Rejected

Postoperative pain after total knee arthroplasty (TKA) is intense and remains an unsolved problem. Some studies show that perioperative, multimodal analgesia, including intravenous dexamethasone, can provide a better analgesic effect; however, the validity of studies has raised concerns and questions remain around the efficacy, dosing, and safety of dexamethasone in patients undergoing total knee arthroplasty.

Clinical presentation of echinococcosis in paediatric population is varied and depends on the site of involvement. The present study was planned to analyse the clinical presentations and therapeutic options for management of echinococcosis in children admitted to a tertiary care hospital. Medical records of children with echinococcosis was reviewed retrospectively over a period of 3 year and 6 months. Demographic data, clinical presentation, management and outcome data were collected and analysed. During the study period, 14 children with hydatid disease were admitted to the hospital. The frequency was higher in male (71.4%) compared to females (28.6%). Liver was found to be the commonest site for hydatid cyst with 78% of all cases had hydatid cyst localised to liver. In half of all cases liver was the only site of involvement. Both liver and lung were involved in 21.4% cases and one patient (7.1%) had pelvic hydatid cyst in addition to liver involvement. Two patients (14.3%) had only pulmonary involvement and one (7.1%) patient had a hydatid cyst in common bile duct. Right upper abdominal pain was the most common presentation (78.5%) with cyst in liver. Cough, breathing difficulty, jaundice was observed in 28.5%, 21.4% and 7.1% of all patients respectively. All children were managed with a combination of surgical and medical therapy. Right upper abdominal pain and chronic cough were the common clinical presentation of hydatid cyst with hepatic and pulmonary involvement respectively. Presence of such chronic symptoms would raise the clinical suspicion of hydatid disease in endemic regions.

Lumbar facet joint (LFJ) pain was reported to occur in 27%-40% of patients with chronic low back pain (LBP). Several therapeutic procedures such as corticosteroid injection (CI) and radiofrequency (RF) ablation have been used. However, there is no clear consensus that one is superior to the other. This study aimed to perform a meta-analysis to compare the effectiveness of CI and RF ablation for LFJ pain.

COVID-19 is typically characterised by a triad of symptoms: cough, fever and loss of taste and smell, however, this varies globally. This study examines variations in COVID-19 symptom profiles based on underlying chronic disease and geographical location.

Variation in care is associated with variation in outcomes after total joint arthroplasty (TJA). Accordingly, much research into enhanced recovery efficacy for TJA has been devoted to linking standardization with better outcomes. This article focuses on recent advances suggesting that variation within a set of core protocol elements may be less important than providing the core elements within enhanced recovery pathways for TJA. Provided the core elements are associated with benefits for patients and health care system outcomes, variation in the details of their provision may contribute to a pathway's success. This article provides an updated review of the literature.

The aim of this study was to assess the prevalence of functional gastrointestinal disorders (FGIDs) in children of Mediterranean area using Rome IV criteria and to compare the prevalence of FGIDs using Rome IV and Rome III criteria.

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by low cerebrospinal fluid (CSF) pressure and postural headaches, and affects 1 per 20,000 individuals every year.

Spinal tuberculosis (Pott's disease) is a frequent manifestation of Mycobacterium tuberculosis infection. It manifests as destruction of 2 or more adjacent vertebral bodies followed with destruction of the intervertebral disc, leading to a condition known as spondylodiscitis. Tuberculous spondylodiscitis represents with back pain, fever, joint stiffness, loss of spinal mobility, neurological symptoms, vertebral body collapse, gibbus formation and kyphosis. Persistent Pott's disease might lead to soft tissues abscesses, frequently involving iliopsoas muscle. We, herein, present a 20 years long follow-up case of a Pott's disease patient. The patient got diagnosed as tuberculous spondylodiscitis, almost 10 years after first symptoms onset. She underwent frequent computed tomography and magnetic resonance scanning, with spinal spondylodiscitis being its only significant finding, while lung parenchyma and other organs were not infected. Patient got treated with multidrug anti-tubercular regimen for 18 months in 2 different periods of time; nonetheless she complicated with iliopsoas muscle abscess and percutaneous fistula. Early diagnosis and treatment of spinal tuberculosis (TB) are of great importance in ensuring a good clinical outcome. Delaying the diagnosis and proper management can lead to spinal cord compression, deformity and irreversible neurological complications. Thus, multidrug anti-tubercular therapy must be started timely and the duration of anti-tubercular therapy needs to be individualized. The decision to terminate anti-tubercular therapy should be based on clinical, radiological, pathological and microbiological indices, rather than being based on specific guidelines.

Cavernous angioma, cavernoma, cavernous hemangioma, also called cerebral cavernous malformation (when present in the brain), are benign vascular malformations, usually intraparenchymal; however, a few reported cases are in the extra-axial location-as middle cranial fossa, near the cavernous sinuses, and in the cerebellopontine angle-and are rarely reported as dura-based convexity lesion resembling meningioma. We report a giant dura-based, convexity, a cerebral cavernous malformation. We wish to notify the case as occurring at a rare location and a large-sized cerebral cavernous malformation. A case of young female presented with a long-standing history of headache. Computed tomography scan and magnetic resonance imagings (MRIs) suggested right occipital dura-based large mass lesion of approximately 5 cm in diameter. The lesion was excised and pathology studies confirmed the diagnosis of a cerebral cavernous malformation. A follow-up MRI confirmed total resection of the lesion and the patient had a smooth postoperative recovery.

Colic is a clinical syndrome and has been defined as a visceral abdominal pain and/or acute abdominal disease. It is a common cause of morbidity and mortality in horses. The most common forms of colics are related to gastrointestinal tract in nature and most often linked to colonic disturbances. However, colics are not well understood in donkeys compared to those of in horses and the literature is poor regarding bowel strangulating obstruction in donkeys. This report described the clinical signs and post-mortem necropsy findings of an abdominal colic due to the left colon volvulus following a non-surgical castration using Burdizzo emasculatome in a 6-year-old donkey. The castration was done under local analgesia following a sedation with a combination of xylazine-acepromazine and physical restraint on a tilt table. Severe abdominal colic and death occurred after discharging from the hospital. Left colon volvulus at the sternal and diaphragmatic flexures in a ventromedial-dorsolateral direction of 720° was the main cause of colic found at the necropsy examination. Although left colon volvulus is not considered as a complication of castration, it maybe rational to prescribe an analgesic agent in postoperative care in donkeys undergoing non-surgical castration.