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While stellate ganglion blockade (SGB) is commonly used in the treatment and management of patients who suffer from chronic pain, we are reporting a case where an ultrasound-guided SGB was used for management of acute perioperative pain for a patient undergoing upper extremity surgery. The patient was classified as the American Society of Anesthesiologists (ASA) class 1, without any significant past medical history, including no history of chronic pain, opioid use, or peripheral neuropathy. The patient was scheduled for tendon repair of the hand following trauma with subsequent lacerations. While general anesthesia, a brachial plexus blockade, or combination of the two are generally used in current practice for upper extremity surgery, these typically do not allow for intraoperative evaluation of motor function. In our case, an ultrasound-guided SGB was used to provide analgesia while still allowing for intraoperative assessment of motor function during the critical components of the repair. This case illustrates the potential advantages of an ultrasound-guided SGB for decreasing acute postoperative pain scores, decreasing overall postoperative pain medication use, as well as maintaining intraoperative motor function in cases where such monitoring may be advantageous and allow for optimal surgical repair.Coeliac disease is the most well-known cause of villous atrophy in duodenal biopsies. Other well recognised causes of villous atrophy include infection with Giardia duodenalis and HIV, peptic duodenitis, drug-induced enteropathy, common variable immunodeficiency, Crohn's disease, Whipple's disease, small intestinal bacterial overgrowth, eosinophilic gastroenteritis, tropical or collagenous sprue and autoimmune enteropathy. While mucosal adaptation due to malnutrition, leading to villous atrophy, has been reported in paediatric populations in Africa and South America, in hibernating animals and animal models of experimental starvation, there is very little literature on adult human subjects. We report a case of a 76-year-old gentleman, presenting with chronic metabolic acidosis and anorexia who was found to have villous atrophy on duodenal biopsy, in the absence of any evidence of coeliac disease or other non-coeliac enteropathy. The nutritional state improved with correction of the underlying metabolic abnormality, and serial endoscopic assessment showed improvement in the villous atrophy. We discuss the relationship between malnutrition and villous atrophy, and suggest a potential workup for non-coeliac villous atrophy.Human herpesvirus 6 (HHV-6) may lead to temporal lobe epilepsy (TLE). Psychotic syndrome frequency in the setting of TLE is 7% to 11%. We report a case of post-ictal psychosis (PIP) secondary to TLE in the setting of HHV-6 encephalitis. A 58-year-old male presented with a two-day history of severe confusion, personality changes, and new-onset psychosis. Lumbar puncture was positive for HHV-6. Electroencephalogram (EEG) revealed left temporal sharp waves during drowsiness and sleep, suggestive of focal epileptiform discharges without clinical seizures. Valproate and olanzapine were employed for epilepsy and agitation. Psychosis and confusion resolved with subsequent discharge. Out of the other diagnoses, PIP in the setting of TLE secondary to HHV-6 given the clinical response to acyclovir. While HHV-6 encephalitis may cause TLE, this patient did not have a history of seizures and EEG did not capture active seizures. It is unclear if the sharp waves were incidental or indicative of TLE. Additionally, PIP is seen more commonly with left-sided EEG changes. see more Low-dose olanzapine was efficacious in resolving symptoms, which is typical in PIP. Both HHV-6 encephalitis and TLE have the potential to cause memory impairments and personality changes, which were seen in this patient. Patients with both TLE and PIP are less likely to exhibit focal ictal discharges than those with only TLE, which may explain the absence of active seizure activity on EEG.Introduction Bariatric surgery offers superior benefits for weight loss, quality of life and a spectrum of metabolic diseases. Despite these benefits, studies so far have shown varying results on its effect on renal function. Aim In this study, we aim to look at bariatric surgery's effect on renal function at one, two and three year post operation (post-op). Methods This is a retrospective cross-sectional single-center study of patients who underwent bariatric surgery between 11/2008 and 06/2018. Renal function was calculated by using Cockroft-Gault equation, expressed as Creatinine Clearance (CrCl). Statistical analysis used was one-way ANOVA (Welch's) with Games-Howell Post-Hoc Test. Results From 307 patients who underwent bariatric surgery within the time period, 145 were studied. 30.3% (n=44) were male. The average age and body mass index (BMI) at referral were 48.1±8.6 years and 47.96±7.9 kgm-2 respectively, while the average age and BMI at surgery were 49.1±8.8 years and 40.62±4.2 kgm-2 respectively. Mean CrCl at surgery, year 1, year 2, and year 3 post-op were 172.35±53.29 mL/min, 179.20±57.87 mL/min, 142.35±46.05 mL/min, and 119.56±42.46 mL/min. Marginal improvement of CrCl at year one post-op (172.35±53.29mL/min to 179.20±57.87mL/min) was statistically insignificant (p=0.731). Meanwhile, there was statistically significant CrCl decline observed from year 1 to year 3 post-op (p less then 0.001). Conclusion Statistically insignificant marginal improvement in CrCl at year one post-op was noted. link2 Beyond this, there was steady CrCl decline, albeit remained higher than the lower limit for respective gender. We recommend for further studies that take into account additional factors affecting renal function.Coronavirus disease 2019 (COVID-19) pandemic is one of the biggest healthcare crises faced globally. Since its emergence, uncertainty about its progress and treatment options has challenged clinicians around the world. Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection pose a higher challenge due to the concerns of an already altered immune system during pregnancy and the disease's effect on the fetus. Thrombocytopenia is associated frequently with moderate to severe coronavirus disease and is also an established marker of worsening of the disease. However, it is infrequently seen in mild or asymptomatic cases. Neuraxial anesthesia is the preferred choice of anesthesia in COVID-19 positive patients but thrombocytopenia in a parturient with coronavirus disease can cause a dilemma for the obstetric anesthesiologist. Here we describe the management of four pregnant women with asymptomatic COVID-19 disease who had moderate to severe thrombocytopenia. These cases highlight the importance of careful monitoring of the platelet count of pregnant women with COVID-19 infection even if asymptomatic.Sequestered disc fragments do not have indistinctive features and often share the clinical and radiological presentation as spinal neoplasms making their diagnosis and treatment a clinical challenge. We report a rare case of sequestered lumbar disc fragment at the level of L2-L3 in a 70-year-old male who presented to the ER complaining of six years' history of low back pain with acute onset lower extremities weakness for six days, associated with right foot drop. He was admitted for tumor workup as the MRI showed diffuse bone high signal intensity throughout the spine with a soft tissue epidural mass at L2/3, causing severe compression on the cauda equina nerve roots. The patient underwent L2-L3 decompression and fixation, mass excision, multiple open biopsies. link3 Soft tissue biopsy of the mass revealed fibrocartilaginous tissue consistent with the intervertebral disc, while the bone biopsy was diagnostic of acute leukemia. The patient was observed postoperatively with unremarkable complications. He did well with physiotherapy, and there was a remarkable improvement of his right lower extremity power reaching 4/5. Our case presented a rare phenomenon in which sequestered disc fragments manifested clinically and radiologically as a spinal neoplasm. Vigilant history taking and physical examination are paramount; a physician should be watchful for any red flags that may warrant further investigation such as in our case.Background Proximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF. Methodology Pilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P0.0014). Conclusion The similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture.Non-small cell lung cancer (NSCLC) constitutes around 85% of lung cancer cases. Advanced non-small cell lung cancer has a poor prognosis. Immunotherapy plays a pivotal role in managing advanced non-small cell lung cancer not positive for driver mutations. Nivolumab is a monoclonal antibody against programmed death-ligand 1 (PDL1). It is approved as a second-line treatment for patients with advanced non-small cell lung cancer who progress on or after chemotherapy. We present a case of a 71-year-old female with advanced non-small cell lung cancer without any driver mutations diagnosed four years ago. Her disease progressed while on conventional chemotherapy, and she was started on nivolumab three and a half years ago. Her lung nodules resolved, she did not show signs of progression, and her performance status improved while on nivolumab. This case report highlights the current role of nivolumab in the management of NSCLC. Patients whose condition worsens while on conventional chemotherapy can respond very well to modern targeted immunotherapy.Surgical management of spinal burst fractures has progressed to include minimally invasive techniques as preferred modalities of treatment. Burst fractures with indications for surgical treatment either through instability or intractable pain classically have required pedicle screw fixation, which requires extensive dissection resulting in postoperative pain and significant recovery time, and also requires longer operative times with more potential blood loss. Balloon kyphoplasty is an established percutaneous technique that can provide quick pain relief for patients with intractable pain following compression and burst fractures, and vertebral body height can also be restored. In the present case, a female patient was seen in the emergency room with intractable pain and a dehiscent thoracolumbar incision after recently undergoing surgery with placement of a Hartshill rectangle and sublaminar wires at another institution for a T12 burst fracture (AO classification [AO] A4 and thoracolumbar injury classification and severity score [TLICS] 4) caused by a motor vehicle accident.