Rejected

Pheochromocytomas and paragangliomas are catecholamine-secreting tumors characterized by excessive adrenergic stimulation. Common manifestations include hypertension, headache, sweating, and palpitations; however, rare life-threatening conditions have also been reported and include cardiovascular shock, myocardial infarction, arrhythmias, and cardiomyopathy. We report a case of a previously healthy 31-year-old postpartum female presenting with headache who died suddenly in an emergency room. Autopsy revealed a pheochromocytoma of the right adrenal with significantly elevated metanephrine concentrations and acute "myocarditis." Sudden excessive catecholamine release can cause cardiovascular complications and be rapidly fatal without significant elevation of blood pressure. Awareness of this association by the medical examiner/coroner is vital in order to properly classify the death and apprise relatives of the potential utility of genetic screening.

Addison disease is chronic primary adrenal insufficiency, which, in developed countries, is most commonly due to autoimmune destruction of the cortex (termed autoimmune or idiopathic Addison disease). Although the disease process has some classic features, such as increased pigmentation, salt craving, and signs and symptoms related to decreased blood pressure, the initial clinical presentation may be vague and/or insidious. Following an acute stressor such as a gastrointestinal (GI) infection, the patient may experience an adrenal crisis, which can cause sudden death. As such, knowledge of this disease process and the diagnostic criteria in the postmortem period is essential for the practicing forensic pathologist. The diagnosis of autoimmune Addison disease at autopsy is aided by several factors including 1) history, including salt craving, features consistent with orthostatic hypotension, and GI complaints including nausea, vomiting and pain, 2) physical examination findings of increased pigmentation and small or unidentifiable adrenal glands, 3) serologic testing for 21-hydroxylase antibodies, 4) serum cortisol concentrations, and 5) vitreous electrolyte testing. While the listed historical information, the increased pigmentation, decreased serum cortisol concentrations, and evidence of hyponatremia may be found in all forms of Addison disease, small or unidentifiable adrenal glands and 21-hydroxylase antibodies are found exclusively in the autoimmune form of Addison disease. While other causes of Addison disease, such as tuberculosis, metastatic tumor, or other infiltrative processes would have enlarged adrenal glands, these diseases would lack 21-hydroxylase antibodies. The purpose of this paper is to focus on the diagnosis of autoimmune Addison disease.

Intravenous lidocaine administration produces an analgesic effect in various pain states, such as neuropathic and acute pain, although the underlying mechanisms remains unclear. Here, we hypothesized that intravenous lidocaine acts on spinal cord neurons and induces analgesia in acute pain. We therefore examined the action of intravenous lidocaine in the spinal cord using the in vivo patch-clamp technique. We first investigated the effects of intravenous lidocaine using behavioural measures in rats. We then performed in vivo patch-clamp recording from spinal substantia gelatinosa (SG) neurons. Intravenous lidocaine had a dose-dependent analgesic effect on the withdrawal response to noxious mechanical stimuli. In the electrophysiological experiments, intravenous lidocaine inhibited the excitatory postsynaptic currents (EPSCs) evoked by noxious pinch stimuli. Intravenous lidocaine also decreased the frequency, but did not change the amplitude, of both spontaneous and miniature EPSCs. However, it did not affect inhibitory postsynaptic currents. Furthermore, intravenous lidocaine induced outward currents in SG neurons. Intravenous lidocaine inhibits glutamate release from presynaptic terminals in spinal SG neurons. Concomitantly, it hyperpolarizes postsynaptic neurons by shifting the membrane potential. This decrease in the excitability of spinal dorsal horn neurons may be a possible mechanism for the analgesic action of intravenous lidocaine in acute pain.

People are increasingly involved in the self-management of their own health, including chronic conditions. With technology advances, the choice of self-management practices, tools, and technologies has never been greater. The studies reported here investigated the information seeking practices of two different chronic health populations in their quest to manage their health conditions. Migraine and diabetes patients and clinicians in the UK and the US were interviewed about their information needs and practices, and representative online communities were explored to inform a qualitative study. We found that people with either chronic condition require personally relevant information and use a broad and varied set of practices and tools to make sense of their specific symptoms, triggers, and treatments. Participants sought out different types of information from varied sources about themselves, their medical condition, and their peers' experiences of the same chronic condition. People with diabetes and migraine expended great effort to validate their personal experiences of their condition and determine whether these experiences were 'normal'. Based on these findings, we discuss the need for future personal health technologies that support people in engaging in meaningful and personalised data collection, information seeking, and information sharing with peers in flexible ways that enable them to better understand their own condition.

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

The Zika Fever is a viral disease caused by a single-stranded RNA virus from the Flavivirus genus, Flaviviridae family, from the Spondweni group. Its transmission occurs through mosquito vectors, principally Aedes Aegypti. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). Other common symptoms include muscle pain and headache. As of now, no vaccine exists for the virus and no official treatment has been developed aside from standard procedures of the use of acetaminophen (paracetamol) and non-steroidal anti-inflammatory drugs. This is a case report of a 54 year-old Hispanic female who arrived at the clinic with symptomatology congruent with the Zika fever. The patient was treated with high doses of intravenous vitamin C over three days. The symptoms resolved after the infusions without any side effects at day four. Recovery from this viral infection takes normally around two weeks. Based on the positive outcome in this case, we propose that intravenous vitamin C should be studied further as a potential treatment for acute viral infections.

This article presents fear- and non-fear-based schemas hypothesized to be important in the development and maintenance of pain related disability. Identified schemas are based on the clinical experience of the authors and a review of the literature. Schemas are presented with the aim of increasing recognition of heterogeneity and improving case formulation and treatment planning including matching of pain problems with interventions. Two case studies are included.

Cortical spreading depression (CSD), an underlying mechanism of migraine aura, propagates to the hippocampus, and might explain hippocampusassociated symptoms during migraine attack. We hypothesised that this process is, some parts, mediated by NMDA receptors. By using a rat model, CSD was elicited by solid KCl for 45 minutes prior to electrophysiological and quantitative analyses. The result from electrophysiological study was the ratio of glutamate NMDA receptor 2A and 2B subunits (GluN2A/B). Total NMDA receptor response was isolated using an AMPA antagonist, prior to a GluN2B receptor antagonist. The GluN2A/B ratio was calculated by dividing the remaining NMDA-mediated field-excitatory synaptic potentials (fEPSP) with the subtracted difference of NMDAmediated fEPSP. Western blot analysis of the hippocampus was performed to confirm the quantitative change of GluN2A/B ratio. In hippocampal slice study (n = 12), the GluN2A/B ratio of hippocampal fEPSP was significantly increased in CSD group. Western blot analysis (n = 30) revealed an increase in GluN2A subunits and a decrease in GluN2B subunits in the hippocampus ipsilateral to the CSD induction. Our current study revealed that GluN2A/B ratio was shown to be elevated following CSD stimulation by increasing the total number of GluN2A while reducing the total number of GluN2B subunits. This ratio was demonstrated to be associated with synaptic plasticity of the hippocampus in numerous studies. In conclusion, we showed that CSD increased GluN2A/B ratio, in turn, would result in altered synaptic plasticity. Our findings provide a probable implication on the correlation of migraine aura and hippocampusassociated symptoms.

It is well known that the tendency toward the medicinal plants is increasing in recent years. They have low side-effects and high varieties of efficient components. This study was designed to investigate the analgesic effect of hydro alcoholic leaf extract of Rhus coriaria (HRCLE) in a rat model. For this purpose, 42 adult male rats were divided into 7 groups: control, HRCLE (80, 100 and 300 mg/kg, i.p.), morphine (1 mg/kg, i.p.), aspirin (1 mg/kg, i.p.), and HRCLE 300 mg/kg plus naloxone (1 mg/kg, i.p.). The analgesic effects of HRCLE were assessed with writhing, tail flick and formalin tests. The data were compared with control by one-way ANOVA and Tukey post hoc test. All dose levels of HRCLE inhibited the number of contractions induced by acetic acid in the writhing test signfiicantly. None of the dose levels of HRCE have been showed antinociceptive activity in the formalin test except the dose of 100 mg/kg (at chronic phase) and the dose of 300 mg/kg (at chronic- acute phase). In the tail flick model, the highest effect was at the dose of 300 mg/kg of HRCLE (P < 0.01). Utilization of naloxone plus extract inhibited the antinociceptive effect of HRCLE. In this study, our findings suggest that analgesic effect for the HRCLE may be mediated via both peripheral and central mechanisms. The presence of flavonoids might be responsible for the antinociceptive activity of this plant.

Migraines typically occur more frequently in women than men because of the effects of estrogen on both the frequency and severity of migraine attacks. Many women suffer from migraine attacks during menstruation, which are known as menstrual migraines. The pathophysiology of menstrual migraines can be explored by using the rat estrous cycle, which shows a cyclical fluctuation of estrogen level that resembles the menstrual cycle. The aim of this study was to investigate whether different stages of the estrous cycle are involved in migraine development by comparing the excitability of trigeminal ganglion (TG) neurons in four different stages of the estrous cycle by using action potential (AP) parameter assessments. The stages of the estrous cycle were identified by a vaginal smear and measuring the estrogen levels in collected blood. The proestrus and estrus stages had higher estrogen levels compared with the diestrus and metestrus stages. Whole-cell patch clamp recordings demonstrated that TG neurons in the proestrus and estrus stage had lower AP threshold, lower rheobase, higher AP height, shorter AP falling time and deeper afterhyperpolarization (AHP) depth. Hence, our results revealed that the high level of estrogen in the proestrus and estrus stage alters the AP properties of TG neurons. Estrogen may increase membrane excitability and the summation of cellular responses, which alters the AP properties. The alterations of the AP properties in the proestrus and estrus stage may relate to a modification of voltage-gated ion channels in TG neurons, which is a pathogenesis for menstrual migraine. No COI.