Case Study of a Rare Genetic Disorder: Congenital Insensitivity to Pain With Anhidrosis.

A rare autosomal recessive disorder, congenital insensitivity to pain with anhidrosis, is characterised by the congenital lack of pain sensation. Other characteristic symptoms include no sweating, recurrent episodes of hyperpyrexia, retardation of mental abilities and self-mutilating behaviour. Herein, we present a case of a one-year-old male child who initially presented with self-bites on the tongue and then multiple fractures with no report of pain or crying, which initially indicated carelessness of parents. Based on further in-depth assessment indicating a family history of similar weak bones and no pain, the paediatric team conducted investigations along with genetic tests. The child was diagnosed with congenital insensitivity to pain with anhidrosis. Another sibling born later also had the same disorder. Both the children developed eczema, which was difficult to cure due to constant scratching by children as they did not feel any pain. Follow-up studies indicated a slight difficulty in learning abilities and delay in the achievement of milestones. This case report indicates the need for rigorous investigations in such cases to understand the aetiology and appropriate counselling of parents for the utmost care of the child.

Is There a Role of Cupping Therapy in the Treatment of Carpal Tunnel Syndrome in Primary Care Setting?

Carpal tunnel syndrome (CTS) is a clinical syndrome, which causes significant morbidity. It is currently managed conservatively with splinting or steroidal injections. Where conservative management is unsatisfactory, surgical decompression is carried out. Because of dangerous complications of surgical procedures and increasing economical burden of CTS condition, safe, traditional, cost effective conservative adjunct option is being evaluated in this review article. Cupping therapy is an ancient but increasingly popular therapy for a variety of pathologies. Studies over the last decade have indicated potential therapeutic value of cupping therapy for the management of CTS. Whilst there is some biomedical rationale supporting the usage of cupping therapy in CTS the evidence is not sufficient to support the inclusion of cupping therapy in management of carpal tunnel syndrome in formal pathways. High quality trials with increased participant numbers, development of blinded study options and a regulatory body for cupping therapy are required so that cupping therapy can be established as a potent therapeutic option for CTS. The review was conducted to examine the efficacy of cupping therapy in management of CTS.