Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study

Abstract Background: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality — all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. Methods: Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. Results: Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. Conclusions: Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.(AU)

Combined atropine and glycopyrrolate in organophosphate poisoning: The right solution for an old problem.

Unintentional and intentional organophosphate (OP) poisonings continue to be a significant cause of morbidity and mortality in India. Conventional treatment with atropine may lead to CNS toxicity, although control of secretions may still be inadequate. The aim of this study was to assess the effectiveness of atropine along with glycopyrrolate in organophosphate poisonings. A prospective randomized double-blinded, placebo-con-trolled trial was done in an emergency department of a university hospital. Patients who consumed OP compounds were included. Pregnant women, hypothermic adults, mixed poisonings, and concomitant alcoholic intoxications were excluded. The subjects received either atropine and glycopyrrolate, or atropine and a matching placebo as a bolus through a peripheral IV line. All other aspects of treatment were carried out as per standard procedure. Seventy six victims were involved during a six month period, 38 belonging to the study group, and the remaining to the control group. There were no significant differences in demographic data, time of arrival, or time of starting treatment. Results revealed that the duration on ventilator was reduced in 60% of the study group as compared to the control group, reduction in the duration of ICU stay occurred in 20% of control group, while it was 72% of the study group. CNS toxicity occurred in 40% of control group, and 2% of study group. Intermediate syndrome developed in 8 of 38 subjects in the control group, and 1 of 38 in the study group. Development of respiratory tract infection was seen in 12% of the control group, while it occurred in only 5% of the study group. Addition of glycopyrrolate appears to be a promising new intervention in the management of OP poisoning.