Neuropathic pain (NP), comprising a range of heterogeneous pathophysiological conditions, is often difficult to manage despite a number of treatment guidelines have been published worldwide. Most of the available treatments in these guidelines have moderate efficacy and present side effects that limit their use. Currently, there is a general agreement on appropriate first-line treatment of NP, whereas debate continues regarding second- and third-line treatments. First-line drugs include antidepressants (tricyclic antidepressants (TCAs) and serotonin–noradrenaline reuptake inhibitors (SNRIs)) and gabapentinoids. Second- and third-line drugs for NP include topical lidocaine, topical capsaicin, anticonvulsants, and opioids. A good understanding of pathophysiology of NP with the mechanism of action of currently available drugs along with their side effect profile helps to tailor therapies both to the specific neuropathic disease and to the needs of an individual patient. This review provides an overview of current drugs available for the treatment of NP with an emphasis on their mechanism of action.
A 19-year-old male presented to us with anasarca and a history of chronic diarrhea. Investigations revealed primary intestinal lymphangiectasia leading to protein losing enteropathy. Patient was doing well for 1 year on a modified diet until he got admitted with a severe headache, vomiting, and papilledema. Complete workup demonstrated cerebral venous thrombosis as a result of deficiency of protein S.
Scrub typhus is an emerging infectious disease in India. The disease can have varied presentations. Recently, during the rainy season, scrub typhus has emerged as one of the main etiologies of febrile illness in West Bengal. We here report four cases of encephalitis caused by scrub typhus. The varied presentations and laboratory features of the patients have been discussed in detail.
In this small article, the true crime story of a fratricidal incident in Calcutta during the 1930s has been recollected. The story is notable for the very unusual murder weapon used by the criminals. (Since this is a story about colonial times, the names of various Indian cities, as used in this article, reflect the names used during the British rule.)
Scientific understanding of systemic lupus erythematosus (SLE) is progressing at a steady pace. Thus, there has been a paradigm shift in the understanding of the pathogenesis of SLE. As clinical experience of SLE is accumulating, the criteria for diagnosis are also being modified. Treatment of SLE still leaves a lot to be desired but every year, there are new additions and alterations. This article sums up these recent changes, especially those in the management of SLE.