Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.

This report presents a perplexing case involving a 16-year-old adolescent presenting with persistent upper abdominal pain and distention. The patient had no history of substance abuse or animal-related encounters. Clinical examination revealed abdominal tension, distention, and localized tenderness. Laboratory analysis indicated elevated white blood cell count, mildly reduced hemoglobin and platelet levels, and notably heightened amylase and lipase levels. Serum albumin displayed a minor decrease. Despite repeated consultations and ultrasound evaluations, the underlying cause remained elusive. Advanced imaging unveiled substantial abdominopelvic ascites, a shrunken pancreas with an expanded main duct, and thickening at the ileocecal junction. Ascitic fluid analysis unveiled hemorrhagic fluid with elevated cell and neutrophil counts. Notably, the fluid accumulation extended into the omental apron covering the intestines. Biopsy results ruled out malignancy and chronic infections. We diagnosed him as a case of idiopathic chronic pancreatitis presenting as hemorrhagic ascites. This case underscores the intricacies of diagnosing complex abdominal disorders. A comprehensive approach, involving multidisciplinary collaboration, rigorous diagnostic assessments, and meticulous patient evaluation, is essential for elucidating such challenging clinical scenarios.

Pretibial pruritic papular dermatitis (PPPD) is a distinctive skin disorder in response to persistent pretibial manipulation. Clinically, it manifests as multiple discrete, pruritic, flesh-colored-to-erythematous papules and plaques confined to the pretibial area. The histological hallmark of PPPD comprises irregular epidermal psoriasiform hyperplasia with parakeratosis and spongiosis, dermal fibrosis, and lymphohistiocytic infiltration. Due to its rarity and underrecognition, the prevalence and standard treatment of the disease have yet to be well elucidated. Here, we present a case of PPPD in a 60-year-old female presenting with numerous pruritic, erythematous-to-brownish papules and plaques on bilateral pretibial areas for 1.5 years. The lesions were significantly improved after 1 month of additional treatment with oral pentoxifylline. In this report, we aim to raise awareness in recognizing PPPD since it manifests unique clinical, dermoscopic, and histological features, representing pretibial skin\'s response to chronic rubbing. In addition, we proposed a novel effective therapy for the disease using pentoxifylline.

BACKGROUND: Mycobacterium tuberculosis (Mtb) has been found to persist within cavities in patients who have completed their anti-tuberculosis therapy. The clinical implications of Mtb persistence after therapy include recurrence of disease and destructive changes within the lungs. Data on residual changes in patients who completed anti-tuberculosis therapy are scarce. This case highlights the radiological and pathological changes that persist after anti-tuberculosis therapy completion and the importance of achieving sterilization of cavities in order to prevent these changes.
METHODS: This is a case report of a 33 year old female with drug-sensitive pulmonary tuberculosis who despite successfully completing standard 6-month treatment had persistent changes in her lungs on radiological imaging. The patient underwent multiple adjunctive surgeries to resect cavitary lesions, which were culture positive for Mtb. After surgical treatment, the patient\'s chest radiographies improved, symptoms subsided, and she was given a definition of cure.
CONCLUSIONS: Medical therapy alone, in the presence of severe cavitary lung lesions may not be able to achieve sterilizing cure in all cases. Cavities can not only cause reactivation but also drive inflammatory changes and subsequent lung damage leading to airflow obstruction, bronchiectasis, and fibrosis. Surgical removal of these foci of bacilli can be an effective adjunctive treatment necessary for a sterilizing cure and improved long term lung health.

UNASSIGNED: and Importance: COVID-19 have wide array of clinical manifestation involving both respiratory and non-respiratory symptoms including neurological symptoms. Hiccups is the involuntary and spasmodic movement of the diaphragm and the intercoastal muscle that leads to the closure of the glottis and limitation of breathing in air.
UNASSIGNED: We present a case of a 72-year old SARS COV-2 positive male with hypertension who have persistent hiccup. The patient is a vaccinated subject with 2 dose of Vero cells.
UNASSIGNED: Vitals were stable.Mild dehydration was present.Bilateral Diffuse wheeze was present on Respiratory examination. No other abnormalities were detected during systemic examination.Imaging of his chest revealed bilateral mid-lung opacities and air bronchogram.
UNASSIGNED: Perisitent hiccup was treated with metoclopramide. The hiccups reduced as the patient required less oxygen supplementation and inflammatory indicators decreased.
UNASSIGNED: This case report tends to provide information and awareness among physicians regarding this atypical presentation of the disease.

To explore exposure to 22 persistent organic pollutants (POPs) and incident type 2 diabetes in a population-based, prospective cohort.
This case-cohort study on 753 participants without type 2 diabetes at baseline, was followed-up over nine years, as part of the French D.E.S.I.R. cohort. We measured 22 POPs in fasting serum at baseline. The associations between baseline POP concentrations, pre-adjusted for lipids, BMI, age and sex, with incident type 2 diabetes, were assessed using Prentice-weighted Cox regression models (time scale: age), adjusted for traditional confounding factors. POPs were also modelled summed in functional groups: polychlorinated biphenyls (∑PCB) and organochlorines (∑OC) and also individually, after log-transformation, in adjusted Cox models.
There were 200 incident diabetes cases over nine years. Pre-adjusted POP concentrations were not related to diabetes risk for any of the 22 POPs examined. The fully-adjusted hazard ratios (HRs) per interquartile range of the pre-adjusted POPs, ranged from 0.87 (95% CI: 0.64,1.19) to 1.22 (0.93,1.59,). For dichlorodiphenyldichloroethylene (p, p\'-DDE) and dichlorodiphenyltrichloroethane (p, p\'-DDT), the HRs were 1.09 (0.83,1.43) and 0.89 (0.70,1.13), respectively. The HRs for PeCB, HCB, β-HCH, γ-HCH, oxychlordane, trans-nonachlor were 0.98 (0.85,1.13), 1.06 (0.84,1.33), 1.22 (0.93,1.59), 1.13 (0.89,1.42), 1.00 (0.76,1.31), 0.86 (0.66,1.13), respectively. HRs for ∑PCB, ∑OC and for individual log-transformed POPs did not differ significantly from one.
We did not observe any relations between exposure to POPs and diabetes in this population-based cohort. These results do not support causal inferences reported in previous studies linking serum POP concentrations and diabetes risk.

The concern about microplastic (a group of polymers) in the environment may cause us to overlook a more substantial problem: microplastics will fragment into nanoplastics. This fragmentation will lead to a high number of nanoplastics particles. Such nanoplastic can be taken up by cells, as opposed to microscale particles that are either not or to much less extend taken up. Fragmentation into nano will also release materials previously safely embedded in the polymer. We here present results from 25 OECD/ISO in vivo hazard tests, and beyond, e.g. extended exposure duration, with Enchytraeus crypticus, using pristine nano-scale materials (NMs) [CuO, Fe2O3, Organic Pigment, MWCNT], fragmented products (polymers) with these NMs embedded in the matrices (FP_NM), and fragmented polymers without NMs (FP) [covering the 4 major plastic types: Acrylic, Polyethylene, Polypropylene and Epoxy]. For example, MWCNTs induced a highly significant population decrease after extended period of 60 days, despite having no impact after 28 days\' exposure, the standard OECD duration. We conclude, that the standard tests were not suitable to evaluate hazards of these plastic fragments, weathering/ageing of materials is recommended, and extension of test duration can add value to the testing of NMs. We must refocus the concern to testing with polymers (not only \"plastics\"), from micro-to nano-polymers, and from aquatic to terrestrial environments.

BACKGROUND: Helicobacter pylori infection is a well-established etiological factor for a variety of diseases such as peptic ulcer and gastric cancer. On the other hand, there is ongoing research suggesting that H. pylori might have a beneficial effect through a pivotal influence in the immunological response especially in asthma. The aim of the current case-control study was to evaluate the prevalence of H. pylori infection in asthmatic children.
METHODS: Twenty-seven children with exacerbation of persistent asthma, aged 8.6±4.5 years (18 males, 9 females) and 54 age-sex-matched non-asthmatic controls were enrolled. Clinical examination and laboratory investigations were performed. Detection of H. pylori antigen (HpSA) in stool samples was performed by a commercial kit (bioNexia® kit, BioMérieux). Serum specific IgG antibodies were detected by a rapid chromatographic immunoassay (DIAsourceImmunoAssays). Serum IgE concentration was determined by electrochemiluminescence (ECL) (Roche Elecsys) and IgE levels ≥ 90 IU/mL were considered significantly elevated.
RESULTS: In 3 (11.1%) of the 27 asthmatic children H. pylori infection (based on both detection of HpSA and specific IgG-Abs) was established, whereas as many as 16 of the 54 (29.6%) non-asthmatic ones were found infected (odds ratio 0.1; 95%CI, 0.039-0.305, p=0.026).
CONCLUSIONS: Our findings reveal an inverse relationship between H. pylori infection and children\'s persistent asthma in Greece.

Carpal tunnel syndrome (CTS) is the most frequently operated neurological disorder of the hand. Incidence of patients remaining symptomatic has been reported up to 30% after primary release. Revision surgery remains challenging although multiple surgical options have been described. In this case series a simple novel technique, the palmaris longus interposition, is described for the treatment of recurrent and persistent CTS. Patients who underwent PLI between October 2013 and 2018 and without underlying neurological or hand disorders severely affecting the operated hand were eligible for inclusion. All were preoperatively diagnosed with recurrent or persistent CTS based on clinical assessment. Eighteen patients with 20 operated hands consented to the study. Patient characteristics were retrospectively reviewed, including nerve conduction studies and ultrasound scans. Patients were postoperatively asked to classify their symptoms as resolved, improved, not improved or worsened. In addition, postoperative symptom severity and functional status were assessed using the Boston Carpal Tunnel Questionnaire. Ten hands showed recurrent symptoms while the other 10 showed persistent symptoms. The average follow-up was 15 months. No improvement was reported in 5 hands, whereas improvement or complete relief of symptoms was reported in 15 hands. The mean total score of the Boston Carpal Tunnel Questionnaire postoperatively was 2.29 and ranged between 1.26 and 4.32. These results suggest that using the palmaris longus tendon as interposition graft between the leaves of the flexor retinaculum may be a suitable technique for the management of patients with mild to moderate symptoms of recurrent and persistent CTS. Further research should investigate whether this technique has better outcome compared to other procedures.

Purpose: Post-traumatic CSF leaks are a complication in 2% of all head injuries. Majority of these patients will recover spontaneously. Whilst recent literature has predominantly centred on CSF leaks and their general investigations and management thereof, there is a paucity of information when it comes to those patients who have persistent post-traumatic CSF leaks, as well as the complication of recurrent meningitis. We present a patient with a persistent post-traumatic CSF leak who presented with recurrent bacterial meningitis thirteen times- the highest documented amount in an adult. We reviewed the literature with regards to the above as well.Material and Methods: We reviewed a vast array of journal articles on the topic of CSF leaks from the PubMed resource, and focused this review specifically on those that documented patients who had uncorrected CSF leaks and their outcomes.Results: Complications include meningitis and rhinorrhoea with brain abscesses and pneumocephalus occurring less frequently. Mortality has been documented to be 9% after 1 year. The rates of persistent CSF leaks were within the same range with an average calculated rate of 21%. Whilst meningitis was recorded and is common, it was not stipulated whether the incidences were recurrent.Conclusion: Post-traumatic persistent CSF leaks remain a therapeutic challenge and continued follow-up with early surgical intervention is highly recommended to prevent complications. One of the more serious complications of a persistent leak is meningitis. The long-term outcomes of recurrent meningitis could include cumulative focal neurological deficitis and cognitive impairment.