Multi-organ system failure secondary to difluoroethane toxicity in a patient "huffing" air duster: a case report.

Inhalant misuse is a growing concern among Americans. According to recent reports by the National Institutes of Health and the Substance Abuse and Mental Health Services Administration, the prevalence of teenage inhalant misuse is increasing. Of the many household items that are "huffed", refrigerant-based propellant cleaners or air dusters, are one of the most misused. Although commonly referred to as "compressed air", refrigerant-based propellant cleaners contain harmful fluorinated hydrocarbons, such as 1,1-difluoroethane, that have significant toxic effects when inhaled. While the central nervous system is primarily affected, there are case reports of cardiovascular, renal, hepatic, and musculoskeletal injury secondary to 1,1-difluoroethane toxicity. However, there are few cases that have presented 1,1-difluoroethane toxicity leading to multi-organ system failure in adults with a long history of inhalant misuse. We present a unique case of multi-system organ failure secondary to 1,1-difluoroethane toxicity in a middle-aged female that was "huffing" a refrigerant-based propellant aerosol duster for more than three months. This case stresses the importance of obtaining a detailed social history to identify inhalant misuse in patients that present with acute illness of unknown etiology. This case also highlights the importance of early communication with toxicology professionals for treatment and supportive care recommendations in patients presenting the life-threatening 1,1-difluoroethane toxicity. Furthermore, this case demonstrates that 1,1-difluoroethane toxicity in the setting of "huffing" air duster has the potential to cause multi-organ system failure.

Effects of FABP knockdown on flight performance of the desert locust, Schistocerca gregaria.

During migratory flight, desert locusts rely on fatty acids as their predominant source of energy. Lipids mobilized in the fat body are transported to the flight muscles and enter the muscle cells as free fatty acids. It has been postulated that muscle fatty acid binding protein (FABP) is needed for the efficient translocation of fatty acids through the aqueous cytosol towards mitochondrial ß-oxidation. To assess whether FABP is required for this process, dsRNA was injected into freshly emerged adult males to knock down the expression of FABP. Three weeks after injection, FABP and its mRNA were undetectable in flight muscle, indicating efficient silencing of FABP expression. At rest, control and treated animals exhibited no morphological or behavioral differences. In tethered flight experiments, both control and treated insects were able to fly continually in the initial, carbohydrate-fueled phase of flight, and in both groups, lipids were mobilized and released into the hemolymph. Flight periods exceeding 30 min, however, when fatty acids become the main energy source, were rarely possible for FABP-depleted animals, while control insects continued to fly for more than 2 h. These results demonstrate that FABP is an essential element of skeletal muscle energy metabolism in vivo.

Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.