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We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs).

To present the detailed history of three cervical cancer patients with rectovaginal fistula, who had undergone radiotherapy.

Lupus enteritis is a poorly studied cause of abdominal pain in patients with systemic lupus erythematosus (SLE). We present the case of a 28-year-old female with a history of SLE for nine years. She has been on chronic immunosuppressant therapy for the last nine years due to an episode of lupus enteritis in the past. Currently, the patient presented to urgent care with a three-day history of waxing and waning symptoms of abdominal pain, vomiting, and diarrhea. In addition, the patient had skin rashes. Laboratory work was significant for leukopenia, hypocomplementemia, hematuria, and proteinuria. CT of the abdomen showed bowel thickening involving the entire ileum, distal jejunum, and first portion of the duodenum. It was accompanied by moderate mesenteric edema and a small amount of ascites. Since the patient was on long-term immunosuppressive therapy with hydroxychloroquine and mycophenolate mofetil, infectious etiology was of high consideration; however, it was ruled out after further testing. Along with continuing her home dose of mycophenolate mofetil and hydroxychloroquine, the patient was started on IV methylprednisolone 1 mg/kg for three days. The patient dramatically responded to IV steroids. The patient was transitioned to oral prednisone 60 mg daily, and steroids were tapered off by 10 mg each week. A repeat CT scan in two months showed the resolution of the previously visualized small bowel wall thickening. This case highlights that chronic immunosuppression should not preclude differential or diagnosis of lupus enteritis in a patient with a history of SLE.

To report the clinical outcomes after biologically augmented rotator cuff repair (RCR) with a fibrin scaffold derived from autologous whole blood and supplemented with concentrated bone marrow aspirate (cBMA) harvested at the proximal humerus.

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system caused by severe immune-mediated demyelination and axonal destruction, mainly affecting optic nerves and the spinal cord. We describe a 26-year-old Nepalese woman with recent onset of headache, nausea, vomiting and hiccups indicative of Area Postrema Syndrome (APS). The antibody test for aquaporin-4 was strongly positive. Brain magnetic resonance imaging (MRI) showed a bilateral hyperintense signal in the area postrema (AP). The patient started on methylprednisolone, and then azathioprine was added. However, the patient was readmitted because of tingling in her right upper extremity and sudden onset of tremors. An MRI scan showed an enlarged lesion in AP. Rituximab was started on top of the previous treatment, and a second dose was given after 2 weeks. The patient had been monitored regularly and symptom-free for 5 months. Hence, we emphasize the immediate need for a diagnostic approach for NMOSD management.

Pelvic floor dysfunction and its associated symptoms are a common clinical challenge in the cancer population. Despite the noninvasive nature of pelvic floor rehabilitation (PFR) for this condition and the promising clinical results observed with its use, PFR appears to be an underused therapy.

Pylephlebitis is a rare and life threatening thrombophlebitis of the portal vein. It commonly occurs following intra abdominal infections like appendicitis.It is even rarer in the pediatric age group. The nonspecific presentation impedes the diagnosis. Timely use of appropriate antibiotics and control of infection is paramount in its treatment and this case report highlights the same.

Acute appendicitis is a clinical diagnosis with marked variations in the clinical presentation, the latter resultant of varied anatomical positions of the appendix.

Burning mouth syndrome (BMS) is a chronic oral disorder of unknown etiology which presents therapeutic challenges. Alpha-lipoic acid (ALA) has been studied as a potential treatment for BMS. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of ALA compared to that of placebo or other interventions in individuals with BMS. Randomized controlled trials (RCT) using ALA to treat BMS were identified from MEDLINE, Cochrane Library, EMBASE, and Web of Science up to February 3, 2021. The assessment of the risk of bias in the included studies was based on the Cochrane guidelines. The primary outcome evaluated was the visual analog scale (VAS) pain intensity. ALA was compared with placebo, clonazepam, gabapentin, pregabalin, ALA plus gabapentin, capsaicin, Biotène, and laser therapy. Altogether, 137 records were scanned for inclusion/exclusion, and nine RCTs (two unclear and seven at high risk of bias) were included in the qualitative and quantitative analyses, with a total of 594 patients with BMS included in this review. All studies reported an improvement in VAS pain scores ranging from -0.72 to -2.77. Meta-analysis results showed a non-significant reduction in pain intensity for ALA (P = 0.616) compared to that of placebo on a VAS of 0-10. Patients taking ALA were 1.923 times more likely to show an improvement in self-reported BMS symptoms (P = 0.031) than those in the placebo group. Clonazepam and pregabalin showed a significant VAS pain reduction of 4.08 and 4.68 (P < 0.001), respectively, compared to that with ALA. Although ALA intervention provided a non-significant improvement in the pain score and was more likely to produce a reduction in BMS symptoms, the evidence was of low quality. Further research is needed to establish clear guidelines for the use of ALA for BMS treatment.

Pelvic venous disorders (PeVDs) have replaced the concept of pelvic congestion syndrome encompassing venous origin chronic pelvic pain (VO-CPP) in women. The evaluation of women with VO-CPP includes the assessment for other causes of pelvic pain as well as imaging evaluation for pelvic varicosities measuring greater than 5 mm diameter, ovarian vein diameter, and flow direction, as well as iliac vein diameter and signs of compression. Proper identification of these patients can lead to high degrees of success eliminating chronic pelvic pain following ovarian vein embolization and/or iliac vein stenting. Strong encouragement is provided to use the symptoms, varices, pathophysiology classification for these patients and upcoming research studies on the specific symptoms of patients with VO-CPP will help elucidate patient selection for intervention. Additional future randomized controlled trials are also upcoming to evaluate for outcomes of ovarian vein embolization and iliac vein.