Postmastectomy Pain Syndrome: A Narrative Review.

Postmastectomy pain syndrome is a very common disorder in breast cancer survivors. The impact on the quality of patients' lives is significantly adverse. The precise pathophysiology has not been determined as yet though various risk factors have been identified that make the patient vulnerable. Required preoperative work includes the identification and possible elimination of risk factors. Treatment is multidisciplinary involving surgical and non-surgical modalities. There is a great scope of research in this field.

Perception, Awareness, and Practices Related to Burn First Aid Among the General Population in Qassim Region, Saudi Arabia.

OBJECTIVES: This study aims to assess the perception, awareness, and practices related to burn first aid among the general population in the Qassim region of Saudi Arabia. METHODS:  This is an observational, cross-sectional study that assesses perception, awareness, and practices related to burn first aid among the general population in the Qassim region of Saudi Arabia. The data was collected using questionnaires. The data was initially filtered and checked for completeness to rectify any errors or discrepancies. The Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM SPSS Statistics, Armonk, NY, USA) was used for data analysis. The data was coded before entry into the software program. Descriptive statistics were applied, summarizing the data in terms of frequency and percentage. Chi-square tests were used for analyzing categorical variables and to determine the association between the groups, with significance set at a P-value of 0.05. RESULTS:  Of the participants, 72.8% had previous knowledge regarding burns' first aid management. Furthermore, 3% obtained knowledge and information about burn first aid from a certified course, while 21.1% obtained the information from the Internet. Of the respondents, 77.8% indicated that during the exposure to burn, they would remove accessories and clothes that covered the injured area. Of them, 79.4% noted that they would apply water to the injured area in case of exposure to burns. In addition, 61.9% of the respondents used honey as a home remedy to treat burns, and 30.1% used toothpaste to treat burns. CONCLUSION: Of the general population in the Qassim region of Saudi Arabia, 72.8% had basic knowledge regarding burns' first aid management. The study found certified courses and the Internet to be the main sources of information and knowledge about burns' first aid management. The study found that clothes and accessories that covered the injured area should be removed when exposed to burns. In addition, cold water should be applied for a period of at least 10 minutes. The study found honey and toothpaste to be the most common home remedies used to treat burns. The use of pure honey is an accepted intervention in the treatment of burns due to its benefit in stimulating the rapid regeneration of tissues and decreasing incidences of scar formation. However, there are wrong beliefs about the use of toothpaste in cases of burns because it exacerbates the initial injury, making it even worse. There are significant differences in the perception, awareness, and practice of the general population according to their education level (P-value = 0.003) and employment (P-value = 0.007).

Tumoral pseudoangiomatous stromal hyperplasia (PASH) of the male breast: A systematic analysis.

<b><br>Aim:</b> The study was conducted to systematically analyze the recent peer-reviewed literature related to tumoral pseudoangiomatous stromal hyperplasia (PASH) in males.</br> <b><br>Materials and methods:</b> Articles published in peer-reviewed journals of repute from 2012 to 2023 were evaluated for eight variables: 1) the age of the patient, 2) clinical presentation, 3) laterality (unilateral or bilateral), 4) associated breast disorder, 5) the presence of systemic co-morbidity, 6) imaging modalities aiding diagnosis, 7) treatment, and 8) recurrence.</br> <b><br>Results:</b> There were 10 patients ranging in age from 1 year to 67 years (mean: 34.5 years). In 8 cases (80%), there were breast lumps; in 2 cases (20%), there were axillary lumps at presentation. Pain was not a prominent symptom. Six patients (60%) had another breast disorder at presentation and 3 (30%) had significant systemic co-morbidities, including diabetes and renal insufficiency. The greatest dimension of the lumps ranged from 2 cm to 12 cm, with 80% of the lumps being below 5 cm in size. Imaging modalities utilized in evaluation included breast ultrasound (USG), mammograms, computerized tomography (CT), and magnetic resonance imaging (MRI). All the cases were treated surgically, and the final diagnosis was made only after the analysis of the surgical specimen. Recurrence was recorded in 2 (20%) cases.</br> <b><br>Conclusions:</b> Tumoral PASH is a benign myofibroblastic proliferation disorder rarely reported in males. This condition should be considered a differential diagnosis of breast or axillary lumps, and an evaluation should be initiated accordingly. The recommended course of treatment is adequate surgical excision with regular clinical and radiological follow-up.</br>.

A Rare Case of COVID-19 Vaccine-Induced Thrombotic Thrombocytopenia in a Young Patient.

The syndrome of pulmonary SARS-Cov-2 resulted in significant morbidity and mortality, with new variants spreading rapidly. Vaccines to prevent COVID-19 have been developed to minimize the impact and severity; however, adverse effects of the vaccine have been documented in several studies. In our case, we report a case of a young female who presented to the emergency department with fever, dizziness, headache, vomiting, blurring of vision, numbness, and weakness of left upper and lower limbs. This weakness progressed rapidly to all limbs within two hours associated with altered behaviors and visual hallucinations. The family reported a history of the patient receiving her first dose of COVID-19 AstraZeneca vaccine 18 days before admission. Based on her clinical picture and investigation, she was diagnosed with vaccine-induced immune thrombotic thrombocytopenia (VITT). She was treated successfully with intravenous immunoglobulin (IVIG) and direct oral anticoagulant apixaban. In a time when there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalization, this particular clinical scenario emphasizes the need for all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.

Spilled gallstones after laparoscopic cholecystectomy: a systematic review.

<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 20122022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.