This systematic review aims to review clinical studies on the use of ketamine infusion for patients with treatment-resistant complex regional pain syndrome (CRPS).The following systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021228470). Studies for the systematic review were identified through three databases: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Reviews. Inclusion criteria for studies consisted of randomized clinical trials or cohort studies that conducted trials on the use of ketamine infusion for pain relief in patients with CRPS. Exclusion criteria for studies included any studies that were systematic reviews, meta-analyses, case reports, literature reviews, or animal studies. In the included studies, the primary outcome of interest was the post-drug administration pain score.In this systematic review, 14 studies met the inclusion criteria and were reviewed. In these studies, the dosage of ketamine infusion used ranged from 0.15 mg/kg to 7 mg/kg with the primary indication being the treatment of CRPS. In 13 of the studies, ketamine infusion resulted in a decrease in pain scores and relief of symptoms.Patients who received ketamine infusion for treatment-resistant CRPS self-reported adequate pain relief with treatment. This suggests that ketamine infusion may be a useful form of treatment for patients with no significant pain relief with other conservative measures. Future large-scale studies, including randomized double-blind placebo-controlled trials on the use of ketamine infusion for CRPS, must be conducted in a large-scale population to further assess the effectiveness of ketamine infusion in these populations.

Rationale Cocaine produces significant aversive/anxiogenic actions whose underlying neurobiology remains unclear. A possible substrate contributing to these actions is the serotonergic (5-HT) pathway projecting from the dorsal raphé (DRN) to regions of the extended amygdala, including the Bed Nucleus of the Stria Terminalis (BNST) which have been implicated in the production of anxiogenic states. Objectives The present study examined the contribution of 5-HT signaling within the BNST to the anxiogenic effects of cocaine as measured in a runway model of drug self-administration. Methods Male Sprague-Dawley rats were fitted with bilateral infusion cannula aimed at the BNST and then trained to traverse a straight alley once a day for a single 1mg/kg i.v. cocaine infusion delivered upon goal-box entry on each of 16 consecutive days/trials. Intracranial infusions of CP 94,253 (0, 0.25, 0.5, or 1.0μg/side) were administered to inhibit local 5-HT release via activation of 5-HT1B autoreceptors. To confirm receptor specificity, the effects of this treatment were then challenged by co-administration of the selective 5-HT1B antagonist NAS-181. Results Intra-BNST infusions of the 5-HT1B autoreceptor agonist attenuated the anxiogenic effects of cocaine as reflected by a decrease in runway approach-avoidance conflict behavior. This effect was reversed by the 5-HT1B antagonist. Neither start latencies (a measure of the subject’s motivation to seek cocaine) nor spontaneous locomotor activity (an index of motoric capacity) were altered by either treatment. Conclusions Inhibition of 5-HT1B signaling within the BNST selectively attenuated the anxiogenic effects of cocaine, while leaving unaffected the positive incentive properties of the drug.

Purpose of Review Chronic pain continues to be one of the leading healthcare cost burdens in the United States and is typically defined as ongoing pain, lasting longer than six months. Various treatment options exist for chronic pain, including physical therapy, medical management, pain psychology, and interventional therapies. Pain medications have been the mainstay of treatment for chronic pain conditions with an increasing use of membrane stabilizers and antidepressants to treat neuropathic pain conditions. Specifically, serotonin noradrenaline reuptake inhibitors (SNRIs) have been used to treat a range of pain conditions expanding from everyday use for depressive disorders. Recent Findings SNRIs, including duloxetine, venlafaxine, and milnacipran, have demonstrated efficacy in reducing pain in musculoskeletal pain (chronic low back pain and osteoarthritis), fibromyalgia, and neuropathic pain conditions (peripheral diabetic neuropathy). Summary The article describes the function, role, and use of SNRIs to treat chronic and neuropathic pain by altering the noradrenergic descending inhibitory pathways.

BACKGROUND Objective-To determine the number of congenital anomalies which were detected antenatally in antenatal scans and those detected during the postnatal period in Krishna Institute of Medical Sciences, Karad. MATERIALS AND METHODS A prospective cross sectional study was done for 1 year. All normal and LSCS deliveries were included in the study. All pregnant registered women were screened for congenital anomalies at around 20 weeks of gestation. Postnatally, all babies with the risk of congenital anomalies detected on the antenatal scan and those with normal antenatal scan but definite/suspected congenital anomalies at birth were evaluated further. RESULTS From a total of 3200 registered pregnant cases which were antenatally scanned,  Number of congenital anomalies detected was 134.  Number of pregnancies terminated due to congenital anomalies which were incompatible with life was 40.  Babies with normal antenatal scans but postnatal defects were 29. CONCLUSION For the detection of foetal anomalies and well-being, antenatal scan should be mandatory in all pregnant women irrespective of outcome of the pregnancy. Early assessment of foetal condition would help us prepare in advance for the anticipated outcome and transfer the baby to the higher centre if necessary or option of MTP can be offered in case of poor prognosis. BACKGROUND The incidence of congenital anomalies has increased due to the greater awareness among people, lately. It has become mandatory for pregnant women to undergo at least 3 ANC scans for assessing the gestational age, congenital anomalies, foetoplacental well-being. The incidence of congenital anomaly being 9% with perinatal death and 2% associated with major defect, the USG scan has gained more importance in detecting foetal anomalies. The 18-20 week foetal anomaly scan is considered watershed in most pregnancies because for the majority of women it will be the last time they will be scanned before they deliver. The scans provide the clinicians with better information because by now the babies were better developed and the functioning of various organs could be assessed.