Neuropathic Pain and Positive Sensory Symptoms in Brachial Plexus Neuropathy: An Exploratory Study of Outcomes after Surgical Decompression and Proposal of a New Sensory Frequency of Symptoms Scale.

BACKGROUND: There are no articles that aim to evaluate the specific role of surgical decompression on the recovery of pain and positive sensory symptoms (PSS) in patients with brachial plexus neuropathy (BPN), as well as the relationship between pain and frequency of sensory manifestations. METHODS: A prospective before and after study was performed, considering the pain intensity through the visual analogue scale (VAS), and the frequency of PSS through a proposed new scale: Sensory Frequency of Symptoms Scale (SFSS). To compare the patients before and after the intervention, a paired T-test, a Wilcoxon signed-rank test, and Cohen's D test were made, coupled with a Spearman analysis in order to establish the relationship between pain and PSS. RESULTS: Sixteen patients were included in the study, the clinical evaluation showed changes in pain according with VAS, going from a mean preoperative state of 8.19 to 1.31 after surgery, showing significant changes (84%, p < 0.00006, Δ = 2.776). Within the PSS, a significant decrease was observed in paresthesias (74%, p < 0.0001, Δ = 1.645), dysesthesias (80%, p < 0.002, Δ = 1.453), and allodynia (70%, p = 0.031, Δ = 0.635). Conversely, the preoperative correlation analysis between pain and dysesthesias/allodynia showed a low and non-significant relationship (R < 0.4, p > 0.05). CONCLUSIONS: Surgical decompression is an effective technique for the relief of pain and sensory manifestations in adult patients with BPN of compressive origin. No relationship was observed between pain and dysesthesias/allodynia. Therefore, during clinical evaluation, they should be considered as independent manifestations, highlighting the need to validate new scales.

Hydrogen peroxide regulates angiogenesis-related factors in tumor cells.

Tumor angiogenesis is required for tumor development and growth, and is regulated by several factors including ROS. H2O2 is a ROS with an important role in cell signaling, but how H2O2 regulates tumor angiogenesis is still poorly understood. We have xenografted tumor cells with altered levels of H2O2 by catalase overexpression into zebrafish embryos to study redox-induced tumor neovascularization. We found that vascular recruitment and invasion were impaired if catalase was overexpressed. In addition, the overexpression of catalase altered the transcriptional levels of several angiogenesis-related factors in tumor cells, including TIMP-3 and THBS1. These two anti-angiogenic factors were found to be H2O2-regulated by two different mechanisms: TIMP-3 expression in a cell-autonomous manner; and, THBS1 expression that was non-cell-autonomous. Our work shows that intracellular H2O2 regulates the expression of angiogenic factors and the formation of a vessel network. Understanding the molecular mechanisms that govern this multifunctional effect of H2O2 on tumor angiogenesis could be important for the development of more efficient anti-angiogenic therapies.

Positive sensory symptoms, in surgically managed patients with carpal tunnel syndrome: A long term follow­up.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. Patients commonly experience neuropathic pain, leading them to seek medical advice. However, other symptoms experienced in patients with CTS, such as paresthesia, dysesthesia and allodynia, classed as positive sensory symptoms (PSS), are often under-reported. In the present study, patients with surgically-managed CTS were observed pre- and post-surgery to evaluate PSS, using the symptoms scale component of the Boston Carpal Tunnel Questionnaire (BCTQ) and the Sensory Frequency of Symptoms Scale. In total, 19 patients were included in the present study, with 79% female patients, and a mean age of 54±10.59 years. In addition, the mean follow-up was 63±29.91 months. The results of the present study revealed a pre-surgery BCTQ score of 3.52±0.63 and a post-surgery BCTQ score of 1.58±0.61. Notably, improvements in pain were observed, at 7.7±2.26 pre-surgery compared with 1.65±2.88 post-surgery. Compared with pre-surgery, post-surgery paresthesia scores were reduced from 2.94±0.82 to 0.47±0.45, dysesthesia scores were reduced from 2.52±0.84 to 0.47±0.39 and allodynia scores were reduced from 0.63±0.75 to 0.26±0.47. In conclusion, the results of the present study demonstrated that median nerve decompression ameliorated CTS symptoms, such as paresthesia and dysesthesia. However, further investigations are required to verify the benefits of surgery in relieving allodynia.

Neuropathic Pain Relief after Surgical Neurolysis in Patients with Traumatic Brachial Plexus Injuries: A Preliminary Report.

Objective: To evaluate the usefulness of surgical neurolysis for neuropathic pain relief in patients with posttraumatic brachial plexus injury (BPI). Methods: A prospective, longitudinal, nonrandomized, self-controlled before and after study was performed to evaluate the pain changes according to their intensity using the Visual Analogue Scale (VAS), and the sensory recovery after surgery using the British Medical Research Council (BMRC) scale for sensory recovery. To establish significant changes, a paired T-test was performed, and in order to determine the magnitude of these changes, an effect size was measured. α = 0.05. Results: Ten patients were included with an average follow-up of 61.9 ± 53.62 months. The main mechanism of injury was vehicular trauma (70%). A significant decrease in pain after the surgical intervention was observed resulting from an average preoperative state according to VAS of 8.4 ± 1.58, to a postoperative state of 3.4 ± 3.27 (59.52%, p = 0.005, Δ = 1.572), added to a mean sensory improvement (25%) from 2.8 ± 1.62 to 3.5 ± 0.97 after surgery according to BMRC, without statistically significant changes (p=0.062), showing a moderate effect size (Δ = 0.413). Almost all patients showed improvement in the continuous and paroxysmal pattern of pain. No postoperative complications were observed. Discussion. These results suggest that in cases of BPI that originates from a compressive syndrome secondary to the posttraumatic fibrosis that surrounds the nerve structures causing strangulation and inducing hypernociception, the use of surgical neurolysis is an appropriate alternative for patients with medically refractory neuropathic pain.

Family history of hypertension as an important risk factor for the development of severe preeclampsia.

OBJECTIVE: To determine the risk of preeclampsia in a population with respect to maternal and sister histories of chronic hypertension, preeclampsia and eclampsia. DESIGN: A case-control study of severe preeclampsia. SETTING: Maternity hospital in Natal, Brazil. PARTICIPANTS: A total of 412 subjects were enrolled, 148 cases and 264 controls. MAIN OUTCOME MEASURES: Personal and familial histories of hypertensive disorders. Odds ratio estimates of preeclampsia with respect to family history of hypertensive diseases. RESULTS: Women with a history of hypertensive disorders were more frequent in the case group (p = 0.001). Women whose mothers had a history of hypertension (p = 0.003), preeclampsia (p = 0.007) or eclampsia (p = 0.038) were at increased risk of severe preeclampsia. The risk of preeclampsia was greater when the woman had a sister with a history of hypertension (OR 2.60, 95% CI 1.60-4.21, p < 0.001), preeclampsia (OR 2.33, 95% CI 1.58-3.45, p < 0.001), or eclampsia (OR 2.57, 95% CI 1.28-5.16, p = 0.008). The risk of preeclampsia was also higher for women who had both a mother and sister with a history of hypertension (OR 3.65, 95% CI 1.65-8.09, p = 0.001). CONCLUSIONS: A family history of hypertensive disorders increased the risk of eclampsia and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome in a Brazilian population.

Reaching 100 in the Countryside: Health Profile and Living Circumstances of Portuguese Centenarians from the Beira Interior Region.

The interest in studying a specific population of centenarians who lives in the country's interior region (PT100-BI) emerged during the first Portuguese systematic study about centenarians (PT100 Oporto Centenarian Study). This region of Portugal is predominantly rural and is one of the regions with the largest number of aged people. The aim of this study is to provide information on the centenarians who live in the Beira Interior region, specifically in terms of their health status and the health services they use. A total of 101 centenarians (mean age: 101.1 years; SD = 1.5 years), 14 males and 87 females, were considered. Most centenarians lived in the community, and 47.6% lived in nursing homes. Nearly half (47.5%) presented cognitive functioning without deficits. A noteworthy percentage presented conditioned mobility and sensory problems. The most common self-reported diseases include urinary incontinence (31.7%), high blood pressure (23.8%), and heart conditions (19.8%). Despite these health and functional characteristics, formal support services and technical assistance were found to be scarcely used. Further research is needed to understand how the role of contextual variables and the countryside environment contribute to the centenarians' adaptation to advanced longevity.

Data on intracellular localization of RPSA upon alteration of its redox state.

Ribosomal Protein SA (RPSA), a component of the 40S ribosomal subunit, was identified as a H2O2 target in HeLa cells [1]. In order to analyze the intracellular localization of RPSA in different redox states we overexpressed wild-type RPSA (RPSAwt) or RPSA containing two cysteine to serine residue substitutions at positions 148 and 163 (RPSAmut) in HeLa cells. The transfected cells were exposed to H2O2 or N-acetylcysteine (NAC) and RPSA subcellular localization was assessed by immunofluorescence in permeabilized cells. In addition, co-immunofluorescence for RPSA and Ribosomal Protein S6 (RPS6) was performed in cells overexpressing RPSAwt or RPSAmut. Finally, the ribosomal expression of endogenous RPSA in the presence or absence of H2O2 was analyzed by Western blot. The data presented in this work is related to the research article entitled "Hydrogen peroxide regulates cell adhesion through the redox sensor RPSA" [1].

Hydrogen peroxide regulates cell adhesion through the redox sensor RPSA.

To become metastatic, a tumor cell must acquire new adhesion properties that allow migration into the surrounding connective tissue, transmigration across endothelial cells to reach the blood stream and, at the site of metastasis, adhesion to endothelial cells and transmigration to colonize a new tissue. Hydrogen peroxide (H2O2) is a redox signaling molecule produced in tumor cell microenvironment with high relevance for tumor development. However, the molecular mechanisms regulated by H2O2 in tumor cells are still poorly known. The identification of H2O2-target proteins in tumor cells and the understanding of their role in tumor cell adhesion are essential for the development of novel redox-based therapies for cancer. In this paper, we identified Ribosomal Protein SA (RPSA) as a target of H2O2 and showed that RPSA in the oxidized state accumulates in clusters that contain specific adhesion molecules. Furthermore, we showed that RPSA oxidation improves cell adhesion efficiency to laminin in vitro and promotes cell extravasation in vivo. Our results unravel a new mechanism for H2O2-dependent modulation of cell adhesion properties and identify RPSA as the H2O2 sensor in this process. This work indicates that high levels of RPSA expression might confer a selective advantage to tumor cells in an oxidative environment.

The extracellular matrix modulates H2O2 degradation and redox signaling in endothelial cells.

The molecular processes that are crucial for cell function, such as proliferation, migration and survival, are regulated by hydrogen peroxide (H2O2). Although environmental cues, such as growth factors, regulate redox signaling, it was still unknown whether the ECM, a component of the cell microenvironment, had a function in this process. Here, we showed that the extracellular matrix (ECM) differently regulated H2O2 consumption by endothelial cells and that this effect was not general for all types of cells. The analysis of biophysical properties of the endothelial cell membrane suggested that this modification in H2O2 consumption rates was not due to altered membrane permeability. Instead, we found that the ECM regulated GPx activity, a known H2O2 scavenger. Finally, we showed that the extent of PTEN oxidation was dependent on the ECM, indicating that the ECM was able to modulate H2O2-dependent protein oxidation. Thus, our results unraveled a new mechanism by which the ECM regulates endothelial cell function by altering redox balance. These results pinpoint the ECM as an important component of redox-signaling.

Active surveillance of Hansen's Disease (leprosy): importance for case finding among extra-domiciliary contacts.

Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae.

Cardiogenic shock caused by disulfiram.

Drug intoxication with disulfiram is a rare condition that may lead to severe and potentially fatal cardiovascular manifestations such as cardiogenic shock. We report the case of a female patient with refractory shock after deliberate self-poisoning with disulfiram. Clinical, biochemical and echocardiographic assessment, as well as invasive monitoring confirmed cardiogenic shock associated with this drug. The known mechanisms of action of disulfiram are discussed, and the major collateral effects, especially cardiovascular effects, are described. We underscore the importance of suspecting this diagnosis and of adopting prompt and the most adequate therapeutic approach in this context.

Emphysematous cystitis--a case report.

Emphysematous Cystitis is a primary infection of the bladder with production of gas by bacteria. The infection is uncommon, still has obvious clinical importance due to its morbidity and mortality potential, as the following case enlightens. We report a clinical case of a patient admitted with acute myocardial infarction who developed an acute emphysematous cystitis, a further complication in his long and complex period of hospitalization.

Choque cardiogênico por dissulfiram / Cardiogenic shock caused by disulfiram / Shockcardiogénico por disulfiram

A intoxicação medicamentosa por dissulfiram é uma situação rara, mas, que pode se apresentar com manifestações cardiovasculares graves e potencialmente fatais, como choque cardiogênico. É apresentado o caso de uma paciente com choque refratário, após intoxicação voluntária por dissulfiram. A avaliação clínica e bioquímica, junto à avaliação ecocardiográfica e à monitorização invasiva, confirmaram tratar-se de um choque cardiogênico associado a esse fármaco. São discutidos os mecanismos de ação conhecidos do dissulfiram e descritos os principais efeitos colaterais, especialmente os cardiovasculares, alertando para a importância da suspeição diagnóstica e da abordagem terapêutica imediata mais adequada nesse contexto.

Drug intoxication with disulfiram is a rare condition that may lead to severe and potentially fatal cardiovascular manifestations such as cardiogenic shock. We report the case of a female patient with refractory shock after deliberate self-poisoning with disulfiram. Clinical, biochemical and echocardiographic assessment, as well as invasive monitoring confirmed cardiogenic shock associated with this drug. The known mechanisms of action of disulfiram are discussed, and the major collateral effects, especially cardiovascular effects, are described. We underscore the importance of suspecting this diagnosis and of adopting prompt and the most adequate therapeutic approach in this context.

La intoxicación medicamentosa por disulfiram es una situación rara, aunque puede presentarse con manifestaciones cardiovasculares graves y potencialmente fatales, como el shock cardiogénico. Este relato presenta el caso de una paciente con shock refractario, tras intoxicación voluntaria por disulfiram. La evaluación clínica y bioquímica, junto a la evaluación ecocardiográfica y el monitoreo invasivo, confirmaron tratarse de un shock cardiogénico asociado a ese fármaco. A lo largo del presente relato se discuten los mecanismos de acción del disulfiram conocidos, así como se describen los principales efectos colaterales, específicamente los cardiovasculares. En este sentido, también se alerta para la importancia de la sospecha diagnóstica y del abordaje terapéutico inmediato más adecuado a este contexto.