A case of neck pain in emergency department

Neck pain is a common presentation to the emergency department (ED) and a prominent source of disability in the adult population, accounting for about 10�% of the population. Neck pain can be challenging for ED clinicians to accurately diagnose and manage. The vital role of ED remains in diagnosing the musculoskeletal red flag conditions such as cervical spine fractures or dislocations, radiculopathies, and disk disruptions. However, most non-traumatic causes of neck pain do not have a specific pathoanatomical etiology that can be identified on imaging to identify the cause of pain in the absence of red flags signs. In this article, we would like to discuss one such case, wherein our patient, a 49-year-old gentleman presented to our ED with neck pain which rapidly progressed to quadri paresis within a short duration of ED stay and the diagnostic hurdles faced and the outcome of the patient.

Comparative assessment of the efficacy of low concentration bleaching agents using quantitative light induced fluorescence in removing stains An In vitro study

Background: Tooth discoloration has become a common esthetic problem in recent years. Removal of stains by bleaching is well-documented. Low concentration home bleaching products are available in market in different forms and concentrations. Aim: The aim of this study is to evaluate and compare the efficacy of low concentration commercially available home bleaching products (whitening strip, gel, and mouthwash) in removing stains and whitening the tooth using clinical and digital methods. Materials and Methods: Sixty permanent enamel samples mounted in an acrylic block were artificially stained and randomly divided into four groups. Negative control, 15 % Carbamide peroxide gel group, 2% Hydrogen 16 peroxide mouthwash group and 6% Hydrogen peroxide strip group respectively. The samples were bleached with respective agents according to the manufacturer's instructions. The efficacy on 7th and 14th day was evaluated clinically (SGU change), photographically (?E), and using quantitative light-induced fluorescence (?F). The data were analyzed using paired t-test and analysis of variance. Results: Postbleaching, 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement (??F – 15.73 and 11.89, ?E – 19.8 and 18.9, respectively) when compared to 2% hydrogen peroxide mouthwash and negative control group (??F – 9.68 and 6.59, ?E – 15.04 and 9.44, respectively). The difference was statistically significant (P = 0.001). Conclusion: 6% hydrogen peroxide strips and 15% carbamide peroxide gel showed maximum improvement in stain removal and tooth whitening however, the strips showed better efficacy than the gel. Strips have the added advantage of lesser contact period, less salivary dilution, and no gingival contact. Therefore, strips can be a better alternative for gels and mouthwashes.

Robotic-assisted interval cytoreductive surgery in ovarian cancer: a feasibility study

OBJECTIVE: The primary objective was to assess the feasibility of robotic-assisted interval cytoreductive surgery for achieving complete cytoreduction for patients with advanced-stage ovarian cancer. The secondary objective was to examine the perioperative outcomes.METHODS: A retrospective study of 12 patients with stage IIIC or IV ovarian, fallopian tube, and primary peritoneal carcinoma who underwent interval cytoreductive surgery after neo-adjuvant chemotherapy.RESULTS: Optimal cytoreduction was achieved in 100% of selected patients. Complete cytoreductive surgery was achieved in 75% of patients. The estimated mean blood loss was 100 mL. The median length of hospital stay was 2 days. Perioperative complication and 30-day readmission rates were 8.3% (1 patient). The median follow-up time was 9.5 months.CONCLUSION: Robotic-assisted interval cytoreductive surgery in ovarian cancer is safe and feasible and may be an alternative to standard laparotomy in selected patients.

Pseudomembranous Colitis: Do We Need A Screening.

In the last few decades, increasing use of antibiotics has dramatically increased incidences of antibiotic associated diarrhea. An unopposed homing of Clostridium difficile in ICU and wards put forward new challenges for physicians. Development of diarrhea during or just after hospital stay especially in old patients is a typical clinical presentation of C. difficile diarrhea. Cytotoxin assay from tissue culture is a gold standard diagnostic test but its poor availability, high cost, time bound results and rapidly development of life-threatening complications made us to think of a screening test. Demonstration of pathognomonic summit lesions and pseudomembrane with colonoscopy or sigmoidoscopy is relatively inexpensive, easily available and diagnosis is prompt. Our experience in few patients with colonoscopy makes us to recommend it as a screening test for all clinically suspected patients. Till today, it is refuted as first-line investigation because of good number of false negative results but demonstration of pathognomonic lesions even in few patients saves the life with minimal expenditure and least time wastage before initiation of definitive treatment.

Extrapulmonary multidrug resistant tuberculosis presenting as chest wall abscess - A rare case report.

Summary: Even though the prevalence of pulmonary drug resistant tuberculosis is showing an increasing trend globally, only a few case reports of extrapulmonary tuberculosis caused by drug resistant mycobacteria have been documented over the last decade. Extrapulmonary tuberculosis is not infrequent and may cause considerable morbidity and mortality. Tuberculous abscess over chest wall is commonly due to the spread from an adjacent affected lymph node group. Multidrug resistance poses a great challenge to the physicians in managing such a condition and significantly affects the prognosis. Here we report a rare presentation of multidrug resistant tuberculosis as anterior chest wall abscess in a young male.

An innovative technique to cut and extract loose bent Kuntscher nail.

Removal of a grossly deformed nail can be a serious and perplexing problem. We report an innovative technique to cut and extract a loose bent Kuntscher nail. The technique is simple and effective; can be used in peripheral hospitals where advanced gadgetries may not be present.