An Updated Review of Neuropathic Pain Treatm ent: State of Art and Future Prospects

El dolor neuropático es un tipo de dolor de difícil manejo con una prevalencia próxima al 10% de la población. Actualmente, existen varios fármacos aprobados para su tratamiento agrupados en distintas líneas. Sin embargo, la eficacia farmacológica es limitada en un número significativo de pacientes, por lo que es necesario desarrollar nuevas estrategias terapéuticas. Varias moléculas se encuentran en fases iniciales de ensayos clínicos en humanos, muchas de las cuales están demostrando resultados esperanzadores. Por otra parte, el conocimiento cada vez más preciso de las distintas vías moleculares implicadas en el dolor neuropático está promoviendo el desarrollo de nuevas moléculas con acción sobre potenciales dianas terapéuticas. Algunos de estos agentes se están ensayando en modelos animales y muestran una significativa potencia analgésica. Por último, el papel del tratamiento no farmacológico en el dolor neuropático, mediante alternativas como la radiofrecuencia, la estimulación o los bloqueos nerviosos, está cobrando una relevancia cada vez mayor en la práctica clínica. El objetivo de este trabajo es revisar el statu quo del tratamiento del dolor neuropático en la actualidad, repasando los fármacos aprobados a día de hoy y sus mecanismos de acción principales, y poniendo especial interés en algunas de las moléculas más novedosas que se encuentran en ensayo clínico en humanos y en desarrollo en modelos animales. Además, se recogen algunas de las estrategias no farmacológicas más relevantes en el manejo del dolor neuropático en la actualidad.Neuropathic pain (NP) is a difficult-to-manage kind of pain that affects 10% of the population. Nowadays, there are some agents that can be used for its treatment, and they are grouped according to different lines. However, their pharmacological effectiveness is only proved on a reduced number of patients. For this reason, new therapeutic strategies need to be developed. Certain molecules currently are on the initial stages of human clinical trials, and many of them are showing encouraging results. Furthermore, there is an increasingly accurate knowledge about the different molecular pathways related to NP. This advance is promoting the development of new molecules with potential therapeutic targets. Some of these agents are being tested with animal models, and they are showing a significant analgesic potency. Finally, non-pharmacological treatment in NP is becoming more important in clinical practice through alternatives such as radio frequency, stimulation, and nerve block therapy. The aim of this work is to review the state of art of NP treatment. For that purpose, the agents approved until today and their main action mechanisms should be considered, with a special emphasis on some of the latest molecules used on human clinical trials and those which are in development with animal models. Moreover, some of the main non-pharmacological strategies used to manage pain nowadays are also reviewed

Fungal Planet description sheets: 1436–1477

Novel species of fungi described in this study include those from various countries as follows: Argentina, Colletotrichum araujiae on leaves, stems and fruits of Araujia hortorum. Australia, Agaricus pateritonsus on soil, Curvularia fraserae on dying leaf of Bothriochloa insculpta, Curvularia millisiae from yellowing leaf tips of Cyperus aromaticus, Marasmius brunneolorobustus on well-rotted wood, Nigrospora cooperae from necrotic leaf of Heteropogon contortus, Penicillium tealii from the body of a dead spider, Pseudocercospora robertsiorum from leaf spots of Senna tora, Talaromyces atkinsoniae from gills of Marasmius crinis-equi and Zasmidium pearceae from leaf spots of Smilax glyciphylla. Brazil, Preussia bezerrensis from air. Chile, Paraconiothyrium kelleni from the rhizosphere of Fragaria chiloensis subsp. chiloensis f. chiloensis. Finland, Inocybe udicola on soil in mixed forest with Betula pendula, Populus tremula, Picea abies and Alnus incana. France, Myrmecridium normannianum on dead culm of unidentified Poaceae. Germany, Vexillomyces fraxinicola from symptomless stem wood of Fraxinus excelsior. India, Diaporthe limoniae on infected fruit of Limonia acidissima, Didymella naikii on leaves of Cajanus cajan, and Fulvifomes mangroviensis on basal trunk of Aegiceras corniculatum. Indonesia, Penicillium ezekielii from Zea mays kernels. Namibia, Neocamarosporium calicoremae and Neocladosporium calicoremae on stems of Calicorema capitata, and Pleiochaeta adenolobi on symptomatic leaves of Adenolobus pechuelii. Netherlands, Chalara pteridii on stems of Pteridium aquilinum, Neomackenziella juncicola (incl. Neomackenziella gen. nov.) and Sporidesmiella junci from dead culms of Juncus effusus. Pakistan, Inocybe longistipitata on soil in a Quercus forest. Poland, Phytophthora viadrina from rhizosphere soil of Quercus robur, and Septoria krystynae on leaf spots of Viscum album. Portugal (Azores), Acrogenospora stellata on dead wood or bark. South Africa, Phyllactinia greyiae on leaves of Greyia sutherlandii and Punctelia anae on bark of Vachellia karroo. Spain, Anteaglonium lusitanicum on decaying wood of Prunus lusitanica subsp. lusitanica, Hawksworthiomyces riparius from fluvial sediments, Lophiostoma carabassense endophytic in roots of Limbarda crithmoides, and Tuber mohedanoi from calcareus soils. Spain (Canary Islands), Mycena laurisilvae on stumps and woody debris. Sweden, Elaphomyces geminus from soil under Quercus robur. Thailand, Lactifluus chiangraiensis on soil under Pinus merkusii, Lactifluus nakhonphanomensis and Xerocomus sisongkhramensis on soil under Dipterocarpus trees. Ukraine, Valsonectria robiniae on dead twigs of Robinia hispida. USA, Spiralomyces americanus (incl. Spiralomyces gen. nov.) from office air. Morphological and culture characteristics are supported by DNA barcodes

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Patrones de uso de los opioides mayores en el dolor de origen neuropático

Introduction: Neuropathic pain exerts a great impact upon patients. It is one of the most complex pain syndromes, and has a diverse origin. The clinical manifestations of neuropathic pain are typically described as burning, pulsing, sharp or itching pain, etc., that may be accompanied by hyperalgesia or allodynia. The pain is usually associated to altered mood states and even depression, with an important impact upon patient social and occupational activity, and a marked worsening of quality of life. Treatment is difficult, and the condition is often refractory to conventional management. The efficacy of opioids has been the subject of controversy, though recent studies show them to be effective in application to neuropathic pain. Objectives: To determine the patterns of major opioid use in the management of neuropathic pain. Material and methods: A cross-sectional, multicenter, descriptive epidemiological study conducted by 107 specialists from Pain Units throughout Spain, in patients with neuropathic pain. The study comprised a questionnaire for the collection of demographic data, the reason for consultation, the background disease of pain, the time elapsed from diagnosis, treatment, and pain intensity as scored by a visual analog scale (VAS). Demographic data on the investigators were also collected, together with their experience and occupational setting. Quantitative variables are reported as the mean and standard deviation (SD), while qualitative variables are expressed as percentages. Statistical significance was considered for p 7. Conclusiones: El tratamiento del dolor neuropático sigue un esquema multimodal donde los anticomiciales y antidepresivos juegan un papel importante; no obstante, los opioides mayores, sobre todo fentanilo TTS, se contemplan como un tratamiento de primera línea en este tipo de dolor

Dolor de miembro fantasma y bomba intratecal de Ziconotide: una unión válida en casos tolerantes o refractarios

Presentamos el caso clínico de una paciente de 30 años de edad con dolor de miembro fantasma en extremidad inferior derecha refractario a tratamiento analgésico vía oral. Fue remitida a nuestra Unidad del Dolor donde se decidió colocación de bomba intratecal de ziconotide, cuyo resultado fue una mejoría de su dolor que permitió a la paciente recuperar su vida cotidiana.We report the case of a 30-year-old female patient with phantom limb pain in right lower extremity refractory to oral analgesic treatment. She was referred to our Pain Unit where we decided to place a ziconotide intrathecal pump. The result was an improvement in pain that allowed the patient to regain her daily life