A Bilateral Lumbar Multidermatomal Herpes Zoster in an Elderly Woman with Chronic Kidney Disease

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P076. Improving patient communication and management by the use of the "Headache Digest", a pilot study

The Headache Digest (HD) is a self-administered questionnaire consisting of 13 items with multiple choice responses constructed according to the ICHD-III beta diagnostic criteria. Seven questions concern headache features. The remaining items collect details regarding onset, clinical course, attack frequency, symptomatic drugs assumption and efficacy. A section is reserved for the doctor dealing with patient’s medical history. The ID-Migraine, a self-administered questionnaire, consisting of only 3 items, is a valid and reliable screening instrument for migraine and was validated in Italy, but it does not provide information concerning headache course HD and ID-Migraine were given to 68 consecutive new patients referring to the Bari Headache Center. Sixty-two patients received the diagnosis of migraine by the headache specialist. HD showed a sensitivity of 0.98 (95% CI 0.91-0.99) and a specificity of 0.66 (95% CI 0.3- 0.90). ID-Migraine showed a sensitivity of 0.75 (95% CI 0.63-0.84) and a specificity of 0.66 (95% CI 0.3-0.90). According to this pilot study, Headache Digest is more sensitive than ID-Migraine whereas both tools showed the same specificity

Candida Colonization Index in Patients Admitted to an ICU

Multiple-site colonization with Candida spp. is commonly recognized as a risk factor for invasive fungal infection in critically ill patients. We carried out a study to determine the relationship between Candida colonization and invasive infection in neurological patients admitted to an ICU. At admission (T0) and every three days for two weeks, different samples (pharynx swab, tracheal secretions, stomach contents, etc.) were collected for mycological surveillance. Candida mannan antigen and Candida anti-mannan antibodies were assayed. The Colonization Index (CI) and Corrected Colonization Index were calculated for each time point. Of all patients 70% was already colonized by Candida spp. at T0 and six of them had CI ≥ 0.5. Three patients developed candidemia; they had CI ≥ 0.5 before infection. Positive values of Candida mannan antigen and anti-mannan antibodies were found only in the patients with candidemia. The sensitivity and specificity of the Candida mannan test were 66.6% and 100%, respectively, while the sensitivity and specificity of the anti-mannan antibody test were 100%. In accordance with other authors, we find the surveillance cultures are useful to monitor the Candida colonization in ICU patients. In addition, the sequential observation of anti-mannan antibodies could contribute to early diagnosis of candidiasis more than Candida mannan antigen in immunocompetent patients

Chronic Non-Cancer Pain: New Definitions, New Paradigms and Old Myths

Chronic pain is a highly prevalent phenomenon that involves biological, psychological, and social aspects with negative effects on function, mood, and quality of life. The International Association for the Study of Pain (IASP) advocates updating the current definition of chronic pain to better recognize the diversity and complexity that is difficult to capture in a brief definition. Treatment of chronic pain is still a challenge, indeed two-thirds of patients report an unsatisfactory level of pain control with currents approaches. This article discusses the features characterizing chronic pain towards new definitions and treatment paradigms while challenging existing myths and considers the obstacles to achieving a satisfactory level of pain control. It highlights the literature’s criticisms of a unimodal approach to chronic pain and supports a multimodal (pharmacological and non-pharmacological) and holistic strategy that comprises the intensity of pain, but also its pathophysiology, comorbidities, such as anxiety and depression, social context, and psychological aspects. Finally, concerns relating to the management of chronic non-cancer pain and the use of opioids are addressed. The good and the bad of opioids are discussed for a more responsible opioid-prescribing strategy in chronic pain based upon a strong clinical and educational component and continuous monitoring of these patients both in primary care as well as in specialized settings. Translating from a multidisciplinary approach to an interdisciplinary team approach will lead to an improved response to the needs of patients, providing a holistic strategy that accounts for the different pathogenese of pain syndromes, their phenotypes, the nervous system involvement, and remodeling, and the biopsychosocial components of chronic pain