Efectos antiisquémicos del bloqueante de la Ca(2+)-ATPasa del retículo sarcoplásmico, ácido ciclopiazónico, sobre la isquemia experimental del corazón

Tesis Univ. Complutense de Madrid, 1996Depto. de Farmacología y ToxicologíaFac. de MedicinaTRUEpu

Transcranial Direct Current Stimulation (tDCS) Combined with Therapeutic Exercise and Cognitive Rehabilitation to Treat a Case of Burning Mouth Syndrome (BMS) Related Pain.

Burning Mouth Syndrome (BMS) is a multifactorial, chronic pain condition with neuropathic and psychogenic mechanisms. Cortical activation as well as sustained attention and executive functions have proven to be affected by chronic pain. The main objectives of this work were to test the efficacy of a multidimensional personalized pain treatment protocol and to investigate if the effects are based on psychophysical pain processing changes or cognitive effects. A 74-year-old female with 2 years of BMS received 10 sessions of a combined protocol of anodal left dorsolateral prefrontal cortex tDCS, cognitive therapy, and therapeutic exercise. The subjective perception of pain decreased by 47% after treatment but returned to the baseline at 45 days. No changes were found in objective pain measurements apart from a transient worsening of conditioned pain modulation. A large effect size was found in all functional scales, processing speed and executive control as well as sustained attention that persisted during follow-up. No changes in anxiety and depression were found. A multimodal therapeutic approach combining TDCS, cognitive rehabilitation and therapeutic exercise produces improved quality of life, disability and pain perception correlated with improvements in processing speed, executive control and sustained attention but independent of changes in psychophysical pain processing.post-print475 K

Tapentadol vs. pregabalina asociada a otros opioides en dolor crónico: Análisis de coste-efectividad

Background: Tapentadol is a new oral analgesic with a dual mode of action as a mu-opioid receptor agonist and as norepinephrine reuptake inhibitor. The cost of treatment can be argued as a problem for prescribing it. Objective: The aim of this study was to compare the cost-effectiveness of tapentadol to that of associations of other opioids with pregabalin. Patients and methods: 21 patients suffering chronic pain under treatment with opioids and pregabalin for more than 3 months and pain poorly controlled (VAS > 4) were proposed to change to tapentadol in a progressive manner: First changing the opioid to tapentadol and then removing pregabalin. Pain (VAS), daily cost of treatments and adverse effects incidence were registered. Results: Four patients returned to prior treatment because of higher incidence of adverse effects. In the group of 17 patients who completed the change of treatment pain improved from 5.7 (VAS) to 3.4 (VAS) (p 4). Se les propuso rotar a tratamiento con tapentadol en dos fases: primero sustituyendo el opioide por tapentadol y posteriormente retirando progresivamente la pregabalina. Se registraron el dolor (EVA), el coste diario del tratamiento y la incidencia de efectos adversos antes y tras la introducción del nuevo tratamiento. Resultados: cuatro pacientes abandonaron el tratamiento y volvieron al previo por mayor incidencia de efectos secundarios. En el grupo restante el dolor mejoró de 5,7 (EVA) a 3,4 (EVA) (p < 0,001), mientras que el coste de tratamiento pasó de 4,57 €/día a 3,78 €/día (p < 0,05). Conclusión: el tratamiento con tapentadol puede resultar coste-efectivo frente a la combinación de otros opioides con pregabalina en pacientes con dolor crónico moderado-grave. Se requieren estudios más amplios que confirmen estos hallazgos

Comparison of the antinociceptive profiles of morphine and oxycodone in two models of inflammatory and osteoarthritic pain in rat

Oxycodone and morphine are two opioid drugs commonly used for the treatment of moderate to severe pain. However, their use in the management of noncancer pain remains a controversial issue and, in this respect, the evidence on their effectiveness and safety, particularly in osteoarthritis, is being questioned. In order to analyse their analgesic profile, two different pain models in rats were used: the formalin-induced inflammatory pain and the monosodium iodoacetate (MIA)-induced knee osteoarthritic pain. Drugs were administered systemically (i.p.) and their antinociceptive effect and potency were assessed. In the formalin test, both morphine and oxycodone produced a dose-dependent antinociceptive effect, but oxycodone outdid morphine in terms of effectiveness and potency (nearly two times) in the early (acute nociceptive) as in the late phase (inflammatory). In the osteoarthritis model, both drugs reduced movement–evoked pain (knee-bend test), mechanical allodynia (von Frey test) and heat hyperalgesia (Plantar test). Pretreatment with naloxone and naloxone methiodide reduced morphine and oxycodone effects. Peripheral mu-opioid receptors play a crucial role in the antinociceptive effect of both drugs on movement-evoked pain and heat hyperalgesia, but not on tactile allodynia. The main finding of our study is that oxycodone has a better antinociceptive profile in the inflammatory and osteoarthritic pain, being more effective than morphine at 14 days post-MIA injection (phase with neuropathic pain); it overcame the morphine effect by improving the movement-induced pain, tactile allodynia and heat hyperalgesia. Therefore, oxycodone could be an interesting option to treat patients suffering from knee osteoarthritis when opioids are required.This study was supported by Mundipharma Pharmaceuticals, S.L.Peer Reviewe

A 1-Year Cost Analysis of Spinal Surgical Procedures in Spain: Neurosurgeons Versus Orthopedic Surgeons

Objective To evaluate the direct costs of various spinal surgical procedures within 1 year of follow-up and to compare the profiles of neurosurgeons and orthopedic surgeons. Methods All spinal procedures performed within a 10-month period in patients covered by a private insurance company were included. Costs related to the spinal interventions were systematically registered in the company database. Associated costs during the 1-year follow-up were recorded. Results In total, 1,862 patients were included, with a total cost of €11,050,970, of whom 34.8% underwent noninstrumented lumbar decompression (€3,473), 27.1% dorsolumbar instrumented fusion (€6,619), 14.6% nucleoplasty (€1,323), 13.5% cervical surgery (€4,463), 3.4% kyphoplasty (€4,200), 2.9% scoliosis (€15,414), 1.2% oncologic surgery (€5,590), 0.5% traumatic compression (€7,844), and 4.7% (€1,343) other minor interventions (mainly rhizotomies). Approximately 42% of patients required reinterventions within the first year, with a global extra cost of €7,280,073; 11% were referred to the pain clinic, with a €114,663 cost; 55.5% were men; and the most common age range of patients who received an intervention was 65–75 years. Neurosurgeons performed 60% of all interventions. Noninstrumented lumbar operations were performed by neurosurgeons twice as often as instrumented operations, and they performed 76% of cervical operations. Orthopedic surgeons performed 2.5 times more instrumented than noninstrumented lumbar operations, and almost all scoliosis and rhizotomy procedures. Conclusion The direct costs of spinal surgery in Spain were generally lower than those reported in other European Union countries and the United States. Neurosurgeons and orthopedic surgeons had different spine surgical profiles and costs

Transferencia y aplicación de experiencias positivas en la enseñanza virtual a diversos ámbitos docentes. Sus aplicaciones en ciencias de la salud para la adquisición y evaluación de competencias frente a emergencias en el paciente infantil.

En el presente proyecto se propuso el establecimiento de metodologías docentes innovadoras para mejorar el sistema de enseñanza/aprendizaje ante las emergencias en MEDICINA y ODONTOLOGÍA.Bajo la plataforma del Campus Virtual y con entornos de enseñanza on line: -Incrementar los conocimientos sobre manejo de la traumatología dentaria, RCP básica y obstrucción de la vía aérea en el niño, para el alumnado de las facultades de medicina y odontología de la Universidad Complutense de Madrid (UCM). -Desarrollo de recursos on line para fomentar la participación activa del estudiante en la adquisición de competencias teóricas y prácticas para el manejo de las citadas situaciones de emergencia en el paciente infantil. -Diseño de metodologías en el Campus Virtual para la adquisición de conocimientos, evaluación y autoevaluación de las competencias genéricas y transversales sobre el manejo de las urgencias en el niño. -Comparación de este nuevo método de aprendizaje con los métodos tradicionales, en cuanto a mejora de la adquisición de conocimientos sobre el manejo de la emergencia pediátrica

Comparative Incidence of Conformational, Neurodegenerative Disorders

<div><p>Background</p><p>The purpose of this study was to identify incidence and survival patterns in conformational neurodegenerative disorders (CNDDs).</p><p>Methods</p><p>We identified 2563 reports on the incidence of eight conditions representing sporadic, acquired and genetic, protein-associated, i.e., conformational, NDD groups and age-related macular degeneration (AMD). We selected 245 papers for full-text examination and application of quality criteria. Additionally, data-collection was completed with detailed information from British, Swedish, and Spanish registries on Creutzfeldt-Jakob disease (CJD) forms, amyotrophic lateral sclerosis (ALS), and sporadic rapidly progressing neurodegenerative dementia (sRPNDd). For each condition, age-specific incidence curves, age-adjusted figures, and reported or calculated median survival were plotted and examined.</p><p>Findings</p><p>Based on 51 valid reported and seven new incidence data sets, nine out of eleven conditions shared specific features. Age-adjusted incidence per million person-years increased from ≤1.5 for sRPNDd, different CJD forms and Huntington's disease (HD), to 1589 and 2589 for AMD and Alzheimer's disease (AD) respectively. Age-specific profiles varied from (a) symmetrical, inverted V-shaped curves for low incidences to (b) those increasing with age for late-life sporadic CNDDs and for sRPNDd, with (c) a suggested, intermediate, non-symmetrical inverted V-shape for fronto-temporal dementia and Parkinson's disease. Frequently, peak age-specific incidences from 20–24 to ≥90 years increased with age at onset and survival. Distinct patterns were seen: for HD, with a low incidence, levelling off at middle age, and long median survival, 20 years; and for sRPNDd which displayed the lowest incidence, increasing with age, and a short median disease duration.</p><p>Interpretation</p><p>These results call for a unified population view of NDDs, with an age-at-onset-related pattern for acquired and sporadic CNDDs. The pattern linking age at onset to incidence magnitude and survival might be explained by differential pathophysiological mechanisms associated with specific misfolded protein deposits.</p></div