الملخص
Itch is an unpleasant sensation that urges people and animals to scratch. Neuroimaging studies on itch have yielded extensive correlations with diverse cortical and subcortical regions, including the insular lobe. However, the role and functional specificity of the insular cortex (IC) and its subdivisions in itch mediation remains unclear. Here, we demonstrated by immunohistochemistry and fiber photometry tests, that neurons in both the anterior insular cortex (AIC) and the posterior insular cortex (PIC) are activated during acute itch processes. Pharmacogenetic experiments revealed that nonselective inhibition of global AIC neurons, or selective inhibition of the activity of glutaminergic neurons in the AIC, reduced the scratching behaviors induced by intradermal injection of 5-hydroxytryptamine (5-HT), but not those induced by compound 48/80. However, both nonselective inhibition of global PIC neurons and selective inhibition of glutaminergic neurons in the PIC failed to affect the itching-scratching behaviors induced by either 5-HT or compound 48/80. In addition, pharmacogenetic inhibition of AIC glutaminergic neurons effectively blocked itch-associated conditioned place aversion behavior, and inhibition of AIC glutaminergic neurons projecting to the prelimbic cortex significantly suppressed 5-HT-evoked scratching. These findings provide preliminary evidence that the AIC is involved, at least partially via aversive emotion mediation, in the regulation of 5-HT-, but not compound 48/80-induced itch.
الموضوعات
Humans , Animals , Serotonin , Insular Cortex , Pruritus/chemically induced , Cerebral Cortex/physiology , Neuronsالملخص
Abstract Nitric oxide (NO) is an abundant mediator which is demonstrated to be involved in pruritus. Assuming that the increased NO also mediates chloroquine-induced pruritus, which is a frequent complication seen in the chronic chloroquine treatment, the current study aimed to investigate the effect of quercetin and the role of NO in chloroquine-induced pruritus in C57BL/6 mice. Model was created with subcutaneous chloroquine (400µg/site) injection to the nape of the mice. Effect of quercetin and role of NO were investigated with administration of quercetin, and co-administration with L-NAME, 7-NI and L-arginine before chloroquine injection. Locomotor activity was assessed by activity cage and number of the scratching bouts after chloroquine injection was recorded for 30 minutes. Our results show that quercetin significantly reduced scratching bouts at the doses of 10, 20, 40 and 80 mg/kg. Locomotor activity was decreased at the 40 and 80 mg/kg doses of quercetin. Additionally, decrease of the number of scratching bouts by quercetin prevented by L-arginine treatment, while L-NAME and 7-NI enhanced the anti-pruritic effect of sub-effective doses of quercetin. Therefore, our study demonstrated that acute injection of quercetin significantly diminished chloroquine-induced scratching behavior, and this effect is partly mediated by inhibition of neuronal nitric oxide synthase enzyme.
الموضوعات
Animals , Male , Mice , Pruritus/chemically induced , Quercetin/adverse effects , Chloroquine/administration & dosage , Nitric Oxide/agonists , Motor Activityالملخص
Mitochondrial reactive oxygen species (mROS) that are overproduced by mitochondrial dysfunction are linked to pathological conditions including sensory abnormalities. Here, we explored whether mROS overproduction induces itch through transient receptor potential canonical 3 (TRPC3), which is sensitive to ROS. Intradermal injection of antimycin A (AA), a selective inhibitor of mitochondrial electron transport chain complex III for mROS overproduction, produced robust scratching behavior in naïve mice, which was suppressed by MitoTEMPO, a mitochondria-selective ROS scavenger, and Pyr10, a TRPC3-specific blocker, but not by blockers of TRPA1 or TRPV1. AA activated subsets of trigeminal ganglion neurons and also induced inward currents, which were blocked by MitoTEMPO and Pyr10. Besides, dry skin-induced chronic scratching was relieved by MitoTEMPO and Pyr10, and also by resveratrol, an antioxidant. Taken together, our results suggest that mROS elicit itch through TRPC3, which may underlie chronic itch, representing a potential therapeutic target for chronic itch.
الموضوعات
Animals , Mice , Antioxidants/pharmacology , Mitochondria , Pruritus/chemically induced , Reactive Oxygen Species/metabolism , TRPA1 Cation Channelالملخص
Abstract: Sulfur mustard is one of the chemical warfare agent. It rapidly reacts with the cutaneous tissues and other tissues, leading to various devastating long-term effects on human health. Mustard-exposed veterans suffer from its chronic skin problems, including itching, burning sensation, and eczema. We aimed to evaluate the protective effects of Myrtus communis L. (myrtle) on chronic skin lesions and quality of life of sulfur mustard-exposed veterans. In this randomized, double-blind clinical trial, 60 sulfur mustard-exposed patients were evaluated. Thirty patients received myrtle essence 5% cream (case group) and 30 patients received Eucerin cream (placebo group) twice in a day for one month. Then, We assessed the chronic skin problems and itching-related parameters (such as the itching time, severity, distribution, frequency, and calculated itching score), duration of sleep, number of waking up at night, and quality of life in the both groups. Our analysis of data revealed that application of myrtle cream effectively decreased skin problems including; itching and burning sensation. Additionally, myrtle markedly decreased skin lesion symptoms such as excoriation in the case group as compared with before treatment. Noticeably, myrtle cream significantly improved quality of life of the patients in the case group. The present study provides more in-depth information regarding the protective role of myrtle on the sulfur mustard-induces skin complication. Also, myrtle effectively improved quality of life of the sulfur mustard-exposed veterans.
الموضوعات
Humans , Middle Aged , Skin Diseases/chemically induced , Plant Extracts/therapeutic use , Chemical Warfare Agents/toxicity , Myrtus communis/therapeutic use , Phytotherapy , Mustard Gas/toxicity , Pruritus/chemically induced , Quality of Life , Veterans , Indicators of Quality of Life , Eczema/chemically induced , War Exposure/adverse effects , Iranالملخص
El consumo ilícito de esteroides anabólicos androgénicos con fines estéticos ha aumentado en los últimos años y, aunque raro, es causa de hepatotoxicidad. Los casos con daño hepatocelular son más frecuentes, pero los colestásicos son más graves y pueden asociarse a falla renal. Salvo por la suspensión del fármaco, la hepatotoxicidad por anabólicos no tiene tratamiento específico. Se describe y discuten las historias clínicas de dos hombres jóvenes, deportistas aficionados que consultaron por ictericia y presentaron colestasis e insuficiencia renal. El reporte de casos, en patologías poco frecuentes, resulta fundamental para difundir y ampliar la información que ayude al clínico a considerar con firmeza este diagnóstico, incluso ante la falta de reconocimiento inicial del consumo por parte del paciente.
Illicit consumption of anabolic-androgenic steroids for aesthetic purposes has increased in recent years. Hepatocellular damage is more frequent, but cholestasis is more dangerous and may be associated with renal failure. The clinical records of two young men, amateur athletes who consulted for jaundice in the last year and denied its consumption at the beginning, are described. Except for the drug interruption, hepatotoxicity by anabolics has no specific treatment. Usually presented as cholestatic liver disease and renal failure, case reports are fundamental to characterize its clinical-evolutionary presentation. This may also allow clinicians to firmly consider diagnosis even when the patient denies consumption.
O uso ilícito de esteróides androgênicos anabólicos para fins estéticos tem aumentado nos últimos anos e, apesar de raro, é causa de hepatotoxicidade. Casos com dano hepatocelular são mais freqüentes, mas colestesia é mais grave e pode estar associada à insuficiência renal. Com exceção da suspensão do medicamento, a hepatotoxicidade anabólica não possui tratamento específico. As histórias clínicas de dois homens jovens, atletas amadores que consultaram para icterícia e apresentaram colestase e insuficiência renal, são descritos e discutidos. O relato de casos, em patologias pouco freqüentes, é fundamental para disseminar e ampliar as informações que auxiliam o clínico a considerar com firmeza esse diagnóstico antes mesmo do não reconhecimento inicial do consumo pelo paciente.
الموضوعات
Humans , Male , Adult , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/rehabilitation , Anabolic Agents/adverse effects , Androgens/adverse effects , Pruritus/chemically induced , Cholestasis/chemically induced , Renal Dialysis , Renal Insufficiency/chemically induced , Renal Insufficiency/therapy , Jaundice/chemically inducedالملخص
The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2 mg were randomized to receive, after the child's birth, metoclopramide 10 mg (Group I - control), droperidol 2.5 mg (Group II) or ondansetron 8 mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively. Ondansetron does not inhibit subarachnoid morphine-induced pruritus.
O efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea. 180 pacientes ASA I ou II programadas para serem submetidas a cesarianas sob anestesia subaracnoidea à qual foram acrescentados 0,2 mg de morfina foram divididas aleatoriamente para receber, logo após o nascimento da criança, 10 mg de metoclopramida (grupo I - controle), 2,5 mg de droperidol (grupo II),ou 8 mg de ondansetron (grupo III). No período pós-operatório as pacientes foram avaliadas quanto ao prurido (ausente, leve, moderado ou intenso) ou outros efeitos colaterais por observadores que não sabiam a alocação das pacientes. As pacientes também não sabiam da sua alocação. Os grupos foram comparados pela sua tendência a apresentar formas mais severas de prurido. Também determinamos o NNT. As pacientes alocadas para receber droperidol [ O ondansetron não inibiu o prurido provocado pela morfina subaracnoidea.
El efecto profiláctico del ondansetrón sobre el prurito provocado por la morfina subaracnoidea es controvertido, mientras las evidencias nos muestran que el droperidol previene el prurito. El objetivo del presente trabajo es comparar el efecto del droperidol con el del ondansetrón sobre el prurito provocado por la morfina subaracnoidea. Ciento ochenta pacientes ASA I o II programadas para someterse a cesáreas bajo anestesia subaracnoidea a la cual se le añadió 0,2 mg de morfina fueron divididas aleatoriamente para recibir, inmediatamente después del nacimiento del niño, 10 mg de metoclopramida (grupo I-control), 2,5 mg de droperidol (grupo II) u 8 mg de ondansetrón (grupo III). En el período postoperatorio las pacientes fueron evaluadas en cuanto al prurito (ausente, leve, moderado o intenso) u otros efectos colaterales por observadores que no sabían nada respecto de la ubicación de las pacientes. Las pacientes tampoco conocían su propia ubicación. Los grupos fueron comparados por su tendencia a presentar formas más severas de prurito. También se determinó el NNT. Las pacientes aleatorizadas para recibir droperidol ( El ondansetrón no inhibió el prurito provocado por la morfina subaracnoidea.
الموضوعات
Humans , Female , Pregnancy , Adult , Pruritus/prevention & control , Ondansetron/therapeutic use , Droperidol/therapeutic use , Morphine/adverse effects , Pruritus/chemically induced , Cesarean Section/methods , Double-Blind Method , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anesthesia, Obstetrical/adverse effects , Anesthesia, Obstetrical/methods , Metoclopramide/therapeutic use , Morphine/administration & dosageالملخص
El gas CS (o-clorobenzolideno malononitrilo) se incluye dentro del grupo de los gases lacrimógenos. La exposición a dicho gas ocurre durante su empleo como gas de defensa o antidisturbios, así como durante el entrenamiento rutinario de las fuerzas de choque especializadas. Su acción tóxica es ejercida a través de un efecto irritante sobre piel y mucosas, así como por mecanismos inmunoalérgicos. Presentamos el caso de un paciente de 24 años, perteneciente a una fuerza de choque, que consultó por lesiones cutáneas luego de una exposición a humo y dispersión de polvo de una granada de gas CS durante ejercicios de entrenamiento. Clínicamente se presentó características peculiares, referidas a sus manifestaciones cutáneas, localización y severidad de las mismas. Se analiza la etiopatogenia de las lesiones y los posibles mecanismos involucrados, diagnósticos diferenciales, así como los pilares del tratamiento frente a una exposición a gas CS...
الموضوعات
Humans , Male , Tear Gases/adverse effects , Tear Gases/toxicity , Skin , o-Chlorobenzylidenemalonitrile/adverse effects , Erythema , Flushing , Pruritus/etiology , Pruritus/chemically inducedالملخص
OBJECTIVE: Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. METHODS: Forty pregnant women received epidural analgesia with 15 mL of 0.125 percent ropivacaine (EA group) and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. RESULTS: There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60 percent of CSE group newborns were found to be neurologically healthy at the 24 hour examination. CONCLUSION: EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.
OBJETIVO: A peridural (AP) e a técnica de duplo bloqueio (DB) são utilizadas em analgesia para o trabalho de parto. Este estudo comparou os efeitos na mãe e no feto de ambas as técnicas em analgesia e anestesia para o parto. MÉTODOS: Quarenta parturientes ASA I e II receberam por via peridural 15 ml de ropivacaína a 0,125 por cento (grupo AP) e 5 µg de sufentanil com 2,5 mg bupivacaína por via subaracnóidea (grupo DB). Foram avaliados: intensidade de dor, altura do bloqueio sensitivo, tempo de latência, bloqueio motor, duração da analgesia de parto, tempo para a resolução do parto, hipotensão materna e presença de prurido. Os recém-nascidos foram avaliados pelo índice de Apgar e escore da capacidade adaptativa e neurológica (ECAN), método de Amiel-Tison. RESULTADOS: Não houve diferenças significativas entre os grupos na intensidade da dor, no tempo de latência, no nível do bloqueio sensitivo e no índice de Apgar. O bloqueio motor, a duração da analgesia e o tempo para resolução do parto foram maiores no grupo DB, do qual sete parturientes apresentaram prurido leve. ECAN foi maior no grupo AP após meia hora, duas horas e 24 horas. Noventa e cinco por cento dos recém-nascidos do grupo AP e 60 por cento do grupo DB foram considerados neurologicamente vigorosos ao exame de 24 horas. CONCLUSÃO: As duas técnicas mostraram-se eficazes para analgesia do trabalho de parto. As parturientes do grupo DB apresentaram prurido e trabalho de parto mais prolongado. Recém-nascidos de mães que receberam analgesia de parto via peridural apresentaram melhor ECAN.
الموضوعات
Female , Humans , Infant, Newborn , Pregnancy , Young Adult , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Anesthesia, Conduction/methods , Fetus/drug effects , Labor, Obstetric/drug effects , Amides , Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/adverse effects , Anesthesia, Conduction/adverse effects , Anesthetics , Chi-Square Distribution , Labor Pain/physiopathology , Mothers , Pruritus/chemically induced , Sufentanil , Young Adultالملخص
BACKGROUND: Cutaneous drug reactions are the most common adverse reactions attributed to drugs. Any skin disorder can be imitated, induced or aggravated by drugs. AIMS: The present study was carried out to determine the age, sex incidence and clinical pattern of drug eruptions, to recognize offending drugs (self medication or prescribed), to evaluate mortality and morbidity associated with drugs, to educate the patients, and to avoid self-administration of drugs and re-administration of the offending drugs. METHODS: The diagnosis of cutaneous drug reactions is mainly based on detailed history and correlation between drug intake and the onset of rash. Two hundred patients (112 males and 88 females) presenting with cutaneous drug reactions were studied. RESULTS: Fixed drug eruption was seen in 61 patients; others being urticaria and angioedema, morbilliform rash in 37, pruritus in 25, Stevens Johnson (SJ) syndrome in six, purpura in six, exfoliative dermatitis in five, photosensitivity in five, Toxic Epidermal Necrolysis in two, acneiform eruption in three, and erythema multiforme in two patients. The most frequently affected age group was 41-50 years, followed by the 21-30 and 31-40 years age groups. The youngest patient was one year old and the oldest was 80 years old. The period of development of lesions after the intake of drug(s) varies from 01-45 days. Cotrimoxazole was the offending drug in 26 cases, followed by Ibuprofen in 20 cases. CONCLUSIONS: Fixed drug eruption was the most common drug eruption seen. Cotrimoxazole was the most common cause of drug eruptions.
الموضوعات
Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Antitubercular Agents/adverse effects , Child , Child, Preschool , Drug Eruptions/classification , Female , Humans , Ibuprofen/adverse effects , Incidence , Infant , Male , Middle Aged , Patient Education as Topic , Prospective Studies , Pruritus/chemically induced , Stevens-Johnson Syndrome/chemically induced , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Young Adultالملخص
O prurido é um efeito colateral, dentre vários outros, gerado pelo uso da morfina administrada por qualquer via. Tal efeito, o prurido, pode assumir, muitas vezes, grandes proporcoes e com isso inviabilizar o emprego da morfina. No presente estudo, procurou-se obseervar os resultados obtidos, para o tratamento do prurido, com o uso de ondansetron, fármaco antagonista dos receptores 5-HT3, que já tem mostrado propriedades antipruriginosas excelentes conforme dados da literatura. Foi realizado um estudo prospectivo e duplo-cego em 80 pacientes com prurido após emprego de morfina administrada via peridural ou subaracnoídea. Nessa pesquisa, observaram-se se valores foram iguais ou superiores a 4 em uma escala variável de 0 a 10. Um grupo (n=40) recebeu 96ml de soluçäo fisiológica mais 8mg de ondansetron (4ml), e outro (n=40) grupo recebeu somente 100ml de soluçäo fisiológica. Considerou-se sucesso o tratamento quando se verificou uma diminuiçäo de 4 ou mais pontos nesta escala após a administraçäo da soluçäo e num período de 1h, medindo-se o resultado de 10 em 10 minutos. Os resultados mostraram sucesso no tratamento com ondansetron em 75 por cento dos casos de peridural e 75 por cento dos casos de bloqueio subaracnoídeo. No grupo tratado com placebo (soro fisiológico, o prurido cessou em 33 por cento dos casos de peridural e em 27,27 por cento dos casos de bloqueio subaracnoídeo. Ocorreu prevalência de sexo nos casos estudados: através de via peridural, o tratamento foi mais efetivo em mulheres, e por via subaracnoídea, os homens apresentaram melhora mais significativa. Quanto à idade, näo houve diferença no tratamento. Estes resultados só diferem dos encontrados na literatura no que se refere ao sexo. Quatro casos com ondansetron e 3 casos com o placebo (soro fisiológico) que apresentou sucesso no tratamento tiveram reincidência do prurido dentro das 12h subseqüentes, o que apresentou um percentual de 13 por cento para o grupo do ondansetron e 25 por cento para o grupo controle. Esses dados equiparam-se com aqueles vistos na literatura. Os resultados säo animadores e mostram outro fármaco com boas perspectivas para o tratamento desse efeito colateral sem comprometer a analgesia produzida pela morfina, como acontece quando säo empregados antagonistas puros dos narcóticos como a naloxona.
الموضوعات
Humans , Male , Female , Analgesics, Opioid/adverse effects , Morphine/adverse effects , Ondansetron/therapeutic use , Prevalence , Pruritus/chemically induced , Pruritus/drug therapy , Serotonin Antagonists/therapeutic use , Analgesia, Epiduralالملخص
O prurido após o emprego de morfina por via peridural é uma complicaçäo frequente. O tratamento com naxolona pode resultar em má qualidade da analgesia. O objetivo deste estudo foi investigar a eficácia do propofol em doses sedativas peroperatórias na profilaxia do prurido induzido pela morfina peridural. Método - Quarenta pacientes, estado físico ASA I e II, foram divididos em dois grupos. No Grupo I foi feita anestesia peridural com licaína 2 por cento com adrelina 1:200.000 (20 ml), associada a 2 mg de morfina. No Grupo II foi feita a mesma anestesia associada a 0,7 mg.kg -1 de proporfol por via venosa como sedativo e 50 ug.kg.min. -1 em infusåo contínua durante todo o período de 24 horas a incidência de prurido no pós-operatório. Resultados - Observamos que a incidência de prurido foi maior no Grupo I (75 por cento) do que no Grupo II (apenas 5 por cento). Conclusöes - O propofol em doses sedativas per-operatórias é droga eficiente na prevençäo do prurido induzido pela morfina administrada por via peridural.
الموضوعات
Humans , Male , Female , Adult , Anesthesia, Epidural/adverse effects , Morphine/adverse effects , Propofol/therapeutic use , Pruritus/chemically induced , Pruritus/prevention & controlالملخص
In eight patients with chronic and stable psoriasis, the usefulness of topical cyclosporine solution using 50 percent dimethylsulfoxide as a vehicle was assessed in a randomly chosen plate and compared with a similar solution without cyclosporine in a contralateral plate. After six months of treatment, the plates involuted in two patients and in the rest there was a 1 to 3 points reduction in the local psoriasis area severity istry were detected. It is concluded that topical cyclosporine is effective in the treatment of psoriasis, but only after a prolonged application period