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Objective Central post-stroke pain (CPSP) refers to neuropathic pain in areas of the body corresponding to stroke lesions. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, is safe and effective against neuropathic pain. In this randomized double-blind placebo-controlled study, we studied the effect of duloxetine in CPSP patients. Methods Consecutive patients satisfying the inclusion criteria were enrolled in the study and were randomized in a simple 1:1 randomization to duloxetine and placebo groups. Baseline demographic, clinical and imaging data were obtained. Prespecified primary outcome was comparison of change in pain intensity from baseline to 4 weeks, as assessed on Numeric Rating Scale (NRS) in both groups. Prespecified secondary outcomes were comparison of change in average pain severity from baseline to 4 weeks as measured on Short-form McGill Pain Questionnaire-2 (SFMPQ-2) score and Pain Disability Index (PDI) score and comparison of Patient Global Impression of Change (PGIC) score at the end of 4 weeks of treatment in both groups. Duloxetine at doses of 30 mg and similarly appearing placebo tablets were given and the dose was doubled if there was no response at the end of 2 weeks. Response to treatment was defined as ≥2 points reduction of NRS pain score. Results In total, 82 patients were enrolled in the study, 41 in each group. There was a significant difference in reduction in NRS score between duloxetine and placebo group from baseline (6.51 ± 1.03 vs 6.37 ± 1.41) to 4 weeks (3.02 ± 1.70 vs 4.40 ± 1.77, P  = .02 for difference in reduction between groups). SFMPQ-2 score (P  = .032) and Pain Disability Index score (P  = .005) also differ significantly from baseline to 4 weeks between the two groups. PGIC score at the end of 4 weeks was significantly different between the two groups (5.15 ± 1.54 vs 3.89 ± 1.51; P  < .001). Responder rate (defined as % of patients with ≥ 2 points reduction on NRS pain score from baseline to end of 4 weeks), on post hoc analysis was found to be significantly higher in duloxetine group (80.5%) than placebo group (43.9%) (P  = .042). Conclusions Duloxetine can be an effective treatment option for patients with moderate to severe central post-stroke pain. [ABSTRACT FROM AUTHOR]

Xanthoma in the gastrointestinal tract are rare lesions and are detected incidentally. Xanthoma cells have abundant clear cytoplasm and are seen in sheets in the mucosa or submucosa and is a mimic various neoplastic and nonneoplastic entities. The present study aims to describe clinicopathological characters of upper gastrointestinal xanthomas. A 10-year retrospective archival search identified 16 cases of upper gastrointestinal xanthomas. The patients were mostly males with an age range of 43-73 years. Most patients presented with abdominal pain (12/16). Gastric antrum (11/16) was the most common site with sessile lesions (5/16) on endoscopy. Associated findings included, H. pylori infection (7/16), intestinal metaplasia (4/16) and chronic gastritis (3/16). Two cases showed adjacent low-grade dysplasia, however, follow up did not show any progression. Literature regarding gastrointestinal xanthomas is limited, making the management strategies ambiguous. Most are benign and incidental however owing to reports of associated dysplasia a follow up is imperative in these cases. [ABSTRACT FROM AUTHOR]

Background: A principal caregiver (CG) is directly affected by the patient's health problems leading to CG strain. In the present study, we evaluated the different factors related to increased CG burden in stroke survivors and assessed the relationship between patient's personal and clinical characteristics and CG's stress. Material and Methods: In this prospective, follow up study, a total of 141 principle CGs of 164 First ever stroke (FES) survivors were subjected to the Caregivers Strain Index (CSI) and Oberst Caregiving Burden Scale (OCBS) at 30 days (n = 141), 90 days (n = 129), and 6 months (n = 119) after informed consent. Patients were subjected to modified Rankin Scale (mRS) and Barthel index score assessment at the end of 30 days. Results: The mean age of CG was 49.8 ± 21.0 years, approximately 20 years lesser than that of the patients. 102 (72.34%) CGs were females. Urinary incontinence (p < 0.006) morbidity at 30 days, mRS (p = 0.004), and moderate to the severe neurological deficit on admission (p = 0.003) were the patient factors in FES cases leading to significant CGs stress. CG factors responsible for major stress were long caregiving hours (P < 0.001), anxiety (P < 0.001), disturbed night sleep (P < 0.001), financial stress (P < 0.001), younger age (P = 0.002), and CGs being daughters in law (P = 0.039). Conclusion: CG burden increases with increased severity of stroke. Integrated stroke rehabilitation services should also address CGs issues along with patients. [ABSTRACT FROM AUTHOR]

Introduction: Metastases to the sinonasal region is rare and presents with features overlapping with various regional neoplastic/non-neoplastic lesions. This series aims to highlight the clinical presentations and diagnostic difficulties of sinonasal metastases. Material and Method: A review of pertinent demographic and laboratory data for patients diagnosed with metastases to the sinonasal region, over a period of 6 years (2012- 2017) was done. Results and Discussion: Seven cases (males- 6, females-1) of sinonasal metastases were identified. The age ranged from 41-72 years. The common clinical presentation was nasal obstruction, epistaxis, and pain. Grossly tumors were irregular masses (mean size - 4.1cm) with maxillary sinus as the most common site. The histologic types included Squamous cell carcinoma (3 cases), clear cell renal cell carcinoma (2 cases), and one case each of infiltrating ductal carcinoma, and eccrine spiradenocarcinoma. The site of the primary tumor was larynx (2/7), kidney (2/7), breast (1/7), lung (1/7), and neck (1/7). The mean time interval between the primary tumor and metastasis was 4.5 months. All cases were managed with resection of the metastatic tumor. Metastatic breast and renal tumors comprise the bulk of reported cases in English literature. Metastasis from a lung carcinoma are rare and here we report the first case of an eccrine spiradenocarcinoma to maxillary sinus. Conclusions: Owing to the overlapping clinical presentations, a high degree of suspicion is needed in patients with previous history of malignancy for early diagnosis. The current course of therapy is palliative for such patients and carries a grim prognosis. [ABSTRACT FROM AUTHOR]