Differentiating neuropathic pain, opioid-induced hyperalgesia and opioid tolerance; considerations following a remarkable case

Most of the problems in pain control in end of life care are encountered due to three main syndromes or their combinations: neuropathic pain, opioid-induced hyperalgesia and opioid tolerance. In this article, we discuss a patient who was no longer responding to opioids and suffering severe pain, while the opioid dose was very high and still rising. It may be apparent that the three syndromes have a lot in common and their differentiation is not straightforward. However, guidelines can be given for differentiation and a rational approach to treatment. Adv. Pall. Med. 2010; 9, 3: 93–98Most of the problems in pain control in end of life care are encountered due to three main syndromes or their combinations: neuropathic pain, opioid-induced hyperalgesia and opioid tolerance. In this article, we discuss a patient who was no longer responding to opioids and suffering severe pain, while the opioid dose was very high and still rising. It may be apparent that the three syndromes have a lot in common and their differentiation is not straightforward. However, guidelines can be given for differentiation and a rational approach to treatment. Adv. Pall. Med. 2010; 9, 3: 93–9

Parasitic diarrhoea in treatment-naïve HIV-positive patients attending the University of Ilorin Teaching Hospital (UITH) Highly Active Antiretroviral Treatment (HAART) Clinic

Background: HIV is a public health issue with diarrhoea being the commonest gastrointestinal symptom especially in individuals with lower CD4+ cell counts. Most times, parasitic infections present as diarrhoea. Depending on geographical location, the pathogens responsible for diarrhoea vary.Aim: To relate the degree of immunodeficiency in HIV-infected patients to diarrhoea as a result of infestation by parasitic agent.Methods: 250 HIV positive and 250 HIV negative participants were recruited. Stool and blood samples were taken from all participants. Macroscopic and microscopic examinations of the stool were done while CD4+ count was estimated from the blood sample collected. Wet preparation of stool sample was done and concentrated stool was used for modified Ziehl Neelsen staining. Results: Diarrhoea was present in 200 participants, 118 of which were among the HIV positive group. Parasites were demonstrated in 82.3% of the test participants with diarrhoea and 17.7% of the controls with diarrhoea. Of the HIV positive with diarrhoea, 70.3% had a CD4 <200 cells/μl and 29.7% had a CD4 of 200-500cells/μl. Parasites in both groups were Ascaris lumbricoides, Balantidium coli, Entamoeba histolytica, Schistosoma mansoni, Hookworm, Strongyloides stercoralis and coccidian parasites though at varying frequencies. Of the 79 with parasites, 60 had single parasitosis, while 19 had multiple parasitosis. CD4 count was the only variable that correctly predicts presence of diarrhoea. Conclusion: Diarrhoea associated with parasitic infection HIV patients is a function of the immune status of the individual.Key words: People Living with HIV/AIDS (PLWHA), HIV/AIDS, diarrhoea, intestinal parasite, HAART NAÏVE, immunosuppressio

Complement factor H levels in steady state sickle cell anaemia

Objective: The red cell membrane of sickle cell anaemia is vulnerable to attack from the alternative complement pathway. The activation of the alternative complement pathway is initiated by externalization of  phosphatidylserine on red cell membrane. Serum and cell bound regulators normally prevent amplification of the cascade. However, red blood cells in sickle cell anaemia appear to be exposed and the cell lysing membrane attack complex is ubiquitous on irreversible sickle red blood cells. It is possible that there are deficiencies (either functional or quantitative) of  complement regulators. In this study the quantitative defects of the most abundant serum phase regulator,   complement factor H in sickle cell anaemia was investigated.Methods: We compared the plasma levels of complement factor H (a serum phase regulator of the alternative pathway) in 61 steady state Hb SS with 60 healthy Hb AA using an enzyme linked immunosorbent assay to analyze complement factor H level in the plasma. The full blood count parameters were estimated using flow cytometry.Results: There was no significant difference in the serum complement factor H levels between the steady state Hb SS and healthy Hb AA.  Significant inverse relationships existed between complement factor H, total white cell count, granulocyte cell count and platelet count as well as  significant direct relationships between complement factor H, haematocrit, and the haemoglobin concentration.Conclusion: Complement factor H in patients with sickle cell anaemia who are in steady state is not significantly lower than in controls.Keywords: Complement factor H, sickle cell anaemia, alternative pathwa

Nodular hidradenoma of the breast: A case report

Nodular hidradenoma is a rare benign skin adnexial lesion of the breast. It is often located in the nipple areolar region and presents as a slow growing painless lesion.We report a case in a 62 yr old male who had a slowly growing left breast lesion of 10 yrs duration. Physical examination revealed an 8 cm superficial, spherical, mobile non tender lump in the nipple areolar region. Excision biopsy with clear margins was performed and histologic examination was nodular hidradenoma after wide consultations.Nodular hidradenoma of the breast is a differential diagnosis of sub areolar masses that must be considered by both pathologist and surgeons to avoid misdiagnosis and overtreatment.Keywords: Nodular hidradenoma, Male breast, Nipple areolar regio

Late style and speaking out: J A Symonds's In the Key of Blue

This article examines In the Key of Blue (1893)—an essay collection by John Addington Symonds—as a case study in queer public utterance during the early 1890s. Viewed through the critical lens of late style, as theorised by Edward Said, the evolution of this project, from compilation through to reader reception, reveals Symonds's determination to “speak out” on the subject of homosexuality. Paradoxically, In the Key of Blue was thus a timely and untimely work: it belonged to a brief period of increased visibility and expressiveness when dealing with male same-sex desire, spearheaded by a younger generation of Decadent writers, but it also cut against the grain of nineteenth-century social taboo and legal repression. Symonds's essay collection brought together new and previously unpublished work with examples of his writing for the periodical press. These new combinations, appearing together for the first time, served to facilitate new readings and new inferences, bringing homosexual themes to the fore. This article traces the dialogic structure of In the Key of Blue , its strategies for articulating homosexual desire, and examines the response of reviewers, from the hostile to celebratory

Alignment of the CMS silicon tracker during commissioning with cosmic rays

This is the Pre-print version of the Article. The official published version of the Paper can be accessed from the link below - Copyright @ 2010 IOPThe CMS silicon tracker, consisting of 1440 silicon pixel and 15 148 silicon strip detector modules, has been aligned using more than three million cosmic ray charged particles, with additional information from optical surveys. The positions of the modules were determined with respect to cosmic ray trajectories to an average precision of 3–4 microns RMS in the barrel and 3–14 microns RMS in the endcap in the most sensitive coordinate. The results have been validated by several studies, including laser beam cross-checks, track fit self-consistency, track residuals in overlapping module regions, and track parameter resolution, and are compared with predictions obtained from simulation. Correlated systematic effects have been investigated. The track parameter resolutions obtained with this alignment are close to the design performance.This work is supported by FMSR (Austria); FNRS and FWO (Belgium); CNPq, CAPES, FAPERJ, and FAPESP (Brazil); MES (Bulgaria); CERN; CAS, MoST, and NSFC (China); COLCIENCIAS (Colombia); MSES (Croatia); RPF (Cyprus); Academy of Sciences and NICPB (Estonia); Academy of Finland, ME, and HIP (Finland); CEA and CNRS/IN2P3 (France); BMBF, DFG, and HGF (Germany); GSRT (Greece); OTKA and NKTH (Hungary); DAE and DST (India); IPM (Iran); SFI (Ireland); INFN (Italy); NRF (Korea); LAS (Lithuania); CINVESTAV, CONACYT, SEP, and UASLP-FAI (Mexico); PAEC (Pakistan); SCSR (Poland); FCT (Portugal); JINR (Armenia, Belarus, Georgia, Ukraine, Uzbekistan); MST and MAE (Russia); MSTDS (Serbia); MICINN and CPAN (Spain); Swiss Funding Agencies (Switzerland); NSC (Taipei); TUBITAK and TAEK (Turkey); STFC (United Kingdom); DOE and NSF (USA)

Commissioning and performance of the CMS pixel tracker with cosmic ray muons

This is the Pre-print version of the Article. The official published verion of the Paper can be accessed from the link below - Copyright @ 2010 IOPThe pixel detector of the Compact Muon Solenoid experiment consists of three barrel layers and two disks for each endcap. The detector was installed in summer 2008, commissioned with charge injections, and operated in the 3.8 T magnetic field during cosmic ray data taking. This paper reports on the first running experience and presents results on the pixel tracker performance, which are found to be in line with the design specifications of this detector. The transverse impact parameter resolution measured in a sample of high momentum muons is 18 microns.This work is supported by FMSR (Austria); FNRS and FWO (Belgium); CNPq, CAPES, FAPERJ, and FAPESP (Brazil); MES (Bulgaria); CERN; CAS, MoST, and NSFC (China); COLCIENCIAS (Colombia); MSES (Croatia); RPF (Cyprus); Academy of Sciences and NICPB (Estonia); Academy of Finland, ME, and HIP (Finland); CEA and CNRS/IN2P3 (France); BMBF, DFG, and HGF (Germany); GSRT (Greece); OTKA and NKTH (Hungary); DAE and DST (India); IPM (Iran); SFI (Ireland); INFN (Italy); NRF (Korea); LAS (Lithuania); CINVESTAV, CONACYT, SEP, and UASLP-FAI (Mexico); PAEC (Pakistan); SCSR (Poland); FCT (Portugal); JINR (Armenia, Belarus, Georgia, Ukraine, Uzbekistan); MST and MAE (Russia); MSTDS (Serbia); MICINN and CPAN (Spain); Swiss Funding Agencies (Switzerland); NSC (Taipei); TUBITAK and TAEK (Turkey); STFC (United Kingdom); DOE and NSF (USA)

Performance of the CMS drift-tube chamber local trigger with cosmic rays

The performance of the Local Trigger based on the drift-tube system of the CMS experiment has been studied using muons from cosmic ray events collected during the commissioning of the detector in 2008. The properties of the system are extensively tested and compared with the simulation. The effect of the random arrival time of the cosmic rays on the trigger performance is reported, and the results are compared with the design expectations for proton-proton collisions and with previous measurements obtained with muon beams

Performance of the CMS Level-1 trigger during commissioning with cosmic ray muons and LHC beams

This is the Pre-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2010 IOPThe CMS Level-1 trigger was used to select cosmic ray muons and LHC beam events during data-taking runs in 2008, and to estimate the level of detector noise. This paper describes the trigger components used, the algorithms that were executed, and the trigger synchronisation. Using data from extended cosmic ray runs, the muon, electron/photon, and jet triggers have been validated, and their performance evaluated. Efficiencies were found to be high, resolutions were found to be good, and rates as expected.This work is supported by FMSR (Austria); FNRS and FWO (Belgium); CNPq, CAPES, FAPERJ, and FAPESP (Brazil); MES (Bulgaria); CERN; CAS, MoST, and NSFC (China); COLCIENCIAS (Colombia); MSES (Croatia); RPF (Cyprus); Academy of Sciences and NICPB (Estonia); Academy of Finland, ME, and HIP (Finland); CEA and CNRS/IN2P3 (France); BMBF, DFG, and HGF (Germany); GSRT (Greece); OTKA and NKTH (Hungary); DAE and DST (India); IPM (Iran); SFI (Ireland); INFN (Italy); NRF (Korea); LAS (Lithuania); CINVESTAV, CONACYT, SEP, and UASLP-FAI (Mexico); PAEC (Pakistan); SCSR (Poland); FCT (Portugal); JINR (Armenia, Belarus, Georgia, Ukraine, Uzbekistan); MST and MAE (Russia); MSTDS (Serbia); MICINN and CPAN (Spain); Swiss Funding Agencies (Switzerland); NSC (Taipei); TUBITAK and TAEK (Turkey); STFC (United Kingdom); DOE and NSF (USA)