Rejected

Hereditary sensory and autonomic neuropathies (HSANs) include hereditary disorders that cause congenital insensitivity to pain. Moreover, patients diagnosed with such disorders are known to have genetic mutations that alter their deep pain sensation, making them more prone to developing bone and joint complications such as repetitive fractures, joint swelling, and Charcot arthropathy. Neuropathic arthropathy (Charcot joint) is a rare and relatively poorly understood condition; it is suggested to be caused by autonomic dysfunction and repetitive microtrauma and characterized by instability and joint destruction. Diagnosing the idiopathic Charcot joint is challenging and is considered to be a diagnosis of exclusion. In addition, there are limited cases of Charcot knees managed by arthroplasty. Patients with Charcot knees are commonly characterized by profound bone loss, diffuse synovitis, and instability in the knee joint. In this article, we report the case of a 13-year-old patient with known gene mutation who presented with recurrent knee joint swelling episodes and instability without pain. She was diagnosed with Charcot knee joint and underwent right hinged total knee replacement. At one-year follow-up, she continued to have good knee stability and an overall functional gait. Our findings suggest that managing Charcot knee joint with total knee replacement in patients with HSAN may show improvement in terms of stability, swelling, and overall gait.

Gallbladder volvulus is a rare gallbladder pathology that can present in adults but is exceedingly rare in children. The diagnosis itself can be very challenging due to its presentation with signs and symptoms of acute cholecystitis without specific imaging findings. The correct identification and prompt intervention with a cholecystectomy are crucial to improve patient outcomes. In this report, we discuss a pediatric patient who presented with gallbladder volvulus and subsequently underwent novel treatment with a single-port laparoscopic cholecystectomy. The patient is a 12-year-old male of Haitian descent who presented to an outside facility following the onset of persistent, right upper quadrant abdominal pain and recurrent nonbilious emesis. The diagnostic workup included serial abdominal exams, laboratory work, right upper quadrant ultrasounds, and a hepatobiliary iminodiacetic acid (HIDA) scan. The patient then underwent single-port laparoscopic removal of the torsed gallbladder with complete resolution of his symptoms. In this case report, the management and clinical presentation of gallbladder volvulus are discussed in more detail as well as the feasibility of single-port laparoscopic cholecystectomy in the setting of pediatric gallbladder volvulus.

•In this paper, we describe our mini-invasive approach for the deactivation of the auriculotemporal nerve in migraine surgery.•After a mean follow-up of 21 months (range, 3-67 months), patients complaining for temporal MH had 83% positive surgical outcome (50% complete MH elimination, 33% significant improvement).•Only rare minor complications are usually reported (eg, oedema, paresthesia hematoma/ecchymosis, and numbness).

Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM).

Drug resistant malaria represents a challenging health problem in developing countries like India. The failure of drug artemisinin, which is the cornerstone of malaria therapy will rapidly compromise the treatment and prognosis of malaria. Resistance should be suspected if inspite of full treatment with Artesunate Combination Therapy and with no history of vomiting or diarrhoea, there is no clinical or parasitological response in the patient after 72 hours. The emergence of partial artemisinin resistant parasites were previously reported from West Bengal in the form of resistance to drugs. Presence of mutations in molecular markers was reported from different parts of India (Uttar Pradesh,Andhra Pradesh,Odisha and Jharkhand).

Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient's weight (<50 kg or >50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14-60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (<50 kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6 hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32 centimetres (cm) per hour (95% confidence interval (CI) = 0.20 to 0.44, p < 0.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8 cm (0-4.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.

Tanners are exposed to raw hides as well as to various toxic chemicals. The study was intended to find out the health problems among tannery workers. This descriptive cross-sectional study was conducted in 2019 among 223 workers working with raw hides and chemicals selected by stratified random sampling in ten tanneries of Leather Industry Area, Hemayetpur, Savar, Dhaka, Bangladesh. Data were collected by the principal investigator after taking informed written consent from the tanners using a pre-tested interview schedule and a check-list. Data were cross-checked for consistency and accuracy. All relevant ethical issues including approval from Institutional Review Board (IRB), and data quality assurance issues were taken into consideration. Analysis of data was carried out by using computer software SPSS version 20.0 with anonymity. Descriptive statistics were used to describe the data, while Chi-square test was carried out to measure statistical association. As many as 97(43.5%) workers were in age group of 15 to 24 years with a mean age of 28.4±9.5 years. An overwhelming majority 204(91.5%) were males, three-fifths 134(60.1%) of the workers were married, while 213(95.5%) tanners had religion Islam. Majority 122(54.7%) tanners had primary level of education, whereas 56(25.1%) had secondary level and 44(19.7%) had no formal schooling. The mean monthly family income was 13744.4±3485.5 Taka. More than three-fourths 170(76.2%) workers had more than four family members with over half 114(51.1%) of the workers were smokers. Of 223, over half 124(55.6%) of the workers were affected with at least one health problem. Majority of the workers suffered from skin diseases (51.6%), musculoskeletal disorders (33.1%), gastrointestinal problems (22.6%), chronic headache (14.5%) and respiratory problems (14.5%). Only 9(4.0%) workers had pre-placement orientation, while 196(66.4%) workers did not notice the necessity for pre-placement training. Of ten tanneries, cent per cent had foul smell, 80.0% each had poor lighting and discomfort temperature, 60.0% had intolerable noise, 50.0% were with poor ventilation system, and only 30.0% had adequate waste management facilities. The tanneries did not have medical facilities even for emergency conditions. Health problems are significantly associated with job duration (p<0.01), working sections (p<0.05) and smoking status (p<0.001) of the workers. The overall environment of the tanneries is far from satisfactory. Skin diseases, musculoskeletal disorders, gastrointestinal problems, chronic headache and respiratory diseases are the common identified health problems. A considerable number of workers are unconcerned for the pre-placement orientation, and do not use Personal Protective Equipments (PPEs). As a rule, Personal Protective Equipments (PPEs) are not made available to workers by the tannery authorities, and lack of treatment facilities of the tanneries is a common place.

The Michigan Hand Questionnaire (MHQ) is a commonly used evaluation for hand problems, but previous work reports conflicting evidence regarding the subscale structures. Rasch analysis uses probabilistic modeling of items and responses: if scale items can be fit to the Rasch model, it provides evidence of construct validity and interval-level measurement for precise statistical estimates. We conducted Rasch analysis on the MHQ to evaluate model fit, unidimensionality of the subscales, bias across person factors, and conversion to interval metrics.

Osteoarthritis (OA) is a chronic degenerative disease of multiple joints with a rising prevalence. Pulsed electromagnetic field (PEMF) therapy may provide a cost-effective, noninvasive, and safe therapeutic modality with growing popularity and use in physical medicine and rehabilitation. The purpose of this study was to synthesize the current knowledge on the use of PEMF in OA.

Essential oils are of great interest for their analgesic and anti-inflammatory properties. We aimed to study the content of the essential oil of the Origanum vulgare of the Armenian highlands (OVA) in different periods of vegetation and to investigate its antinociceptive and anti-inflammatory effects in mice (in vivo) and cytotoxic action in cultured cells (in vitro). OVA essential oil was extracted from fresh plant material by hydro-distillation.