Search

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Aripiprazole, a commonly prescribed antipsychotic, has been rarely associated with the onset of hiccups. This study aims to elucidate the prevalence, risk factors, and management of aripiprazole-induced hiccups. Methods: We report a case of aripiprazole-induced hiccups in a 32-year-old male diagnosed with Somatic Symptom Disorder per DSM-5 criteria.A comprehensive literature review was conducted, identifying 29 case reports of aripiprazole-induced hiccups. Patient demographics, dosage, onset and duration of hiccups, and management strategies were analyzed. Results: Aripiprazole-induced hiccups predominantly affected adolescents and middle-aged male patients (86.7%). The majority of hiccups developed within 1-2 days post-prescription (90.9%) and resolved within 1-4 days after discontinuation of aripiprazole. Discontinuation of aripiprazole was the most effective management strategy (51.7%). Co-administration with benzodiazepines was identified as a significant risk factor. Discussion: The findings suggest that clinicians should be vigilant for the onset of hiccups during the early stages of aripiprazole treatment, especially in male patients and those co-administered with benzodiazepines. Conclusion: Clinicians should be vigilant for hiccups during early aripiprazole treatment. Considering personality and psychological factors is crucial in managing hiccups in psychiatric patients. [ABSTRACT FROM AUTHOR]

Aim: Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups. Methods: To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4. Results: A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21--1.33; P < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: 1.28, 95% CI: -1.64 to -0.93; P < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323--9.617; P < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-- 1.25; P = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; P < 0.00001). Conclusions: Our investigation suggests that acupuncture could prove effective in poststroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative. [ABSTRACT FROM AUTHOR]

ObjectiveTo observe the safety and effectiveness of low-dose remidazolam combined with propofol in painless gastroenterscopy in elderly patients. MethodsA total of 120 elderly patients who underwent painless gastroenteroscopy in Hebei General Hospital from February 2022 to July 2022 were selected. Patients were randomly divided into group C(1.5mg/kg propofol), group R1(0.05mg/kg remidazolam combined with 1mg/kg propofol) and group R2(0.1mg/kg remidazolam combined with 1mg/kg propofol), 40 patients in each group. The values of SBP, DBP, HR, SpO2 and bispectral index(BIS) were recorded at four time points: after the patient entering the room(T1), the MOAA/S score being 0 after anesthesia induction(T2), the gastroscope being inserted(T3) and the end of examination(T4). The success rate of sedation, dosage of propofol, the time of endoscopy examation, awakening time, and time of leaving the recovery room, the satisfaction of patients and operating physician were recorded. The adverse reactions during and after operation were observed and recorded. ResultsCompared with T1, HR, SBP, DBP and BIS values of three groups were significantly decreased at T2, T3 and T4(P＜0.05). At T2, the values of SBP, DBP and BIS in group R1 and group R2 were significantly higher than those in group C(P＜0.05). There were statistically significant differences in the dosage of propofol, the time of awakening, the time of leaving the room (F=164.904, 29.878, 89.058, P＜0.05) and the incidence of hypoxemia, Hypotension, hiccup, body motion reaction and injection pain (χ2=8.772, 11.563, 9.697, 8.607, 21.943, P＜0.05) among the three groups. Compared with group C, in R1 and R2 group the total dosage of propofol reduced significantly(P＜0.05), the time for awakening and leaving recovery room shortened(P＜0.05), the incidence of hiccups increased(P＜0.05), while the incidences of hypoxemia, body movement reaction, hypotension and injection pain reduced significantly(P＜0.05). ConclusionA combined propofol anesthetic regimen with remazolam, which can stably maintain hemodynamic changes, reduce the amount of propofol, shorten the time of awakening and leauing recovery room, and reduce the incidence of adverse effects. It can be safely and effectively applied to elderly patients during painless gastrointestinal endoscopy. Rimazoparin 0.05 mg/kg is associated with a lower incidence of hiccups than 0.1 mg/kg, has less impact on the operating physician, and the protocol is more optimal.

الملخص: الفواق في الغالب حميدة وذاتية الحد. من ناحية أخرى، يمكن للفواق المستمر أو المستعصي أن يكون موهنا ويشير إلى وجود اضطراب نفسي أو فسيولوجي أساسي. قدم رجل يبلغ من العمر 63 عاما إلى عيادة الطب السلوكي في مستشفى الرعاية الثالثية في مسقط، عمان ، مع تاريخ 4 سنوات من الفواق المستعصي ؛ بعد استبعاد جميع الأسباب العضوية للفواق المستعصي ، تم تشخيص الفواق النفسي المنشأ. الفواق النفسي المنشأ نادر جدا، حيث تم نشر 7 سلسلة حالات وتقارير فقط حتى الآن على بوبميد وقوقل سكولار. يتضمن هذا التقرير مراجعة شاملة للأدبيات المتعلقة بجميع حالات الفواق النفسي التي تم الإبلاغ عنها والتي نشرت حتى الآن على بوبميد وقوقل سكولار للتحقيق في فعالية العلاجات المختلفة لهذه الحالة بدقة. الفواق النفسي المنشأ نادر جدا، ويجب أن يتم التشخيص بعد استبعاد الأسباب العضوية. يمكن أن تكون الإدارة صعبة بسبب نقص التدخلات القائمة على الأدلة. Abstract: Hiccups are typically benign and self-limiting. However, persistent or intractable hiccups can be debilitating, and may indicate the presence of an underlying physiological or psychological disorder. A 63-year-old man presented to the behavioral medicine clinic at a tertiary care hospital in Muscat, Oman, with a 4-year history of intractable hiccups. After exclusion of all organic causes of intractable hiccups, a diagnosis of psychogenic hiccups was made. Psychogenic hiccups are very rare, and only seven case series and reports have been published to date, according to PubMed and Google Scholar. This report includes a comprehensive review of the literature on all reported cases of psychogenic hiccups published to date, according to these two databases, to thoroughly investigate the effectiveness of various therapies for this condition. Psychogenic hiccups are very rare, and diagnosis should be made after exclusion of organic causes. Management can be challenging because of the lack of evidence-based interventions.

Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hiccups are a rare but potentially debilitating side effect of opioid treatment, with only a handful of reported cases in the medical literature. The pathophysiological mechanism linking opioids and hiccups is unknown, and a lack of evidence exists concerning the optimal management of the condition. We report on a 64-year-old man diagnosed with advanced renal cancer and painful osteolytic metastases, presenting persistent hiccups while on opioid treatment. Hiccups recurred after multiple challenges with codeine, morphine and hydromorphone on separate occasions. Hiccups ceased only after opioid discontinuation, although various pharmacological treatments were tried to shorten the duration of hiccups. Eventually, fentanyl was introduced and was well tolerated by the patient, without any recurrence of hiccups. The chronological correlation between opioid initiation and the onset of hiccups, as well as opioid discontinuation and the termination of hiccups leads to the conclusion that a causal role of codeine, morphine and hydromorphone in this occurrence is likely. Individual susceptibility probably plays a central role in the development of opioid-related hiccups. Opioid rotation is a promising strategy in the management of opioid-related hiccups, particularly when the mere discontinuation of the opioid is not a viable option, such as in the oncology and palliative care field. [ABSTRACT FROM AUTHOR]

Abstract Background Area postrema syndrome (APS) as the isolated manifestation in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy has been rarely reported. Case presentation A 61-year-old male patient presented with intractable hiccup. He was first admitted to the department of Gastroenterology because he had no symptoms other than hiccup. Then he was diagnosed with possible digestive system disease and started on treatment. 2 weeks later, his symptom didn’t improve at all. After consultation, the patient was referred to our department. Cerebrospinal fluid (CSF) analysis revealed lymphocytes pleocytosis, elevated protein level. Cell-based assays demonstrated GFAP antibodies in blood and CSF. His symptom improved with steroid pulse therapy (methylprednisolone, 1 g for 5 days), followed by a gradual tapering of oral prednisolone. Three months after the initial presentation, he showed no relapses. Conclusions We report atypical manifestation of autoimmune GFAP astrocytopathy which presented as APS, suggesting that autoimmune GFAP astrocytopathy should be added to the list of possible cause of APS.

Background: Hiccup can cause significant distress to patients and affect medication compliance. Individuals with olfactory reference disorder (ORD) who might develop persistent hiccups when treated with a combination of antidepressant and antipsychotic, leading to significant distress and impairment. Case summary: We report a rare case of an adolescent with ORD who was treated with aripiprazole combined with sertraline and who began to hiccup persistently after 6 days on this treatment. He stopped hiccupping after the aripiprazole had been suspended for 12 h. After discharge, the patient continued on sertraline alone and reported no hiccupping at 1-month follow-up. Conclusion: Clinicians should consider that the combination of aripiprazole and sertraline can induce hiccups during the acute administration period in adolescents with ORD. [ABSTRACT FROM AUTHOR]

Background: Area postrema syndrome (APS) as the isolated manifestation in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy has been rarely reported.Case Presentation: A 61-year-old male patient presented with intractable hiccup. He was first admitted to the department of Gastroenterology because he had no symptoms other than hiccup. Then he was diagnosed with possible digestive system disease and started on treatment. 2 weeks later, his symptom didn't improve at all. After consultation, the patient was referred to our department. Cerebrospinal fluid (CSF) analysis revealed lymphocytes pleocytosis, elevated protein level. Cell-based assays demonstrated GFAP antibodies in blood and CSF. His symptom improved with steroid pulse therapy (methylprednisolone, 1 g for 5 days), followed by a gradual tapering of oral prednisolone. Three months after the initial presentation, he showed no relapses.Conclusions: We report atypical manifestation of autoimmune GFAP astrocytopathy which presented as APS, suggesting that autoimmune GFAP astrocytopathy should be added to the list of possible cause of APS. [ABSTRACT FROM AUTHOR]

Hiccups occur at all ages but are most common during fetal development, and accordingly, they are seen regularly in preterm infants. However, the physiologic correlate of hiccups has never been established. We present the case of a preterm infant who developed a spell of hiccups and compared lung volume changes during hiccups with spontaneous breaths using electrical impedance tomography. Hiccups mostly occurred during the expiratory phase of breathing and were associated with a shorter inspiratory time and a larger tidal volume compared with spontaneous breaths. The center of ventilation was shifted toward the ventral (non-gravity-dependent) part of the lung during hiccups and volume changes were mainly restricted to the larger airways, but some gas flow also reached the lung parenchyma. Our observations shed new light on this phenomenon, which is well known but little researched, and our findings may imply a physiological impact of hiccups during fetal development. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hiccups are usually self-limiting and benign but can be distressing when they become persistent or intractable and produce significant morbidity. In the intubated patients in neurocritical care, persistent hiccups may cause respiratory alkalosis and are also associated with an increased incidence of ventilator-associated pneumonia. Several pharmacological and nonpharmacological strategies have been devised for the treatment of persistent and intractable hiccups. The evidence to support or declare any intervention as harmful is scarce. In this review, we have presented the pathophysiology and workup, and a stepwise management protocol for intractable hiccups.

The hiccup (Latin singultus) is an involuntary periodic contraction of the diaphragm followed by glottic closure, which can be a rare side effect of aripiprazole. In contrast to the structurally closely related aripiprazole, brexpiprazole was not associated with this particular adverse drug reaction. Having two very similar drugs that differ in their ability to induce hiccups represents a unique opportunity to gain insight into the receptors involved in the pathophysiology of the symptom and differences in clinical effects between aripiprazole and brexpiprazole. The overlap between maneuvers used to terminate paroxysmal supraventricular tachycardia and those employed to terminate bouts of hiccups suggests that activation of efferent vagal fibers can be therapeutic in both instances. Recent work seems to support a pivotal role for serotonin receptors in such vagal activation. It is unlikely that a unique receptor-drug interaction could explain the different effects of the examined drugs on hiccup. The different effect is most likely the consequence of several smaller effects at more than one receptor. Brexpiprazole is a highly affine (potent) α2⁢C antagonist and, therefore, also an indirect 5-HT1⁢A agonist. In contrast, aripiprazole is a partial 5-HT1⁢A agonist (weak antagonist) and an HT3 antagonist. Activation of 5-HT1⁢A receptors enhances vagal activity while HT3 blockade reduces it. Vagus nerve activation is therapeutic for hiccups. A definitive answer continues to be elusive.

The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve. A computerised systematic search of the Web of Science database was conducted. The key terms used were phrenic nerve, subdiaphragmat*, esophag*, liver, stomach, pancre*, duoden*, intestin*, bowel, gangli*, biliar*, Oddi, gallbladder, peritone*, spleen, splenic, hepat*, Glisson, falciform, coronary ligament, kidney, suprarenal, and adrenal. The 'cited-by' articles were also reviewed to ensure that all appropriate studies were included. A total of one thousand three hundred and thirty articles were found, of which eighteen met the inclusion and exclusion criteria. The Quality Appraisal for Cadaveric Studies scale revealed substantial to excellent methodological quality of human studies, while a modified version of the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool denoted poor methodological quality of animal studies. According to human studies, phrenic supply has been demonstrated for the gastro-esophageal junction, stomach, celiac ganglia, liver and its coronary ligament, inferior vena cava, gallbladder and adrenal glands, with half of the human samples studied presenting phrenic nerve connections with any subdiaphragmatic structure. This review provides the first systematic evidence of subdiaphragmatic phrenic nerve supply and connections. This is of interest to professionals who care for people suffering from neck and shoulder pain, as well as patients with peridiaphragmatic disorders or hiccups. However, there are controversies about the autonomic or sensory nature of this supply. • The phrenic nerve provides connections and innervates the subdiaphragmatic viscera. • This review helps professionals who care for people with neck and shoulder pain, hiccups and peridiaphragmatic disorders. • The phrenic nerve constitutes a new therapeutic target in case of visceral pathologies and referred pain. [ABSTRACT FROM AUTHOR]

The hiccup or singulto can be considered a banal symptomatology but it can become a very disabling factor for patients. The relationship between oral corticosteroids and the appearance of hiccups is well known, but the relationship between the two by peridural procedure is much less described, with only six cases published to date. We present the case of a young patient without basic treatment, in whom the only risk factor for the onset of this symptomatology was the performance of an epidural-caudal technique with betamethasone as treatment for left lumbociatalgia. [ABSTRACT FROM AUTHOR]

Introduction Among the less common symptoms associated with the SARS-CoV-2 infection the attention is drawn by a persistent hiccup that was recently quoted in the literature. Case report We present the case of a 46-year-old Caucasian male patient hospitalized in the Infectious Diseases Clinic of the Academic Emergency Hospital Sibiu, Romania with laboratory confirmation of SARS-CoV-2 infection with a positive result of real-time reverse transcriptase--polymerase chain reaction (RT-PCR) assay from nasopharyngeal swabs, that during the disease course developed persistent hiccup associated with the administration of cortisone therapy, dexamethasone. A decision to stop the treatment with cortisone preparations was made, with the disappearance of the hiccup after 36 hours. Conclusions From our experience, other cases of SARS-CoV-2 infection that we managed during these months of the pandemic, with mild or severe forms of the disease, showed hiccup under treatment with dexamethasone, an event also described in other medical conditions under the same treatment and improved at its cessation or when replaced by methylprednisolone. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to examine the prevalence of myoclonus, sweating, pruritus, hiccup, and vesical and rectal tenesmus, and to explore associated factors in patients with advanced cancer. Methods: This multicenter prospective cohort study was conducted in 23 inpatient hospices/palliative care units in Japan from January to December 2017. The prevalence and characteristics of each symptom were assessed on admission and in the 3 days before death. We selected factors that might influence the occurrence of each symptom and investigated the association. Results: A total of 1896 patients were enrolled. The prevalence of orphan symptoms rose from admission to the 3 days before death: myoclonus 1.3 to 5.3% (95% CI 0.9–1.9%/4.3–6.5%), sweating 1.8 to 4.1% (95% CI 1.3–2.6%/3.1–5.1%), hiccup 1.1 to 1.8% (95% CI 0.7–1.7%/1.2–2.6%), and tenesmus 0.7 to 0.9% (0.4–1.2%/0.5–1.5%). Prevalence of pruritus fell from 3.5 to 2.5% (95% CI 2.7–4.4%/1.8–3.4%). Sweating, pruritus, and hiccups persisted throughout the day in nearly half of the patients. Myoclonus was significantly associated with brain tumors, sweating with opioids and antipsychotics, pruritus with liver and biliary tract cancer, cholestasis and severe diabetes, hiccup with male gender, digestive tract obstruction, severe diabetes, and renal failure. Vesical tenesmus was associated with urinary cancer, antipsychotics, and anticholinergics and rectal tenesmus with pelvic cavity cancer. Conclusion: We found that orphan symptoms occurred in 0.5–5.0% of patients, increased over time except for pruritus, and persisted in half of the patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The postrema area syndrome is included in neuromyelitis optica spectrum disorders, which contain a heterogeneous group of autoimmune and demyelinating inflammatory disorders of the central nervous system, associated frequently with the specific water channel antibody of aquaporin-4 (AQP4). The postrema area syndrome is characterized by intractable nausea, vomiting and hiccups without any apparent cause. The postrema area is a circumventricular organ with abundant AQP4 located on the floor of the fourth ventricle with multiple connections to structures of the brainstem and hypothalamus; with important physiological functions in the control of vomiting reflex, appetite and blood pressure, among others. CLINICAL CASE: A 32-year-old female patient with postrema area syndrome, who started with intractable hiccups associated with the AQP4 antibody. CONCLUSIONS: The postrema area syndrome is a manifestation of the neuromyelitis optica spectrum disorders with a higher incidence in the adult population; it should be suspected in the presence of intractable emesis or hiccups that persist for more than 48 hours without a probable cause. [ABSTRACT FROM AUTHOR]

Hiccup is the characteristic voice caused by the sudden closure of the glottis during the contraction of the muscles of respiration especially diaphragm. It usually ends spontaneously in a short time. If it lasts more than one month, it is called as intractable hiccup. Intractable hiccups may lead to malnutrition, hypoxia, arrhythmia, dehydration, depression, tiredness and sleep disorder. Those can affect the quality of life of the patient. It is reported that pharmacologic agents such as gamma-aminobutyric acid receptor agonists, dopamine antagonists, antipsychotics and baclofen may be beneficial in the treatment of intractable hiccups. If success is not achieved with these methods, invasive methods such as phrenic nerve block, regional anesthesia, and phrenic nerve pulse radiofrequency may be applied as alternative therapies. In this case report, it is aimed to present the medical management of a palliative care patient with intractable hiccup. A 55-year-old male patient underwent gastrectomy and distal esophagectomy due to esophagogastric junction tumor. He suffered from intractable hiccup after esophageal hematoma. Bilateral phrenic nerve block was performed; hence no recovery was achieved after five weeks of medical treatment. Most of his complaint about hiccup was recovered after phrenic nerve block.

The hiccup or singultus is a repetitive involuntary spasm that causes the closing of the glottis producing the characteristic sound. It is usually benign and self-limiting condition. There are many etiologies, the most frequent is the gastrointestinal and from this the gastric distension and gastroesophageal reflux. Most of the time it does not merit study, being always necessary to carry out diagnostic protocol in those that last more than 48 hours, since they could be serious or urgent diseases. There are multiple home remedies that can function, mainly in those that last less than 24 hours. The pharmacological treatment can be used whereas the etiological cause is diagnosed or if it is an untreatable hiccup. The most commonly prescribed drugs are baclofen, chlorpromazine and gabapentin. The intractable hiccup leads to deterioration in the quality of life, being associated with depression, sleep disorders and sometimes in the diet. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is a life-threatening condition that may present as dyspnea, chest pain,cough or hemoptysis, but often occurs without symptoms. It is not typically associated with hiccups.Hiccups are generally self-limiting benign contractions of the diaphragm that may be associatedwith medications or food but may also be symptomatic of serious disease when persistent. Wereport 3 cases of PE presenting as persistent hiccups. [West J Emerg Med. 2012;13(6):479-483]

The use of dopamine receptor blockers for chronic singultus treatment is based—at least partially—on circular thinking: chlorpromazine is FDA-approved for hiccups, chlorpromazine is a neuroleptic, neuroleptics are dopamine receptor blockers, and therefore hiccup is due to dopaminergic dysfunction. Chlorpromazine interacts with high affinity with a multitude of receptors and ion channels. This promiscuity is the basis for many of the therapeutic effects and adverse drug reactions of this drug. While an involvement of dopamine is certain, it is by no means clear that dopaminergic dysfunction is the hallmark of singultus. The common denominator of most remedies for transient hiccup is their ability to activate the vagus nerve. Both afferent and efferent vagal activity and the central integration of the Xth cranial nerve function are modulated, inter alia, via serotonergic mechanisms; beneficial (therapeutic) effects for hiccup are to be expected from serotonin (5-HT) receptor subtype ligands that enhance vagal activity. Taken together, it appears that the ability to increase vagus output is mainly associated with 5-HT1A, 5-HT3, and 5-HT7 agonists and with 5-HT2C antagonists. The plausibility of the serotonergic singultus hypothesis is examined against available pharmacokinetic, pharmacodynamic, and clinical data for a number of drugs.

Abstract Background Continuous hiccups during surgery not only affect the surgical procedure, they can also cause adverse effects for the patient. Apart from active investigation of the cause of the hiccups, their timely termination is also necessary. Case presentation We reported a case of a 70-year-old woman with continuous intraoperative hiccups that appeared during vaginal hysterectomy under low continuous epidural anesthesia. After the ineffectiveness CO2 repeated inhalation and intravenous administration of chlorpromazine and methoxychlorpromide, we performed unilateral phrenic nerve block under ultrasound guidance. Hiccups were terminated without any related complications. Conclusions During intraoperative continuous hiccups, ultrasound guided phrenic nerve block may be a suitable treatment option when physical methods and drug therapy are not effective. However, given the absence of a vital risk related to hiccups, this block should imply the complete absence of any respiratory contraindication and a prolonged postoperative respiratory monitoring.

Background Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. Case Report We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. Conclusion We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.

Background: Lead-related infections that might develop after pacemaker implantation associated with high mortality and morbidity rates are challenging to manage and pose high-cost. Patients with lead-related infections usually present with fever, chills and fatigue and the treatment can be challenging unless the implant system is extracted. Case presentation: A 66-year old male patient who underwent dual chamber pacemaker and implantable cardioverter defibrillator was admitted to the emergency service with a six-week history of complaints of hiccups and fever. After a detailed investigation, lead-related infective endocarditis was the diagnosis. The patient was initiated on antibiotic therapy and lead extraction was performed. Conclusions: Patients with signs of infection who underwent pacemaker implantation may present with atypical symptoms such as hiccup. In these cases, imaging, particularly echocardiography, should be performed as soon as possible and the localization of the pacemaker leads and signs of infective endocarditis should be investigated.

Aortic dissection is a highly lethal condition in which a tear in the intimal layer of the aorta causes blood to enter in between the intimal and medial layers of aorta causing them to separate (dissect). The dissection of aortausually presents with excruciating pain radiating to the back. Here we present a unique presentation of aortic dissectionwhere an elderly male presented with a chronic history of intractable hiccups or singultuses. His computed tomography (CT scan) revealed a dissection of the descending thoracic aorta. He was managed conservatively and was discharged home in stable condition. The purpose of this report is to highlight this unusual presentation of aortic dissectionand unmask the possible etiology of hiccups in such cases.

Aortic dissection (AD) is a serious condition in which the intimal layer of aorta tears and blood surges in between the intimal and medial layers of aorta causing it to separate (dissect). It usually presents with excruciating pain radiating to the back. Here we present a unique presentation of AD where an old-aged Caucasian male presented with a chronic history of intractable hiccups. His computed tomography (CAT scan) revealed the dissection of the descending thoracic aorta. He was managed conservatively and was discharged home in stable condition. The purpose of this report is to highlight this unusual presentation of AD and unmask the possible etiology of hiccups in such cases.

Aripiprazole has a distinct place amongst other antipsychotics with its partial agonist-antagonist effect on dopaminergic and serotonergic receptors. Several case reports are associating aripiprazole to hiccups, but most of them are in the adult age group. The exact pathophysiologic mechanisms underlying this side effect are still fairly unknown and case reports displaying this phenomenon in adolescent patients are scarce. We report an adolescent bipolar patient who developed hiccups right after panic-like symptoms while switching from quetiapine to aripiprazole. Switching from a more potent D2 and 5HT1A antagonist to aripiprazole seems to increase the risk of hiccups as a side-effect. It should be emphasized that clinicians using aripiprazole for the treatment of adolescent patients should be mindful of this rare and fairly unknown phenomenon, especially in the early stages of drug initiation and while increasing the dosage. [ABSTRACT FROM AUTHOR]

• Diaphragm contraction in neonates evoked a sequence of three event-related potentials. • Hiccups can be encoded by the brain as early as ten weeks prior to average time of birth. • Hiccups – frequent in neonates – provide afferent input to the developing brain. Involuntary isolated body movements are prominent in pre-term and full-term infants. Proprioceptive and tactile afferent feedback following limb muscle contractions is associated with somatotopic EEG responses. Involuntary contractions of respiratory muscles, primarily the diaphragm – hiccups – are also frequent throughout the human perinatal period during active behavioural states. Here we tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction. In 13 infants on the neonatal ward (30–42 weeks corrected gestational age), we analysed EEG activity (18-electrode recordings in six subjects; 17-electrode recordings in five subjects; 16-electrode recordings in two subjects), time-locked to diaphragm contractions (n = 1316) recorded with a movement transducer affixed to the trunk. All bouts of hiccups occurred during wakefulness or active sleep. Each diaphragm contraction evoked two initial event-related potentials with negativity predominantly across the central region, and a third event-related potential with positivity maximal across the central region. Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth. Hiccups – frequently observed in neonates – can provide afferent input to developing sensory cortices in pre-term and full-term infants. [ABSTRACT FROM AUTHOR]

Abstract Backgrounds The main culprit lesion causing hiccup in patients with ischemic stroke is thought to involve the medulla oblongata, but some cases of hiccups caused by damage to the supratentorial cortex have been reported. The present study aimed to address the clinical and radiological characteristics of acute stroke patients accompanied by hiccups caused by supratentorial lesions. Method We retrospectively studied 5,309 consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted to our institute within 7 days after onset between April 2006 and September 2017. We searched for the term “hiccup” in prospectively collected descriptive datasets and analyzed associations between hiccup and clinical and radiological findings, with particular focus on patients with supratentorial lesions. Results We finally selected 16 stroke patients accompanied by hiccup. Nine patients had infarcts in the lateral medulla oblongata, and others had supratentorial infarcts (three patients with cortical infarcts, four patients with subcortical infarcts). Moreover, the right hemisphere was frequently damaged in this series (6/7, 86%). Conclusions Hiccup could be caused by supratentorial infarcts including the insular cortex, temporal lobe, and subcortex.

Aim: Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups. Methods: To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4. Results: A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21-1.33; P  < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: -1.28, 95% CI: -1.64 to -0.93; P  < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323-9.617; P  < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-1.25; P  = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; P  < 0.00001). Conclusions: Our investigation suggests that acupuncture could prove effective in post-stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative.

Hiccup is the characteristic voice caused by the sudden closure of the glottis during the contraction of the muscles of respiration especially diaphragm. It usually ends spontaneously in a short time. If it lasts more than one month, it is called as intractable hiccup. Intractable hiccups may lead to malnutrition, hypoxia, arrhythmia, dehydration, depression, tiredness and sleep disorder. Those can affect the quality of life of the patient. It is reported that pharmacologic agents such as gamma-aminobutyric acid receptor agonists, dopamine antagonists, antipsychotics and baclofen may be beneficial in the treatment of intractable hiccups. If success is not achieved with these methods, invasive methods such as phrenic nerve block, regional anesthesia, and phrenic nerve pulse radiofrequency may be applied as alternative therapies. In this case report, it is aimed to present the medical management of a palliative care patient with intractable hiccup. A 55-year-old male patient underwent gastrectomy and distal esophagectomy due to esophagogastric junction tumor. He suffered from intractable hiccup after esophageal hematoma. Bilateral phrenic nerve block was performed; hence no recovery was achieved after five weeks of medical treatment. Most of his complaint about hiccup was recovered after phrenic nerve block. [ABSTRACT FROM AUTHOR]