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Introduction: Stiff Person Syndrome is a rare autoimmune neurological disorder with chronic muscle spasms leading to chronic pain and debilitation. Case Report: We describe a case of a 57-year-old man with the history of Diabetes mellitus type 1 diagnosed 15 years back with high-titer positive anti-GAD antibodies and poorly controlled blood sugar levels under highly dosed insulin treatment. Conclusion: Intrathecal baclofen showed a marked improvement for the relief of spasticity with the choice of a baclofen pump for similar patients. [ABSTRACT FROM AUTHOR]

Objective This study aims to identify the demographic, clinical, and therapeutic characteristics of four patients with hemimasticatory spasm (HMS) seen in our outpatient department over a period of 20 years. Methods We performed a retrospective chart review of four patients with HMS who visited outpatient services in the Department of Neurology from 2001 to 2020. Results The follow-up for all patients ranged from 2 years to 9 years. Three patients had facial or bucco-oral morphea. Two patients maintained long-term improvements in symptoms after being treated with botulinum toxin for 4–7 years, while one patient reported improvement in symptoms with treatment of carbamazepine that subsequently remitted after pregnancy. Conclusion This report highlights the long-term outcome of HMS in our patients. Our patients reported a significant reduction or complete resolution of symptoms after treatment, and eventually, two patients were asymptomatic while off treatment.

The roots of Traditional Iranian Medicine (TIM) go back to thousand years ago. Based on TIM, black bile, one of the four humors within the body, is the concentrated part of the blood representing a cold and dry quality. Black bile tends to deposit in tissues, leading to diseases such as spasm, which is a painful paralysis-like immobility condition. One of its possible causes is muscle dehydration, resembling the dryness caused by dominance of black bile. In TIM, several medicinal plants are claimed to be effective in the regulation of black bile; among them, the presence of the Lamiceae family is very notable. In this review, the relationship between spasm as one of the symptoms of increasing black bile in the body was discussed. Also, the compounds reported in the black-bile eliminating plants have been found in the literature. The majority of them were from monoterpenes and sesquiterpenes such as citral, carvacrol, fenchone and pulegone in the essential oil of black bile reducing plants. The main compounds properties of black bile reducing plants can be used to orient quantitative system pharmacology models in further studies. [ABSTRACT FROM AUTHOR]

Abstract Background Common complications of carotid artery stenting (CAS) are cerebral ischemia and hyperperfusion syndrome. To date, only a few cases of late-onset cerebral vasoconstriction occurring several hours after CAS have been reported. However, there are no reports of developed vasoconstriction and hyperperfusion syndrome. Case presentation A 79-year-old man developed vasoconstriction 1 day after carotid artery stenting. Vasoconstriction improved immediately with glucocorticoid. However, a week later, the patient developed hyperperfusion syndrome. Conclusions Postoperative vasoconstriction and hyperperfusion syndrome is an unrecognized complication and surgeons should be aware of it.

Introduction: Nocturnal Leg Cramps (NLC) are painful, involuntary spasms of the calf, hamstring, or foot muscles at night, causing severe pain and disrupting sleep. Through physiotherapy interventions, we can prevent the nocturnal leg cramps. In NLC, on palpation muscle became tender or hard and affect or disturb the sleep. The study is done to know about the various physiotherapy intervention and its effectiveness in nocturnal leg cramps, based on various articles. Aim: To identify the most effective physiotherapy intervention for reducing or preventing nocturnal leg cramps, based on various articles. Materials and Methods: This review utilised PubMed, Cochrane, MEDLINE databases are searched to find the desired articles. In addition, physiotherapy interventions of the desired articles were checked to conduct the study. Older adults (above 55 yrs. of age), Pregnant female and patient with lumbar degenerative disorder were included. Results: Eight articles highlight the effectiveness of various physiotherapy interventions, including tendoachilles, hamstring and calf stretching, moist heat pack, cryotherapy, self-myofascial technique in reducing nocturnal leg cramps, including in pregnant females. Conclusion: The stretching is the more effective in reducing the nocturnal leg cramps as compared to other physiotherapy interventions but further high-quality research is still required to confirm these results. [ABSTRACT FROM AUTHOR]

Respiratory failure because of muscle spasms is a major sequela of tetanus. Spasms can be controlled with sedation and adjunctive treatment, albeit at the expense of respiratory drive and weakness. Invasive ventilation under deep sedation with intensive care unit admission is the best practice. Where invasive ventilation is unavailable and when patients decline intubation, the management of muscle spasms and respiratory failure is extremely limited, with low survival rates. Herein, we present a case of severe tetanus in a 90-year-old female farmer who declined intubation and whose respiratory failure was managed with noninvasive positive pressure ventilation (NPPV) with a moderate dose of continuous benzodiazepine infusion to treat spasms. Compared with invasive ventilation, NPPV reduces the duration of ventilatory support and the risk of nosocomial pneumonia. Because spontaneous respiratory drive of the patient was maintained to trigger ventilation, pressure control ventilation was initiated. In previous references to tetanus management, the application of NPPV has not been mentioned. NPPV is a treatment option for patients with tetanus who are not intubated owing to limited medical resources or do-not-intubate orders for older patients.

Earp, JE, Stearns, RL, Agostinucci, J, Lepley, AS, and Ward-Ritacco, CL. Total body and extracellular water measures are unrelated to cramp sensitivity in euhydrated cramp-prone individuals. J Strength Cond Res 36(9): 2653–2656, 2022—Spectral bioelectrical impedance analysis (BIA) is a valid and noninvasive tool for measuring total body water (TBW), intracellular water (ICW), and extracellular water (ECW). As altered hydration and electrolyte imbalance have been proposed as one of 2 etiologies for exercise-associated muscle cramps (EAMC), the purpose of this study was to determine if distribution of body water is related to cramp sensitivity in similarly hydrated cramp-prone individuals. To this end, 11 euhydrated subjects who regularly experience EAMC had their relative TBW, ICW, and ECW assessed using 8-pole spectral BIA. Subjects' cramp sensitivity was then assessed by electrically stimulating the tibial nerve at increasing frequencies until a muscle cramp occurred, allowing for the determination of the threshold frequency (TF) at which the cramp occurred. It was observed that TF was not significantly related to TBW (r = 0.087, p = 0.368), ICW (r = 0.105, p = 0.338), ECW (r = 0.087, p = 0.368), or ECW:TBW (r = 0.147, p = 0.280). As cramp etiology is poorly understood, these results add to a growing body of literature questioning the role of hydration and electrolyte imbalance in EAMC. Although fluid distribution may be unrelated to TF in those who commonly experience EAMC, additional research is needed to compare those who commonly experience cramps (athletes as well as individuals with specific neuropathies or pharmacologically induced cramps) with those who do not experience cramps and to determine if acute shifts in body water compartmentalization are related to changes in cramp sensitivity. [ABSTRACT FROM AUTHOR]

Background: Addiction to Smartphone usage has psychological and physical impacts. However, the state of spasm of accommodation is unclear in Smartphone abusers.Methods: We performed a cross-sectional study among adults aged 18-35 years between October 2016 and December 2018. Forty participants were Smartphone abusers according to the Smartphone addiction questionnaire, and 40 participants were non users. We measured auto refraction precycloplegia and postcycloplegia at far for all participants to evaluate the state of spasm of accommodation. We assessed the ultrasound biomicroscopy (UBM) parameters including anterior chamber angle (ACA).Results: There was a significant difference in the odds of having spasm of accommodation between Smartphone abusers compared to non-users (OR = 6.64, 95% CI = 1.73-25.47; adjusted OR = 14.63, 95% CI = 2.99-71.62). The Smartphone abusers and non-users groups had a superior ACA median of 30.45° ± 8.3° vs. 26.75° ± 6.6° (P = 0.04) precycloplegia at far and 31.70° ± 11.8° vs. 31.45° ± 8.3° (P = 0.15) postcycloplegia at far, respectively, demonstrated by the Mann-Whitney U test. There was significant higher difference in the precycloplegic nasal ACA at far in the Smartphone abusers group than the non-users group (mean precycloplegic nasal ACA difference = 3.57°, 95% CI = 0.76° - 6.37°), demonstrated by the independent t test. Similarly, there was significant higher difference in the postcycloplegic nasal ACA at far (mean postcycloplegic nasal ACA difference = 4.26°, 95% CI = 1.33° - 7.19°).Conclusions: Smartphone abusers are in a condition of accommodation spasm. As a result, cycloplegic refraction should be done for Smartphone abusers. [ABSTRACT FROM AUTHOR]

Objective: To explore the therapeutic effect of combined selective peripheral neurotomy (cSPN) on the spasm of the lower limbs after spinal cord injury. Methods: A prospective intervention (before-after trial) with an observational design was conducted in 14 spinal cord injury patients with severe lower limbs spasticity by cSPN. Given the severe spasm of hip adductor, triceps surae, and hamstring muscles in these patients, a total of 26 obturator nerve branches, 26 tibia nerve branches, and 4 sciatic nerve branches partial neurotomy were performed. The modified Ashworth scale, composite spasticity scale, surface electromyography, gait analysis, functional ambulation category, spinal cord independence measure, and modified spinal cord injury–spasticity evaluation tool were used before and after surgery. Results: Compared with preoperative, the spasm of the hip adductor, triceps surae, and hamstrings of the lower limbs in the postoperative patients decreased significantly. The abnormal gait of knee flexion and varus in the standing stage were significantly reduced. The grading of walking ability and activities of daily living were significantly improved. Conclusions: Combined selective peripheral neurotomy can significantly reduce the spasm of lower limbs post spinal cord injury, improve abnormal gait, and improve motor function and activities of daily living. Trial registration: ChiCTR1800019003 (2018–10-20). [ABSTRACT FROM AUTHOR]

Introduction Surgically created arteriovenous fistulas are the gold standard for the vascular access for hemodialysis. Radiocephalic fistulas are the first recommended access. Aim of the study was to find the patencies in upper limb fistulas after being successfully created, over a period of two years. Material & Methods In this prospective study 212 arteriovenous fistulas were created in the patients of end stage renal disease over a period of two years from September 2017 to August 2019. Patients were clinically evaluated and examined for upper limb vessels. Those with apparently small veins were advised duplex ultrasonography to check the size and confirm the patency of vessels. After the successful creation of arteriovenous fistulas, patients were followed up for 2 years. Results 212 AVFs were successfully created and operative success rate was 90.2%. Mean age of the patients was 53.3 years. Over a period of 2 years of follow up a total of 41 (19.3%) fistulas failed. 42% of those failures occurred within the first 72 hours of surgery and the remaining 58% failed gradually over 2 years. Radiocephalic fistulas were made in 67.4% of the patient population but failure percentage was 22.4% which was considerably higher compared to the other types of fistulas. Conclusions Fistula patency decreases over a period of time mainly because of thrombosis, spasm, atherosclerosis and intimal hyperplasia. This is particularly drastic within the first 72 hours and then gradual. Radiocephalic fistulas, although a preferred method of access for hemodialysis, have greater chances of failures. [ABSTRACT FROM AUTHOR]

Radical S-adenosylmethionine (RS) enzymology has emerged as a major biochemical strategy for the homolytic cleavage of unactivated C-H bonds. At the same time, the post-translational modification of ribosomally synthesized peptides is a rapidly expanding area of investigation. We discuss the functional cross-section of these two disciplines, highlighting the recently uncovered importance of protein-protein interactions, especially between the peptide substrate and its chaperone, which functions either as a stand-alone protein or as an N-terminal fusion to the respective RS enzyme. The need for further work on this class of enzymes is emphasized, given the poorly understood roles performed by multiple, auxiliary iron-sulfur clusters and the paucity of protein X-ray structural data.

A 70-year-old man was admitted to our hospital for restoration of sinus rhythm from atrial fibrillation by direct current counter shocks. On admission, he had a coronavirus disease 2019 (COVID-19) infection and syncope during bed rest. Electrocardiography revealed polymorphic ventricular tachycardia after ST-segment elevation with a normal QT interval. Coronary angiography revealed coronary vasospasm. Coronary vasospasm may be a cause of polymorphic ventricular tachycardia in COVID-19 patients.

Background: Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited., Hypothesis: Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses., Patients and Methods: Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer., Results: In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert's classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009)., Discussion: The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site., Level of Evidence: IV., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: Honeysuckle (Lonicera japonica) is an ornamental flowering plant with numerous traditional medicinal uses. It has been claimed to have anti-spasmodic activities, but only limited studies have been done to support this. The objective of this research was to investigate anti-spasmodic effect of L. japonica flower extract on uterus contractions. Methods: Hydroalcoholic extract was prepared using the maceration technique. In addition, chloroform and ethyl acetate fractions were prepared using a solvent in solvent fractionation technique. Essential oils were collected using the hydro-distillation technique. Rat isolated uterus was suspended in an organ bath and contracted with oxytocin, acetylcholine (ACh), KCl, or application of electrical field stimulation (EFS). The relaxant effects of the extract, its fractions, and nifedipine were examined on uterine contrition induced by the above-mentioned stimuli. Results: Nifedipine in a concentration-dependent manner inhibited uterine contraction induced by oxytocin, KCl, ACh, and EFS. L. japonica flower extract also exhibited an inhibitory effect on the isolated rat uterus. Comparison of the hydroalcoholic extract with its chloroform and ethyl acetate fractions showed that the chloroform fraction was the most potent and the ethyl acetate the weakest part of the plant with antispasmodic activity. The relaxant effect of essential oil had close similarities to that of chloroform extract. Conclusion: Lipophilic compounds isolated by the chloroform partition of crude hydroalcoholic extract of L. japonica flower exhibited the most antispasmodic activity. Ethyl acetate partition of the same extract exhibited the least activity. Therefore, it can be concluded that the spasmolytic constituents of L. japonica flower reside in chloroform partitioning. The nonpolar essential oils may also have a contribution.