As the global community continues to recover from the COVID-19 pandemic, the World Health Organization has issued a warning of another viral infection, mpox (monkeypox), that can pose a significant threat to public health. Mpox was once endemic in Africa but has spread globally, prompting the World Health Organization to declare it a public health emergency. In response, healthcare personnel must initiate timely, decisive, and robust action before the infection escalates. Moreover, accurate diagnosis is crucial, given the similarity between mpox and other rash-causing infections. This article provides a comprehensive overview of the symptoms, differentiating it from similar diseases, risk assessment, and treatment strategies. In addition, it aims to educate healthcare personnel with the necessary knowledge to educate others and take preventative measures when handling cases, thereby avoiding the spread of infection.

Objective: To compare the characteristics of patients between adverse event (AE) group and non-AE group, and to assess the causes, preventability, and severity of AE. Methods: A retrospective triple-phase medical record study was conducted at a Spanish tertiary hospital. Data was collected over a 6-month period, including all patients with an unplanned intensive care admission. Demographic characteristics, APACHE II, length of ICU stay, mortality were compare between AE and non-AE group causes, preventability and severity were analyzed in AE cases. Results: 597 Patients were included in the study. The overall incidence of AEs was 17.3% (n=103), of which 83.5% were considered preventable. Mortality within the AE group was higher than in the non-AE group (23.3% vs. 13.6%), making it 1.7 times more frequent in the AE group (95% CI: 1.143-2.071). The primary cause of AE was associated with surgical procedures (43.7%). Of the AEs, 18.4% were classified as mild, 58.3% as moderate, and 23.3% as severe. Conclusions: The incidence of unplanned intensive care admissions due to AE is high and potentially preventable. This is concerning given the high mortality observed in patients admitted to the intensive care unit because of an AE, although direct causality cannot always be established. The findings emphasize the importance of patient safety and underscore the need for improved quality and management of care resources. They also indicate where efforts should be directed to enhance care risk management.

Objective: To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia (IVRA) on pain and hemodynamic parameters. Methods: This randomized controlled trial was done in 2023. Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital, Arak, Iran. They were allocated by block randomization to three different groups, namely nitroglycerin group, rocuronium group and control group. Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time. Sensory block and motor block onset and duration and pain were also evaluated. The data analysis was carried out by IMB SPSS software 20.0. Results: 177 Eligible patients were included in study, with 59 in each group. Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups ( P<0.001). Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness. The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups ( P=0.009). Conclusions: Nitroglycerin significantly reduces the time to sensory and motor block onset, while rocuronium is more effective in prolonging the time of motor block. Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration, nitroglycerin is associated with a higher prevalence of medication side effects. Therefore, both nitroglycerin and rocuronium can be used as adjuvant for IVRA. The final choice relies on patients’ conditions and anesthesiologists’ judgment.

Objective: To investigate the effectiveness of the systemic immune-inflammatory (SII) index and other inflammatory parameters in predicting mortality among patients with acute cholecystitis (AC). Methods: 279 Patients presented to the emergency department with abdominal pain and diagnosis of AC between September 2021 and September 2023 were included in the study. Demographic data, laboratory parameters, clinical follow-ups, and outcomes of the patients were recorded. Results: The mean age of the patients was (55.0±16.3) years and 36.6% were male. 63.8% Had gallbladder/choledochal stones and 49.5% underwent surgery. The mortality rate was 6.1%. Advanced age (P=0.170) and prolonged hospitalization (P=0.011) were statistically significant risk factors for mortality. Decreased lymphocyte count (P=0.020) and increased C-reactive protein (CRP) levels (P=0.033) were found to be risk factors for mortality. According to the mortality predictor ROC analysis results, the cut-off for SII index was 3 138 (AUC=0.817, sensitivity=70.5%, specificity=84.7%), the cut-off for neutrophil count was 15.28×10³/mm³ (AUC=0.761, sensitivity=52.9%, specificity=95.0%), the cut-off for leukocyte count was 19.0×10³/mm³ (AUC=0.714, sensitivity=52.9%, specificity=98.0%), cut-off for CRP was 74.55 (AUC=0.758, sensitivity=70.5%, specificity=79.0%), cut-off for aspartate transaminase (AST) was 33.0 IU/L (AUC=0.658, sensitivity=82.3%, specificity=50.3%). Conclusions: The SII index may be a good predictor of mortality with high sensitivity and specificity. Elevated levels of neutrophils, leukocytes, CRP, and AST are other inflammatory parameters that can be used to predict mortality associated with AC.

Rationale: Transmitted to humans via the Aedes mosquito, Chikungunya virus (CHIKV) is associated with multi-system complications, sometimes collectively referred to as “atypical features.” However, a disorder of the nervous system appears to be the most common severe complication of CHIKV infection. Patient’s Concern: A seventy-five-year-old patient from India presented to the hospital with fever, chills, rigors, and multiple joint pains for which he was worked up. Diagnosis: CHIKV encephalitis. Interventions: The patient was treated initially on supportive therapy with antipyretics, intravenous fluids; however, during his hospital stay, the patient had altered sensorium during which he was managed in the intensive care unit; required mechanical ventilation. Outcomes: The patient sccumbed to his illness. Lessons: Treating clinicians should keep CHIKV disease in the differential diagnosis in cases of febrile exanthems associated with disabling arthritis, especially in a CHIKV-endemic country like India.

Rationale: Lepromatous leprosy is a skin condition. Erythema nodosum leprosum (ENL) aids in its diagnosis. ENL is a type-2 immune response, whereas lepra ENL is characterized by a hypersensitivity reaction and an exaggerated immune response through a different pathway. Patient's Concern: A 40-year-old male patient, previously diagnosed with lepromatous leprosy, displayed painful skin lesions on his extremities. Diagnosis: Type-2 lepra reaction, specifically erythema nodosum leprosum. Interventions: The patient was initially treated with 100 mg dapsone daily and then with fusidic acid, prednisone, and other MDT agents, after development of dapsone resisitance. After type-2 lepra reaction was lessened in just two weeks, the regimen was adjusted to prednisolone (up to 2 g daily), thalidomide (300 mg daily), minocycline (1.5 g daily), ofloxacin (1 g twice daily), and pentoxifylline (400 mg three times daily) over a six-month period. Outcomes: The treatment effectively reduced the type-2 lepra reaction and improved the patient's skin lesions and overall health. Lessons: Healthcare providers should maintain a high level of awareness regarding the symptoms and medical history associated with ENL to facilitate timely diagnosis and appropriate management strategies. It is critical to tailor treatment to each patient’s symptoms and responses for successful management. Consistent monitoring of inflammatory markers and regular follow-up appointments play vital roles in preventing complications and ensuring positive outcomes for patients with ENL.