Serotonin norepinephrine reuptake inhibitors in managing neuropathic pain following spinal and non-spinal surgery: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: While serotonin norepinephrine reuptake inhibitors (SNRIs) offer promise in managing Post-surgical neuropathic pain (PSNP), uncertainties remain. This study aims to evaluate the effectiveness and adverse events of SNRIs in managing PSNP. METHODS: Systematic searches of PubMed, Embase, and Cochrane databases up to January 1st 2023 identified randomized controlled trials (RCTs) comparing SNRIs to placebo for PSNP. The primary outcome measures were pain at rest and adverse events post-surgery. Subgroup analyses were conducted based on surgical type and specific SNRIs. RESULTS: A total of 19 RCTs, encompassing 1440 participants (719 in the SNRI group vs 721 in the placebo group), met the inclusion criteria and were included. The pooled results demonstrated that pain scores were significantly lower in patients treated with SNRIs at 2 hours (MD:-0.26; 95%CI: -0.47 to -0.04; p=0.02), 6 hours (MD:-0.68; 95%CI: -1.01 to -0.34; p<0.0001), 24 hours (MD:-0.54; 95%CI: -0.99 to -0.09; p=0.02), and 48 hours (MD:-0.66; 95%CI: -1.23 to -0.10; p=0.02) post-surgery. In terms of adverse events, dizziness (OR:2.53; 95%CI: 1.34-4.78; p=0.004) and dry mouth (OR:2.21; 95%CI: 1.25-3.92; p=0.007) were significantly higher in the SNRIs group. Subgroup analysis showed that SNRI was found to significantly lower the 24-hour pain score after spinal surgery (MD:-0.45; 95%CI: -0.84 to -0.05; p=0.03). Duloxetine (MD:-0.63; 95%CI: -1.15 to -0.11; p=0.02) had a significant effect in lowering the 24-hour pain score at rest compared to placebo, whereas venlafaxine did not. CONCLUSIONS: SNRIs yielded considerable pain score reductions across multiple post-surgical intervals, although accompanied by an increased incidence of dizziness and dry mouth.

Cerebellar Cryptococcal Abscess in HIV-Negative Patient: A Case Report and Literature Review.

BACKGROUND: Cryptococcus is a common cause of opportunistic infection in HIV-positive patients. While the incidence of this disease has decreased in AIDS-associated cases, cryptococcal infection in immune-competent person has been increased. CASE PRESENTATION: We report a case of cryptococcosis and literature review of pathogenesis and clinical aspects of cryptococcal central nervous system infection. A 64-year-old man, from Flores, complaining of severe headache since a few days before admitted to hospital. Head MRI showed multiple hypointense lesions in the left cerebellar hemisphere, suspected abscess or metastatic process. HIV testing was non-reactive. Surgery was performed, and microscopic evaluation revealed multiple abscesses containing PAS-positive budding yeasts consistent with cryptococcal abscesses. CONCLUSION: Cryptococcosis rarely occur in immunocompetent patients. The clinical manifestation depends on pathogenic factors of pathogen and host factor. Treatment is with the administration of antifungal drugs, and the prognosis mostly depends on the underlying disease.

Chronic Osteomyelitis after Seven Years Neglected Bone Exposed in 12-Year-Old Boy: A Case Report.

BACKGROUND: Access to modern medicine is still limited in some rural areas in Indonesia. This is mostly due to lack of people's knowledge and concern for their health, especially in orthopaedic cases. Osteomyelitis is generally described as infection and inflammation of the bone, which results in local bone destruction, necrosis, and apposition of new bone. Chronic post-traumatic osteomyelitis (CPTO) is a complex condition and one of the most challenging problems in orthopaedic surgery that cause considerable morbidity. CASE PRESENTATION: We present a case of chronic post-traumatic osteomyelitis with radial nerve injury, in which radical surgical debridement and broad-spectrum antibiotic administration were done. A 12-year-old boy with a history of falling from the three-meter-high tree had swollen, deformed, and neglected humerus bone exposed. After stabilisation in the emergency room, surgical limb amputation was scheduled, yet the family refused this medical care and chose debridement instead. CONCLUSION: This case is an important addition to the literature about chronic post-traumatic osteomyelitis with neglected bone exposed and the lacking of society's concern in regards to orthopaedic cases.

Elevated High-Sensitivity C-Reactive Protein And Interleukin-6 Plasma As Risk Factors For Symptomatic Lumbar Osteoarthritis In Postmenopausal Women.

AIM: To determine whether elevated high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR), as risk factors of symptomatic lumbar osteoarthritis (OA) in estrogen deficiency postmenopausal women. METHODS: A case-control study was conducted between January and June 2017. The inclusion criteria include post-menopausal women with estrogen deficiency with low back pain. Exclusion criteria were: patients with a history of undergoing bilateral oophorectomy, taking hormonal replacement therapy or corticosteroid, malignancies, and lumbosacral spine trauma. The blood examinations were taken to measure IL-6 level by ELISA, hs-CRP level by spectrophotometry and ESR by modified Westergren method. RESULTS: A group of 44 pairs of subjects were divided equally into case and control groups showed that in estrogen deficiency postmenopausal women, an increased level of hs-CRP increased the risk for symptomatic lumbar OA (OR = 2.83, CI95% = 1.065-8.776, p = 0.034). Also, a high level of IL-6 increased the risk of symptomatic lumbar OA (OR = 2.7, CI95% = 0.991-8.320, p = 0.033). No such significant findings were found for an increased ESR level. CONCLUSION: Elevated level of plasma hs-CRP and IL-6 were concluded as risk factors for symptomatic lumbar OA in post-menopausal women.

Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016.

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33-77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.