Immunosuppressant Medication–Induced Lower Extremity Pain After Combined Liver and Kidney Transplant: A Case Report

Calcineurin inhibitors are imperative in the success of a transplanted organ. However, these immunosuppressants can lead to a rare complication known as calcineurin inhibitor–induced pain syndrome, which may not be recognized early and managed appropriately. We present a case of a 35-year-old woman who underwent a combined liver/kidney transplant and developed lower extremity pain while being maintained on tacrolimus. This case illustrates a patient with previously reported characteristic clinical features of calcineurin inhibitor–induced pain syndrome in addition to uncharacteristic neuropathic symptoms and imaging findings. The patient was treated successfully with gabapentin, calcitonin nasal spray, and acupuncture. Early recognition of this syndrome can help improve a patient’s quality of life.

Obturator hernia—a condition seldom thought of and hence seldom sought

Purpose  

Obturator hernia is an extremely rare type of hernia with an incidence of less than 1% of all abdominal wall hernias occurring predominantly in elderly females characterized by protrusion of the intra-abdominal viscera into the obturator foramen. It presents with pain along the medial aspect of the thigh referred to the knee due to compressed obturator nerve and sometimes as an uncommon cause of intestinal obstruction. It remains a clinical diagnostic dilemma and often perplexing the decision for surgery. This explanatory review emphasizes and illuminates its various facets under the rationale of its diagnosis and management to familiarize surgeons with the condition.     

Combined thalamic ptosis and astasia

Isolated cases of astasia or ptosis have each been reported in ischemic or hemorrhagic strokes involving the thalamus. We report a 70-year-old man with a medical history of hypertension who presented with left ptosis and gait disturbance despite intact motor strength in the legs and normal sensory function. MRI of the brain showed an evolving subacute infarction confined to the anteromedial-medial part of the left thalamus with no other areas of recent infarction identified. To our knowledge, combined ptosis and astasia in thalamic infarction has not been reported in the English literature. We identified 11 patients with thalamic ptosis and 21 with thalamic astasia in the literature. Patients who had ptosis, or gait abnormality which would not be related to thalamic stroke, were excluded; for example, evidence of infarction in the hypothalamus, midbrain, pons, cerebellum, or cingulate gyrus.     

Cultural Specificity of Emotional Overinvolvement: A Systematic Review

Understanding cross-cultural aspects of emotional overinvolvement (EOI) on psychosis outcomes is important for ensuring cultural appropriateness of family interventions. This systematic review explores whether EOI has similar impact in different cultural groups and whether the same norms can be used to measure EOI across cultures. Thirty-four studies were found that have investigated the impact of EOI on outcomes across cultures or culturally adapted EOI measures. The relationship between high EOI and poor outcome is inconsistent across cultures. Attempts to improve predictive ability by post hoc adjustment of EOI norms have had varied success. Few studies have attempted a priori adaptations or development of culture-specific norms. Methodological differences such as use of different expressed emotions (EE) measures and varying definitions of relapse across studies may explain a lack of EOI outcome relationship across cultures. However, our findings suggest that the construct and measurement of EOI itself are culture-specific. EOI may not necessarily be detrimental in all cultures. The effect of high EOI may be moderated by the unexplored dimension of warmth and high levels of mutual interdependence in kin relationships. Researchers should reevaluate the prevailing concepts of the impact of family relations on the course and outcome of psychotic disorders, specifically focusing on the protective aspects of family involvement. Clinically, family interventions based on EE reduction should take cultural differences into account when treating families from different ethnocultural groups.     

A randomized clinical trial of a culturally responsive intervention for African American women with asthma

Background

Few interventions have focused on the difficulties that African American women face when managing asthma.

Alterations in redox potential of glutathione/glutathione disulfide and cysteine/cysteine disulfide couples in plasma of dropsy patients with argemone oil poisoning

Several incidences of adverse effects on human health have been reported in many countries, due to consumption of edible oil adulterated with argemone oil (AO). The clinical manifestation of the disease is commonly referred to as epidemic dropsy. In the present study, we determined the relationship between redox potentials (E(h)) of glutathione/glutathione disulfide (GSH/GSSG), cysteine/cysteine disulfide (Cys/CySS) couples and non-enzymatic antioxidants such as alpha-tocopherol and ascorbic acid status in plasma of dropsy patients (n=14) from an outbreak of argemone oil poisoning in Lucknow (March, 2005), India. Depleted GSH (55%) and concomitant enhancement (163%) of plasma GSSG content was observed in patients (P<0.05). Furthermore, lower content of Cys (42%) and CySS (25%) was noticed in patients (P<0.05) when compared to control subjects. Eh GSH and Eh Cys values were shifted by +46 mV and +12 mV towards more oxidizing environment in patients (P<0.05). In addition, alpha-tocopherol and ascorbic acid contents were found to be depleted significantly (P<0.05) in plasma of patients (59-58%). The alterations in redox potentials and antioxidants in plasma, which are synthesized in liver, may be responsible for histopathological changes in hepatic tissue of patients showing swelling of hepatocytes, fluid accumulation in spaces of Desci along with mild kupfur cell hyperplasia. Over all the present study shows that redox state of GSH/GSSG and Cys/CySS pools become oxidized which inturn causes depletion of alpha-tocopherol and ascorbic acid, thus providing a strategy to distinguish pro-oxidant and antioxidant events in patients.