Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that, although exceedingly rare, carries a significant burden for the affected patient population. The complex and ...ambiguous pathophysiology of this condition further complicates clinical management and therapeutic interventions. Furthermore, being a diagnosis of exclusion requires a diligent workup to ensure an accurate diagnosis and subsequent targeted management. The development of the Budapest diagnostic criteria helped to consolidate existing definitions of CRPS but extensive work remains in identifying the underlying pathways. Currently, two distinct types are identified by the presence (CRPS type 1) or absence (CRPS type 2) of neuronal injury. Current management directed at this disease is broad and growing, ranging from non-invasive modalities such as physical and psychological therapy to more invasive techniques such as dorsal root ganglion stimulation and potentially amputation. Ideal therapeutic interventions are multimodal in nature to address the likely multifactorial pathological development of CRPS. Regardless, a significant need remains for continued studies to elucidate the pathways involved in developing CRPS as well as more robust clinical trials for various treatment modalities.
Keywords: radiofrequency ablation, atrial fibrillation, supraventricular tachycardia, electrophysiology The reported incidence of atrial fibrillation (AF) varies but it is generally acknowledged that ...the incidence and prevalence is expected to increase with continued rise in the aging population.1,2 Given the known medical complications from unmanaged AF, surgical and catheter ablation has increasingly become the recommended standard of treatment for patients with persistent and paroxysmal AF.3 Despite the successes of this therapy, there are serious potential complications whose anesthesia management requires robust preparation and meticulous perioperative management. ...a thorough preoperative evaluation is imperative. AF catheter ablation therapy is a minimally invasive procedure performed with a specially designed catheter which combines laser, cryothermic energy, and ultrasound or RF technology to create scar tissue to impede the aberrant conduction from previously mapped foci areas thought to be contributing to AF.4,5 The pulmonary vein (PV), muscular sleeves extending from the PV in the LA, lesions in the superior vena cava and cavotricuspid isthmus have all been identified as common foci sites amendable to RF ablation.4,5 The RF technology generates heat energy with temperatures as high as 50°C to form irreversibly non-conducting myocardial tissue at the foci site. ...adequate communication between the anesthesia, surgical team, and PACU staff remains invaluable.
Introduction: Sleep disturbance is common in persons with stroke and when unrecognised and untreated may hinder rehabilitation efforts and lead to poor functional outcome. It may also result in ...increased risk for stroke recurrence. Aim: We investigated the frequency and associated factors of sleep disturbances amongst stroke survivors. Methodology: One hundred and ten stroke survivors attending the neurology outpatient clinics of two tertiary hospitals, from February 2021 to January 2022, were interviewed after obtaining ethical approval and informed consent. We used a structured questionnaire to obtain their socio-demographic, clinical characteristics and sleep disturbances. Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Data were analysed with statistical significance set at P < 0.05. Results: Eighty (72.7%) patients were males with a mean age of 61.4 ± 11.8, slightly older than the females (30, 27.3%) with a mean age of 60.9 ± 2.9. Their median follow-up duration was 7.5 months. Majority (84, 76.4%) had ischaemic stroke, and the frequency of sleep disturbances was 37 (33.6%) consisting of insomnia (19, 17.3%), hypersomnia (10, 9.0%), sleep-disordered breathing (5, 4.5%) and sleep-related movement disorder (3, 2.7%), respectively. Using the ESS score, 22 (20.0%) had mild, 10 (9.0%) had moderate and 7 (6.4%) had severe ESS scores, respectively. Univariate analysis showed depression to be significantly associated with ESS (P = 0.006) whereas multivariate analysis revealed age and sex as significant associated factors (P = 0.008 and P = 0.009) of ESS. Conclusion: More than one-third of participants reported sleep disturbances with depression, age and gender as associated factors.
Objective: Myeloid sarcoma is a rare form of acute myeloid leukaemia characterized by extramedullary proliferation of myeloid blasts which can occur as an isolated lesion in any organ. Even rarer it ...may occur in the orbit as the initial presentation without a leukaemic phase and diagnosis may be challenging when it is not suspected.
Methods: We report a case of orbital myeloid sarcoma as the initial presentation of acute myeloid leukaemia in an adult who was misdiagnosed and treated as a case of a pseudotumour with resultant significant disease progression and worsening of the clinical condition. There was a lag of four months from the onset of eye mass to the development of acute myeloid leukaemia.
Result: Due to patients worsening condition and tumour progression, a repeat biopsy for a second histology opinion at a different facility, immunophenotyping and immunohistochemistry were employed to arrive at the correct diagnosis. Following chemotherapy, the orbital mass reduced markedly and clinical condition improved. The patient was indigent and could not sustain further funding of his treatment because he had already spent much on for management of complications he developed before a definitive diagnosis could be made.
Conclusion: Myeloid sarcoma can present as an orbital mass without a leukemic disease. Therefore a high index of suspicion, meticulous examination of biopsy, immunohistochemistry and collaboration between oncologists and ophthalmologists, are required to arrive at an early accurate diagnosis.
Background. We examined the role of herpes simplex virus type 2 (HSV-2) and other genital infections on human immunodeficiency virus type 1 (HIV-1) incidence in a cohort study conducted between 2002 ...and 2005 among female bar/hotel workers in Moshi, Tanzania. Methods. At baseline and every 3 months thereafter, participants were interviewed, and blood and genital samples were collected. Predictors of HIV-1 incidence were evaluated using a Cox proportional hazards regression model. Results. Of 845 women who were HIV-1 seronegative at baseline, 689 (81.5%) were monitored in the study for a total of 698.6 person-years at risk (PYARs). The overall HIV-1 incidence was 4.6/100 PYARs (95% confidence interval CI, 3.0–6.2/100 PYARs), and condom use was very low. After adjustment for other risk factors, the risk of HIV-1 was increased among women with HSV-2 at baseline (hazard ratio HR, 4.3 95% CI, 1.5–12.4) and in those who acquired HSV-2 during the study period (HR, 5.5 95% CI, 1.2–25.4). Other independent predictors of HIV-1 were baseline chlamydial infection (HR, 5.2), bacterial vaginosis (HR, 2.1), and the occurrence of genital ulcers (HR, 2.7). Conclusion. HSV-2 and other genital infections were the most important risk factors for HIV-1. Control of these infections could help to reduce HIV-1 incidence in this population.
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