Neuromielitis óptica y lupus eritematoso sistémico en un hombre: caso clínico / Neuromyelitis optica presenting concomitantly with systemic lupus erythematosus: report of one case

Neuromyelitis optica (NMO) is a severe demyelinating disease of the central nervous system, which preferentially attacks the optic nerve and spinal cord. It is associated with antibodies against aquaporin 4. Morbidity and mortality are higher than in multiple sclerosis and its treatment focuses on immunosuppressive drugs. Immunomodulators are contraindicated. We report a previously healthy 35-year-old man, presenting with NMO concomitantly with systemic lupus erythematosus. His evolution was torpid with three outbreaks in the 10 months after the diagnosis, requiring a first-line therapy with methylprednisolone and cyclophosphamide and then a second-line therapy with rituximab.

Efficacy of thiocolchicoside in Indian patients suffering from low back pain associated with muscle spasm.

Low back pain (LBP), a high prevalent condition among middle aged population, is usually associated with 'muscle spasm' that is responsible for giving rise to pain as well as its persistence. Muscle spasm is an involuntary, painful contraction of muscles that interferes with the function and cause of muscular disorder. Therefore centrally acting skeletal muscle relaxants, also called lissive drugs, are commonly used for its treatment. Sometimes these are combined with NSAIDs. The use of centrally acting skeletal muscle relaxants, though efficacious, is associated with frequent development of dose-related adverse drug reactions like sedation, impairment of voluntary motor functions and ataxia. So there is an urgent need for newer better drugs for treatment of conditions associated with muscle spasm. The objective of this study was to assess the efficacy and safety of oral thiocolchicoside (TC), a natural glycoside as compared to an adrenergic alpha 2 agonist tizanidine (TZ) in the Indian patients with LBP accompanied by muscle spasm. In this randomised, non-cross over clinical study, 60 adult Indians aged between 18 and 65 years with clinical diagnosis of muscle spasm associated with low back pain were enrolled. Patients satisfying the inclusion and exclusion criteria were either treated with TC and TZ for one week duration. Visual analogue scale (VAS) for pain at rest and VAS for tiredness, drowsiness, dizziness and alertness was used as the self-rated primary efficacy and safety variable. Pain was also assessed by mobility assessment; muscle spasm assessment and analgesic consumption. Data obtained from 58 patients (those who completed the study) indicated that in this one week study both TC and TZ provided sustained symptoms relief compared with the baseline. There was statistically significant reduction in severity of symptoms from day 0 to day 7 in both the groups. Patients were followed up on 3rd and 7th day and severity score of various parameters was recorded. There was significant difference among the treatment groups in favour of TC than TZ in efficacy parameters thus showing TC is at slightly better effective than TZ and in case of safety, TC scores significantly better over TZ in the patients with accompanying muscle spasm. These findings confirm that TC is a preferred option for the LBP with muscle spasms.

Role of temporalis muscle over activity in chronic tension type headache: effect of yoga based management.

The role of central versus peripheral mechanisms has always been questioned while explaining the etiopathogenesis of chronic tension type headache (CTTH). The following study was done to study the role of muscle spasm in CTTH. 15 patients of CTTH and 7 age matched controls were included in the study and their m. temporalis EMG was recorded for one minute each during rest, mental activity and maximal voluntary contraction and subjective pain scoring was done by visual analogue scale. The results revealed significant overactivity of m.temporalis in CTTH patients at rest when compared with control subjects (P = 0.01 and 0.03 left and right side respectively). After respective interventions namely non steroidal anti inflammatory drugs, botulinum toxin injections and yogic life style course, the EMG records revealed decrease in the mean EMG amplitude of m. temporalis during rest and mental activity more significantly after yoga based interventions (P = 0.03) and subjective pain scores decreased from 7.00 +/- 2.10 to 2.00 +/- 1.26 (P = 0.02) supporting the beneficial effect of such non invasive techniques.

Satoyoshi syndrome.

Satoyoshi syndrome (Komuragaeri disease) is a rare disorder of presumed autoimmune etiology, characterized by painful muscle spasms, alopecia, diarrhea, endocrinopathy with amenorrhoea and secondary skeletal abnormalities. Most of the previous reports are of the Japanese people. We report the first case from India.

Edema pulmonar no cardiogénico secundario a laringoespasmo posterior a anestesia general / Laryngospasm induced pulmonary edema following general anesthesia. A case report

Se presenta el caso clínico de un paciente joven, sano, que desarrolló edema pulmonar no cardiogénico secundario a laringoespasmo posterior a la extubación, no detectándose el problema en forma inmediata, sino hasta 24 hrs después cuando se manifestó con taquicardia y desaturación por oximetría de pulso. La radiografía de tórax, mostró infiltrados alveolares bilaterales difusos y zona de confluencia en el lóbulo superior del pulmón derecho. No requirió reintubación. La terapia consistió en oxígeno suplementario por puntas nasales, restricción de líquidos, diuréticos, esteroides, broncodilatadores y antibióticos. Después del tratamiento establecido, hubo franca mejoría 24 hrs después, confirmado clínica y radiológicamente

Colapso circulatorio intraoperatorio debido a espasmo coronario después de revascularización coronaria exitosa / Intraoperative circulatory collapse due to coronary artery spasm folowing successfully coronary artery bypass graftin

Es espasmo de las arterias coronarias es una entidad actualmente reconocida como causa de isquemia y de colapso circulatorio en el trans y post-operatorio de la cirugía de revascularización coronaria. Presentamos nuestra experiencia en la detección y manejo de 2 casos con colapso hemodinámico durante el retiro de la circulación extracorpórea. Estos síntomas fueron refractarios al tratamiento con inotrópicos como la norepinefrina, y la epinefrina y con vasodilatadores como la nitroglicerina. Los cambios electrocardiográficos y la pobre respuesta al tratamiento, en ambos casos, donde la cirugía se consideró exitosa, en base a protección miocárdica excelente y revascularización completa, sugirieron un espasmo coronario severo. En ambos se usó nifedipina sublingual, obteniéndose una respuesta satisfactoria e inmediata, lo que permitió retirar el apoyo inotrópico y la circulación extracorpórea. Revisamos la literatura sobre la fisiopatología y el tratamiento del espasmo coronario en la cirugía cardiaca

Espasmo hemifacial e impressäo basilar associados a malformaçäo de Arnold-Chiari: relato de caso / Hemifacial spasm and basilar impression associated with Arnold-Chiari deformity: report of a case

Os autores relatam o caso de uma paciente com espasmo hemifacial e impressäo basilar associados a malformaçäo de Arnold-Chiari. Com a descompressäo cirúrgica da fossa posterior, empregada no tratamento da impressäo basilar, houve melhora do quadro clínico e o espasmo hemifacial se reduziu quanto à freqüência, duraçäo e intensidade. É enfatizada a necessidade do tratamento etiológico do espasmo hemifacial, antes de se recorrer à toxina botulínica