Ultramicronized palmitoylethanolamide treatment in central neuropathic pain following longstanding spinal cord injury: try to extinguish the fire after everything was burned

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Extended Treatment with Micron-Size Oral Palmitoylethanolamide (PEA) in Chronic Pain: A Systematic Review and Meta-Analysis

Palmitoylethanolamide (PEA) emerged over the years as a promising approach in the management of chronic pain. Despite the fact that the efficacy of micron-size PEA formulations appears to be time-dependent, the optimal timing has not yet been elucidated. This systematic review and meta-analysis aim to estimate the possible advantage of an extended treatment in the relief of chronic pain. The literature search was conducted consulting scientific databases, to identify clinical trials in which micron-size PEA was administered for at least 60 days, and pain assessed by the Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS). Nine studies matched the required criteria, for a total of 742 patients involved. The meta-analysis showed a statistically and clinically significant pain intensity reduction after 60 days of micron-size PEA supplementation, compared to 30 days (1.36 points, p < 0.01). The secondary analysis revealed a weighted NRS/VAS score decrease of 2.08 points within the first month of treatment. These two obtained scores corresponded to a 35.1% pain intensity reduction within the first month, followed by a further 35.4% during the second month. Overall, these results confirm the clinically relevant and time-depended pain-relieving effect of micron-size PEA and therefore the advantage of an extended treatment, especially in patient with incomplete pain management

A retrospective case series of ultrasound-guided suprascapular nerve pulsed radiofrequency treatment for hemiplegic shoulder pain in patients with chronic stroke

Purpose: Hemiplegic shoulder pain (HSP) is the most common pain condition after stroke. Pulsed radiofrequency (PRF) treatment of the suprascapular nerve (SSN) effectively relieves shoulder pain conditions. To date, there is no study about the effects of PRF treatment for HSP. Thus, our aim was to report on a case series about its use in chronic stroke. Patients and methods: Six chronic stroke patients with HSP (visual analog scale [VAS] score for pain 6530 mm) underwent ultrasound-guided SSN PRF treatment. All were evaluated before treatment and at 4 and 16 weeks of follow-up. The main outcome was VAS score. Secondary outcomes were Modified Ashworth Scale, shoulder passive range of motion (PROM), Disability Assessment Scale (DAS), Fugl-Meyer Assessment, and EuroQol-5 dimension questionnaire (EuroQol-5D) scores. Results: As compared with baseline, improvement was observed in the following parameters: VAS for pain (at 4 weeks, P=0.023; at 16 weeks, P=0.023); shoulder PROM for abduction (at 4 weeks, P=0.023; at 16 weeks, P=0.024), flexion (at 4 and 16 weeks, P=0.024), extension (at 4 and 16 weeks, P=0.02), and external rotation (4 and 16 weeks, P=0.02); DAS for hygiene (at 4 and 16 weeks, P=0.024), dressing (at 4 weeks, P=0.02; at 16 weeks, P=0.024), and pain (at 4 weeks, P=0.024; at 16 weeks, P=0.023); and EuroQol-5D (at 4 and 16 weeks, P=0.024). Conclusion: Our observations support the use of ultrasound-guided SSN PRF treatment for HSP in chronic stroke patients

Comparison between Acupuncture and Nutraceutical Treatment with Migratens\uae in Patients with Fibromyalgia Syndrome: A Prospective Randomized Clinical Trial

Fibromyalgia syndrome (FMS) is a chronic clinical condition characterized by pain, fatigue, altered sleep, and cognitive disturbances. The purpose of this study was to compare two alternative treatments (nutraceutical and acupuncture) in FMS patients through a randomized clinical trial

Bipolar Spectrum Symptoms in Patients with Fibromyalgia: A Dimensional Psychometric Evaluation of 120 Patients

Background: Fibromyalgia Syndrome (FMS) is characterized by chronic widespread pain, fatigue, unrefreshing sleep and cognitive dysfunction. Depressive and manic symptoms are often reported in FMS patients' history. The aim of this study was to evaluate the prevalence of bipolar spectrum symptoms (BSS) and to correlate these with quality of life (QoL) scores and antidepressant treatment. Methods: From October 2017 to July 2018, a battery of QoL questionnaires (FIQ, PSQI and SF-12) was administered to 120 FMS patients after a clinical examination. The MOODS-SR lifetime questionnaire was then remotely administered to the patients included in the study. Results: The presence of depressive and manic lifetime symptoms was found, in line with the results of the available literature. A correlation was found between the history of depressive symptoms and the severity of FIQ and SF-12 scores. Despite a low statistical strength, a trend toward a correlation between a history of manic symptoms and SNRI treatment was detected. Conclusions: The correlation between the MOOD-depressive domains and poor QoL is in line with the available literature. Further studies are needed to corroborate these findings and to elucidate the relationship between manic symptoms and SNRI treatment

Expansão do crédito para pessoas físicas no segmento de cartões de crédito e possíveis riscos à estabilidade do SFN

O presente trabalho tem como propósito analisar a evolução das operações de crédito com cartões ao longo de período de 2003 a 2015 e seus possíveis riscos à estabilidade do Sistema Financeiro Nacional. Para tal, realizou-se a revisão dos principais fundamentos da evolução da intermediação financeira, do funcionamento da indústria de cartões e dos indicadores de estabilidade financeira. Através disso, foi possível entender a colocação das operações com cartões de crédito dentro do SFN e Sistema de Pagamentos Brasileiros (SPB). Para estimar possíveis riscos ao SFN, avaliou-se o indicador de Gap de crédito/PIB, um modelo de auto-regressão vetorial (VAR) e a estrutura de capital regulamentar dos principais bancos comerciais atuando no país. A primeira ferramenta demonstrou que as operações evoluíram com crescimento equilibrado em relação às suas tendências de longo prazo; já a segunda metodologia demonstrou que a inadimplência da carteira de crédito de cartões é pouco sensível quando suscetível a choques em variáveis macroeconômicas. Finalmente, considerando a previsão de inadimplência, o volume das operações e a atual estrutura de capital das instituições investigou-se a possibilidade de a carteira de crédito de cartões gerar riscos relevantes ao SFN.This study analyzes the development of credit card operations over the period of 2003-2015 and its possible implications to the stability of the National Financial System. We assessed the main fundaments of the evolution of financial intermediaries, the credit card industry, and the key indicators of financial stability. Through this analysis, we were able to understand the role of the credit card industry within the Brazilian financial and payment systems. In order to evaluate risks to the financial system, we studied the credit-to-GDP gap, a Vector Auto-regression (VAR) model, and regulatory structure of the main commercial banks in the country. The first tool showed that the operations grew according to their long-term trends, whereas the second methodology demonstrated that credit card default rates are not very sensitive to shocks in a number of macroeconomic variables. Finally, considering default projections, the industry’s volume, and the capital structure of financial institutions, we consider the possibility of relevant risks to the financial system

Expansão do crédito para pessoas físicas no segmento de cartões de crédito e possíveis riscos à estabilidade do SFN

O presente trabalho tem como propósito analisar a evolução das operações de crédito com cartões ao longo de período de 2003 a 2015 e seus possíveis riscos à estabilidade do Sistema Financeiro Nacional. Para tal, realizou-se a revisão dos principais fundamentos da evolução da intermediação financeira, do funcionamento da indústria de cartões e dos indicadores de estabilidade financeira. Através disso, foi possível entender a colocação das operações com cartões de crédito dentro do SFN e Sistema de Pagamentos Brasileiros (SPB). Para estimar possíveis riscos ao SFN, avaliou-se o indicador de Gap de crédito/PIB, um modelo de auto-regressão vetorial (VAR) e a estrutura de capital regulamentar dos principais bancos comerciais atuando no país. A primeira ferramenta demonstrou que as operações evoluíram com crescimento equilibrado em relação às suas tendências de longo prazo; já a segunda metodologia demonstrou que a inadimplência da carteira de crédito de cartões é pouco sensível quando suscetível a choques em variáveis macroeconômicas. Finalmente, considerando a previsão de inadimplência, o volume das operações e a atual estrutura de capital das instituições investigou-se a possibilidade de a carteira de crédito de cartões gerar riscos relevantes ao SFN.This study analyzes the development of credit card operations over the period of 2003-2015 and its possible implications to the stability of the National Financial System. We assessed the main fundaments of the evolution of financial intermediaries, the credit card industry, and the key indicators of financial stability. Through this analysis, we were able to understand the role of the credit card industry within the Brazilian financial and payment systems. In order to evaluate risks to the financial system, we studied the credit-to-GDP gap, a Vector Auto-regression (VAR) model, and regulatory structure of the main commercial banks in the country. The first tool showed that the operations grew according to their long-term trends, whereas the second methodology demonstrated that credit card default rates are not very sensitive to shocks in a number of macroeconomic variables. Finally, considering default projections, the industry’s volume, and the capital structure of financial institutions, we consider the possibility of relevant risks to the financial system

A prospective evaluation of the Infection Probability Score (IPS) in the intensive care unit

Objectives: Identification of infection remains a major challenge, particularly in acutely ill patients. The Infection Probability Score (IPS) was developed to help rule out infection in acutely ill patients. In the present study, we determined the IPS in acutely ill, intensive care unit (ICU) patients to assess its use in the diagnosis and treatment of infection. Methods: In this prospective, observational study, we enrolled 107 consecutive patients who were admitted to the ICU without antibiotic therapy. Patients were allocated to four groups according to the probability of infection determined from clinical and microbiological data and their IPS values were then evaluated daily throughout the ICU stay. Results: The IPS was higher in patients with the highest clinical probability of infection and decreased significantly in these patients after 5 days of effective antimicrobial therapy. The IPS remained below the cut-off value in non-infected patients. Patients in whom inadequate antimicrobial therapy was administered had a greater mortality than the other patients. Conclusions: The IPS had a good predictive value for diagnosis of infection. In addition, dynamic evaluation of this score may help to assess the response to therapy. © 2008 The British Infection Society.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Acupuncture and auricular cryotherapy for chronic headache in a patient with type III von Willebrand disease

[No abstract available