A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients

Ovariectomia Laparoscopica e Ovariectomia Laparotomica nella cagna: confronto tra le tempistiche e le complicanze post operatorie.

La finalità di questo studio è di confrontare la tecnica chirurgica laparoscopica con la tecnica chirurgica laparotomica(open) nell’intervento di ovariectomia nella cagna . Il nostro lavoro è stato effettuato con lo scopo di andare a confrontare in particolare le tempistiche e le complicanze post-operatorie tra i due interventi . In questo studio sono stati inclusi 67 soggetti di età compresa tra 7 mesi e 9 anni che sono stati sottoposti all’intervento di ovariectomia (sia laparoscopica che laparotomica) ai fini della castrazione . I risultati del nostro lavoro hanno messo in evidenza che tra i due interventi non ci sono significative differenze per quanto riguarda le complicanze post-operatorie mentre per quanto riguarda le tempistiche di svolgimento dell’intervento si è rivelata piu rapida la tecnica laparoscopica rispetto alla laparotomica . Viceversa per quanto riguarda il “dolore” post-operatorio è risultato al quanto maggiore nella laparotomia rispetto alla laparoscopia . Abstract : The purpose of this study is to compare laparoscopic surgical technique with laparotomic(open) surgical technique in ovariectomy surgery in the bitch . Our work was carried out with the purpose of going to compare in particular the timing and postoperative complications between the two surgeries . This study included 67 subjects aged 7 months to 9 years who underwent ovariectomy surgery (both laparoscopic and laparotomic) for the purpose of castration . The results of our work showed that there were no significant differences between the two surgeries with regard to postoperative complications while with regard to the timing of the procedure, the laparoscopic technique proved to be faster than the laparotomic technique . Viceversa regarding postoperative "pain" was at how much greater in laparotomy than laparoscopy

A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

Background: Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients. Methods: We conducted a systematic literature search in EMBASE and PubMed up to the 24th of November 2016 following Cochrane Handbook and PRISMA guidelines. Two independent reviewers screened titles and abstracts along with full-text papers; disagreements were resolved by discussion with two other independent reviewers. We used a data extraction form to provide details of the included studies, and conducted quality assessment using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Young age, lung or gastrointestinal cancer, neuropathic or breakthrough pain and anxiety or sleep disturbance were associated to a worse response to opioid analgesia. No clear association was identified in literature regarding gender, ethnicity, weight, presence of metastases, biochemical or hematological factors. Studies in children were lacking. Between June 2011 and April 2014, the Italian STOP Pain project enrolled 87 paediatric cancer patients under treatment with opioids (morphine, codeine, oxycodone, fentanyl and tramadol). Conclusions: Future studies on cancer pain should be designed with consideration for the highlighted factors to enhance our understanding of opioid non-response and safety. Studies in children are mandatory

The importance of monitoring adverse drug reactions in pediatric patients: the results of a national surveillance program in Italy

Objective: To gain information on safety of drugs used in pediatrics through a 4-year post-marketing active pharmacovigilance program. The program sampled the Italian population and was termed 'Monitoring of the Adverse Effects in Pediatric population' (MEAP). Research design and methods: Adverse drug reactions (ADRs) were collected for individuals aged 0 - 17 years treated in hospitals and territorial health services in Lombardy, Tuscany, Apulia and Campania; located to gain an appropriate sampling of the population. ADRs were evaluated using the Adverse Drug Reaction Probability Scale (Naranjo) and analyzed with respect to time, age, sex, category of ADR, seriousness, suspected medicines, type of reporter and off-label use. Results: We collected and analyzed reports from 3539 ADRs. Vaccines, antineoplastic and psychotropic drugs were the most frequently pharmacotherapeutic subgroups involved. Seventeen percent of reported ADRs were serious; of them fever, vomiting and angioedema were the most frequently reported. Eight percent of ADRs were associated with off-label use, and 10% were unknown ADRs. Analysis of these revealed possible strategies of therapy optimization. Conclusions: The MEAP project demonstrated that active post-marketing pharmacovigilance programs are a valid strategy to increase awareness on pediatric pharmacology, reduce underreporting and provide information on drug actions in pediatrics. This information enhances drug therapy optimization in the pediatric patients