Is Serratus Posterior Superior Intercostal Plane Block a Novel Indication for the Management of Pain in Thoracic Acute Herpes Zoster? A Case Report.

ABSTRACT: Postherpetic Neuralgia (PHN) results from Varicella-Zoster Virus (VZV) reactivation post-chickenpox infection, manifesting as persistent and severe pain lasting a minimum of three months post-herpes zoster onset. Traditional PHN management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising PHN treatment. In a case involving a 58-year-old male with severe thoracic herpes zoster lesions, the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores SPSIPB's secure, effective role in managing thoracic herpes zoster and mitigating PHN risk. This case report represents the pioneering application of SPSIPB for PHN, offering a promising avenue for relieving patients suffering from this condition.

Dexmedetomidina, un agonista de alfa 2, incrementa el efecto analgésico de la morfina y reduce el desarrollo de tolerancia a la morfina suprimiendo el estrés oxidativo y la vía de señalización de TNF/IL-1 en ratas / Dexmedetomidine, an alfa 2 agonist, increases the morphine analgesic effect and decreases morphine tolerance development by suppressing oxidative stress and TNF/IL-1 signalling pathway in rats

Antecedentes: El objetivo del presente estudio es examinar el posible efecto de dexmedetomidina en el desarrollo de tolerancia a la morfina en ratas, incluyendo nocicepción, analgesia con morfina, apoptosis, estrés oxidativo, y las vías del factor de necrosis tumoral (TNF)/interleucina-1 (IL-1). Materiales y métodos: En este estudio se utilizaron 36 ratas Wistar Albino (225–245 g) dividiéndose a los animales en seis grupos: solución salina (S), 20 mcg/kg de dexmedetomidina (D), 5 mg/kg de morfina (M), M + D, tolerancia a la morfina (MT), y MT + D. El efecto analgésico se midió mediante las pruebas analgésicas de placa caliente (hot-plate) y de retirada de la cola (tail-flick). Tras dichas pruebas, se extirparon los ganglios de la raíz dorsal (GRD), y se midieron en los tejidos de los mismos los parámetros del estrés oxidativo (estado antioxidante total [TAS], estado oxidante total [TOS]), TNF, IL-1 y enzimas de la apoptosis (Caspasa-3, Caspasa-9). Resultados: Dexmedetomidina reflejó un efecto antinociceptivo al administrarse en solitario (p < 0,05 a p < 0,001). Además, dexmedetomidina incrementó el efecto analgésico de la morfina (p < 0,001), y también redujo la tolerancia a la morfina a un nivel significativo (p < 0,01 a p < 0,001), reduciendo también los niveles de estrés oxidativo (p < 0,001) y TNF/IL-1 al administrarse como fármaco adicional al grupo de dosis única de morfina y tolerancia a la morfina (p < 0,001). Además, dexmedetomidina redujo los niveles de Caspasa-3 y Caspasa-9 tras el desarrollo de tolerancia (p < 0,001). Conclusión: Dexmedetomidina tiene propiedades antinociceptivas, e incrementa el efecto analgésico de la morfina, previniendo también el desarrollo de tolerancia. Estos efectos se producen probablemente debido a la modulación del estrés oxidativo, la inflamación y la apoptosis.(AU)

Background: The aim of the present study is to examine the possible effect de dexmedetomidine on the development of morphine tolerance in rats including nociception, morphine analgesia, apoptosis, oxidative stress, and tumour necrosis factor (TNF)/ interleukin-1 (IL-1) pathways. Materials and methods: In this study, 36 Wistar Albino (225–245 g) rats were used. Animals were divided into 6 groups: saline (S), 20 mcg/kg dexmedetomidine (D), 5 mg/kg morphine (M), M + D, morphine tolerance (MT), and MT + D. The analgesic effect was measured with hot plate and tail-flick analgesia tests. After the analgesia tests, the dorsal root ganglia (DRG) tissues were excised. Oxidative stress parameters [total antioxidant status (TAS), total oxidant status (TOS)], TNF, IL-1 and apoptosis enzymes (Caspase-3, Caspase-9), were measured in DRG tissues. Results: Dexmedetomidine showed an antinociceptive effect when given alone (p < 0.05 to p < 0.001). In addition, dexmedetomidine increased the analgesic effect of morphine (p < 0.001), and also decreased the tolerance to morphine at a significant level (p < 0.01 to p < 0.001). Moreover, it decreased oxidative stress (p < 0.001) and TNF/IL-1 levels when given as an additional drug of single-dose morphine and morphine tolerance group (p < 0.001). Furthermore, dexmedetomidine decreased Caspase-3 and Caspase-9 levels after tolerance development (p < 0.001). Conclusión: Dexmedetomidine has antinociceptive properties, and it increases the analgesic effect of morphine and also prevents tolerance development. These effects probably occur by the modulation of oxidative stress, inflammation and apoptosis.(AU)

Dexmedetomidine, an α2 agonist, increases the morphine analgesic effect and decreases morphine tolerance development by suppressing oxidative stress and TNF/IL-1 signalling pathway in rats.

BACKGROUND: The aim of the present study is to examine the possible effect de dexmedetomidine on the development of morphine tolerance in rats including nociception, morphine analgesia, apoptosis, oxidative stress, and tumour necrosis factor (TNF)/ interleukin-1 (IL-1) pathways. MATERIALS AND METHODS: In this study, 36 Wistar Albino (225-245 g) rats were used. Animals were divided into 6 groups: saline (S), 20 mcg/kg dexmedetomidine (D), 5 mg/kg morphine (M), M + D, morphine tolerance (MT), and MT + D. The analgesic effect was measured with hot plate and tail-flick analgesia tests. After the analgesia tests, the dorsal root ganglia (DRG) tissues were excised. Oxidative stress parameters [total antioxidant status (TAS), total oxidant status (TOS)], TNF, IL-1 and apoptosis enzymes (Caspase-3, Caspase-9), were measured in DRG tissues. RESULTS: Dexmedetomidine showed an antinociceptive effect when given alone (p < 0.05 to p < 0.001). In addition, dexmedetomidine increased the analgesic effect of morphine (p < 0.001), and also decreased the tolerance to morphine at a significant level (p < 0.01 to p < 0.001). Moreover, it decreased oxidative stress (p < 0.001) and TNF/IL-1 levels when given as an additional drug of single-dose morphine and morphine tolerance group (p < 0.001). Furthermore, dexmedetomidine decreased Caspase-3 and Caspase-9 levels after tolerance development (p < 0.001). CONCLUSION: Dexmedetomidine has antinociceptive properties, and it increases the analgesic effect of morphine and also prevents tolerance development. These effects probably occur by the modulation of oxidative stress, inflammation and apoptosis.

Erythema measurements may allow early diagnosis of diabetes mellitus in adult psoriatics.

BACKGROUND: We have observed that the erythema in subjects with psoriasis vulgaris associated with non-insulin-dependent diabetes mellitus (NIDDM) presents a mostly deep-red to purple hue instead of the typical pink to red tones. We carried out a descriptive clinical study, including 141 patients with psoriasis vulgaris to quantify these colour differences. METHODS: Mean erythema index values were established for the psoriatic plaques of adult subjects using an optoelectronic method. Non-diabetic psoriatics underwent an oral glucose tolerance test (OGTT), and based on the results of the oral OGTTs, the subjects were divided into three groups: 18 psoriatics with NIDDM, 16 psoriatics with impaired glucose tolerance (IGT) and 107 psoriatics with normal glucose tolerance. The mean erythema index value was calculated for each group and the findings were compared. RESULTS: The differences in the erythema were found to be highly significant between the group of subjects with psoriasis having normal glucose tolerance and both those with IGT and those with NIDDM (P < 0.01 and P < 0.01). The differences in the erythema were also highly significant between the psoriatic group with normal glucose tolerance and the group of 34 psoriatics with IGT and NIDDM all together (P < 0.01). CONCLUSIONS: Individuation of the various hues of erythema in psoriatics by careful dermatological examination or routine measurements of lesional erythema may alert the physician to possible IGT in the presenting subject, and this may affect disease severity.

Helicobacter pylori and Behçet's disease.

BACKGROUND: Recent investigation of the etiology of Behçet's disease (BD) has focused on heat shock proteins (HSP) which belong to the HSP 60 family. Both the gastric pathogen Helicobacter pylori (HP) and BD may cause ulcers in the gastrointestinal tract and, HP expresses HSP 60. OBJECTIVE: Whether HP is linked to the pathogenesis of BD or not, and to investigate the influence of HP eradication on clinical parameters of BD. METHODS: Patients with BD were divided into two groups. Group I comprised 49 patients and was investigated for HP seroprevalence and compared with age- and sex-matched controls. Group II comprised 20 patients with BD and HP infection diagnosed by serological and endoscopic examinations as well as the rapid urease test (RUT). A 1-week eradication therapy was administered for HP infection. Patients were examined for the course of BD at monthly intervals. Two months after the eradication therapy, patients underwent an endoscopic examination and RUT for eradication control. Seven patients were excluded because of eradication failure. Thirteen patients were evaluated for the influence of HP eradication on clinical manifestations of BD. The number and size of oral and genital ulcers before the eradication and at the end of the follow-up period were compared statistically. RESULTS: HP seroprevalence between patients with BD and controls did not show significant difference. In 13 patients with BD, the number and size of oral and genital ulcers diminished significantly and various clinical manifestations regressed after the eradication of HP. CONCLUSION: HP may be involved in the pathogenesis of BD.

Effective treatment of persistent papular acantholytic dermatosis with cyclosporine.

We describe a patient with persistent papular acantholytic dermatosis provoked by phototoxic reaction to his usual perfumed soap and shaving foam. Therapy with systemic and topical corticosteroids failed to improve the patient. Treatment with cyclosporine was found to be effective.

Subclinical cerebral involvement in Behcet's disease: a SPECT study.

Neurologic involvement has been reported in Behcet's disease (BD) with prevalence rates of 4-49%. Involvement of the central nervous system (CNS) usually follows systemic manifestations of BD by months to years, but as the initial future in only 5% of cases. The variance of the prevalence rates of neurologic involvement in BD raises the possibility of subclinical neurologic involvement. For the purpose of explaining the variance in the prevalence rates, 20 patients with BD, but without neurological symptoms and signs, were investigated by using cerebral single photon emission computed tomography (SPECT) which seems to be more convenient for BD than other scanners. A control group of patients with various diseases that were not expected to influence the cerebral blood flow was included. Brain magnetic resonance imaging (MRI) scans were performed in cases in which abnormal SPECT findings were obtained. Decreased and asymmetrical tracer uptakes were detected in 35% of patients with BD. MRI scans were normal in these patients. We concluded that functional imaging using SPECT may detect abnormalities at an initial stage prior to their progression to morphological damage detectable by MRI, and this imaging modality can be used even in cases which show no neurologic symptom to indicate the subclinical neurologic involvement.

A case of Hutchinson-Gilford progeria syndrome mimicking scleredema in early infancy.

We report a case of Hutchinson-Gilford progeria syndrome (HGPS). The patient showed the characteristics of scleredema at the age of 2.5 months but developed all the manifestations of HGPS gradually until 10 months old. The possibility of development of HGPS should by considered in any case of scleredema at birth or in early infancy.