Rejected

Moyamoya is a progressive cerebrovascular disease associated with stenosis or occlusion of the arteries of the Circle of Willis. It is uncommon in thalassemia. We present a 9-year-old girl with HbEβ-thalassemia who presented with headache, vomiting, and episodes of transient hemiparesis with complete occlusion internal carotid arteries.

Osteoarthritis (OA) is a complex disease associated with chronic pain. Many patients treat their joint pain at a symptomatic level with over-the-counter (OTC) pain medications, often without the knowledge of their physicians. The aim of this study was to provide physicians with data about osteoarthritic patients' habits of pain management and to examine the explanatory factors of various ways of self-treatment.

A 2-year-old, 4.2 kg, spayed female, Maine coon cat was referred to the veterinary hospital for evaluation of hyporexia, slow growth, and chronic, intermittent, mucoid, bloody, voluminous, and fetid diarrhea. The diarrhea had been observed since the cat was acquired from a cattery at 4 months of age; with acute worsening in the 5 d before presentation. Abdominal palpation revealed moderate pain. Ultrasonographic examination showed thickening of the jejunal wall and ileal loops, increased echogenicity of the jejunal mucosa, and enlargement of the jejunal and ileocolic lymph nodes. Histopathology of full-thickness intestinal biopsies showed moderate, diffuse, lymphoplasmacytic, erosive enteritis with hemorrhage and edema. Diffuse, lymphoplasmacytic, erosive colitis with mild, interstitial fibrosis and hemorrhage was also noted. The ileocecal lymph node biopsy showed eosinophilic lymphadenitis. Based on the immunohistochemical evaluation of intestinal samples with CD3 and CD79a antibodies, a diagnosis of lymphoma was ruled out. Fecal polymerase chain reaction testing was positive for . Based on these results, inflammatory bowel disease and trichomonosis were diagnosed. Treatment for the cat included a hypoallergenic diet and an oral omega-3 fatty acid supplement, in conjunction with prednisolone, to manage the inflammatory bowel disease. Ronidazole was administered to target the . The cat was clinically normal during a follow-up examination after 6 months of treatment.

To assess the safety and efficacy of gemcitabine and cisplatin as neoadjuvant chemotherapy followed by selective bladder preservation chemoradiotherapy in muscle-invasive bladder cancer (MIBC).

Vestibular migraine (VM) is a common condition; individuals experience dizziness with migraine symptoms. Vestibular rehabilitation therapy (VRT) has been reported as an effective treatment for VM, however, evidence is limited. VM and traumatic brain injury (TBI) can co-occur, and some suggest that TBI can induce VM. There is limited evidence on the effect a history of TBI has on VRT in patients with VM.

Situs inversus totalis (SIT) is a rare developmental abnormality where the organs throughout both the thoracic cavity and abdomen are a mirror image of normal anatomy, often occurring concomitantly with other genetic and developmental defects. Acute spinal cord ischemia is diagnosed based on the clinical presentation along with consistent imaging, but since clinical manifestations of acute spinal cord ischemia- rapidly progressive motor, sensory, and autonomic dysfunction-overlap with a wide spectrum of myelopathies, a thorough diagnostic workup with consideration of inflammatory, infectious, compressive and nutritional etiologies is required to establish the diagnosis. In this report, we present the case of an 18-year-old female patient who was admitted with acute onset of severe lower back pain, progressive weakness, paralysis, loss of sensation in both lower limbs and voiding difficulties. The diagnosis of acute spinal cord ischemia in a patient with situs inversus totalis was made. Our case highlights the spectrum of the pathological entities that can be associated with situs inversus totalis. Due to the lack of the classic signs and symptoms of sinus inversus, a diagnosis of situs inversus totalis with concomitant pathological conditions may require a more in-depth evaluation by complex imaging modalities to ensure a comprehensive assessment of the condition and its associated complications.

The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS).

Flagellate dermatitis (FD) is a rare skin rash, which may occur following the administration of antineoplastic agents. It has been reported following the administration of bleomycin, docetaxel, trastuzumab, cisplatin, bendamustine and doxorubicin. We provide a summary of the epidemiology, aetiology, pathophysiology, and distribution of chemotherapy-induced FD.

Introduction Optic neuritis (ON) is a blinding inflammatory disease of the optic nerve, typically affecting young adults as described in the Optic Neuritis Treatment Trial (ONTT). However, there is limited information describing ON in patients older than 45 years of age. The aim of this study was to determine the clinical profile of ON in this age group in Malaysia. Methods A retrospective case series study was performed between January 2014 and December 2018 among patients older than 45 years old, treated as ON in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Clinical features, visual acuity, imaging, laboratory results, aetiologies, and visual outcomes were analyzed. Results This study comprised 17 patients (20 eyes) with a gender distribution of eight males and nine females. The mean age of ON onset was 55.8 ± 7.7 years (46-80 years). Most patients (94.1%) presented with reduced vision and retroorbital pain, and three patients (17.6%) had bilateral eye involvement. Papillitis was observed in 13 eyes (65%), retrobulbar ON in five eyes (25%), and optic atrophy in two eyes. Presenting visual acuity was moderately correlated with final visual outcome (rs= 0.47, n = 20, p < 0.05). Post-treatment visual improvement (good and slight) was reported in 14 eyes (70%), four (20%) had no improvement while the remaining two eyes (10%) had worsening best-corrected visual acuity (BCVA). Infective causes accounted for 23.5% of cases (one ocular syphilis, two ocular tuberculosis, and one case of toxoplasmosis). Most cases (70.6%) were idiopathic ON, and only one case was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). Conclusion ON in Malaysian patients older than 45 years of age has no gender predilection and is most likely to be idiopathic; however, infective ON must still be ruled out. Overall visual outcomes were satisfactory. Among the infective causes, ocular tuberculosis caused poor visual recovery as compared with syphilitic and toxoplasmosis-related ON cases.

Introduction Clonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery. On the other hand, dexmedetomidine is highly selective and has a greater affinity toward α2 adrenergic receptors, especially toward its α2a subtype, accountable for more analgesic and hypnotic effects than clonidine. Aims and objectives We designed a prospective, double-blinded, randomized controlled trial to compare the analgesic efficacy and adverse effects of clonidine and dexmedetomidine when combined with bupivacaine for caudal analgesia in children undergoing infraumbilical surgeries. Materials and methods A total of 60 children aged one to eight years were randomly assigned into two different groups in a double-blinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 µ/kg) in normal saline or dexmedetomidine (1 µ/kg) in normal saline. We noted the hemodynamic variables and postoperative sedation scores. Duration and quality of postoperative analgesia and the number of rescue analgesic drug doses required were recorded during the first 24 hours postoperatively. We also observed the patients for any adverse effects to the study drugs. Result Adding dexmedetomidine to caudally administered bupivacaine significantly increased the duration of analgesia (15 ± 0.78 hours) and decreased the need for rescue drug doses than the addition of clonidine to bupivacaine (9.63 ± 1.95 hours) in children undergoing infraumbilical surgeries. Incidences of hemodynamic changes or other side effects were comparable between patients of two groups. Conclusion The addition of dexmedetomidine to caudally administered bupivacaine in children undergoing infraumbilical surgeries may provide a longer duration of analgesia than the addition of clonidine, with less requirement of rescue analgesic doses and without any significant differences in the hemodynamic parameters or other side effects.