Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive

Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review

<p>Abstract</p> <p>Background</p> <p>Over the past several decades, complementary and alternative medications have increasingly become a part of everyday treatment. With the rising cost of prescription medications and their production of unwanted side effects, patients are exploring herbal and other natural remedies for the management and treatment of psychological conditions. Psychological disorders are one of the most frequent conditions seen by clinicians, and often require a long-term regimen of prescription medications. Approximately 6.8 million Americans suffer from generalized anxiety disorder. Many also suffer from the spectrum of behavioural and physical side effects that often accompany its treatment. It is not surprising that there is universal interest in finding effective natural anxiolytic (anti-anxiety) treatments with a lower risk of adverse effects or withdrawal.</p> <p>Methods</p> <p>An electronic and manual search was performed through MEDLINE/PubMed and EBSCO. Articles were not discriminated by date of publication. Available clinical studies published in English that used human participants and examined the anxiolytic potential of dietary and herbal supplements were included. Data were extracted and compiled into tables that included the study design, sample population, intervention, control, length of treatment, outcomes, direction of evidence, and reported adverse events.</p> <p>Results</p> <p>A total of 24 studies that investigated five different CAM monotherapies and eight different combination treatments and involved 2619 participants met the inclusion criteria and were analyzed. There were 21 randomized controlled trials and three open-label, uncontrolled observational studies. Most studies involved patients who had been diagnosed with either an anxiety disorder or depression (n = 1786). However, eight studies used healthy volunteers (n = 877) who had normal levels of anxiety, were undergoing surgery, tested at the upper limit of the normal range of a trait anxiety scale, had adverse premenstrual symptoms or were peri-menopausal, reported anxiety and insomnia, or had one month or more of elevated generalized anxiety. Heterogeneity and the small number of studies for each supplement or combination therapy prevented a formal meta-analysis. Of the randomized controlled trials reviewed, 71% (15 out of 21) showed a positive direction of evidence. Any reported side effects were mild to moderate.</p> <p>Conclusions</p> <p>Based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects. There is the possibility that any positive effects seen could be due to a placebo effect, which may have a significant psychological impact on participants with mental disorders. However, based on this systematic review, strong evidence exists for the use of herbal supplements containing extracts of passionflower or kava and combinations of L-lysine and L-arginine as treatments for anxiety symptoms and disorders. Magnesium-containing supplements and other herbal combinations may hold promise, but more research is needed before these products can be recommended to patients. St. John's wort monotherapy has insufficient evidence for use as an effective anxiolytic treatment.</p

Examining the Relationships among Motivation, Service Quality and Loyalty: The case of the National Museum of Natural Science

This study explores causal relationships between push and pull motivations, perceptions of service quality and loyalty intention, and examines the moderating role of membership status in the National Museum of Natural Science, the largest museum in Taiwan. Data were collected from 405 paid admission visitors, with a quota and systematic sampling, from two stages of pre- and post-visit corresponding with two questionnaires. The results demonstrate that push and pull motivations impact on service quality perceptions, which in turn influence museum loyalty; the effect of pull motivation on service quality perceptions in the nonmember group was stronger than in the member group; the effect of service quality perceptions on loyalty in the member group was stronger than in the nonmember group. Museum managers could tailor and advertise existing museum products and services to different types of visitors; assuring the museum's continued operation and success

Passiflora incarnata attenuation of neuropathic allodynia and vulvodynia apropos GABA-ergic and opioidergic antinociceptive and behavioural mechanisms

Background: Passiflora incarnata is widely used as an anxiolytic and sedative due to its putative GABAergic properties. Passiflora incarnata L. methanolic extract (PI-ME) was evaluated in an animal model of streptozotocininduced diabetic neuropathic allodynia and vulvodynia in rats along with antinociceptive, anxiolytic and sedative activities in mice in order to examine possible underlying mechanisms. Methods: PI-ME was tested preliminary for qualitative phytochemical analysis and then quantitatively by proximate and GC-MS analysis. The antinociceptive property was evaluated using the abdominal constriction assay and hot plate test. The anxiolytic activity was performed in a stair case model and sedative activity in an open field test. The antagonistic activities were evaluated using naloxone and/or pentylenetetrazole (PTZ). PI-ME was evaluated for prospective anti-allodynic and anti-vulvodynic properties in a rat model of streptozotocin induced neuropathic pain using the static and dynamic testing paradigms of mechanical allodynia and vulvodynia. Results: GC-MS analysis revealed that PI-ME contained predominant quantities of oleamide (9-octadecenamide), palmitic acid (hexadecanoic acid) and 3-hydroxy-dodecanoic acid, among other active constituents. In the abdominal constriction assay and hot plate test, PI-ME produced dose dependant, naloxone and pentylenetetrazole reversible antinociception suggesting an involvement of opioidergic and GABAergic mechanisms. In the stair case test, PI-ME at 200 mg/kg increased the number of steps climbed while at 600 mg/kg a significant decrease was observed. The rearing incidence was diminished by PI-ME at all tested doses and in the open field test, PI-ME decreased locomotor activity to an extent that was analagous to diazepam. The effects of PI-ME were antagonized by PTZ in both the staircase and open field tests implicating GABAergic mechanisms in its anxiolytic and sedative activities. In the streptozotocin-induced neuropathic nociceptive model, PI-ME (200 and 300 mg/kg) exhibited static and dynamic anti-allodynic effects exemplified by an increase in paw withdrawal threshold and paw withdrawal latency. PI-ME relieved only the dynamic component of vulvodynia by increasing flinching response latency. Conclusions: These findings suggest that Passiflora incarnata might be useful for treating neuropathic pain. The antinociceptive and behavioural findings inferring that its activity may stem from underlying opioidergic and GABAergic mechanisms though a potential oleamide-sourced cannabimimetic involvement is also discussed

Comparison of effects on heamodynamic response between Promethazine and Droperidol for patients of elective surgery

Effects of preanaesthetic medication are as follows: 1) Promotion of mental and emotional relaxation. 2) Inhibition of nausea and vomiting after surgery. 3) Stability of haemodynamic response. We performed 105 patients, randomized, single blind clinical trial, preanaesthetic drugs, promethazine and droperidol: A comparison of haemodynamic response for patients in elective surgery at imam hospital. 105 patients were divided in three groups. Promethazine group 35 patients, dropetidol group 35 patients and normal saline group 35 patients. Systolic and diastolic blood pressure and pulse rate were recorded before and after intramuscular injection. Patients of promethazine and droperidol groups responded with decreasing in blood pressure and pulse rat lower than normal saline. But haemodynamic response did not show any difference between two groups (promethazine and droperidol)

Methylcoenzyme a Mutase Deficiency (MMCOA) Combined with Homocystinuria

Background: The combined MMCOA deficiency and Hemocystinuria results from defect in cb1c & cb1d & cb1F genome. Until now only 100 cases of this disease has been reported. Most of them with cb1c deficiency. Due to this enzymatic defect, mild to moderate retention of Hemocystin (MMA) and their precursors in the body fluids (blood and urine) ensues. Although, acidemia, Hypoglycemia & megaloblastic anemia are common but hyperamonemia and hyperglycemia were not reported in these patients. Our case is a 3 years old girl with known MMCOA deficiency and Hemocystinuria who needed G.A for partial resection of the mandible because of osteomilitis. Materials and Methods: In this report we explain the preoperative preparation of the patient, induction and maintenance of Anesthesia, and discuss the biochemical, lab results during & after surgery. Results & Conclusion: Due to our result, the urine and blood hemocystin & MMCOA were not increased. This case is interesting because no theoretical or practical report on the G.A of these patients exists

A COMPARISON OF DEXAMETASONE AND METOCLOPRAMIDE FOR PREVENTING PAIN ON INJECTION OF DIAZEPAM

Intravenous administration of dexamethasone before diazepam injection seems &quot;0 reduce the incidence or pain on injection. We conducted a randomized. prospective, double-blind. placebocontrolled clinical trial to compare effect or dexamethasone, mctoclopramidc ami placebo in reducing the injection pain.:&quot; total of 120 ASA class I and ll mcn aged 20-45 years that needed more than one intravenous access were enrolled in the study and were randomly allocated to one of the three groups: group 1, :2 ml intravenous normal saline and 2 1111 dexamethasone (X mgj: group 2. 2 1111 intravenous normal saline and 2 1111 mctoclopramidc l10 mg), and group 3.:2 ml intravenous dexamethasone (X mg) and 2 ml ructoclopramidc (10 mg). After 30 seconds. I ml diazepam (5 mg) was injected simultaneously into each of patients&apos; hand veins and a maximal visual analog scale (VAS) for pain of each venous discomfort was assessed separately. In group I. the mean of VAS for pain was significantly less in dexamethasone pretreatment than saline pretreatment. In group 2. the mean of VAS for pain was significantly less in mctoclopramidc pretreatment than saline pretreatment. In group 3, the mean of VAS for pain was significantly less in dexamethasone pretreatment than mctocloprauudc pretreatment. There were no significant differences in incidence of pain between pretreatment and placebo in three groups. Dexamethasone or mctoclopramidc pretreatments arc effective in reducing the severity of pain on injection of diazepam and dexamethasone pretreatment has greater efficacy in reducing the intensity of pain