Physiographic Environment Classification: a Controlling Factor Classification of Landscape Susceptibility to Waterborne Contaminant Loss.

Spatial variation in the landscape factors climate, geomorphology, and lithology cause significant differences in water quality issues even when land use pressures are similar. The Physiographic Environment Classification (PEC) classifies landscapes based on their susceptibility to the loss of water quality contaminants. The classification is informed by a conceptual model of the landscape factors that control the hydrochemical maturity of water discharged to streams. In New Zealand, a case study using climatic, topographic, and geological data classified the country into six, 36, and 320 classes at Levels 1 (Climate), 1-2 (Climate + Geomorphology), and 1-3 (Climate + Geomorphology + Lithology), respectively. Variance partitioning analysis applied to New Zealand's national surface water monitoring network (n = 810 stations) assessed the contributions of PEC classes and land use on the spatial variation of water quality contaminants. Compared to land use, PEC explained 0.6× the variation in Nitrate Nitrite Nitrogen (NNN), 1.0× in Total Kjeldahl Nitrogen (TKN), 1.8× in Dissolved Reactive Phosphorus (DRP), 2.3× in Particulate Phosphorus (PP), 2.6× in E. coli, and 4.3× in Turbidity (TURB). Land use explained more variation in riverine NNN, while landscape factors explained more variation in DRP, PP, E. coli, and TURB. Overall, PEC accounted for 2.1× more variation in riverine contaminant concentrations than land use. The differences in contaminant concentrations between PEC classes (p < 0.05), after adjusting for land use, were consistent with the conceptual model of hydrochemical maturation. PEC elucidates underlying causes of contaminant loss susceptibility and can inform targeted land management across multiple scales.

Lateral Femoral Cutaneous Nerve Cryoneurolysis for Meralgia Paresthetica: A Case Report.

Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are short-lived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain.

Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study.

Post-COVID-19 condition, also known as long COVID-19 syndrome and post-acute sequelae of SARS-CoV-2, encompasses an array of symptoms that persist well beyond the initial phase of the viral infection. These symptoms can range in intensity, from mild and manageable to severe and incapacitating. Due to the evolving nature of the SARS-CoV-2 pandemic, treatment protocols for the illness are in a constant state of evolution. The early stage of long COVID-19 syndrome contributes to a dearth of treatment protocols based on empirical evidence, while the absence of a conclusive pathophysiological understanding further complicates the development of such protocols. Current treatment regimens include homeopathic medicine, specialist system-focused treatments, infusion therapies, hyperbaric oxygenation, antivirals, and polypharmacy. The physiological, psychological, and societal impact of long COVID-19 cannot be approached casually and must govern the intensity with which the healthcare community approaches the treatment of long COVID-19 syndrome. In this 41-patient cohort study from a chronic pain management practice, the use of either unilateral or bilateral stellate ganglion block (SGB) was explored to manage symptoms associated with long COVID-19 syndrome. Results indicated that a substantial proportion of patients (86%) experienced a reduction of their symptoms following SGB treatment.

Pneumocephalus secondary to removal of an osteoma from the paranasal sinuses of a horse.

CASE DESCRIPTION: A 2-year-old Quarter Horse was evaluated because of a progressive left-sided facial deformity and unilateral nasal and ocular discharge. CLINICAL FINDINGS: Physical examination revealed convexity of the left frontonasal region, left-sided nasal and ocular discharge, and decreased air flow through the left nares. Radiography and computed tomography revealed an extensively mineralized mass occupying most of the left paranasal sinuses. TREATMENT AND OUTCOME: The mass was surgically debulked, but complete removal was precluded because the mass was tightly adhered to the frontal and maxillary bones. Results of histologic examination of the mass were consistent with a diagnosis of osteoma. The horse developed transient pyrexia and colic following surgery, and postoperative radiography revealed gas opacities in the lateral ventricles of the brain, consistent with iatrogenic pneumocephalus. However, the horse did not develop any neurologic signs and was performing normally 2 years after surgery. CLINICAL RELEVANCE: Findings reinforce concerns that paranasal sinus surgery in horses can be associated with intracranial complications such as pneumocephalus. In horses with a mass involving the paranasal sinuses, computed tomography may be helpful in determining the boundaries of the mass and formulating a surgical treatment plan.