Recurrent Symptoms Research Articles

Keyhole Mini-Craniotomy Middle Fossa Approach for Tegmen Repair: A Case Series and Technical Instruction

Background and Importance: Tegmen defects associated with cerebrospinal fluid (CSF) leaks are a rare pathology that can result in severe complications if left untreated. There is no universal optimal surgical algorithm for repair, though the most common techniques are the middle fossa craniotomy (traditionally 25 cm2 in area), the transmastoid approach, or both. Here, we describe successful use of a keyhole mini-craniotomy, only 6 cm2 in area, without mastoidectomy or days of lumbar drainage. Clinical Presentation: Three patients presented with right-sided CSF otorrhea and hearing loss, with varying sizes of tegmen defects and associated encephaloceles. Keyhole craniotomies measuring 3 x 2 cm were used to perform a multilayer repair comprising an intradural collagen dural substitute, extradural fascial graft, extradural collagen dural substitute, fibrin sealant, and sometimes bony reconstruction using partial thickness craniotomy grafting. All patients were discharged on postoperative day one or two, with no recurrence of symptoms at six months. Conclusion: The keyhole craniotomy approach does not sacrifice the extent of operative access for this pathology. This minimally invasive approach can likely be used more often without need for concomitant mastoidectomy, ultimately enabling shorter hospital stays and more rapid recovery.

Post Traumatic Lamellar Corneal Laceration Repair Using Shaped SMILE Lenticule.

A 24-years-old male with seven years history of recurrent symptoms following a 6 mm curvilinear laceration in right eye, involving epithelial ingrowth and stromal scarring, underwent surgical repair. The laceration dimensions were measured using Anterior Segment Optical Coherance Tomogrpahy (AS-OCT), and a Small Incision Lenticule Extraction (SMILE) derived graft was fashioned to match the defect. After scar excision, the graft was secured with fibrin glue. Postoperatively, the laceration healed without complications, and visual acuity improved from 20/80 to 20/30 at six weeks, with a stable, well-epithelialized graft. This case highlights the potential of shaped SMILE lenticule grafts as a sutureless, effective treatment for challenging corneal lacerations unresponsive to conservative therapy.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Commentary: Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema

BackgroundAngiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced angioedema in the United States. Our primary objective was to provide descriptive evidence regarding emergency department (ED) disposition of ACEI-induced angioedema patients. Our secondary objective was to evaluate unique patterns in those with ACEI-induced angioedema at a tertiary referral center, including demographics, details of those requiring intubation, length of inpatient stay, and allergy documentation.MethodsThis was a retrospective study evaluating all cases of ACEI-induced angioedema at a large, regional academic medical center. We performed a medical record review to identify patients with ACEI-induced angioedema who presented to the ED from January 1, 2016, to December 31, 2022. A structured data abstraction process was utilized to select patients of interest, followed by descriptive statistics, chi-square tests and odds ratios for categorical data, and Kruskal Wallis tests for continuous data.ResultsA total of 637 unique patient encounters met potential inclusion. After a substantial, standardized review, 94 patients met inclusion. During the study period, there were 94 patients presenting to the ED who were diagnosed as having angioedema secondary to an ACEI (90 patients) or angiotensin receptor blocker (ARB) (4 patients). Overall, 53 patients (56.38%) improved during their ED stay, and of those, 32 patients (60.38%) were discharged home. None of the 12 patients that worsened were sent home from the ED. Those who were discharged from the ED with a median stay of 4 h had no increased risk of return to the ED versus those who were admitted. The only treatment found to have statistical association with disposition was intramuscular epinephrine. Only 13 of 43 ED discharged patients (23.64%) had their ACEI/ARB documented in their allergy listings compared to 42 of 51 patients (76.36%) of admitted patients, odds ratio of failure to document was 0.0929 (95% CI, 0.0352 to 0.24512). Only one patient out of the total 94 returned to the ED due to recurrent angioedema symptoms during our study period and was subsequently discharged.ConclusionOur results indicated that at a large, tertiary care referral center, patients with ACEI-angioedema who did not exhibit severe symptoms were safely discharged home with low risk of early return visit to the ED. Severe symptoms were found to be any throat symptoms, voice change, drooling, worsening swelling, or complaints of dyspnea. Further, among those admitted, patients in our study had a short inpatient stay and were safely discharged with no documented early return visit to the ED.

Efficacy of vidian neurectomy in treating chronic rhinosinusitis with nasal polyps combined with allergic rhinitis: A systematic review and meta-analysis.

To evaluate the impact of additional vidian neurectomy or posterior nasal neurectomy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and allergic rhinitis (AR), compared to the outcomes of conventional endoscopic sinus surgery alone. Up to May 2024, six databases were systematically searched. We evaluated studies that compared the clinical improvement of chronic sinusitis-related symptoms and endoscopic findings between the neurectomy group (endoscopic sinus surgery plus vidian neurectomy or posterior nasal neurectomy) and the control group (endoscopic sinus surgery only). The neurectomy group showed a significant reduction in the Lund-Kennedy endoscopic score (SMD = -1.3163 [-1.6519; -0.9807]; I² = 53.3 %). However, this treatment did not have a significant effect on the Quality-of-life score (SMD = -0.1222 [-0.3427; 0.0983]; I² = 27.5 %) or patient-reported nasal symptom-related VAS scores (SMD = -1.6690 [-3.7062; 0.3682]; I² = 96.3 %). In the subgroup analyses of these results according to time points of measurement, the Lund-Kennedy endoscopic score was statistically lower in the treatment group during treatment periods (postop 6months, 12months, and 24months). However, there were no statistically significant differences in Quality-of-life score and VAS between the treatment and control groups during all treatment periods. There was no significant difference in the recurrent rate of CRS during the following up periods (odds ratio=0.5263 [0.1518; 1.8254], I2 = NA) between two groups. Regarding the adverse effect of neurectomy, this additional procedure did not induce the postoperative bleeding (odds ratio=0.8886 [0.3411; 2.3150]; I2 = 0.0 %) and dry eye related discomfort (odds ratio=65.3560 [0.1044; 40,908.1619]; I2 = 88.9 %) significantly compared to control group. Additional neurectomy shows better efficacy in improving endoscopic findings and is safer in patients with CRSwNP combined with AR; however, more clinical studies are needed to evaluate its long-term symptomatic effects and disease recurrence.

Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study.

Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7. DERR1-10.2196/58563.

Life after benign paroxysmal positional vertigo: one-year analysis of recurrence, headaches, neck pain, falls, and functional vestibular symptoms.

Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms. This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models. 201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events. Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.

Acute Generalized Exanthematous Pustulosis Induced by Hyaluronic Acid Knee Injection: ACase Report.

Acute generalized exanthematous pustulosis is a severe cutaneous adverse reaction characterized by the rapid onset of nonfollicular, sterile pustules on an erythematous base, typically accompanied by fever (≥38 °C), neutrophilia (7.0× 10⁹/L), and characteristic histopathological features. This case report presents the first documented instance of acute generalized exanthematous pustulosis after hyaluronic acid viscosupplementation. A 61-year-old female developed a pruritic, erythematous rash that rapidly evolved into generalized erythroderma with systemic manifestations after receiving intra-articular hyaluronic acid injections for knee osteoarthritis. Initial physical examination and diagnostic workup, including biopsy and blood tests, were performed to exclude other differential diagnoses such as generalized pustular psoriasis, subcorneal pustular dermatosis, and immunoglobulin A pemphigus. The temporal association with hyaluronic acid injections and the patient's positive response to treatment with systemic corticosteroids and antihistamines supported the definitive diagnosis of drug-induced acute generalized exanthematous pustulosis. The patient was managed with the withdrawal of the offending agent, and supportive care was provided. She did not require rehabilitation and experienced no adverse events during the recovery period. Follow-up visits confirmed the absence of recurrence and complete resolution of symptoms, with no lasting sequelae. This case underscores the importance of recognizing acute generalized exanthematous pustulosis' acute manifestations and potential triggers, even with treatments generally considered safe. ED personnel, including advanced practice registered nurses and other clinicians, must include acute generalized exanthematous pustulosis in their differential diagnoses of severe cutaneous disorders to initiate prompt and appropriate management. The development of atrial fibrillation during hospitalization in this patient raises questions about the systemic effects of acute generalized exanthematous pustulosis, suggesting an area for further research. Early detection and treatment of acute generalized exanthematous pustulosis are crucial for favorable outcomes, illustrating the vital role ED personnel play in managing this condition. Awareness of rare triggers such as hyaluronic acid is essential for preventing and effectively treating such severe adverse reactions.

Double Outlet Right Ventricle: A Rare Finding in a 15-Month-Old Female With Failure to Thrive.

Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery originate from the right ventricle, often accompanied by additional cardiac anomalies to mitigate circulatory imbalance, though such compensations usually fail. We report a 15-month-old infant with recurrent respiratory infections and poor weight gain, referred for computed tomography angiography. Physical examination showed a small, non-syndromic infant with pallor, tachypnea, irritability, and finger clubbing. Initial imaging revealed cardiomegaly and lung infiltrates; echocardiography and computed tomography angiography confirmed additional intracardiac defects of double superior vena cavae, a hypoplastic aortic arch, hypertrophic right ventricular wall, and a patent ductus arteriosus. Corrective surgery was delayed due to respiratory complications. This case emphasizes the critical need to consider cardiac pathology in pediatric patients with recurrent respiratory symptoms, as untreated DORV can lead to high mortality.

Effects of a supplement associating Lactobacillus strains and proanthocyanidin-rich plant extracts against recurrent uncomplicated, urinary tract infections: A prospective, controlled study.

Recurrent cystitis, particularly common in women, substantially diminishes patient quality of life and represents a major clinical practice and public health burden. Increasing development of resistance to antibiotics has encouraged the search for alternative treatments. The benefits of a food supplement associating two Lactobacillus strains with proanthocyanidin A-rich cranberry and cinnamon extracts were evaluated in 80 women with a history of cystitis recurrence. Post-inclusion recurrence frequency was compared between women taking the investigated supplement daily for 6 months and non-supplemented women, based on patient-completed Acute Cystitis Symptom Score (ACSS) questionnaires. Two-thirds (64.9%) of supplemented women experienced no further episodes of cystitis during the first 6 months of the study compared to only one-third (31.6%) of non-supplemented women (p=0.004), the difference between the two groups being significant from 3 months onward. ACSS scores revealed significantly fewer and less severe urinary symptoms in supplemented women, as well as a significantly reduced impact of these symptoms on quality of life (p<0.0001). The results shown by extensive data on women suffering from recurrent cystitis, collected over 8 months, indicate that taking the tested supplement daily for 6 months can provide significant benefits in terms of recurrence frequency, symptoms, and quality of life. The study is registered on the ClinicalTrials.gov site under the identifier NCT04987164.

Anaphylaxis in pediatric patients: single-center study in a private hospital.

This study aimed to characterize the profile of probable anaphylaxis cases treated at a private pediatric hospital emergency department in São Paulo. It investigated triggering factors, the presence of cofactors, treatments administered, and follow-up for these cases through interviews with the patients' families. A single-center cross-sectional study analyzed medical records of children and adolescents treated between 2016 and 2020. Allergist physicians evaluated cases with symptoms consistent with anaphylaxis to identify probable cases, and the parents or legal guardians of these cases were interviewed to gather detailed information about the episodes. A total of 69 probable cases of anaphylaxis (PCA) were identified among 460,434 visits. Of the 51 PCAs evaluated, most presented with cutaneous and respiratory symptoms, with a male predominance (63%), and 27% were under 2 years old. Foods, particularly nuts and peanuts, were the primary triggers. Nearly one-third of the patients did not undergo investigation following the episode, and intramuscular adrenaline (37%) and auto-injectable adrenaline (4%) were underutilized as treatments. Eight cases exhibited recurrence of symptoms after initial improvement, suggesting a potential biphasic reaction. In conclusion, this study revealed that the majority of PCAs occurred in male children, with nuts and peanuts as the main triggers. The management of PCAs was suboptimal, characterized by the underutilization of intramuscular adrenaline as the first-line treatment and low rates of auto-injectable adrenaline prescriptions during follow-up. Increasing awareness and education about anaphylaxis in children, along with emphasizing the importance of proper treatment, are crucial to reducing the risk of morbidity and mortality in this vulnerable population.

Full-Endoscopic Midline Foraminoplasty: An Alternative Method for Treating Lumbar Foraminal Stenosis

Objective: To describe the full-endoscopic lumbar foraminoplasty with midline skin incision (FEFM) and lateral recess decompression procedure and to report its clinical outcomes at the 1-year follow-up.Methods: Consecutive patients with lumbar foraminal and/or lateral recess stenosis who underwent FEFM procedures were retrospectively reviewed. Clinical outcomes were evaluated with a visual analogue scale (VAS) of back and leg pain and Oswestry Disability Index (ODI) up to 1 year postoperatively. The complications and recurrence rate were also recorded.Results: A total of 30 cases (51 levels) were included (L3–4, 6 cases [11.8%]; L4–5, 23 [45.1%]; L5–S1, 22 cases [43.1%]). VAS scores collected at preoperative, postoperative day 1, 3 months, 6 months, and 1 year were 9.16, 1.7, 1.36, 1.3, and 1.43, respectively. The ODI scores collected at preoperative, postoperative 3 months, 6 months, and 1 year were 46.63, 11.5, 10.66, and 10.46, respectively (p&lt;0.05). The mean operation time was 88.7 minutes (range, 45–152 minutes). The length of hospital stay was 1.21 days (range, 1–3 days). No immediate complications were identified, and no patients experienced a recurrence of symptoms requiring revision surgery.Conclusion: FEFM is an effective procedure for treating foraminal and/or lateral recess stenosis. It demonstrates the capability to decompress both bilateral foraminal and lateral recess stenosis through a single-entry point.

Migratory Polyarthritis Associated With Clopidogrel: A Case Report

Clopidogrel, a selective thienopyridine, is used for secondary prevention of major adverse cardiovascular events. Some studies have reported inflammatory arthritis as a rare adverse effect of Clopidogrel. A 47-year-old male underwent percutaneous coronary intervention and was subsequently prescribed a 600 mg loading dose of Clopidogrel, followed by a daily dose of 75 mg. After six days of taking Clopidogrel, the patient presented to the emergency department with right knee pain. The knee joint exhibited swelling, warmth, and tenderness, although there was no redness or crusting. After two and six days of hospitalization, despite receiving antibiotics and Indomethacin, he developed arthritis of the metacarpophalangeal and metatarsophalangeal joints, respectively. According to the laboratory investigation, cultures, synovial fluid analysis, and imaging, infectious, rheumatologic, and crystallopathy diseases were ruled out for the patient. Clopidogrel was discontinued, and the patient was switched to ticagrelor 90 mg twice daily. All symptoms and signs of joint inflammation had improved within five days of stopping the Clopidogrel. After one week and one and six months of follow-up, there has been no recurrence of symptoms.

Successful treatment of Cervical Type Cervical Spondylosis with Meridian Balancing Acupuncture: A significant case study with excellent outcomes

This case report presents an office worker diagnosed with Cervical Type Cervical Spondylosis who underwent Meridian Balancing Acupuncture therapy. The patient had experienced recurrent episodes of pain and stiffness over several years, with exacerbations in the past three years, which were managed with conventional, modern medical treatments. However, these interventions did not result in long-term resolution, as symptoms consistently relapsed within a few days. Due to the increasing burden of the condition, the patient opted for acupuncture treatment and was administered a prescribed Meridian Balancing Acupuncture regimen. The treatment protocol consisted of three 30-minute acupuncture sessions, administered every other day over the course of one week. Distal acupuncture points on the limbs were selected and manipulated every 5-10 minutes. During palpation of sensitive/reactive points, as well as during needling and manipulation, the patients were instructed to gradually rotate their neck in various directions to assess symptom relief. After the initial treatment, the patient experienced complete resolution of pain and stiffness, though a mild relapse was observed before the second and third sessions. By the conclusion of the treatment course, both pain and stiffness were fully resolved. A follow-up conducted four weeks post-treatment revealed no recurrence of Cervical Spondylosis symptoms.

Epiploic Appendagitis: An Infrequent Offender in Abdominal Pain

Epiploic appendages are fat-filled outpouchings arising from the serosal surface of the colon and have uncertain physiological functions. Epiploic appendagitis is characterized by inflammation of these appendages. Primary appendagitis often results from ischemic injury, while secondary appendagitis may arise from the contiguous spread of inflammation or infection from adjacent structures. Clinical features of epiploic appendagitis include acute or subacute abdominal pain, most commonly in the lower quadrants, without significant concurrent constitutional or other gastrointestinal symptoms. Diagnosis relies on imaging modalities, with Computed Tomography (CT) being the preferred method. Management of epiploic appendagitis is mainly conservative, with analgesic and anti-inflammatory agents being the mainstay of treatment. Surgical indications are poorly defined, but laparoscopic excision of the inflamed appendage may be considered in cases of recurrent or refractory symptoms. This review article explores the anatomy, pathophysiology, clinical features, diagnosis, and management of epiploic appendages and appendagitis. Keywords: Acute Abdomen, appendagitis, epiploic Appendages

Evaluation of Left Ventricular Function and Volumes at Maximum Workload in Patients with Euthyroid Goiter

Objective: The left ventricular ejection fraction (LVEF) is a critical predictor of coronary artery disease and cardiac mortality. This study aimed to evaluate changes in cardiac volume at rest and under stress conditions in patients with euthyroid goiter who were followed in a thyroid diseases outpatient clinic. Mateial and Methods: This retrospective study included 557 patients who underwent gated myocardial perfusion scintigraphy between 2016 and 2023. Of these, 378 patients (66%) were female, with a mean age of 57 years (range: 48–64). Pharmacological stress was administered to 123 (44%) of the 277 patients with euthyroid goiter, while treadmill exercise stress was applied to 154 (56%). In the control group of 280 patients, 125 (45%) underwent pharmacological stress, and 155 (55%) underwent treadmill exercise stress. Results: No significant difference was observed between the two groups regarding resting ejection fraction values. However, post-stress ejection fraction values were significantly lower in patients with euthyroid goiter compared to the control group. This difference was particularly pronounced in patients subjected to pharmacological stress using adenosine. Conclusion: While euthyroid goiter patients are typically monitored without treatment, the emergence of recurrent hypothyroid symptoms may indicate the need for thyroxine therapy. Even in the absence of hypothyroid symptoms at rest, these patients may exhibit atypical responses to certain medications and cardiac stress procedures. Clinicians should exercise caution regarding the potential for prolonged drug effects in this population.

Prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam zones comprehensive specialized hospitals, Northwest Ethiopia

BackgroundBenign prostatic hyperplasia (BPH) is non-cancerous growth of the prostate gland which surrounds the urethra. For men with BPH who are older than 50, a prostatectomy is a common surgical procedure. Open prostatectomy is still more prevalent in regions with limited access to advanced surgical procedures like transurethral resection of the prostate and robotic-assisted laparoscopic prostatectomy. Determining prostatectomy outcomes for BPH and associated factors is essential to optimize patient care and improve awareness of this condition. However, the outcomes of prostatectomy and associated factors are not studied in Ethiopia.ObjectivesTo assess prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam Zones, 2021.MethodsA facility-based cross-sectional study was employed among 412 patients with prostatectomy using systematic sampling. Five-year secondary data from 2016 to 2021 data was extracted from patients’ medical records using a structured proforma. The outcomes of prostatectomy for BPH are categorized into good outcomes if significant symptom relief such as reduced urinary frequency, urgency, and nocturia and preserved sexual function using International Prostate Symptom Scores and Sexual Health Inventory for Men. A poor outcome involves minimal symptom improvement, recurrence of symptoms, severe complications like urinary incontinence or retention, and erectile dysfunction. Besides this, logistic regression models were computed to assess the relationship between variables.ResultsAmong 412 patients with prostatectomy, 68 (16.5%; 95% CI 12.9–20.1) had poor outcomes, and 344 (83.5%; 95% CI 79.9–87.1) had good outcomes. In addition, patients who took venous thromboembolism (VTE) prophylaxis were 80% less likely to develop good prostatectomy outcomes than those who did not take prophylaxis (AOR = 0.2; 95% CI 0.07–0.6). Good prostatectomy outcomes were 86% lower in those who did not obtain the proper wound care than in those who did (AOR = 0.14; 95% CI 0.03–0.6). Comparably, patients with hypertension comorbidity were 70% (AOR = 0.3; 95% CI 0.1–0.6) less likely to have good prostatectomy outcomes. On the other hand, patients who underwent transurethral resection of the prostate (TURP) had twice the odds of a good prostatectomy outcome compared to those who underwent transvesical prostatectomy (TVP) (AOR = 2; 95% CI 1.5–5.4). Moreover, patients who received preoperative oral medical therapy for benign prostatic hyperplasia (BPH) were twice as likely to experience poor prostatectomy outcomes compared to those who did not take preoperative medical therapy (AOR = 2; 95% CI 1.2–8.7). Similarly, patients with a prostate volume of 100–200 cm3 were five times more likely to develop poor prostatectomy outcomes compared to those with a prostate volume of 30–60 cm3 (AOR = 5; 95% CI 2.3–10).ConclusionsA total of 16.5% of the participants experienced poor outcomes following prostatectomy. The factors associated with these outcomes included venous thromboembolism prophylaxis intake, appropriate wound care, hypertension as a comorbidity, surgical modality, preoperative oral medication therapy for BPH, and prostate volume.

Conversion of 2-dimensional to 3-dimensional mesh for resource-limited centres in developing countries.

In recent years, laparoscopic hernia repair, i.e. transabdominal pre-peritoneal and totally extraperitoneal repairs have been considered the method of choice, especially for recurrent hernias after open repair or bilateral inguinal hernias. However, they pose numerous challenges such as increased post-operative pain due to tacking or fixation of mesh, chronic pain syndrome due to entrapment of nerves and mesh migration or invagination. A 3-dimensional (3D) mesh was introduced to overcome the shortcomings of a 2-dimensional (2D) mesh which does not conform to inguinal anatomy. However, in a resource-limited country like India, the widespread use of a 3D mesh may not be possible owing to its high cost. We included a total of 55 patients in our study who underwent laparoscopic extended totally extraperitoneal repair hernia repair for 1 year beginning from December 2021 to November 2022 with a follow-up of a minimum of 1 year till November 2023. In our study group ( n = 27), we used a novel technique of converting a 2D mesh to a 3D mesh, which was subsequently placed without fixation. In our control group ( n = 28), we used a standard polypropylene mesh with one-point suture fixation. All patients in our study showed satisfactory post-operative recovery. There was no significant difference in the post-operative pain (assessed by mean Visual Analogue Scores 1.24 ± 0.44 vs. 1.87 ± 0.56; P > 0.1) and the mean length of hospital stay in days (1.12 ± 0.33 vs. 1.16 ± 0.38; P > 0.1), respectively, in the study and control groups. None of our patients showed signs or symptoms of chronic pain or recurrence in our period of follow-up. Our technique of converting 2D to 3D mesh is a safe and feasible approach and maybe a potential alternative to a traditional 3D mesh in resource-limited settings.

Clinical presentation and management of Tolosa-Hunt syndrome: a case report

Tolosa-Hunt Syndrome (THS) is an exceptionally rare disorder characterised by recurrent episodes of excruciating ophthalmoplegia, commonly affecting one side of the face and involving the third, fourth, sixth, and fifth cranial nerves. This syndrome results from non-specific inflammation affecting the cavernous sinus, superior orbital fissure (SOF), and/or orbital apex. In this case report, we present the clinical features, diagnostic evaluation, and management of a 46-year-old female with THS. The patient initially presented with right-sided peri-orbital pain, swelling, chemosis, and headache. Ocular examination revealed mild to moderate proptosis, complete ophthalmoplegia, and normal findings in the left eye. Imaging studies, including CT and contrast-enhanced MRI, confirmed the presence of non-specific inflammation in the cavernous sinus and associated structures. Immediate treatment with oral Prednisolone led to a significant reduction in symptoms within five days, with complete resolution of chemosis and pain. Ocular movements gradually improved over the following week. Long-term follow-up showed no recurrence of symptoms. Keywords: Chemosis; Ophthalmoplegia; Cavernous Sinus.

The Role of Gut Microbiome in Irritable Bowel Syndrome: Implications for Clinical Therapeutics.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic or recurrent gastrointestinal symptoms without organic changes, and it is also a common disorder of gut-brain interaction (DGBIs).. The symptoms of IBS not only affect the quality of life for individual patients but also place a significant burden on global healthcare systems. The lack of established and universally applicable biomarkers for IBS, along with the substantial variability in symptoms and progression, presents challenges in developing effective clinical treatments. In recent years, preclinical and clinical studies have linked the pathogenesis of IBS to alterations in the composition and function of the intestinal microbiota. Within the complex microbial community of the gut, intricate metabolic and spatial interactions occur among its members and between microbes and their hosts. Amid the multifaceted pathophysiology of IBS, the role of intestinal microenvironment factors in symptom development has become more apparent. This review aims to delve into the changes in the composition and structure of the gut microbiome in individuals with IBS. It explores how diet-mediated alterations in intestinal microbes and their byproducts play a role in regulating the pathogenesis of IBS by influencing the "brain-gut" axis, intestinal barrier function, immune responses, and more. By doing so, this review seeks to lay a theoretical foundation for advancing the development of clinical therapeutics for IBS.