Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report -

Background: In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.Case: We report a case of a 23-year-old man with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved.Conclusions: Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.

Repeated hypoxia exposure induces cognitive dysfunction, brain inflammation, and amyloidβ/p-Tau accumulation through reduced brain O-GlcNAcylation in zebrafish

Repetitive hypoxia (RH) exposure affects the initiation and progression of cognitive dysfunction, but little is known about the mechanisms of hypoxic brain damage. In this study, we show that sublethal RH increased anxiety, impaired learning and memory (L/M), and triggered downregulation of brain levels of glucose and several glucose metabolites in zebrafish, and that supplementation of glucose or glucosamine (GlcN) restored RH-induced L/M impairment. Fear conditioning (FC)-induced brain activation of and PKA/CREB signaling was abrogated by RH, and this effect was reversed by GlcN supplementation. RH was associated with decreased brain O-GlcNAcylation and an increased O-GlcNAcase (OGA) level. RH increased brain inflammation and p-Tau and amyloid β accumulation, and these effects were suppressed by GlcN. Our observations collectively suggest that changes in O-GlcNAc flux during hypoxic exposure could be an important causal factor for neurodegeneration, and that supplementation of the HBP/ O-GlcNAc flux may be a potential novel therapeutic or preventive target for addressing hypoxic brain damage.

Optimization of Hypoxic Brain Injuries Diagnostics in Full-Term Newborns

The problem of early diagnosis of the central nervous system damage in newborn before the onset of clinical symptoms remains relevant at the present time.The aim of the study was to optimize the hypoxic brain damage diagnosis in full-term newborns by analyzing the concentration of cytokines in the umbilical cord blood.Materials and methods. During the first stage of the study, a prospective analysis of concentrations of interleukins (IL-1β, IL-4, IL-6, IL-8, IL-10), TNF-α and neuron-specific enolase (NSE) in the umbilical cord blood serum of full-term newborns was performed. The second stage of the study included the retrospective analysis of clinical data and instrumental research methods. The main method for diagnosing in the development of hypoxic brain damage in newborns was neurosonography.Results. The development of hypoxic brain damage is evidenced by the concentration of IL-1β over 30.3 pg/ml, IL-4 – over 1.7 pg/ml, IL-6 – over 79.4 pg/ml, IL-8 – over 107.7 pg/ml, NSE – more than 10.3 ng/ml and TNF-α – more than 1.6 pg/ml in umbilical cord blood.Conclusion. The results of the study confirmed that the comprehensive assessment of the cytokines concentration in the umbilical cord blood improves the hypoxic brain damage diagnosis in newborns. Analysis of the level of these markers immediately after the birth will optimize the management tactics of newborns who have undergone hypoxic exposure in antenatal and intranatal period.

Cardiac and Respiratory Arrest in a 12-Year-Old Girl with Acute Permethrin Toxicity: A Case Report

Background: Permethrin (PER) is widely employed as the most frequently used type I synthetic pyrethroid insecticide. Despite its worldwide application, reports of pediatric toxicity following permethrin administration are scarce.Case presentation: The present case report involves a 12-year-old Afghan girl, with no previous medical problems, who drank an unknown insecticide covertly at home. Two hours after ingestion, she was taken to the emergency room with neither breathing signs nor a heartbeat. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room, and her spontaneous circulation was returned after a few minutes of CPR. She was then intubated, volume resuscitated with intravenous normal saline, and connected to the mechanical ventilator after being transferred to the ICU ward. The patient remained comatose without spontaneous breathing, her pupils became bilateral mydriasis, and central diabetes insipidus became evident after three days due to apnea and hypoxic brain damage following insecticide ingestion. The chemical analysis of the insecticide bottle showed 10% permethrin without organophosphates, as initially expected. Unfortunately, after seven days, the patient passed away due to resistant hypotension and severe brain damage.Conclusion: Permethrin is widely used globally as an insecticide. However, there are many unmet needs in permethrin toxicity treatment, and the treatment is mainly supportive. Depending on the amount and dose of permethrin, the most common symptoms can vary from headache, dyspnea, and vomiting to metabolic acidosis and cardiac and respiratory arrest, which can lead to hypoxic brain damage and death, as was the outcome in our case.

Cardiac and Respiratory Arrest in a 12-Year-Old Girl with Acute Permethrin Toxicity: A Case Report

BackgroundPermethrin (PER) is widely employed as the most frequently used type I synthetic pyrethroid insecticide. Despite its worldwide application, reports of pediatric toxicity following permethrin administration are scarce.Case presentationThe present case report involves a 12-year-old Afghan girl, with no previous medical problems, who drank an unknown insecticide covertly at home. Two hours after ingestion, she was taken to the emergency room with neither breathing signs nor a heartbeat. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room, and her spontaneous circulation was returned after a few minutes of CPR. She was then intubated, volume resuscitated with intravenous normal saline, and connected to the mechanical ventilator after being transferred to the ICU ward. The patient remained comatose without spontaneous breathing, her pupils became bilateral mydriasis, and central diabetes insipidus became evident after three days due to apnea and hypoxic brain damage following insecticide ingestion. The chemical analysis of the insecticide bottle showed 10% permethrin without organophosphates, as initially expected. Unfortunately, after seven days, the patient passed away due to resistant hypotension and severe brain damage.ConclusionPermethrin is widely used globally as an insecticide. However, there are many unmet needs in permethrin toxicity treatment, and the treatment is mainly supportive. Depending on the amount and dose of permethrin, the most common symptoms can vary from headache, dyspnea, and vomiting to metabolic acidosis and cardiac and respiratory arrest, which can lead to hypoxic brain damage and death, as was the outcome in our case.

Evaluation of fetal condition in uncomplicated pregnancies at 40 weeks and beyond by calculation of amniotic fluid indexes and Doppler in the middle cerebral artery.

Objective. The aim of our data is to reveal the method of prognosis abnormal perinatal outcome, using combination US and Doppler results in uncomplicated pregnancies at 40 weeks and beyond. Design.1020 uncomplicated pregnant women at 40 weeks and beyond were examined 48 hours before delivery. We analyzed fetus’s condition during labor and just after. Setting. According these dates all women were divided into 3 groups after amniotic index(AI)and pulsatility indices(PI) in the middle cerebral artery(MCA). Population.260 women were included in the study because they met the inclusion criteria. Methods.All women were divided into 3 groups (group 1 - PI>0.835, any value of AI, group 2-AI >85, PI ≤ 0.835, group 3- AI ≤ 85 and PI ≤ 0.835).We analyzed fetus’s condition during labor and just after delivery (Apgar score <=7 and >7 on the 1st minute). Result. We’ve got trigger level for pulsatility index (PI) as 0.835, if we had PI less than that threshold cases of emergency cesarean section increases in 2,12 times, if PI less than 0,835 in combination with Amniotic Index(AI) 85 and less in 5,28 times. If PI =<0,835 risk of newborns having Apgar 7 and less increases in 1,18, but in combination with AI =<85 in 4,72 times. Conclusion. In results we found out the following data: low PI in the MCA may be parameter which cans prognoses fetus distress. Combination of PI reduce with low AI increases its specific and can use in practical ways to avoid hypoxic brain damage during labor.

Hemolytic Anemia and Hypoxic Brain Injury following Mothball Ingestion in a G6PD Nondeficient Infant: A Case Report

Mothballs are a common household item used as repellents and deodorizers. They are potential hazards and rare agents of poisoning in children. They are composed mainly of naphthalene, camphor, and 1, 4-dichlorobenzene in varying amounts depending on the manufacturers. It is essential to rule out poisoning by naphthalene in children presenting with hemolysis by eliciting a proper history. Since mothballs are readily available at home, children are drawn to it because of its attractive color and its consumption is a likely possibility. This is a case of ingestional naphthalene poisoning in a 1-year-old glucose 6-phosphate dehydrogenase nondeficient male child who presented with altered sensorium and hemolytic anemia. The child developed methemoglobinemia and sustained hypoxic brain injury. He was successfully managed by oral ascorbic acid, blood transfusion, and requisite supportive treatments. We report a case of naphthalene toxicity with hemolytic anemia and hypoxic brain damage to highlight the possibility of naphthalene poisoning in young children presenting with hemolytic anemia.

Features of electrophysiological activity in a neonate with severe post-hypoxic brain damage (post-hypoxic cerebral depression)

The article briefly presents the literature data and a description of the clinical dynamic observation of a patient with severe hypoxic brain damage (from the neonatal period to 4 months of life), in the conditions of the neonatal intensive care unit. The article describes the clinical picture, features of paroxysmal states and antiepileptic therapy, dynamics of neuroimaging data, electroencephalographic phenomena recorded in a patient with cerebral depression and structural cerebral injuries. The significance of electroencephalographic examination in the intensive care unit as an informative method for assessing cerebral activity in young children with central nervous system depression syndrome is shown. Disorganization of background activity, indicating structural cerebral damage, long-term persistence of slow-wave activity, detection of epileptic changes in the form of generalized flashes of pointed waves in the theta range, alpha-coma pattern, subsequently replaced by suppression of the background pattern in the patient, are typical electrophysiological disorders recorded in severe hypoxic encephalopathy. In conditions of limited opportunities for visual diagnosis of a patient with impaired consciousness, EEG remains the only method of obtaining information about the functional state of the brain, the data obtained during the study are an important prognostic criterion.