Neuropathic itch occurs due to damage of neurons of the peripheral or central nervous system. Several entities, including metabolic, neurodegenerative, orthopedic, infectious, autoimmune, malignant, and iatrogenic conditions, may affect the somatosensory system and induce neuropathic itch. Due to the complex nature of neuropathic itch, particularly concerning its clinical presentation and possible etiological factors, diagnostic work-up of this condition is challenging. A detailed medical history, especially in regard to the itch, and a comprehensive physical examination are relevant to detect characteristic signs and symptoms of neuropathic itch and to rule out other possible causes for chronic itch. Complementary diagnostic exams, especially laboratory tests, determination of the intraepidermal nerve fiber density via a skin biopsy and radiological examinations may be indicated to confirm the diagnosis of neuropathic itch and to identify underlying etiological factors. Functional assessments such as quantitative sensory testing, nerve conduction studies, evoked potentials, or microneurography may be considered in particular cases. This review article provides a comprehensive overview of the diagnostic work-up recommended for patients with neuropathic itch.

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Neuropathic Itch: Routes to Clinical Diagnosis.

Background Knee pain has a variety of etiologies in the pediatric population, including septic arthritis, osteomyelitis, fracture, ligamentous injury, and neoplasms. Extrinsic sources of knee pain may also be intra-abdominal, although abdominal pathology is much more likely to manifest as hip or proximal thigh musculature pain. Case Report A 5-year-old healthy male presented with atraumatic right knee pain, discomfort with weightbearing, fever, and elevated inflammatory laboratory markers. Physical examination and magnetic resonance imaging findings of the knee were benign, leading to low clinical suspicion for knee septic arthritis. Blood cultures were positive for a gastrointestinal organism, Granulicatella adiacens, suggesting abdominal pathology leading to referred pain. Ultrasound evaluation and computed tomography (CT) of the abdomen revealed a large abscess secondary to perforated appendicitis, which was treated with CT-guided drainage and i.v. antibiotics. The patient's musculoskeletal pain subsided with treatment of the appendicitis. Why Should an Emergency Physician Be Aware of This? Acute appendicitis may present as knee pain, with other signs and symptoms mimicking septic arthritis, such as fever, inability to bear weight, and elevated inflammatory markers. Considering an array of differential diagnoses in pediatric patients with apparent knee septic arthritis is crucial to prevent delay in diagnosis of alternative infectious sources.

Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report.

Lower Abdominal Pain

BACKGROUND: Neurogenic and referred leg pain are some of the most challenging clinical problems in spinal surgery due to the diversity of conditions that can act as aetiological factors. 
METHODS: The literature was reviewed and combined with case studies to demonstrate different aetiological factors. 
RESULTS: At least 300 conditions were identified that might cause neurogenic and referred leg pain. An aetiological classification of neurogenic and referred leg pain is presented. The classification includes systemic conditions, conditions from the brain, spinal cord, cervical and thoracic spinal canal, lumbar spinal canal, lumbar nerve root canal, lumbar extraforaminal area, the pelvis and the lower extremity. Each one of these conditions can mimic a lumbar disc herniation accurately. 
CONCLUSION:The aetiological classification can be used as a checklist when evaluating neurogenic and referred leg pain. Each condition deserves careful consideration and when overlooked might result in a missed diagnosis.

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The differential diagnosis of neurogenic and referred leg pain

Hip pain is a common presenting complaint in the pediatric emergency department, which can be attributed to many possible causes. It may be due to a benign "growing pain" or a potentially serious illness requiring urgent evaluation. At times, hip pain can be a manifestation of an underlying appendicitis in a child; thus, it can be confused with many other conditions. Children can be at particular risk for misdiagnosis or delayed diagnosis of appendicitis as it often can have an uncommon presentation with atypical signs and symptoms. Early identification, however, is important to prevent potential complications of delaying the diagnosis. We present a case that illustrates an atypical presentation of acute appendicitis. This report also highlights the diagnostic dilemma encountered during the evaluation of hip pain in children.

Hip pain in a child: myositis or appendicitis?

Paroxysmal neuropathic pain is an uncommon complaint among pediatric patients visiting the emergency department It is a rare presentation in children with syringomyelia Patients with syringomyelia may present with a variety of pain symptoms It is the site and extension of the syrinx, which determines the character of pain We report an adolescent with Chiari malformation type 1 with syringomyelia who presented with neuropathic pain, dysesthesia, and absent triceps (C7) reflex The pertinent literature is reviewed

Paroxysmal neuropathic pain in an adolescent female with syringomyelia: a review of literature.

Background: Hematoma development is the most common vascular access complication among post-cardiac catheterization patients. It requires safe and standardized nursing care protocol, as well as qualified and skilled healthcare providers to obtain good outcomes of management. The vascular access complications were severe and increased the length of stay in the hospital. Timely recognition and management can diminish their burden. Objectives: 1. To evaluate the effectiveness of Standardized Nursing Care Protocol among Post cardiac catheterization patients to reduce hematoma development. 2. To assess the association of hematoma development between procedure site (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) among post-cardiac catheterized patients. Methodology: This quasi-experimental (posttest only) study was conducted at Coronary Care Units at tertiary care hospitals in Karachi. In this study, a total of 108 post-cardiac catheterized patients were participated. The patients were divided into two groups; the interventional group and Original Research Article Sania et al.; JPRI, 34(39A): 49-58, 2022; Article no.JPRI.85874 50 the control group. In the control group, 54 post-cardiac catheterized patients were selected and data were taken based on inclusion criteria who received routine holistic nursing care post-procedure and have been discharged. Besides 54 patients participated in the interventional group who received Standardized Nursing Care Protocol post-cardiac catheterization including proper patient assessment, compression techniques, interventions pre, during and post sheath and TR-band removal to discharge instruction by the principal investigator (PI). The data was collected through patients’ assessment sheets and hematoma scales for the identification of hematoma development rate among post-cardiac catheterized patients. The non-probability consecutive sampling technique was accomplished for the collection of data. Findings: The rate of hematoma development in the (control) group was reflected at 18 (33.3 %) while after the implementation of the standardized nursing care protocol the rate of hematoma development was 9 (16.6%) in the (interventional) group out of 54 (50%) post-cardiac catheterized patients. There was a significant difference between the (control) and (interventional) groups regarding the rates of hematoma development among post-cardiac catheterization i.e. the P values were 0.037 ˂ 0.05. Thus, the standardized nursing care protocol among post-cardiac catheterization was effective in the reduction of hematoma development. Furthermore, the radial site procedure reflected fewer rates of hematoma development 8 (14.81%) as compared to the femoral site procedure 19 (35.1%) among post-cardiac catheterized out of 54 (50%). The P-value was 0.058 > 0.05 there was no association between hematoma development and procedure site in the (interventional and control) groups post-cardiac catheterization. Similarly, the P-value was greater than 0.05 hence there was no association between hematoma development and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization. Conclusion: The implementation of Standardized Nursing Care Protocol among post-cardiac catheterization was effective for the reduction of hematoma development in the (intervention) group while there was an association of hematoma development between the (control and interventional) groups. However, there was no association between hematoma development and site procedure (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization patients.

Andaleeb Raja

Papers

Hip pain in a child: myositis or appendicitis?

Paroxysmal neuropathic pain in an adolescent female with syringomyelia: a review of literature.

Effectiveness of Standardized Nursing Care Protocol among Post Cardiac Catheterization Patients to Reduce Hematoma Development