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Neuropsychiatric disorders associated with coronavirus infections emerged with the coronavirus disease 2019 (COVID-19) pandemic. We describe the clinical, laboratory and radiological features of a patient who presented, after recent COVID-19, two rare neuropsychiatric manifestations: a brief psychotic break followed by severe bilateral peripheral facial palsy.

Adolescents with sickle cell disease (SCD) have been shown to have pain-related sequelae following COVID-19 infection. In this case series, we discuss five adolescents with SCD and SARS-CoV-2 infection who subsequently developed complex pain circumstances manifested as: (1) increased frequency of acute care visits or admissions for pain; (2) new onset chronic pain; (3) new onset neuropathic pain; (4) escalation in the complexity of pharmacologic therapies; (5) increased use of nonpharmacologic interventions. While more research is needed to fully understand the implications of COVID-19 infection on pain in adolescents with SCD, these cases suggest the presence of a complex relationship.

A 67-year-old woman presented with lower abdominal pain, diarrhea, nausea, vomiting and fatigue. Computed tomography was suggestive of cholecystitis, but neither ultrasound nor magnetic resonance cholangiopancreatography found evidence of cholecystitis or biliary ductal dilatation. The patient was started on piperacillin-tazobactam, and blood cultures revealed gram-negative-rod bacteremia. Laparoscopic cholecystectomy was performed and bile cultures grew susceptible to ciprofloxacin, which was identical to the speciation of her positive blood cultures. In addition, pathology revealed adenomyomatous hyperplasia of the gallbladder and chronic cholecystitis. Unlike other cases of cholecystitis, our patient had no significant risk factors for the infection-no history of immunosuppression, diabetes mellitus, nor underlying malignancy. We discuss the current knowledge of infection in the setting of chronic cholecystitis and adenomyomatous hyperplasia.

Endometriosis, manifested by pain and infertility, is a chronic inflammatory disease, associated with a large disability of daily living, causing a socio-economic diastrophic problem and burden. The main goal of therapy attempts to reduce pain, correct infertility and possibly avoid or delay occurrence of long-term endometriosis-associated sequelae, such as fibrosis, adhesion and malignant transformation. Although the advanced technology (minimally invasive diagnostic tools, magnetic resonance imaging, high-resolution vaginal ultrasound etc.) and the better understanding pathophysiology of endometriosis for development of new therapeutic strategy is continuous for both diagnosis and management of endometriosis, there is still presence of many debated issues, which commonly occur in routine clinical practice. For example, the timing and duration of medications may be one of most frequently discussed issues. In this part I, we would like to overview the general background knowledge (basic concept) about the endometriosis, and emphasize the role of clinical diagnosis and possible empirical medical treatment (therapeutic test) for the management of women with endometriosis.

Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI.

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon's perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient's comfort and surgeon's perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45± 0.96 and average patient cooperation score based on surgeon assessment was 3.42 ± 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.

To reduce postpartum morbidity and mortality, optimizing routine outpatient postpartum care has become a focus of national attention and a healthcare priority.

Following epileptic seizures, patients can subsequently experience a post-ictal state characterized by disorienting symptoms, such as confusion, drowsiness, hypertension, headache, and nausea, rather than neurobehavioral sequelae. We report the case of a 64-year-old male with unilateral left temporal lobe injury, who presented with post-ictal transient Kluver-Bucy Syndrome symptomatology following a complex partial seizure. Brain magnetic resonance imaging revealed encephalomalacia of the left temporo-parieto-occipital region from a previous infarct, and his symptoms resolved following the administration of antiepileptic medications. Therefore, transient Kluver-Bucy Syndrome can follow unilateral temporal lobe injury and should be suspected in patients who fit the clinical criteria, even in the absence of classic bilateral temporal lobe damage on imaging.

Multimodal analgesia that combines around-the-clock medications and regional techniques can be especially effective for postoperative pain control. We describe a pediatric patient who underwent vertebral body tethering via an open thoracolumbar approach to treat juvenile idiopathic scoliosis. Erector spinae plane blocks (ESPBs), cryoablation to the intercostal nerves, and multimodal medications helped control our patient's pain well enough for her to be discharged home on postoperative day 2. To the best of our knowledge, this is the first report of this combination of regional techniques used for vertebral body tethering (VBT).

: Long-term treatment-free remission (TFR) represents a new goal for chronic myeloid leukemia (CML). Optimizing dose of tyrosine kinase inhibitors (TKIs) in the CML treatment maybe a new challenge to maintain effective and improving patients' quality of life. We hypothesized that administration of low-dose TKIs does not compromise major molecular response (MMR) in patients with CML who have a deep molecular response (DMR). : We did an open-label, randomized trial at eight hospitals in China. Eligible CML-CP patients (aged 18-70 years) had shown continuous response to TKI more than 5 years and maintained MR4.5 (BCR-ABLIS ≤ 0.0032%) in recent 18 months. Patients were randomly assigned (1:1) to the TKI de-escalation group or the discontinuation group. Randomization was done with permuted blocks (block size four) and implemented through an interactive web-based randomization system. Recurrence was defined as the single sample with real time Quantitative PCR (RT-qPCR) measurement greater than 0.1% (MMR). The primary endpoint was 12-month MMR rate in patients who received de-escalation or discontinuation of TKIs. This study was registered at ClinicalTrials.gov (NCT04143087). : Around 125 patients were enrolled between October 23, 2019 and October 31, 2020, 62 patients received dose de-escalation of TKIs, while 63 patients in the discontinuation group. In the de-escalation group, molecular recurrence-free survival at 12 months was 88.32% (95% CI 79%-98%), whereas molecular recurrence-free survival in the discontinuation group at 12 months was 59.98% (95% CI 47-73). No progressions occurred at the data cut-off date. All 29 recurrence cases restart TKI treatment returned to MMR. Cytolytic NK cells as a proportion of lymphocyte cells were significantly increased from baseline after 6 months whether in the de-escalation or TKIs cessation group ( = 0.048, 0.001, respectively); compared with the relapsing patients, Tregs proportion was decreased ( = 0.003), and higher proportion of NK cells were found in non-relapsing patients whether in TKI de-escalation or discontinuation group ( = 0.011, 0.007, respectively). We also found that the de-escalation group showed better disease-specific HRQOL in regards to its impact on emotional functioning, fatigue, pain, and financial difficulties. : With 88.32% MMR in 12-months follow-up after de-escalation TKIs' treatment, dose-halving could become a new treatment paradigm for CML patients who with DMR under continuing maintenance therapy with TKIs.