Recent advances in pain management

Pain is one of the most common complaints for which patients approach physicians. In spite of this there is a huge unmet need for developing medications for pain that are safe and efficacious. Owing to the heterogeneity of clinical pain and complex pathophysiology, target identification for drug development is difficult. Preclinical models have also proven unreliable for the development of novel analgesics. Recent advances in understanding the physiology of nociception has enabled the development of novel analgesics including abuse deterrent opioids, drugs targeting several receptors, ion channels and enzymes. This review will attempt to cover the physiology of nociception focusing on the novel targets, the challenges in development of novel analgesics and give an overview of the recently developed drugs and those in the pipeline for the management of pain

Comparison of Halmágyi–Curthoys Head Impulse (Thrust) Test with Romberg’s Test in Detection of Vestibular Hypofunctioning in Vertigo Patients

This study aimed to compare the diagnostic efficacy of the Halmágyi–Curthoys headimpulse (thrust) test and Romberg’s test in detecting vestibular hypofunctioning among two groupsof 50 vertigo patients each; the two groups were randomly assigned. The assessment utilizedthe visual analog scale (VAS) to quantify subjective experiences of vertigo. The results revealeddistinctive patterns in the detection of vestibular hypofunctioning, highlighting the strengths andlimitations of each test. The Halmágyi–Curthoys head impulse test demonstrated utility in identifyingvestibular hypofunctioning and its effect on vestibulo–ocular reflexes, particularly in cases withsudden head movements. Romberg’s test was useful in assessing postural instability in vestibularhypofunctioning due to defects in vestibulospinal reflexes. The integration of VAS scores providedvaluable subjective insights into the patient experience. This comparative analysis contributes toa nuanced understanding of diagnostic tools for vestibular hypofunctioning in vertigo patients,offering clinicians valuable information for tailored assessments and interventions</p

Intravitreal bevacizumab for treatment of choroidal neovascularization associated with osteogenesis imperfecta

A 12-year-old girl, diagnosed of osteogenesis imperfecta, presented with sudden visual loss in the left eye. Investigations revealed an active choroidal neovascular membrane. She underwent treatment with intravitreal Bevacizumab (1.25 mg/0.05 ml). Follow-up at 1 month revealed the development of lacquer crack running through the macula, underlying the fovea. The patient received two re-treatments at 1-month intervals, following which the choroidal neovascularization (CNV) regressed completely. However, further progression of lacquer cracks was noted. At the last follow-up, 6 months following the last injection, the fundus remained stable and vision was maintained at 20/200. Considering the natural history of the disease and the increased risk of rupture of the Bruch's membrane in such eyes, the possible complication of a lacquer crack developing must be borne in mind, before initiating treatment

Nkx2.5+ Cardiomyoblasts Contribute to Cardiomyogenesis in the Neonatal Heart

During normal lifespan, the mammalian heart undergoes limited renewal of cardiomyocytes. While the exact mechanism for this renewal remains unclear, two possibilities have been proposed: differentiated myocyte replication and progenitor/immature cell differentiation. This study aimed to characterize a population of cardiomyocyte precursors in the neonatal heart and to determine their requirement for cardiac development. By tracking the expression of an embryonic Nkx2.5 cardiac enhancer, we identified cardiomyoblasts capable of differentiation into striated cardiomyocytes in vitro. Genome-wide expression profile of neonatal Nkx2.5+ cardiomyoblasts showed the absence of sarcomeric gene and the presence of cardiac transcription factors. To determine the lineage contribution of the Nkx2.5+ cardiomyoblasts, we generated a doxycycline suppressible Cre transgenic mouse under the regulation of the Nkx2.5 enhancer and showed that neonatal Nkx2.5+ cardiomyoblasts mature into cardiomyocytes in vivo. Ablation of neonatal cardiomyoblasts resulted in ventricular hypertrophy and dilation, supporting a functional requirement of the Nkx2.5+ cardiomyoblasts. This study provides direct lineage tracing evidence that a cardiomyoblast population contributes to cardiogenesis in the neonatal heart. The cell population identified here may serve as a promising therapeutic for pediatric cardiac regeneration