and septic arthritis can have very similar presentations and can be indistinguishable if a joint fluid aspiration sample cannot be obtained. Septic arthritis of the SC joint accounts for less than 1% of all joint infections. Diagnosis is usually made on the basis of the clinical history combined with elevated infection markers in the blood, specific imaging findings, and most importantly, a positive joint aspiration bacterial culture. To make a diagnosis of SC joint septic arthritis, a high index of suspicion is generally necessary. We herein present the case of a previously healthy 52-year-old man with a 10-day history of left SC pain who improved transiently with anti-inflammatory oral medication; however, the pain subsequently increased over the next 10 days. Follow-up magnetic resonance imaging of the left SC area revealed fluid in the joint with an abscess adjacent to the joint, which was aspirated, and the sample yielded a positive culture. Septic arthritis of the left SC joint was diagnosed, and the patient was treated surgically. This case highlights the initial challenges of distinguishing inflammatory from septic arthritis in joints in which a sample for bacterial culture cannot be easily obtained.

To describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain.

Inadequate postoperative analgesia has been noted in patients with dementia, but this topic has only been studied in hip fractures. This study aimed to examine whether the duration of postoperative analgesia associated with three surgical procedures was shorter in patients with dementia than in those without dementia.