Report of erucism caused by Automeris egeus Cramer (Lepidoptera: Saturniidae) and a brief update on caterpillar envenomation in Brazil

We report a case of erucism provoked by the Automeris egeus Cramer caterpillar and update the distribution of caterpillar poisoning in Brazil, showing the regions with the highest incidence rates. We also correlated the incidence rate with anthropic impact rates in all Brazilian municipalities, taking as a reference the Human Footprint Index. The victim presented erucism, burning pain, itching, and local hyperthermia. The highest incidence rates were in southern Brazil. We suggest including A. egeus in the Brazilian list of animals with medical importance, and that Brazilian Ministry of Health indicates the genus of the animals involved in envenomation events on its platform.

Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus

Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

Experience of using photodynamic therapy for treatment of genitourinary syndrome of menopause

This study reports about efficacy and safety of photodynamic therapy in Genitourinary Syndrome of Menopause (GSM).Material and methods. The study group included 12 patients with a diagnosis of urogenital syndrome of menopause. The trismeglumine salt of chlorin E6 in the form of a 1% gel was used as a photosensitizer. LED phototherapy apparatus Garmonia (photodynamic therapy apparatus (emitter 660 nm) was used as a radiation source. The PDT procedure was performed once every 7 days. The following scales were used to assess the effectiveness: Vaginal Health Index, Visual Analogue Scale, Dermatology Life Quality Index score, and general satisfaction with the course of procedures was also assessed.Results. The patients noted a significant regression of itching, burning, pain and dyspareunia after the course of photodynamic therapy. There was a decrease in dryness, on average, up to 3 points upon completing the course of procedures. Itching completely regressed in 6 out of patients. Dyspareunia significantly decreased in 4 patients and completely disappeared in 2 patients. The greatest effect according to the results of assessing the index of vaginal health was noted in relation to Ph-metry, as well as in relation to elasticity (4.17 points) and moisture (4.33 points). The median satisfaction score with treatment outcomes was 2.7 at last follow-up. There were no serious side effects during the entire period of treatment and after it.Conclusions. The following study reports that the photosensitizer with trismeglumine salt of chlorin E6 and PDT with a wavelength of 660 nm with an exposure for 30 minutes, an energy of 100 J/cm2, a power of 100 mV/cm2 , once every 7 days, is an effective and harmless method of treating GSM.

STAT1: a novel candidate biomarker and potential therapeutic target of the recurrent aphthous stomatitis

Background The recurrent aphthous stomatitis (RAS) frequently affects patient quality of life as a result of long lasting and recurrent episodes of burning pain. However, there were temporarily few available effective medical therapies currently. Drug target identification was the first step in drug discovery, was usually finding the best interaction mode between the potential target candidates and probe small molecules. Therefore, elucidating the molecular mechanism of RAS pathogenesis and exploring the potential molecular targets of medical therapies for RAS was of vital importance. Methods Bioinformatics data mining techniques were applied to explore potential novel targets, weighted gene co-expression network analysis (WGCNA) was used to construct a co-expression module of the gene chip data from GSE37265, and the hub genes were identified by the Molecular Complex Detection (MCODE) plugin. Results A total of 16 co-expression modules were identified, and 30 hub genes in the turquoise module were identified. In addition, functional analysis of Hub genes in modules of interest was performed, which indicated that such hub genes were mainly involved in pathways related to immune response, virus infection, epithelial cell, signal transduction. Two clusters (highly interconnected regions) were determined in the network, with score = 17.647 and 10, respectively, cluster 1 and cluster 2 are linked by STAT1 and ICAM1, it is speculated that STAT1 may be a primary gene of RAS. Finally, genistein, daidzein, kaempferol, resveratrol, rosmarinic acid, triptolide, quercetin and (-)-epigallocatechin-3-gallate were selected from the TCMSP database, and both of them is the STAT-1 inhibitor. The results of reverse molecular docking suggest that in addition to triptolide, (-)-Epigallocatechin-3-gallate and resveratrol, the other 5 compounds (flavonoids) with similar structures may bind to the same position of STAT1 protein with different docking score. Conclusions Our study identified STAT1 as the potential biomarkers that might contribute to the diagnosis and potential therapeutic target of RAS, and we can also screen RAS therapeutic drugs from STAT-1 inhibitors.

Filiform projections of the vestibular mucosa: What’s your diagnosis?

29-year-old recently married woman was reffered by her gynecologist to our dermatology department for suspected vulvar condyloma acuminatum. She had no history of any extramarital sexual contacts and her partner was free of any clinical features of genital HPV infections. She was anxious about the origin of her lesions and the risk of her husband’s contamination. She reported burning sensation, irritation and vulvar pain. On clinical examination soft digitate mucous colored papules with a smooth surface were noted at the vulvar vestibule. These papillomatous projections were pearly, uniformly arranged and had separate bases (Fig. 1). Dermatoscopy demonstrated regular and linear pinkish projections arranged in a symmetric distribution. Irregular linear vascular channels were observed (Fig. 2). Figure 1: Clinical aspect: multiple skin-colored filiform and soft projections. Figure 2: Dermatoscopy showing regular and linear pinkish projections arranged in a symmetric distribution. WHAT’S YOUR DIAGNOSIS? ANSWER: Vestibular Papillomatosis Vestibular papillomatosis (VP) is a normal variant of the female genital mucosa [1,2]. It is first described in 1981 by Altemeyer and named pseudocondylomata of the vulva [3]. VP is frequently misdiagnosed as condyloma acuminatum and presents a source of anxiety in patients, aggressive investigations and inappropriate treatment [2]. This entity is most often asymptomatic, but it can be accompanied, as our case, by a feeling of burning, pain or dyspareunia. To avoid the misdiagnosis of VP as genital warts, Moyal-Barranco et al. had proposed five clinical parameters [4]. Unlike condyloma acuminatum, VP is formed by regular, soft and pink-colored papillae arising from a separate base. It is also characterized by the lack of circumscribed whitening on 5% acetic acid application. Dermoscopy can help to differentiate these two conditions by allowing a better identification of these clinical parameters. Linear vessels may sometimes be observed in the transparent core of the finger-like projections [5]. On the other hand, dermoscopy of condyloma acuminatum shows irregular whitish projections with tapering end that arise from a common base and comprise conglomerate vessel. Based on these clinical criteria and the dermoscopic aspect, biopsies will be unnecessary to confirm the diagnosis of VP.

A case of vestibular schwannoma with oral burning sensation: surgical complication or burning mouth syndrome?

Background Despite improvements in surgical techniques, the removal of vestibular schwannoma is related to some complications. Recovery from surgical complications of vestibular schwannoma is often difficult and complications sometimes lead to permanent deficits. However, treatable trigeminal symptoms may be missed in atypical cases. Case presentation A 46-year-old woman complained about burning sensation on her tongue and maxilla for four years before her first visit to our clinic. She visited the neurosurgery department in a university hospital because her facial pain and burning sensation of her tongue were suddenly aggravated. She was diagnosed with vestibular schwannoma and tumour resection was performed. However, her oral pain persisted after surgery. Two months before the initial visit to our clinic, the oral pain became more severe than ever before. When the patient visited a psychiatrist due to a panic attack, the psychiatrist diagnosed her as having somatic symptom disorder and depression and referred her to our clinic. Based on the characteristics of the pain, she was diagnosed as burning mouth syndrome and treated for the same. Within 1.5 months, the pain and burning sensation of the tongue and maxilla almost completely remitted with low dose amitriptyline. Conclusions Our case suggests that there are exceptional cases in which burning mouth syndrome and vestibular schwannoma occur simultaneously. Burning pain after vestibular schwannoma surgery cannot always be considered a complication of surgery.

Is Neuropathic Pain a Good Marker of Peripheral Neuropathy in Hospice Patients with Advanced Cancer? The Single Center Pilot Study

Neuropathic pain (NP) affects approximately 30% of patients with advanced cancer. The prevalence of neuropathic pain related to peripheral neuropathy (NP-RPN) in these patients is not known. The aim of the study was to evaluate NP-RPN prevalence in hospice patients and to find out whether the absence of this pain is sufficient to rule out peripheral neuropathy. The study included a total of 76 patients with advanced cancer who were cared for at inpatient hospices. All patients were asked about shooting or burning pain (of the feet and hands), were examined systematically for sensory deficits and had a nerve conduction study performed. NP-RPN was found in 29% of the patients. Electrophysiologically-diagnosed peripheral neuropathy was found in 79% of patients, and the diagnostic electrophysiological criteria for neuropathy were met by one half of the patients without NP-RPN. The severity of NP-RPN was correlated with the clinically assessed severity of sensory neuropathy and the Karnofsky score, but was not correlated with the intensity of the clinical signs of motor neuropathy. The presence of NP-RPN did not reflect greater prevalence of motor and sensory abnormalities in neurological and electrophysiological examinations. The absence of NP-RPN did not rule out polyneuropathy in hospice patients.

Effect of Murivenna Ointment in the Management of Parikarthika (Acute Fissure in Ano) – A Pilot Study

Parikarthika (Fissure in ano) is one of the most painful condition which is occurring in the ano rectal region. Due to irregular food habits and modern life styles of peoples in the present era has also added to the increase in the rate of incidence of fissure in ano. The aim of the present pilot study was to assess the effectiveness of Murivenna ointment in the management of Parikarthika. This study was conducted in 22 patients diagnosed as acute fissure in ano. Patients Murivenna ointment was applied locally with digitally in fissure bed (Parikartika) of all 22 patients. All patients were advised to follow this twice daily after sitz bath for 4 weeks or till healing of fissure bed whichever is earlier. Adjuvant drug Triphalachurnam 5 gm orally at bedtime with lukewarm water was prescribed daily to all patients with constipation. There was significant relief in symptoms like pain in ano and bleeding per rectum in all patients after 30 days of treatment. The anal sphincter tonicity became normal in 21 patients (95.45%) after 30 days of treatment. Ulcer in ano was completely healed in 19 patients (86.36%) after 30 days of treatment. There was no reoccurrence in all patients after 30 days of follow up. The irritable symptoms like pain and bleeding per rectum were effectively relieved within 14 days of treatment in all patients. It is one of the effective treatments in the management of fissure in ano as it relieved the cardinal symptoms of fissure in ano such as cutting pain and burning pain.

Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

Neuropathic pain post-COVID-19: a case report

A 61-year-old man with no significant medical history developed fever, headache and mild shortness of breath. He tested positive for SARS-CoV-2 and self-isolated at home, not requiring hospital admission. One week after testing positive, he developed acute severe burning pain affecting his whole body, subsequently localised distally in the limbs. There was no ataxia or autonomic failure. Neurological examination was unremarkable. Electrophysiological tests were unremarkable. Skin biopsy, lumbar puncture, enhanced MRI of the brachial plexus and MRI of the neuroaxis were normal. His pain was inadequately controlled with pregabalin but improved while on a weaning regimen of steroids. This case highlights the variety of possible symptoms associated with SARS-CoV-2 infection.