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Post-herpetic neuralgia (PHN) is neuropathic pain persisting after an acute episode of herpes zoster, and is associated with severe pain and sensory abnormalities that adversely affect the patient's quality of life and increase health care costs. Up to 83% of patients with PHN describe localized neuropathic pain, defined as "a type of neuropathic pain characterized by consistent and circumscribed area(s) of maximum pain". Topical treatments have been suggested as a first-line treatment for localized neuropathic pain. Use of 5% lidocaine medicated plaster could reduce abnormal nervous peripheral discharge and via the plaster could have a "protective" function in the affected area. It has been suggested that use of this plaster could reduce pain as well as the size of the painful area. To evaluate this possible outcome, we retrospectively reviewed eight patients with PHN, treated using 5% lidocaine medicated plaster. During a follow-up period of 3 months, we observed good pain relief, which was associated with a 46% reduction in size of the painful area after one month (from 236.38±140.34 cm2 to 128.80±95.7 cm2) and a 66% reduction after 3 months (81.38±59.19 cm2). Our study cohort was composed mainly of elderly patients taking multiple drugs to treat comorbidities, who have a high risk of drug-drug interactions. Such patients benefit greatly from topical treatment of PHN. Our observations confirm the effectiveness of lidocaine plasters in the treatment of PHN, indicating that 5% lidocaine medicated plaster could reduce the size of the painful area. This last observation has to be confirmed and the mechanisms clarified in appropriate larger randomized controlled trials. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection is associated with frequent thrombotic events, at the micro and macro-vascular level, due to the perpetuation of a state of hypercoagulability. The so-called 'COVID-19 associated coagulopathy' (CAC) represents a key aspect in the genesis of organ damage from SARS-CoV-2. The main coagulative alterations described in the literature are represented by high levels of D-dimer and fibrinogen. Although CAC has some common features with disseminated intravascular coagulation and sepsis-induced coagulopathy, there are important differences between these clinical pictures and the phenotype of CAC is unique. The pathogenesis of CAC is complex and is affected by the strong interconnection between the inflammatory system and coagulation, in the phenomenon of immunothrombosis and thrombo-inflammation. Several mechanisms come into play, such as inflammatory cytokines, neutrophils, the complement system as well as an alteration of the fibrinolytic system. Finally, an altered platelet function and especially endothelial dysfunction also play a central role in the pathophysiology of CAC. Heparin has several potential effects in CAC, in fact in addition to the anticoagulant effect, it could have a direct antiviral effect and anti-inflammatory properties. The high incidence of thrombo-embolic phenomena despite the use of antithrombotic prophylaxis have led some experts to recommend the use of anticoagulant doses of heparin, but at present the optimal anticoagulant regimen remains to be determined., (Published on behalf of the European Society of Cardiology. © The Author(s) 2021.)

Aim: Despite strong evidence of benefit, few stroke units exist in New Zealand. In this paper, we describe the process and outcome for the country's first, comprehensive Acute Stroke Unit (ASU), established at Middlemore Hospital in 2001., Methods: The evaluation comprised: (a) two independent 'before and after' audits of medical records of a random selection of patients (2 x n=100) identified from Diagnostic Related Group (DRG) discharge codes for stroke in 1999 (12 months) and 2001-02 (9 months); (b) a review of all DRG stroke outcome data and internal cost analyses for the study periods; and (c) a 'time-in-motion' study of nursing care requirements., Results: The DRG data showed an increase in separations (538 vs 613); stable re-admissions (8% vs 7%); and declines in average length of stay (6.1 vs 5.4 days), deaths (14.0% vs 8.8%), and referrals for rehabilitation (127 vs 67); while the audit indicated shorter times from admission to brain imaging, and swallow and allied health assessments, for stroke f rom 1999 to 2001-02. A 1:4 nurse:patient ratio seems to provide an optimum level of care for costs., Conclusions: The introduction of the ASU has been associated with improvements in several key indicators of quality of care for patients with stroke.