Adult Epiglottitis as an Often Overlooked, Life-threatening Condition Requiring Special Airway Consideration; a Case Report.

After the implementation of vaccination against Haemophilus Influenza Type B (Hib), adult patients comprise the majority of patients with acute epiglottitis. Its presentation with stridor mandates swift recognition and intervention to prevent airway compromise and mortality. Here, we present a case of a 44-year-old male with diabetes mellitus who presented with acute onset of shortness of breath and stridor following days of throat soreness and fever. Initial treatment for suspected anaphylaxis provided partial relief, and emergency department evaluation revealed characteristic signs of acute epiglottitis on lateral soft tissue neck x-ray and nasopharyngoscopy. Treatment was initiated with intravenous ampicillin/sulbactam and dexamethasone, and the patient was discharged home on day 4. This case underscores the critical importance of maintaining a high index of suspicion for acute epiglottitis in adults presenting with stridor and respiratory distress. Prompt recognition, airway management, and appropriate antibiotic therapy are paramount in mitigating the potentially devastating outcomes associated with this condition. As demographics shift and vaccination impacts epidemiology, heightened vigilance in emergency settings is essential to improve outcomes in adult patients with acute epiglottitis.

The Role of Exercise in the Alleviation of Neuropathic Pain Following Traumatic Spinal Cord Injuries: A Systematic Review and Meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries. METHODS: The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source. RESULTS: Fifteen preclinical studies were included. Meta-analysis demonstrated that exercise significantly improves mechanical allodynia (standardized mean difference [SMD], -1.59; 95% confidence interval [CI], -2.16 to -1.02; p < 0.001; I2 = 90.37%), thermal hyperalgesia (SMD, 1.95; 95% CI, 0.96-2.94; p < 0.001), and cold allodynia (SMD, -2.92; 95% CI, -4.4 to -1.43; p < 0.001). The improvement in mechanical allodynia is significantly more in animals with a compression model of SCI (meta-regression coefficient, -1.33; 95% CI, -1.84 to -0.57; p < 0.001) and in mild SCI (p < 0.001). Additionally, the improvement was more prominent if the training was started 7 to 8 days postinjury (coefficient, -2.54; 95% CI, -3.85 to -1.23; p < 0.001) and was continued every day (coefficient, -1.99; 95% CI, -3.07 to -0.9; p < 0.001). Likewise, voluntary exercise demonstrated a significantly more effect size (coefficient, -1.45; 95% CI, -2.67 to -0.23; p = 0.02). CONCLUSION: Exercise is effective in the amelioration of neuropathic pain. This effect in mechanical allodynia is more prominent if voluntary, continuous training is initiated in the subacute phase of mild SCI.

Muscimol as a treatment for nerve injury-related neuropathic pain: a systematic review and meta-analysis of preclinical studies.

Background: : Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain. Methods: : Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source. Results: : Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; P < 0.0001; I2 = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; P < 0.0001; I2 = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; P < 0.0001; I2 = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (P < 0 .0001). Conclusions: : Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.

Soluble Suppression of Tumorigenicity-2 as a Candidate Prognostic Marker for Stroke: A Systematic Review.

Background: Risk stratification of patients for incidence of stroke and its outcomes can aid in decision-making regarding treatment options and rehabilitative care. We systematically reviewed the literature to provide comprehensive evidence for the value of serum soluble suppression of tumorigenicity-2 (sST-2) in the prediction of stroke incidence and the evaluation of post-stroke outcomes. Methods: The Medline, Scopus, Web of Science, and Embase databases were searched until the end of August 2022 for studies investigating the value of serum sST-2 in the prediction of stroke incidence and post-stroke outcomes. Results: Nineteen articles were included. The articles reported conflicting results on the predictive value of sST-2 measurement in the incidence of stroke. Studies investigating the value of sST-2 measurement for the prognosis of post-stroke outcomes have reported positive associations between sST-2 levels and post-stroke mortality, composite adverse events, major disability, cerebral-cardiac syndrome, and cognitive impairment. Conclusions: Although some studies have reported a predictive value of serum sST-2 measurement in the incidence of stroke, a clear consensus has yet to be reached because of discrepancies in the results. As for the prognosis of post-stroke outcomes, sST-2 may be a predictor of mortality, composite adverse events, and major disability after stroke. Overall, more well-designed prospective cohort studies are needed to reach a more decisive conclusion on the value of sST-2 measurement for the prediction of stroke and its outcomes and to determine optimal cutoffs.

Cerebellar Leukoencephalopathy following Fentanyl Intoxication. A case report and review of the literature.

The opioid crisis has become a significant public health concern in recent years. Although respiratory depression and overdose are the most reported side effects of fentanyl, there have been rare cases of cerebellar leukoencephalopathy (CLE) following fentanyl intoxication. A 29-year-old man with a history of opioid use disorder and intravenous drug use presented to the emergency room with significant ataxia and dysarthria following fentanyl intoxication. According to the patient, the symptoms began four days prior after "chasing the dragon" with "pure fentanyl", and he reported experiencing nausea and dizziness, particularly during ambulation. Neurological examination revealed a positive Romberg test, ataxia, and delayed speech. Brain magnetic resonance imaging (MRI) indicated there was toxic degeneration of the cerebellar white matter that extended into the posterior limbs of the internal capsule. Urine drug screening was positive for opioids, making fentanyl-induced cerebellar leukoencephalopathy the most likely diagnosis in this case. This case of opioid-induced CLE underscores the critical significance of early recognition, which is vital for enhancing a patient's recovery and averting the development of severe neurological complications.