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Continuous spinal anesthesia (CSA) is a mode of anesthesia and analgesia that has various therapeutic advantages. CSA allows the anesthesiologist to titrate tiny doses of a local anesthetic to achieve the desired degree of spinal anesthesia. The duration can be extended to accommodate the demands of the protracted operation. Due to a lack of equipment and financial restraints, particularly in resource-constrained areas, and worries of neurologic consequences such as cauda equina syndrome, CSA is yet to acquire general acceptability among anesthesiologists. In terms of postoperative pain management, CSA can be comparable to epidural analgesia and is considered far superior to abdominal wall blocks when correctly applied. Here we discuss a case wherein a standard epidural catheter in subarachnoid space was used to successfully perform an emergency exploratory laparotomy.

Prurigo nodularis (PN) is a chronic skin disease that manifests with severe itchy, firm, hyperkeratotic nodules distributed on the trunk and the extremities symmetrically. Here, we report a unique presentation of PN. A 26-year-old male presented with multiple itchy nodules over the hands and feet sparing the trunk, which were confirmed histologically as PN. This is the first reported case of PN with exclusive acral distribution.

Itch is a common symptom of skin diseases and significantly reduces patients' quality of life. Melatonin has anti-inflammatory and antioxidant effects. Our study examined the potential anti-itch effects of melatonin (N-acetyl-5-methoxytryptamine) in mice.

A 74-year-old woman visited our department for distally predominant unpleasant pain in the bilateral feet for several months. She had a history of chronic lumbago. Neurological examinations showed normal findings other than involuntary movements. A nerve conduction study, electroencephalography, and brain MRI revealed unremarkable findings, while spinal MRI revealed mild lumbar spinal stenosis. Given the typical unique movements, i.e., bilateral toe movements, which are asynchronous and consist of extension, flexion, and, rarely, abduction, she was diagnosed with painful leg moving toes syndrome. Administration of duloxetine produced partial pain relief and reduced movements. We considered that clinicians should be aware of this unique movement disorder in order to avoid misdiagnosis with psychogenic conditions.

The therapeutic significance of carbamazepine in individuals with trigeminal neuralgia, epilepsy, and bipolar disorder is well recognized. Although it has high effectiveness, it raises the patient's risk for some adverse effects. The relationship between carbamazepine usage and agranulocytosis is well-established. Agranulocytosis is characterized by an unusually low number of neutrophils. This disorder poses a grave hazard to the patient since they are more likely to get potentially lethal bacterial or fungal infections. Moreover, carbamazepine is one of the most common causes of Stevens-Johnson syndrome (SJS), a severe skin condition with a high mortality rate. In cases where agranulocytosis and Stevens-Johnson syndrome coexist, the prognosis is relatively poor. We report a rare case of a patient who developed agranulocytosis and Stevens-Johnson syndrome after taking carbamazepine. Neutrophils accounted for 2.1% of the patient's differential leukocyte count. Furthermore, Naranjo's scale found a score of 8 for Stevens-Johnson syndrome, placing it in the "probable" category, while a score of 9 for agranulocytosis indicated that it was a confirmed adverse reaction to carbamazepine.

Ten to 12 percent of the adult population globally suffers from migraine, which is the second most frequent type of primary headache, according to the American Academy of Neurology. Even though pain and attack-related impairment scored first, cognitive symptoms were the second most common. ; The current study intended to measure the latency of P300 wave during and after an acute attack of migraine among a group of patients known to have migraine in order to introduce an objective method to measure the cognitive function of migraineurs during migraine attack. ; This is a potential cohort study conducted at the neurological outpatient's clinics of Basra hospitals to the period from January until August 2021. The total number of subjects included in the study were forty-eight (48), thirty (30) patients and eighteen (18) age and gender matched control subjects. Patients were examined and selected by senior neurologist and diagnosed as having common migraine, then refereed to the neurophysiology clinic to perform cognitive function tests, for each patient two tests were done; first one during the acute migraine attack and second one after one month far ahead from the end of the migraine attack. In addition, one cognitive function test was done for the control group.; We discovered a highly important variance of the mean P300 latency of the patients during the acute attack of migraine as compared to the same group of the patients after repeating the exam one month far ahead from the end of the last migraine attack and one week ahead of being medication free. Also, we found the mean P300 latency of the patients during the acute attack of migraine is significantly higher than the mean P300 latency of the control subjects (P. value <0.00).; We found that all migraineurs in our study are having higher P300 latency values than control group during moderate migraine attack and this difference was significant which indicates that during moderate migraine attacks there is obvious impairment of cognitive performance abilities of those patients.

An ampullary carcinoma (AC) is defined as cancer that arises in the ampulla of Vater (AV). It is a tiny opening in the beginning segment of the small intestine called the duodenum. Pancreatic and bile duct fluids are pumped into the intestines via the AV. There are various factors listed as the causes of AC. A 45-year-old male presented to the emergency department with complaints of pain in the abdomen for two months, vomiting for two days, and a history of fever for four days, which was persistent in nature. He had been operated on for endoscopic retrograde cholangiopancreatography (ERCP) stenting two months back due to pain in the abdomen. The patient underwent investigations such as blood tests, histopathology, ultrasonography, abdominal contrast-enhanced computed tomography (CECT), and ampullary mass biopsy, based on which a final diagnosis was made. The patient was operated on by the Whipple surgical procedure and was later treated with antibiotics and analgesics. Surgical management for AC is a novel treatment chosen instead of chemotherapy. Although early-stage AC can be cured with radical surgery, around half of the patients experience tumor recurrence. The prognosis of our patient was good.

Managing cancer pain is a growing challenge. Individualized pharmaceutical care is particularly important for opioid-tolerant outpatients due to variation in terms of their knowledge about pain, treatment adherence, and risk of experiencing inadequate analgesia and severe adverse events. This study aimed to determine the influence of individualized pharmaceutical care on outcomes in opioid-tolerant outpatients with cancer pain.

Individuals with human immunodeficiency virus (HIV) disease frequently suffer from anemia. The causes include anemia of chronic disease, vitamin B12 and iron deficiency, opportunistic infections (), HIV-related bone marrow suppression, AIDS-associated malignancies, and antiretroviral therapy (ART), specifically zidovudine. In HIV patients with advanced immunodeficiency, failure to produce neutralizing antibodies can lead to chronic parvovirus B19 (B19) infection. Normally, in persons with intact immunity, the progression of B19 is self-limited. However, in chronic B19 infection, it can lead to pure red cell aplasia (PRCA) and chronic anemia. In human immunodeficiency virus (HIV)-infected patients, B19-related anemia is rare and underdiagnosed. It has a great response to intravenous immunoglobulin (IVIG) therapy. Hence, early diagnosis and prompt treatment can significantly reduce mortality. In this article, we described the case of a 25-year-old male with HIV infection who presented with a headache. He had severe normocytic anemia with a low reticulocyte count. The workup for blood loss, hemolysis, hemoglobinopathy, and iron deficiency was negative. Because of extremely low reticulocytopenia with severe anemia, the investigations favored multiple myeloma, parvovirus infection, and bone marrow aspiration biopsy. He was tested for parvovirus B19 deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) test due to insufficient seroconversion. It turned out to be positive and he was treated with IVIG therapy.