Although human oral fluid has become more routine for quantitative drug detection in pain management, detecting a large scope of medications and substances is costly and technically challenging for laboratories. This paper presents a quantitative assay for 64 pain medications, illicit substances, and drug metabolites in human oral fluid. The novelty of this assay is that it was developed on an older model AB SCIEX 4000 instrument and renders obscure the need for more technical and expensive laboratory equipment. This method includes addition of internal standard and a 2-step liquid-liquid extraction and dry-down step to concentrate and clean the samples. The samples were suspended in 50% MeOH in water and separation and detection was accomplished using triple quadrupole mass spectrometry (LC-MS/MS). Separation was achieved using reverse-phase liquid chromatography with detection by LC-MS/MS. A second injection was done in negative mode to determine THC-COOH concentration as an indicator of THC. An aliquot of the (already) extracted samples was analyzed for D- and L- isomers of amphetamine and methamphetamine using a chiral column. The standard curve spanned from 5 to 2000 ng/mL for most of the analytes (1 to 2000 ng/mL for fentanyl and THC-COOH) and up to 1000 ng/mL for 13 analytes. Pregabalin and gabapentin ranged from 25 to 2000 ng/mL. The result is a low-cost method for the sensitive detection of a wide-ranging oral fluid menu for pain management. This assay has a high sensitivity, and good precision and accuracy for all analytes with an older model mass spectrometer.

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

Background: Currently, the DRL quantity in mammography are evaluated in terms of mean glandular dose (MGD). Since the MGD cannot be measured directly, it can be obtained by calculation using the equation (D=K*g*c*s). In previous studies, the conversion factor g was calculated by Monte Carlo simulation and is not reported from actual measurements. In this study, we focused on the g-factor, which is a conversion factor to the MGD at 50% glandularity, and attempted to measure it using a nanoDot dosimeter to see if it can be used in mammography. Methods: The nanoDot dosimeters were inserted in a PMMA phantom at depths ranging from 0 cm to 6 cm in 1 cm increments, and measurements were made in three HVLs of 0.3 mmAl, 0.35 mmAl, and 0.4 mmAl HVL. The g-factor was calculated from the nanoDot dosimeter values using a conversion equation. Results and Discussion: The measured g-factors for all the HVLs were in close agreement with those of Dance et al. The values of the previous studies did not include the backscatter factor, which may have underestimated the MGD. The difference was smaller for the 0.4 mm Al. Compared to the other HVLs, the 0.4 mm Al was measured without a compression plate, which may have been influenced by the presence or absence of a compression plate. Conclusion: The nanoDot dosimeters were used to calculate g-factors. The results agreed with those of previous studies within uncertainty. This indicates that nanoDot dosimeters can be used in the mammography field.

Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to Emergency room with headache, chest pain, vomiting. SARS-CoV-2 IgG Antibodies were reactive. Except for elevated PTT-Lupus Anticoagulant at 50 Sec, Hypercoagulable workup was negative. The MRI venogram findings were consistent with the Dural thrombus of superior sagittal sinus. Patient subsequently developed chest pain, and Computed tomography angiography found pulmonary emboli within segmental branches of the right lower lobe pulmonary artery. Patient was managed in the ICU with Heparin and switched to Coumadin for discharged. Conclusion: The incidence of Cerebral Venous Sinus thrombus (CVST) among Covid-19 patients is inferior to 0.02%. And most of the patients lack typical Covid-19 presentations such as pneumonia. The lack of symptoms may promote the insidious course of pre-thrombotic events that lead to CVST. However more Retrospective studies are necessary to established consistent odd ratios. Due to the higher mortality associated with CVST and the ongoing of Covid-19 pandemic, we recommend a higher level of clinical suspicion.

A 75-year-old female is referred for evaluation of a progressive leg swelling. Angiological and MRI evaluation show the presence of inflammatory tissue surrounding the aorta and the left iliac vessels, causing significant stenosis. Upon suspicion of retroperitoneal fibrosis, we actively seek for secondary causes such as malignancies, autoimmune diseases and infections, as well as IgG4-related disease. All investigations result negative and we make the diagnosis of idiopathic retroperitoneal fibrosis. Steroid therapy was started and we observed a rapid amelioration of symptoms and radiological disappearance of the inflammatory tissue around the aorta.