Understanding and Managing Autonomic Disorders in the Neurocritical Care Unit: A Comprehensive review.

Background: For a favorable outcome, patients admitted to critical care units require continuous monitoring and swift decision-making ability regarding management. One of the biggest challenges in neurocritical care units is the identification and management of autonomic dysfunction and in the worst-case scenario, autonomic storms. Objective: Most of the literature available focuses mainly on autonomic storms following traumatic brain injury. However, due to the myriad neurological presentations in a critical care setting, it is particularly important for physicians and intensivists to suspect and manage autonomic dysfunction in various neurological scenarios. Methods: Understanding the mechanism of paroxysmal sympathetic hyperactivity (PSH) is essential for early recognition and treatment. PSH-AM is an assessment measurement scale to diagnose and assess the severity of PSH in traumatic brain injury. However, this is not yet standardized across all neurological settings. Conclusion: We present a comprehensive report on understanding the mechanism of autonomic storms across various neurological disorders and outline the management.

A Trigeminal Neuropathy From an Inactive Hepatocellular Carcinoma.

Breast, lung, prostate, thyroid, and kidney carcinomas are the primary tumors that are known to have bony metastasis. Hepatocellular carcinoma (HCC) frequently involves the lung and lymph nodes and less commonly the osseous system. Numbness/persistent pain in the distribution of the trigeminal nerve is more likely a neuropathy. The causes are idiopathic(common), unintentional injury to the trigeminal nerve during surgery or trauma, blood vessel pressing the trigeminal nerve, tumor infiltration, multiple sclerosis, and stroke. Unresolved facial pains after conventional treatment should prompt additional investigation to rule out other causes. In this case, we report a trigeminal neuropathy of rare cause, which is a solitary metastasis from an inactive HCC involving the osseous structures.

Domestic Violence and its Determinants among 15-49-Year-Old Women in a Rural Block in South India.

CONTEXT: Domestic violence in Indian setting has five major components: emotional abuse; physical violence; sexual violence; honor killing; dowry-related abuse; and death. AIMS: The aim of the study was to estimate the prevalence of domestic violence and 3 of its components - emotional abuse, physical violence, and sexual violence among women in the age group of 15-49 years in Kaniyambadi block, rural Vellore, Tamil Nadu and to determine the risk factors of domestic violence. SETTINGS AND DESIGN: A community-based cross-sectional study among women between the ages 15 and 49 years at the rural setting of Kaniyambadi block, Tamil Nadu. RESULTS: Prevalence of all forms of domestic violence among women was 77.5%, and forty percent women were classified as having ever been subjected to severe domestic violence. Prevalence of physical violence was 65.8%, sexual abuse was 17.5%, and emotional abuse was 54.2%. Alcohol consumption by husband (adjusted odds ratio [AOR] 4.37; 1.35, 14.18), controlling behavior by family member (AOR 8.07; 2.47, 26.37), and woman's employment (AOR 4.33; 1.27, 14.77) were statistically significant determinants of domestic violence. Three-fourth (73.1%) of the women felt that being subjected to domestic violence has affected their physical and mental health. CONCLUSIONS: The high prevalence of domestic violence in our community needs to be addressed as it has tacit implications on socioeconomic well-being, physical and mental health of a woman, her family, and thereby, society as a whole.