Efficacy of Cyclooxygenase-2 Inhibitors for Headache in Acute Brain Injury: A Systematic Review.

Background: Headache management after acute brain injury (ABI) is challenging. While opioids are commonly used, selective cyclooxygenase-2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. Methods: A systematic review was conducted through MEDLINE and Embase for articles published through 09/2023 (PROSPERO CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using Distiller SR®. Descriptive statistics were used for data analysis, while meta-analysis was unfeasible due to study heterogeneity. Results: Of 3190 articles identified, six studies met inclusion criteria: four randomized controlled trials and two retrospective cohort studies, all conducted in neurosurgical patients (total n=738) between 2006-2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, while one showed improvement only at 6 hours postoperative, and one did not find significant differences. Pain scores decreased between 4-15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, while one reported a reduction at 12 hours postoperative only. Opioid consumption decreased between 9-90%. Two studies found a decrease in hospital-length-of-stay by ~1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically non-significant 3% reduction in the intervention group. Conclusions: In adults with ABI, COXIBs may serve as opioid-sparing adjunctive analgesics for headache control, with limited but pointed data to indicate efficacy in the post-neurosurgical setting. However, further safety data remains to be elucidated.

Aortoiliac Occlusion in a Rare Instance of Leriche Syndrome Type I in a 65-Year-Old Woman With Chronic Leg Discomfort Refractory to Pregabalin.

Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome, is a form of peripheral artery disease (PAD) that involves narrowing, and in severe cases, complete occlusion, of infrarenal abdominal aorta and/or iliac and femoropopliteal arteries. It classically presents as a triad of symptoms, i.e., leg pain, erectile dysfunction, and abnormally weak or absent femoral pulses. If untreated, it can progress to ischemia and gangrene of the affected regions of pelvis and lower extremities. Like any other PAD, AIOD is most commonly caused by atherosclerosis and usually occurs in strong association with severe cardiovascular diseases. Due to the rarity of this disease, its incidence and prevalence are still unknown making it harder to diagnose especially in patients without the classic risk factors and typical presentation. We report a case of AIOD in a 65-year-old woman who presented with atypical symptoms. She was diagnosed with AIOD type I upon further investigation, which was managed successfully.

Effects of the COVID-19 Pandemic on the Success of Traditional Small and Medium Enterprises (SMEs): An Investigation of the Footprints of Economic Crisis Attributable to COVID-19.

The COVID-19 pandemic created a significant economic decline and altered market behavior, forcing buyers and dealers online. The traditional local market merchants are not fully equipped with e-commerce business techniques and strategies, which is a barrier to their e-commerce behavior and success. The study aims to help small-medium firms adapt to an uncertain economic environment instead of reducing or shutting down business-like in Pakistan. From health to education, economy to domestic and social protection, various researches have been done since 2020. The researcher used primary data sources and did a Quantitative study after collecting the 240 samples size of data from the successful e-commerce players of Pakistan. The results confirm that customer satisfaction is essential for entrepreneurs to succeed, as customers were not satisfied with online shopping during COVID-19. Customer knowledge management (CKM) and job satisfaction (JS) are studied as potential and realized capacity variables. CKM act as a strategic asset to collect and assimilate the external customer knowledge. In contrast, satisfied employees act as a valuable asset that dynamically responds to changing customer needs and business environment by efficiently utilizing their knowledge and skills and reaching business success which is mirrored in customer satisfaction. Conclusive results enable practitioners to perceive the business success during economic crises in the organization's absorptive capacity.