10751
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Ghosh S, Sahoo R, Rao S, Rath D. Pituitary macroadenoma: a rare cause of thyrotoxic hypokalaemic periodic paralysis. BMJ Case Rep 2013; 2013:bcr-2012-008411. [PMID: 23391961 DOI: 10.1136/bcr-2012-008411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyrotoxic hypokalaemic periodic palsy (THPP) is a well-recognised but under-diagnosed complication of hyperthyroidism and is commonly seen in Asian males. Patients usually present fully conscious with acute onset of severe motor weakness. Baseline investigation reveals severe hypokalaemia due to Na(+)/K(+) ATPase overactivity causing a massive influx of intracellular potassium ions. The most common cause of THPP identified in the medical literature is Graves' disease. We report an interesting and unusual case of THPP due to previously undiagnosed hyperthyroidism secondary to a pituitary macroadenoma. The patient was consequently found to have a tumour secreting gonadotropin and thyrotropin.
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Affiliation(s)
- Soumik Ghosh
- Department of Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India.
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10752
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Murinson BB, Gordin V, Flynn S, Driver LC, Gallagher RM, Grabois M. Recommendations for a new curriculum in pain medicine for medical students: toward a career distinguished by competence and compassion. PAIN MEDICINE 2013; 14:345-50. [PMID: 23387441 DOI: 10.1111/pme.12051] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The education of physicians is a fundamental obligation within medicine that must remain closely aligned with clinical care. And although medical education in pain care is essential, the current state of medical education does not meet the needs of physicians, patients, or society. To address this, we convened a committee of pain specialist medical student educators. METHODS Tasked with creating systematically developed and valid recommendations for clinical education, we conducted a survey of pain medicine leadership within the American Academy of Pain Medicine (AAPM). The survey was conducted in two waves. We asked AAPM board members to rate 194 previously published pain medicine learning objectives for medical students; 79% of those eligible for participation responded. RESULTS The "Top 5" list included the awareness of acute and chronic pain, skillfulness in clinical appraisal, promotion of compassionate practices, displaying empathy toward the patient, and knowledge of terms and definitions for substance abuse. The "Top 10" list included the major pharmacological classes as well as skills in examination, communication, prescribing, and interviewing. The "Top 20" list included the pain care of cognitively impaired populations, those with comorbid illness, and older adults. With the survey results in consideration, the committee produced a new recommended topic list for curricula in pain medicine. We strongly recommend that adequate resources are devoted to fully integrated medical curricula in pain so that students will learn not only the necessary clinical knowledge but also be prepared to address the professional, personal, and ethical challenges that arise in caring for those with pain. CONCLUSIONS We conclude that improved medical education in pain is essential to prepare providers who manifest both competence and compassion toward their patients.
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Affiliation(s)
- Beth B Murinson
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
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10753
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Matlani M, Kaur R, Shweta. A case of scedosporium prolificans osteomyelitis in an immunocompetent child, misdiagnosed as tubercular osteomyelitis. Indian J Dermatol 2013; 58:80-1. [PMID: 23372223 PMCID: PMC3555384 DOI: 10.4103/0019-5154.105319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Monika Matlani
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India. E-mail:
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10754
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Frehywot S, Vovides Y, Talib Z, Mikhail N, Ross H, Wohltjen H, Bedada S, Korhumel K, Koumare AK, Scott J. E-learning in medical education in resource constrained low- and middle-income countries. HUMAN RESOURCES FOR HEALTH 2013; 11:4. [PMID: 23379467 PMCID: PMC3584907 DOI: 10.1186/1478-4491-11-4] [Citation(s) in RCA: 238] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/23/2013] [Indexed: 05/06/2023]
Abstract
BACKGROUND In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used. METHODS Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators "AND" and "OR" to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles. RESULTS Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities. CONCLUSIONS E-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context.
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Affiliation(s)
- Seble Frehywot
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Yianna Vovides
- Georgetown University, 3700 O St NW, Washington, DC, 20057, USA
| | - Zohray Talib
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Nadia Mikhail
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Heather Ross
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Hannah Wohltjen
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Selam Bedada
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Kristine Korhumel
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
| | - Abdel Karim Koumare
- Université de Bamako - Colline de Badalabougou, BP E2528, Bamako, Mali, West Africa
| | - James Scott
- The George Washington University, 2121 K St NW, Washington, DC, 20037, USA
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10755
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Tana C, Tafuri E, Tana M, Martelletti P, Negro A, Affaitati G, Fabrizio A, Costantini R, Mezzetti A, Giamberardino MA. New insights into the cardiovascular risk of migraine and the role of white matter hyperintensities: is gold all that glitters? J Headache Pain 2013; 14:9. [PMID: 23565964 PMCID: PMC3620371 DOI: 10.1186/1129-2377-14-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/23/2013] [Indexed: 01/16/2023] Open
Abstract
The role of migraine as an independent risk factor for cardiovascular events has been debated for several years, while it is more established for ischemic stroke. Recently, new studies have examined the likelihood of migraine to determine cardiovascular events, supporting the hypothesis of a predominant role in patients with migraine with aura, the risk including both sexes. In the literature, multiple pathophysiological mechanisms are described to explain this association, and are here discussed. Furthermore, the emerging evidence that a higher headache frequency and long-term migraine may worsen the cardio-metabolic profile in migraineurs (e.g. with a higher Framingham risk score and risk of developing atherosclerosis, insulin resistance and metabolic syndrome) makes it increasingly necessary to reduce the number and severity of attacks, not only to alleviate the painful symptoms, but also to improve the prognosis in these patients.
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Affiliation(s)
- Claudio Tana
- Department of Medicine, "G, D'Annunzio" University of Chieti, and Center of Excellence on Aging, "G, D'Annunzio" University Foundation, Chieti, Italy
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10756
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Roos PM, Vesterberg O, Syversen T, Flaten TP, Nordberg M. Metal concentrations in cerebrospinal fluid and blood plasma from patients with amyotrophic lateral sclerosis. Biol Trace Elem Res 2013; 151:159-70. [PMID: 23225075 DOI: 10.1007/s12011-012-9547-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 11/08/2012] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal degenerative disorder of motor neurons. The cause of this degeneration is unknown, and different causal hypotheses include genetic, viral, traumatic and environmental mechanisms. In this study, we have analyzed metal concentrations in cerebrospinal fluid (CSF) and blood plasma in a well-defined cohort (n = 17) of ALS patients diagnosed with quantitative electromyography. Metal analyses were performed with high-resolution inductively coupled plasma mass spectrometry. Statistically significant higher concentrations of manganese, aluminium, cadmium, cobalt, copper, zinc, lead, vanadium and uranium were found in ALS CSF compared to control CSF. We also report higher concentrations of these metals in ALS CSF than in ALS blood plasma, which indicate mechanisms of accumulation, e.g. inward directed transport. A pattern of multiple toxic metals is seen in ALS CSF. The results support the hypothesis that metals with neurotoxic effects are involved in the pathogenesis of ALS.
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Affiliation(s)
- Per M Roos
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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10757
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Lim KS, Hills MD, Choo WY, Wong MH, Wu C, Tan CT. A web-based survey of attitudes toward epilepsy in secondary and tertiary students in Malaysia, using the Public Attitudes Toward Epilepsy (PATE) scale. Epilepsy Behav 2013; 26:158-61. [PMID: 23314303 DOI: 10.1016/j.yebeh.2012.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Students' attitudes toward epilepsy have been studied in several countries, but none of the studies used a quantitative scale. We aimed to determine the validity and reliability of the Public Attitudes Toward Epilepsy (PATE) scale in a homogenous population consisting of secondary and tertiary students in Malaysia and to quantify their attitudes toward epilepsy, using a web-based survey. RESULTS A total of 227 respondents with a mean age of 19.6±2.07 years, predominantly Chinese (85%), female (62%), and in a pre-university education level (71%) completed the web-based survey. Psychometric testing showed that the PATE is a valid and reliable scale to be applied in a homogenous population. The mean score in the personal domain was significantly higher than that in the general domain (2.73±0.61 vs. 2.12±0.60, respectively, p<0.001). Compared with a study previously performed on a general population (Lim et al., 2012 [10]), the mean score in the general domain was significantly lower (p<0.01), whereas there was no significant difference between the mean scores in the personal domain. The mean scores in the general domain were significantly lower for those with tertiary education (p<0.001) but did not correlate with gender and ethnicity. CONCLUSION The attitudes of secondary and tertiary students are more positive than those of the general population in the general domain but not in the personal domain.
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Affiliation(s)
- Kheng Seang Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
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10758
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Structural and molecular insights into the mechanism of action of human angiogenin-ALS variants in neurons. Nat Commun 2013; 3:1121. [PMID: 23047679 PMCID: PMC3493651 DOI: 10.1038/ncomms2126] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/06/2012] [Indexed: 12/11/2022] Open
Abstract
Mutations in angiogenin (ANG), a member of the ribonuclease A superfamily, are associated with amyotrophic lateral sclerosis (ALS; sporadic and familial) and Parkinson's disease. We have previously shown that ANG is expressed in neurons during neuro-ectodermal differentiation, and that it has both neurotrophic and neuroprotective functions. Here we report the atomic resolution structure of native ANG and 11 ANG-ALS variants. We correlate the structural changes to the effects on neuronal survival and the ability to induce stress granules in neuronal cell lines. ANG-ALS variants that affect the structure of the catalytic site and either decrease or increase the RNase activity affect neuronal survival. Neuronal cell lines expressing the ANG-ALS variants also lack the ability to form stress granules. Our structure–function studies on these ANG-ALS variants are the first to provide insights into the cellular and molecular mechanisms underlying their role in ALS. Mutations in human angiogenin are implicated in the progression of amyotrophic lateral sclerosis. Thiyagarajan and colleagues show that structural differences between angiogenin variants affect neuronal survival, and the ability to induce stress granules in neuronal cell lines.
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10759
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Zhu S, Rong Q, Chen S, Li X. Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia. J Craniomaxillofac Surg 2013; 41:652-6. [PMID: 23375531 DOI: 10.1016/j.jcms.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To explore an effective surgical treatment for pain in the distribution area of the maxillary branch of trigeminal nerve (TN). MATERIALS AND METHODS Twenty-six patients with pain in the distribution of the maxillary branch of TN were followed up after they had undergone pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route. RESULTS In all cases, the pain initially resolved after operation, with anaesthesia or paraesthesia in the operated side of the maxillary nerve-distributed area. After a mean follow-up period of 24 (range 3-36) months, 19 (73.08%) of the 26 patients had an excellent response, 5 (19.23%) had a good response, 2 (7.69%) had a fair response, and none (0%) had a poor response. One patient had a recurrence with palatal pain 3 months after the operation. CONCLUSIONS The maxillary sinus route can provide a clear vision for sectioning of the maxillary nerve. This new surgical technique has proven to be safe and effective. It provides another option for the weak elderly who are intolerant of craniotomy or patients who have contraindications for craniotomy when radiofrequency thermocoagulation (RFT) and percutaneous glycerol neurolysis (PGR) treatment is not possible.
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Affiliation(s)
- Shuangxi Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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10760
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Naik KR, Saroja AO, Khanpet MS. Reversible electrophysiological abnormalities in acute secondary hyperkalemic paralysis. Ann Indian Acad Neurol 2013; 15:339-43. [PMID: 23349611 PMCID: PMC3548384 DOI: 10.4103/0972-2327.104354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/14/2012] [Accepted: 06/23/2012] [Indexed: 11/26/2022] Open
Abstract
Hyperkalemia manifests clinically with acute neuromuscular paralysis, which can simulate Guillain Barré syndrome (GBS) and other causes of acute flaccid paralysis. Primary hyperkalemic paralysis occurs from genetic defects in the sodium channel, and secondary hyperkalemic paralysis (SHP) from diverse causes including renal dysfunction, potassium retaining drugs, Addison's disease, etc. Clinical characteristics of SHP have been addressed in a number of publications. However, electrophysiological evaluations of these patients during neuromuscular paralysis are infrequently reported and have demonstrated features of demyelination. The clinical features and electrophysiological abnormalities in secondary hyperkalemia mimic GBS, and pose diagnostic challenges. We report the findings of nerve conduction studies in a middle-aged man who was admitted with rapidly reversible acute quadriplegia resulting from secondary hyperkalemic paralysis.
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Affiliation(s)
- Karkal R Naik
- Department of Neurology, KLE University's Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Nehrunagar, Belgaum, India
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10761
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Affiliation(s)
- Nadir E Bharucha
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, 12 Marine Lines, Mumbai, Maharashtra, India
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10762
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Wang J, Nachtigal MW, Kardami E, Cattini PA. FGF-2 protects cardiomyocytes from doxorubicin damage via protein kinase C-dependent effects on efflux transporters. Cardiovasc Res 2013; 98:56-63. [PMID: 23341575 DOI: 10.1093/cvr/cvt011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The anti-cancer anthracycline doxorubicin (DOX) increases the risk of cardiac damage, indicating a need to protect the heart and still allow the benefits of drug treatment. Fibroblast growth factor-2 (FGF-2) is cardioprotective against ischaemia-reperfusion injury. Our aim is to investigate: (i) the ability of FGF-2 to protect against DOX-induced cardiomyocyte damage and (ii) the contribution of efflux drug transport to any increase in injury-resistance. METHODS AND RESULTS Neonatal rat cardiomyocyte damage was assessed by measuring cell death markers and lactate dehydrogenase (LDH) activity in the culture medium. LDH activity was increased significantly after incubation with 0.5 μM DOX for 24 h in the absence but not presence of 10 nM FGF-2; this beneficial effect of FGF-2 was blocked by tyrosine kinase (FGF) receptor inhibition. An increase in efflux drug transporter RNA levels was also detected after FGF-2 treatment in the presence of DOX. The beneficial effect of FGF-2 against cell damage and increased transporter RNA levels were blunted with protein kinase C (PKC) inhibition. Finally, FGF-2 stimulated efflux transport of calcein and DOX, and treatment with efflux transporter inhibitors significantly attenuated the protective effect of FGF-2 from DOX-induced injury. CONCLUSION Administered FGF-2 increases resistance to DOX-induced cardiomyocyte damage, by a mechanism dependent on PKC as well as regulation of efflux transporter production and/or function.
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Affiliation(s)
- Jie Wang
- Department of Physiology, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, Canada R3E 3J7
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10763
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Corticosteroids for neurocysticercosis: a systematic review and meta-analysis of randomized controlled trials. Int J Infect Dis 2013; 17:e583-92. [PMID: 23339852 DOI: 10.1016/j.ijid.2012.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 11/29/2012] [Accepted: 12/14/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neurocysticercosis is an infection of the central nervous system by the larval stage of Taenia solium. It is a major cause of epileptic seizures in low- and middle-income countries. Corticosteroids are frequently used to reduce inflammation and perilesional edema. We aimed to evaluate their efficacy for reducing the rate of seizures and lesion persistence in imaging studies. METHODS We searched randomized controlled trials in Medline, Central, EMBASE, LILACS, and the gray literature without language restrictions. We assessed eligibility, extracted data, and assessed the risk of bias in the included studies. The main outcomes included seizure recurrence and lesion persistence on imaging studies at 6-12 months of follow-up. Risk ratios (RR) were used for evaluating the main outcomes. RESULTS Thirteen studies involving 1373 participants were included. The quality of the evidence was deemed low to very low. Corticosteroids alone versus placebo/no drug (five trials) reduced the rate of seizure recurrence at 6-12 months (RR 0.46, 95% confidence interval (CI) 0.27-0.77; 426 participants) and the persistence of lesions in imaging studies (RR 0.63, 95% CI 0.43-0.92; 417 participants). No differences were noted in other comparisons, including the use of corticosteroids and albendazole combined. Corticosteroids plus albendazole increased the risk of abdominal pain, rash, and headaches (odds ratio 8.73, 95% CI 2.09-36.5; 116 participants, one trial). CONCLUSIONS Although the evidence suggest corticosteroids can reduce the rate of seizure recurrence and speed up resolution of lesions at 6-12 months of follow-up, there remains uncertainty on the effect estimate due to a high risk of methodological and publication bias. More adequately performed randomized trials that evaluate the use of anthelmintics, corticosteroids, and both combined against placebo are needed.
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10764
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Chaudhary SC, Sawlani KK, Malhotra HS, Singh J. Snake bite-induced leucoencephalopathy. BMJ Case Rep 2013; 2013:bcr2012007515. [PMID: 23334491 PMCID: PMC3604001 DOI: 10.1136/bcr-2012-007515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Snake bite is an important cause of mortality and morbidity in India with an estimated 35 000-50 000 fatal bites occurring annually. Neurological deficits following vasculotoxic snake bite are either due to intracranial haemorrhage or subarachnoid bleed as a result of consumption coagulopathy. However, ischaemic strokes and acute disseminated encephalomyelitis have been reported occasionally. We hereby report a case of snake bite leading to leucoencephalopathy.
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Affiliation(s)
- Shyam Chand Chaudhary
- Department of Medicine, K.G. Medical University (Erstwhile C.S.M.M.U.), Lucknow, Uttar Pradesh, India.
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10765
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10766
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Demir CF, İnci MF, Özkan F, Özdemir HH. Is it possible to detect active multiple sclerosis plaques using MR thermometry techniques? Med Hypotheses 2013; 80:321-4. [PMID: 23312112 DOI: 10.1016/j.mehy.2012.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/07/2012] [Accepted: 12/13/2012] [Indexed: 01/12/2023]
Abstract
Multiple sclerosis lesions or plaques are considered to be the result of an inflammatory process in the brain that leads to attack myelin. Inflammation causes disruption of blood-brain barrier in acute, active plaque areas. This process may lead to increase blood supply that causes increase in temperature in these associated areas. These plaques can be seen by examining the brain using magnetic resonance imaging (MRI). Presence of these plaques plays an important role in indicating dissemination in time within the new diagnostic criteria and in treatment of active MS. Gadolinium-based contrast agents help for quantitative assessment of inflammatory activity and lesion load. However, these agents have serious risks such as anaphylaxis and kidney damage. We wanted to open up a discussion for the feasibility of using noninvasive MR thermometer technique instead of conventional MRI techniques, for evaluating the temperature and the extent of temperature changes of white matter and plaques in MS patients. After successful using of MR thermometer technique with upgraded applications, the time needed to perform the studies in a routine setting can be significantly shortened. With eliminating usage of contrast agent, considerable influx money can be provided along with preventing the adverse effects and risks of contrast agent usage.
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Affiliation(s)
- Caner Feyzi Demir
- Department of Neurology, Firat (Euphrates) University Hospital, Elazığ, Turkey.
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10767
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Qi Z, Liu W, Luo Y, Ji X, Liu KJ. Normobaric hyperoxia-based neuroprotective therapies in ischemic stroke. Med Gas Res 2013; 3:2. [PMID: 23298701 PMCID: PMC3552719 DOI: 10.1186/2045-9912-3-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/07/2013] [Indexed: 01/11/2023] Open
Abstract
Stroke is a leading cause of death and disability due to disturbance of blood supply to the brain. As brain is highly sensitive to hypoxia, insufficient oxygen supply is a critical event contributing to ischemic brain injury. Normobaric hyperoxia (NBO) that aims to enhance oxygen delivery to hypoxic tissues has long been considered as a logical neuroprotective therapy for ischemic stroke. To date, many possible mechanisms have been reported to elucidate NBO’s neuroprotection, such as improving tissue oxygenation, increasing cerebral blood flow, reducing oxidative stress and protecting the blood brain barrier. As ischemic stroke triggers a battery of damaging events, combining NBO with other agents or treatments that target multiple mechanisms of injury may achieve better outcome than individual treatment alone. More importantly, time loss is brain loss in acute cerebral ischemia. NBO can be a rapid therapy to attenuate or slow down the evolution of ischemic tissues towards necrosis and therefore “buy time” for reperfusion therapies. This article summarizes the current literatures on NBO as a simple, widely accessible, and potentially cost-effective therapeutic strategy for treatment of acute ischemic stroke.
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Affiliation(s)
- Zhifeng Qi
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, No,45 Changchun Street, Beijing, 100053, China.
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10768
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Comparative docking and ADMET study of some curcumin derivatives and herbal congeners targeting β-amyloid. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13721-012-0021-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10769
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Rhabdomyolysis and dengue Fever: a case report and literature review. Case Rep Med 2013; 2013:101058. [PMID: 23424589 PMCID: PMC3568885 DOI: 10.1155/2013/101058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 12/17/2012] [Indexed: 01/06/2023] Open
Abstract
The medical literature contains only a few reports of rhabdomyolysis occurring in patients with dengue fever. We report the case of a 25-year-old Jamaican man who was admitted to a private hospital four days after the onset of an acute febrile illness with fever, myalgia, and generalized weakness. Dengue fever was confirmed with a positive test for the dengue antigen, nonstructural protein 1. He remained well and was discharged on day 6 of his illness. On day 8, he started to pass red urine and was subsequently admitted to the University Hospital of the West Indies. On admission he was found to have myoglobinuria and an elevated creatine phosphokinase (CPK) of 325,600 U/L, leading to a diagnosis of rhabdomyolysis. Dengue IgM was positive. He was treated with aggressive hydration and had close monitoring of his urine output, creatinine, and CPK levels. His hospital course was uneventful without the development of acute renal failure and he was discharged after 14 days in hospital, with a CPK level of 2463 U/L. This case highlights that severe rhabdomyolysis may occur in patients with dengue fever and that early and aggressive treatment may prevent severe complications such as acute renal failure and death.
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10770
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Camara-Lemarroy CR, Lara-Campos JG, Perez-Contreras E, Rodríguez-Gutiérrez R, Galarza-Delgado DA. Takayasu's arteritis and posterior reversible encephalopathy syndrome: a case-based review. Clin Rheumatol 2013; 32:409-15. [PMID: 23292521 DOI: 10.1007/s10067-012-2151-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
Autoimmune vasculitides can have diverse neurological manifestations, including posterior reversible encephalopathy syndrome (PRES). Takayasu's arteritis (TA) is an uncommon vasculitis rarely associated with PRES. Common clinical features of TA include hypertension, audible arterial bruits, absence of peripheral pulses, claudication of the extremities, reduced blood pressure in one or both arms, and angiographic abnormalities. PRES has been mostly associated with severe hypertension, endothelial injury, and conditions such as renal disease, immunosuppressive medication use, and rheumatologic diseases. Headaches, seizures, and altered mental status are the main clinical features as well as characteristic findings in magnetic resonance imaging. TA frequently presents with hypertension and is associated with endothelial injury, making this entity an ideal setting for the development of PRES. We report the case of a 17-year-old female who presented to the emergency department with severe hypertension, headache, and seizures. Magnetic resonance imaging findings were suggestive of PRES. She had absent pulses in the right upper extremity, abdominal bruits, and angiographic findings included subclavian and renal artery stenoses. The diagnosis of TA was made, and she responded well to treatment. We found ten additional cases of TA and PRES in the literature. All patients were females under the age of 40, had renovascular hypertension, and presented with headaches and seizures. Current literature relevant to this rare association is presented and discussed.
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Affiliation(s)
- Carlos Rodrigo Camara-Lemarroy
- Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, Nuevo León 64460, México.
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10771
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Kapur N, Cole J, Manly T, Viskontas I, Ninteman A, Hasher L, Pascual-Leone A. Positive Clinical Neuroscience. Neuroscientist 2013; 19:354-69. [DOI: 10.1177/1073858412470976] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disorders of the brain and its sensory organs have traditionally been associated with deficits in movement, perception, cognition, emotion, and behavior. It is increasingly evident, however, that positive phenomena may also occur in such conditions, with implications for the individual, science, medicine, and for society. This article provides a selective review of such positive phenomena – enhanced function after brain lesions, better-than-normal performance in people with sensory loss, creativity associated with neurological disease, and enhanced performance associated with aging. We propose that, akin to the well-established field of positive psychology and the emerging field of positive clinical psychology, the nascent fields of positive neurology and positive neuropsychology offer new avenues to understand brain-behavior relationships, with both theoretical and therapeutic implications.
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Affiliation(s)
| | | | - Tom Manly
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
| | - Indre Viskontas
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Hasher
- University of Toronto, Toronto, Ontario, Canada
| | - Alvaro Pascual-Leone
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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10772
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Nebhinani N. Commentary. J Neurosci Rural Pract 2013; 4:154-5. [PMID: 23914090 PMCID: PMC3724292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, Postgraduate Institute Medical Science, Rohtak, Haryana, India,Address for correspondence: Dr. Naresh Nebhinani, Department of Psychiatry, Postgraduate Institute Medical Science, Rohtak, Haryana, India. E-mail:
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10773
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Priyadarshini N, Rajkumar ER. Finite Element Modeling of scattered electromagnetic waves for stroke analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:2404-2407. [PMID: 24110210 DOI: 10.1109/embc.2013.6610023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Stroke has become one of the leading causes of mortality worldwide and about 800 in every 100,000 people suffer from stroke each year. The occurrence of stroke is ranked third among the causes of acute death and first among the causes for neurological dysfunction. Currently, Neurological examinations followed by medical imaging with CT, MRI or Angiography are used to provide better identification of the location and the type of the stroke, however they are neither fast, cost-effective nor portable. Microwave technology has emerged to complement these modalities to diagnose stroke as it is sensitive to the differences between the distinct dielectric properties of the brain tissues and blood. This paper investigates the possibility of diagnosing the type of stroke using Finite Element Analysis (FEA). The object of interest is a simulated head phantom with stroke, created with its specifying material characteristics like electrical conductivity and relative permittivity. The phantom is then placed in an electromagnetic field generated by a dipole antenna radiating at 1 GHz. The FEM forward model solver computes the scattered electromagnetic field by finding the solution for the Maxwell's wave equation in the head volume. Subsequently the inverse scattering problem is solved using the Contrast Source Inversion (CSI) method to reconstruct the dielectric profile of the head phantom.
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10774
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Bose KSC, Gokhale PV, Dwivedi S, Singh M. Quantitative evaluation and correlation of serum glycoconjugates: Protein bound hexoses, sialic acid and fucose in leukoplakia, oral sub mucous fibrosis and oral cancer. J Nat Sci Biol Med 2013; 4:122-5. [PMID: 23633847 PMCID: PMC3633261 DOI: 10.4103/0976-9668.107275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is one of the most common causes of mortality and morbidity today, with more than 10 million new cases and more than 6 million deaths each year worldwide. Globally Oral Cancer is the sixth most common cause of cancer related death. India accounts for 86% of the world's oral cancer cases. Often it proceeds by pre cancerous conditions and lesions. In search for biological markers with diagnostic value, we investigated serum glycoconjugates like protein bound hexoses, fucose and sialic acid in these diseases. MATERIALS AND METHODS For this Study 27 newly diagnosed Oral leukoplakia, 27 OSMF and 26 Oral Cancer patients, 40 healthy controls who are non tobacco users and 40 healthy controls who are tobacco users were selected. In all these groups we estimated serum glycoconjugates. RESULTS We observed no difference in serum glycoconjugates levels between tobacco and non tobacco controls (P > 0.05), but very high levels in oral cancer, Leukoplakia and oral sub mucous fibrosis (OSMF) patients (P < 0.001) when compared to control groups. Fucose levels were significant (P < 0.05) of all the glycoconjugates between OSMF and Leukoplakia. CONCLUSION The serum glycoconjugates whose levels were very high in OSMF, Leukoplakia and Oral Cancer, do have a significant diagnostic and prognostic value in these diseases.
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Affiliation(s)
- K. Subhash Chandra Bose
- Department of Biochemistry, L. N. Medical College and Research Centre, Kolar Road, Bhopal, India
| | - Prerna Vyas Gokhale
- Department of Biochemistry, L. N. Medical College and Research Centre, Kolar Road, Bhopal, India
| | - Sunil Dwivedi
- Department of Biochemistry Kalka Dental College, Meerut, Uttar Pradesh, India
| | - Manika Singh
- Department of Oral Medicine, Peoples College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
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10775
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Maladkar M, Saggu NJS, Moralwar P, Mhate AA, Zemse D, Bhoraskar A. Evaluation of efficacy and safety of epalrestat and epalrestat in combination with methylcobalamin in patients with diabetic neuropathy in a randomized, comparative trial. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jdm.2013.31004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10776
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Intracranial hypotension syndrome: A post dural puncture headache? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2012.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10777
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Sharma G, Sood S, Sharma S. Seasonal, Age & Gender Variation of Guillain Barre Syndrome in a Tertiary Referral Center in India. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/nm.2013.41004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10778
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Varghese T, Sheelakumari R, James JS, Mathuranath P. A review of neuroimaging biomarkers of Alzheimer's disease. NEUROLOGY ASIA 2013; 18:239-248. [PMID: 25431627 PMCID: PMC4243931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Neuroimaging biomarkers have potential role in the early diagnosis as well as periodic follow-up of neurodegenerative diseases such as Alzheimer's disease (AD). Structural imaging biomarkers can be used to predict those who are at risk or in preclinical stages of AD. It could possibly be useful even in predicting the conversion of Mild Cognitive Impairment (MCI) an early stage of AD to AD. In addition there has been a lot of progress in molecular imaging in AD. This article presents a review of recent progress in selected imaging biomarkers for early diagnosis, classification, and progression, of AD. A comprehensive integrative strategy initiated early in the cognitive decline is perhaps the most effective method of controlling progression to Alzheimer's disease.
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Affiliation(s)
- Tinu Varghese
- Cognition and Behavioral Neurology Section, Department of Neurology, Trivandrum ; Department of Electronics and Instrumentation, Noorul Islam University, Kumaracoil, Thuckalay, Tamilnadu
| | - R Sheelakumari
- Cognition and Behavioral Neurology Section, Department of Neurology, Trivandrum
| | - Jija S James
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum
| | - Ps Mathuranath
- Cognition and Behavioral Neurology Section, Department of Neurology, Trivandrum ; Cognition & Behavioural Neurology Section, Department of Neurology, National Institute of Mental Health & Neuro Sciences, Banglore, India
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10779
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Jacob KS, Kallivayalil RA, Mallik AK, Gupta N, Trivedi JK, Gangadhar BN, Praveenlal K, Vahia V, Rao TSS. Diagnostic and statistical manual-5: Position paper of the Indian Psychiatric Society. Indian J Psychiatry 2013; 55:12-30. [PMID: 23441009 PMCID: PMC3574451 DOI: 10.4103/0019-5545.105500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The development of the Diagnostic and Statistical Manual-5 (DSM-5) has been an exhaustive and elaborate exercise involving the review of DSM-IV categories, identifying new evidence and ideas, field testing, and revising issues in order that it is based on the best available evidence. This report of the Task Force of the Indian Psychiatric Society examines the current draft of the DSM-5 and discusses the implications from an Indian perspective. It highlights the issues related to the use of universal categories applied across diverse cultures. It reiterates the evidence for mental disorders commonly seen in India. It emphasizes the need for caution when clinical categories useful to specialists are employed in the contexts of primary care and in community settings. While the DSM-5 is essentially for the membership of the American Psychiatric Association, its impact will be felt far beyond the boundaries of psychiatry and that of the United States of America. However, its atheoretical approach, despite its pretensions, pushes a purely biomedical agenda to the exclusion of other approaches to mental health and illness. Nevertheless, the DSM-5 should serve a gate-keeping function, which intends to set minimum standards. It is work in progress and will continue to evolve with the generation of new evidence. For the DSM-5 to be relevant and useful across the cultures and countries, it needs to be broad-based and consider social and cultural contexts, issues, and phenomena. The convergence and compatibility with International Classification of Diseases-11 is a worthy goal. While the phenomenal effort of the DSM-5 revision is commendable, psychiatry should continue to strive for a more holistic understanding of mental health, illness, and disease.
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Affiliation(s)
- K. S. Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - R. A. Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - A. K. Mallik
- Department of Psychiatry, Burdwan Medical College, Burdwan, India
| | - N. Gupta
- Department of Psychiatry, Govt. Medical College and Hospital, Chandigarh, India
| | - J. K. Trivedi
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
| | - B. N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - K. Praveenlal
- Department of Psychiatry, Kerala University of Health Sciences, Trichur, Kerala, India
| | - V. Vahia
- Department of Psychiatry, Cooper Hospital, Mumbai, Maharashtra, India
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10780
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Baweja R, Avasthi A, Chakrabarti S, Prabhakar S. Psychiatric morbidity in patients with transverse myelitis and stroke: A comparison. Indian J Psychiatry 2013; 55:59-62. [PMID: 23439765 PMCID: PMC3574457 DOI: 10.4103/0019-5545.105509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Psychiatric morbidity may be highly prevalent in transverse myelitis (TM), but data on this aspect are limited. AIM To assess psychiatric morbidity in a clinical sample of patients with idiopathic TM compared to patients with a recent stroke. MATERIALS AND METHODS Consecutive patients with idiopathic TM and stroke (30 each) underwent two-stage screening with the General Health Questionnaire-12 (GHQ-12) and Structured Clinical Interview for Axis I DSM-IV Disorders - Clinician Version (SCID I-CV), and ratings of depression, disability levels, and cognitive impairment. RESULTS Seventy percent of the patients with TM scored above the cut-off on the GHQ; 30% had a positive diagnosis of a psychiatric disorder. Major depression (17%) was the commonest psychiatric disorder. Mini-Mental State Examination (MMSE) scores indicated cognitive impairment in 23% of patients with TM. Higher GHQ-12 scores were associated with greater disability. These results were similar to those obtained among patients with stroke. CONCLUSION A high prevalence of psychological distress and psychiatric morbidity was found in idiopathic TM. This morbidity was associated with greater disability.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry and Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry and Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudesh Prabhakar
- Department of Psychiatry and Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10781
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Authors' reply. Ann Indian Acad Neurol 2013; 16:459-60. [PMID: 24101852 PMCID: PMC3788316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10782
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Custodio N, Herrera-Perez E, Lira D, Montesinos R, Bendezu L. Prevalence of frontotemporal dementia in community-based studies in Latin America: a systematic review. Dement Neuropsychol 2013; 7:27-32. [PMID: 29213816 PMCID: PMC5619541 DOI: 10.1590/s1980-57642013dn70100005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/13/2013] [Indexed: 11/30/2022] Open
Abstract
Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in geriatric problems such as dementia. There are few epidemiological studies assessing the magnitude of dementia and dementia subtypes in LA. OBJECTIVE To identify published community-based studies on the prevalence of FTD in LA countries. METHODS A database search for door-to-door studies on FTD prevalence in LA was performed. The search was carried out on Medline, Embase, and LILACS databases for research conducted between 1994 and 2012. The main inclusion criteria were: use of any internationally accepted diagnostic criteria and investigation of community samples. RESULTS Four hundred and ninety two articles were found, of which 26 were initially pre-selected by title or abstract review. Five studies from 3 different countries were included. The FTD prevalence rates in community-dwelling elderly were 1.2 (Venezuela), 1.3 (Peru) and 1.7-1.8 (Brazil) per thousand persons, depending on age group. CONCLUSION The FTD prevalence in LA studies showed values mid-way between those observed in western and in oriental populations. Despite the magnitude of this problem, epidemiological information on FTD remains scarce in LA.
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Affiliation(s)
- Nilton Custodio
- Department of Neurology, Clinica Internacional, Lima,
Peru. Unit of Cognitive Impairment and Dementia Prevention, Clinica Internacional,
Lima, Peru
| | - Eder Herrera-Perez
- Unit of Cognitive Impairment and Dementia Prevention,
Clinica Internacional, Lima, Peru. Research Projects Unit, National Institute of
Child Health. Lima, Peru
| | - David Lira
- Department of Neurology, Clinica Internacional, Lima,
Peru. Unit of Cognitive Impairment and Dementia Prevention, Clinica Internacional,
Lima, Peru
| | - Rosa Montesinos
- Unit of Cognitive Impairment and Dementia Prevention,
Clinica Internacional, Lima, Peru. Rehabilitation Medicine Unit, Clinica
Internacional, Lima, Peru
| | - Liliana Bendezu
- Department of Neurology, Clinica Internacional, Lima,
Peru. Unit of Cognitive Impairment and Dementia Prevention, Clinica Internacional,
Lima, Peru
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10783
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Ekenze OS, Ndukuba AC. Perception of epilepsy among public workers: perspectives from a developing country. Epilepsy Behav 2013; 26:87-90. [PMID: 23247269 DOI: 10.1016/j.yebeh.2012.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 10/26/2012] [Accepted: 10/28/2012] [Indexed: 12/17/2022]
Abstract
A cross-sectional survey of health-care workers and other public servants was undertaken to determine the perception of epilepsy and attitudes towards persons with epilepsy (PWE) in Eastern Nigeria. Response rate was 89.4% (161/180) comprising 95 (59%) health-care workers (Group A) and 66 (41%) other public servants (Group B). Epilepsy was considered a mental disorder by 16 (16.8%) of Group A and 16 (24.2%) of Group B, while 74 (77.9%) of Group A and 20 (30.3%) of Group B considered it a brain disorder. It was thought to occur following head injury by 60 (63.2%) of Group A and 11 (16.7%) of Group B, while 6 (6.3%) of Group A and 1 (1.5%) of Group B considered it to be contagious. Twelve (12.6%) and 33 (34.7%) of Group A and 8 (12.1%) and 27 (40.9%) of Group B will marry or hire PWE. Health-care workers have better perceptions of epilepsy, but stigma against PWE is still prevalent. Perception of epilepsy and attitudes towards PWE may improve with public enlightenment programs.
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Affiliation(s)
- O S Ekenze
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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10784
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Kondo T, Kakuda W, Yamada N, Shimizu M, Hagino H, Abo M. Effect of low-frequency rTMS on motor neuron excitability after stroke. Acta Neurol Scand 2013; 127:26-30. [PMID: 22494271 DOI: 10.1111/j.1600-0404.2012.01669.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to test the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the non-lesional hemisphere on motor neuron excitability of the paretic upper limb in post-stroke patients by electrophysiological examination. MATERIALS AND METHODS Thirteen post-stroke patients with spastic upper limb hemiparesis were studied (age, 57.5 ± 11.1 years; time after stroke, 55.2 ± 51.4 months). Low-frequency rTMS of 1 Hz was applied for 20 min to the motor cortex of the non-lesional hemisphere. The M-response amplitude and F-wave parameters were recorded in the abductor pollicis brevis muscle following stimulation of the median nerve in both the affected and unaffected upper limbs. The F-wave frequency, F-max/M ratio (ratio of maximum F-wave amplitude to M-response amplitude), and F-mean/M ratio (the ratio of mean F-wave amplitude to the M-response amplitude) were measured before and after the 20-min rTMS, analyzed for both limbs. RESULTS Application of low-frequency rTMS did not result in significant changes in the frequency of F-wave and F-max/M ratio in both upper limbs, but significantly decreased F-mean/M ratio in the affected upper limb (P < 0.005), but not in the unaffected limb. CONCLUSIONS Low-frequency rTMS applied to the non-lesional hemisphere might be potentially useful therapeutically for post-stroke patients with spastic upper limb hemiparesis.
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Affiliation(s)
- T. Kondo
- Department of Rehabilitation Medicine; Shimizu Hospital; Tottori; Japan
| | - W. Kakuda
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo; Japan
| | | | - M. Shimizu
- Department of Rehabilitation Medicine; Shimizu Hospital; Tottori; Japan
| | - H. Hagino
- Department of Health Science; Tottori University School; Tottori; Japan
| | - M. Abo
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo; Japan
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10785
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Kim SH, Lee JY, Park SH, Jang HC, Lim EJ, Chang SJ, Lee SS. Plasma B-type natriuretic peptide level in patients with acute cerebral infarction according to infarction subtype and infarction volume. Int J Med Sci 2013; 10:103-9. [PMID: 23289011 PMCID: PMC3534883 DOI: 10.7150/ijms.5005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 12/24/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Plasma B-type natriuretic peptide (BNP) is used as a diagnostic marker of cardiovascular diseases. BNP is secreted mainly from the myocardium and has been detected by immunoreactivity in brain and cerebral arteries. The aim of our study was to investigate plasma BNP in patients with acute cerebral infarction according to infarction subtype and infarction volume. METHODS We studied 141 patients with acute cerebral infarction, classified as large artery atherosclerosis (LAA), cardioembolism (CE), or small vessel disease (SA) according to the Trial of Org 10172 in Acute Stroke Treatment classification. Plasma BNP level was measured in patients and 61 healthy controls. We analyzed various clinical and laboratory variables of patients according to plasma BNP level. RESULTS Compared to controls, the patients had higher plasma BNP (11.9 ± 11.7 pg/mL versus 124.6 ± 228.8 pg/mL, p <0.01). The highest quartile BNP group was associated with advanced age, female gender, current non-smoker, atrial fibrillation, heart failure, CE group, increased white blood cell counts, increased high sensitivity C-reactive protein, increased left atrium size, decreased left ventricular ejection fraction, increased initial National Institute of Health Stroke Scale, and increased infarction volume. According to multiple regression analysis, CE group, female gender, and infarction volume were independently associated with plasma BNP. Plasma BNP level showed statistically significant differences among LAA (n = 71), CE (n = 50), and SA (n = 20) groups (p <0.001), and the expression decreased in order of CE (253.8 ± 337.1 pg/mL), LAA (61.6 ± 78.8 pg/mL), and SA (25.3 ± 24.8 pg/mL). Increased plasma BNP correlated with increased infarction volume (r = 0.42, p <0.001). CONCLUSIONS Plasma BNP may be helpful for prediction of etiologic classification of acute cerebral infarction and infarction volume.
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Affiliation(s)
- Seo Hyun Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Kangwon-do, Korea.
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10786
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Landry M, Dornelles AC, Hayek G, Deichmann RE. Patient Preferences for Doctor Attire: The White Coat's Place in the Medical Profession. Ochsner J 2013; 13:334-342. [PMID: 24052762 PMCID: PMC3776508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The white coat's place in the medical profession is a heavily debated topic. Five years after the bare-below-the-elbow policy took effect in England, we reexamined the evidence about coats' potential to transmit infection, reviewed previous studies, and explored our patients' opinions on doctor attire. METHODS We administered a survey at 3 locations in the Ochsner Health System (hospital clinic, satellite clinic, and inpatient ward) in 2013. The survey assessed patient preference for doctors to wear white coats and included 4 images of the same doctor in different attire: traditional white coat, bare-below-the-elbow attire, a white coat with scrubs, and scrubs alone. Respondents rated images head-to-head for their preferences and individually for their confidence in the physician's skills and for their comfort level with the physician based upon the displayed attire. Participants' attitudes were then reassessed after they were given information about potential disease transmission. RESULTS Overall, 69.9% of the 153 patients surveyed preferred doctors to wear white coats. When locations were compared, a statistically higher proportion of outpatients preferred coats (P=0.001), a trend most pronounced between hospital clinic (84%) and ward inpatients (51.9%). Patients disliked bare-below-the-elbow attire, scoring it lowest on the comfort and confidence scales (0.05 and 0.09, respectively). Information regarding risks of coat-carried infections did not influence respondents' opinions; 86.9% would still feel comfortable with a doctor who wore one. CONCLUSIONS These findings suggest patients prefer white coats, and they contribute to greater comfort and confidence in their physicians, despite knowledge of theoretic concerns of disease transmission.
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Affiliation(s)
- Miles Landry
- The University of Queensland School of Medicine, Ochsner Clinical School, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Genevieve Hayek
- The University of Queensland School of Medicine, Ochsner Clinical School, Ochsner Clinic Foundation, New Orleans, LA
| | - Richard E. Deichmann
- The University of Queensland School of Medicine, Ochsner Clinical School, Ochsner Clinic Foundation, New Orleans, LA
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
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10787
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Abstract
Peripheral neuropathies are the most common neurological manifestations occurring in HIV-infected individuals. Distal symmetrical sensory neuropathy is the most common form encountered today and is one of the few that are specific to HIV infection or its treatment. The wide variety of other neuropathies is akin to the neuropathies seen in the general population and should be managed accordingly. In the pre-ART era, neuropathies were categorized according to the CD4 count and HIV viral load. In the early stages of HIV infection when CD4 count is high, the inflammatory demyelinating neuropathies predominate and in the late stages with the decline of CD4 count opportunistic infection-related neuropathies prevail. That scenario has changed with the present almost universal use of ART (antiretroviral therapy). Hence, HIV-associated peripheral neuropathies are better classified according to their clinical presentations: distal symmetrical polyneuropathy, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), mononeuropathies, mononeuropathies multiplex and cranial neuropathies, autonomic neuropathy, lumbosacral polyradiculomyelopathy, and amyotrophic lateral sclerosis (ALS)-like motor neuropathy. Treated with ART, HIV-infected individuals are living longer and are at a higher risk of metabolic and age-related complications; moreover they are also prone to the potentially neurotoxic effects of ART. There are no epidemiological data regarding the incidence and prevalence of the peripheral neuropathies. In the pre-ART era, most data were from case reports, series of patients, and pooled autopsy data. At that time the histopathological evidence of neuropathies in autopsy series was almost 100%. In large prospective cohorts presently being evaluated, it has been found that 57% of HIV-infected individuals have distal symmetrical sensory neuropathy and 38% have neuropathic pain. It is now clear that distal symmetrical sensory neuropathy is caused predominantly by the ART's neurotoxic effect but may also be caused by the HIV itself. With a sizeable morbidity, the neuropathic pain caused by distal symmetrical sensory neuropathy is very difficult to manage; it is often necessary to change the ART regimen before deciding upon the putative role of HIV infection itself. If the change does not improve the pain, there are few options available; the most common drugs used for neuropathic pain are usually not effective. One is left with cannabis, which cannot be recommended as routine therapy, recombinant human nerve growth factor, which is unavailable, and topical capsaicin with its side-effects. Much has been done to and learned from HIV infection in humans; HIV-infected individuals, treated with ART, are now dying mostly from cardiovascular disease and non-AIDS-related cancers. It hence behooves us to find new approaches to mitigate the residual neurological morbidity that still impacts the quality of life of that population.
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Affiliation(s)
- Alberto Alain Gabbai
- Department of Neurology, UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil.
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10788
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Intracranial hypotension syndrome: A post dural puncture headache?☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341010-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10789
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10790
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Sadeghniiat-Haghighi K, Saraie M, Ghasemi M, Izadi N, Chavoshi F, Khajehmehrizi A. Assessment of peripheral neuropathy in male hospitalized patients with lead toxicity in Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:6-9. [PMID: 23901334 PMCID: PMC3719229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 10/20/2012] [Accepted: 12/03/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study assessed the effect of lead exposure on the peripheral nervous system in 40 hospitalized patients with lead toxicity [blood lead level (BLL) >70 μg/dl] and compared their electrodiagnostic indices with the results of the control group. MATERIALS AND METHODS We assessed signs and symptoms of neuropathy in patients and conducted nerve conduction velocity (NCV) in patients and control groups, then compared the results between the two groups. RESULTS Average duration of exposure to lead was 10.85 years. The mean BLL of patients was 100.32 μg/dl (SD = 18.42). The most common symptoms in patients were mood and sleep disturbance (64.1%) and paresthesia (47.5%). Among the patients, all of the NCV indices in median, ulnar, and radial nerves were normal. On comparing the average indices of NCV in lead-exposed men with controls, significant reductions were noted in most of the indices and with prolonged distal motor latency and peak latency. Significant but weak correlations were found between BLL and some of the indices (P value < 0.05, r = 0.33-0.52). CONCLUSION Comparing electrophysiological study indicators between case vs controls and considering the symptoms of patients, our study showed that patient may progress to sensory neuropathy.
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Affiliation(s)
| | - Maryam Saraie
- Department of Occupational Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghasemi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nazanin Izadi
- Department of Occupational Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Chavoshi
- Department of Occupational Medicine, Tehran University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Farzaneh Chavoshi, Department of Occupational Medicine, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Ahmad Khajehmehrizi
- Department of Occupational Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10791
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Affiliation(s)
- Arvind Kankane
- Department of Neurology, Maharani Laxmibai Medical College Jhansi, Uttar Pradesh, India,For correspondence: Dr. Arvind Kankane, Asst. Professor, Department of Neurology, Maharani Laxmibai Medical College, Jhansi, Uttar Pradesh - 284 128, India. E-mail:
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10792
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Ansari NN, Naghdi S, Hasson S, Rastgoo M, Amini M, Forogh B. Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: inter-and intra-rater reliability of the Modified Tardieu Scale. Brain Inj 2013; 27:605-12. [PMID: 23473023 DOI: 10.3109/02699052.2012.750744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PRIMARY OBJECTIVE To evaluate the reliability of the Modified Tardieu Scale (MTS) in the measurement of ankle plantarflexor spasticity in patients after stroke. RESEARCH DESIGN Inter- and intra-rater reliability study. INTERVENTIONS Not applicable. METHODS AND PROCEDURES Adult patients after stroke participated. Patients were tested by two raters for inter-rater reliability. Patients were re-tested by one rater at least 1 week later for intra-rater reliability. The plantarflexors on the hemiparetic side were tested. MAIN OUTCOMES AND RESULTS The ICCs of inter and intra-rater reliability across all components of MTS were moderate and moderately high (range 0.40-0.71). Inter- and intra-rater reliability for the dynamic component of spasticity (R2-R1) were moderate (ICC = 0.57 and 0.40, respectively). The difference between the two raters for R2 was statistically significant (p = 0.001). CONCLUSIONS The reliability of the Modified Tardieu Scale in the measurement of ankle plantarflexor spasticity in adult patients after stroke was insufficient for routine use in clinical settings and research.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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10793
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Celis-Aguilar E. Commentary. J Neurosci Rural Pract 2013; 4:355-6. [PMID: 24250187 PMCID: PMC3821440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Erika Celis-Aguilar
- Department of Otolaryngology (Neurotology), Centro de Investigación y Docencia en Ciencias de la salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico,Address for correspondence: Dr. Erika Celis-Aguilar, Eustaquio Buelna No. 91 Col. Gabriel Leyva, C.P. 80030, Culiacán, Sinaloa, Mexico. E-mail:
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10794
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Del Brutto OH. Neurological effects of venomous bites and stings: snakes, spiders, and scorpions. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:349-68. [PMID: 23829924 DOI: 10.1016/b978-0-444-53490-3.00028-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Snake and spider bites, as well as scorpion sting envenoming, are neglected diseases affecting millions of people all over the world. Neurological complications vary according to the offending animal, and are often directly related to toxic effects of the venom, affecting the central nervous system, the neuromuscular transmission, the cardiovascular system, or the coagulation cascade. Snake bite envenoming may result in stroke or muscle paralysis. Metalloproteinases and other substances (common in vipers and colubrids) have anticoagulant or procoagulant activity, and may induce ischemic or hemorrhagic strokes. The venom of elapids is rich in neurotoxins affecting the neuromuscular transmission at either presynaptic or postsynaptic levels. The clinical picture of scorpion sting envenoming is dominated by muscle weakness associated with arterial hypertension, cardiac arrythmias, myocarditis, or pulmonary edema. These manifestations occur as the result of release of catecholamines into the bloodstream or due to direct cardiac toxicity of the venom. Cerebrovascular complications have been reported after the sting of the Indian red scorpion. Intracranial hemorrhages occur in the setting of acute increases in arterial blood pressure related to sympathetic overstimulation, and cerebral infarctions are related to either cerebral hypoperfusion, consumption coagulopathy, vasculitis, or cardiogenic brain embolism. Three main syndromes result from spider bite envenoming: latrodectism, loxoscelism, and funnel-web spider envenoming. Latrodectism is related to neurotoxins present in the venom of widow spiders. Most cases present with headache, lethargy, irritability, myalgia, tremor, fasciculation, or ataxia. Loxoscelism is caused by envenoming by spiders of the family Sicariidae. It may present with a stroke due to a severe coagulopathy. The venom of funnel-web spiders also has neurotoxins that stimulate neurotransmitter release, resulting in sensory disturbances and muscle paralysis. Proper management of the envenomed patient, including prompt transport to the hospital, correction of the hemostatic disorder, ventilatory support, and administration of antivenom, significantly reduce the risk of neurological complications which, in turn, reduce the mortality and improve the functional outcome of survivors.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espiritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital Clinica Kennedy, Guayaquil, Ecuador.
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10795
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Kim MS, Choi J, Jung JH. Bilateral Abducens Nerve Palsy in Pediatric Patients with Epstein-Barr Virus Encephalitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.8.1303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Choi
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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10796
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Temel SG, Bostan OM, Cangul H, Cil E. Turkish perspective of Jervell and Lange-Nielsen syndrome. Ann Indian Acad Neurol 2013; 16:129-30. [PMID: 23661983 PMCID: PMC3644775 DOI: 10.4103/0972-2327.107703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sehime G Temel
- Department of Medical Genetics, University of Uludag, Faculty of Medicine, Bursa
- Department of Histology and Embryology, University of Near East, Faculty of Medicine, Lefkosia, North Cyprus, Turkey
| | - Ozlem M. Bostan
- Department of Pediatric Cardiology, University of Uludag, Faculty of Medicine, Bursa, Turkey
| | - Hakan Cangul
- Department of Medical Genetics, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey; Department of Medical and Molecular Genetics, University of Birmingham, Clinical and Experimental Medical Faculty, England
- Department of Pediatric Cardiology, University of Uludag, Faculty of Medicine, Bursa, Turkey
| | - Ergun Cil
- Department of Pediatric Cardiology, University of Uludag, Faculty of Medicine, Bursa, Turkey
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10797
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Uribarri López M, Aguilera Celorrio L, Miguel Martínez C, Yuste Del Valle S. [Guillain-Barré syndrome in the critical care unit in the last 10 years]. ACTA ACUST UNITED AC 2012; 60:257-62. [PMID: 23260991 DOI: 10.1016/j.redar.2012.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy, which constitutes an important proportion of acute flaccid paralysis cases. Our objective was to present the clinical characteristics of patients with the GBS who required admission to a critical care unit. METHODS A retrospective study over a period of ten years was conducted on patients with GBS, who were admitted to the critical care unit in a tertiary hospital. The proportion of patients requiring connection to mechanical ventilation (MV) and associated complications was analysed, along with certain clinical features which implied a more severe illness and worse functional recovery. RESULTS MV was required in 58.8% of cases (mean duration 29.8 days). Nine patients received tracheostomy. Pulmonary complications were observed in all patients that needed MV (50% tracheobronchitis and 50% ventilator-associated pneumonia). MV is associated with pulmonary complications (P=.001) and those, in turn, to the development of sepsis (P=.006). Only one patient died (5.88%). No relationship was found between advanced age, MV, comorbidity, sepsis, or hemodynamic complications and the mortality of GBS. CONCLUSIONS Death in these patients results from pulmonary complications, sepsis and less frequently due to autonomic dysfunction or pulmonary embolism. Emphasising the importance of their prevention, detection and management.
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Affiliation(s)
- M Uribarri López
- Servicio de Anestesia-Reanimación, Hospital de Basurto, Bilbao, Bizkaia, España.
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10798
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Joseph EK, Levine JD. Role of endothelial cells in antihyperalgesia induced by a triptan and β-blocker. Neuroscience 2012; 232:83-9. [PMID: 23262231 DOI: 10.1016/j.neuroscience.2012.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/27/2012] [Accepted: 12/11/2012] [Indexed: 01/08/2023]
Abstract
While blood vessels have long been implicated in diverse pain syndromes (e.g., migraine headache, angina pectoris, vasculitis, and Raynaud's syndrome), underlying mechanisms remain to be elucidated. Recent evidence supports a contribution of the vascular endothelium in endothelin-1-induced hyperalgesia, and its enhancement by repeated mechanical stimulation; a phenomenon referred to as stimulus-induced enhancement of (endothelin) hyperalgesia (SIEH). SIEH is thought to be mediated by release of ATP from endothelial cells, to act on P2X3 receptors on nociceptors. In the present study we evaluated the ability of another vasoactive hyperalgesic agent, epinephrine, to induce endothelial cell-dependent hyperalgesia and SIEH. We found that epinephrine also produces hyperalgesia and SIEH. Both P2X3 receptor antagonists, A317491 and octoxynol-9, which attenuate endothelial cell function, eliminated SIEH without affecting epinephrine hyperalgesia. We further evaluated the hypothesis that members of two important classes of drugs used to treat migraine headache, whose receptors are present in endothelial cells - the triptans and β blockers - have a vascular component to their anti-hyperalgesic action. For this, we tested the effect of ICI-118,551, a β₂-adrenergic receptor antagonist and sumatriptan, an agonist at 5-HT1B and 5-HT₁D receptors, on nociceptive effects of endothelin and epinephrine. ICI-118,551 inhibited endothelin SIEH, and attenuated epinephrine hyperalgesia and SIEH. Sumatriptan inhibited epinephrine SIEH and inhibited endothelin hyperalgesia and SIEH, while having no effect on epinephrine hyperalgesia or the hyperalgesia induced by a prototypical direct-acting inflammatory mediator, prostaglandin E₂. These results support the suggestion that triptans and β-blockers interact with the endothelial cell component of the blood vessel to produce anti-hyperalgesia.
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Affiliation(s)
- E K Joseph
- Department of Medicine, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143-0440, USA; Department of Oral Surgery, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143-0440, USA
| | - J D Levine
- Department of Medicine, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143-0440, USA; Department of Oral Surgery, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143-0440, USA.
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10799
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Santhoshkumar A, Kalpana D, Sowrabha R. Rabies encephalomyelitis vs. ADEM: Usefulness of MR imaging in differential diagnosis. J Pediatr Neurosci 2012; 7:133-5. [PMID: 23248695 PMCID: PMC3519073 DOI: 10.4103/1817-1745.102578] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of rabies encephalomyelitis in a 12-year-old boy who had received anti-rabies vaccine 6 weeks after being bitten by a puppy. The MR (magnetic resonance) imaging helped to differentiate rabies from acute disseminated encephalomyelitis (ADEM). ADEM involves the white matter predominantly, whereas rabies has a predilection for grey matter, that too of midline regions. This report emphasizes the usefulness of MRI in differentiating rabies and ADEM when encephalomyelitis occurs in a vaccinated child.
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Affiliation(s)
- Asokan Santhoshkumar
- Department of Pediatrics, Government Medical College, Thiruvananthapuram, Kerala, India
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10800
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Udayashankar C, Oudeacoumar P, Nath AK. Congenital insensitivity to pain and anhidrosis: a case report from South India. Indian J Dermatol 2012; 57:503. [PMID: 23248377 PMCID: PMC3519266 DOI: 10.4103/0019-5154.103080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital insensitivity to pain with anhidrosis, also known as hereditary sensory and autonomic neuropathy type IV, is an autosomal recessive disorder characterized by the congenital lack of pain sensation, inability to sweat, episodes of recurrent hyperpyrexia, mental retardation, and self-mutilating behavior. It is an extremely rare disorder with only a handful of reports from India. A five- year- old boy, born to second-degree consanguineous parents after uneventful antenatal period, presented to us with history of recurrent unexplained fever, recurrent ulcers in the lower limbs, insensitivity to painful stimuli (like injections, vaccination) and self-mutilating behavior from early childhood. Cutaneous examination showed multiple ulcers, loss of teeth, loss of tip of the tongue (due to biting), scarring of finger tips, xerosis and lichenification. Sensory examination showed complete loss of pain and temperature sensations, but fine touch and vibration were preserved. Deep tendon reflexes were normal. Evaluation for Hansen's disease was non-contributory. An intradermal injection of histamine did not show any flare response. Based on clinical as well as compatible histological features a diagnosis of congenital insensitivity to pain with anhidrosis was made. The ulcers were treated with appropriate antibiotics and daily dressings. The parents were counseled about appropriate care of the child.
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Affiliation(s)
- Carounanidy Udayashankar
- Department of Dermatology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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