Chemotherapy-induced neuropathic pain characteristics in Mexico’s National Cancer Center pain clinic

Ulises Coffeen,1 Marco Antonio Sotomayor-Sobrino,2,3 Ariadna Jiménez-González,2,3 Luis Gerardo Balcazar-Ochoa,3 Pamela Hernández-Delgado,3 Ana Fresán,1 Ricardo Plancarte-Sanchez,4 Samantha Daniela Arias-Muñóz,5 Abraham Ochoa-Aguilar2,61Laboratorio de Neurofisiología Integrativa. Investigaciones en Neurociencias y División de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Clinical Research Division, Mexico City, Mexico; 2Hospital Loma Linda, Translational Research Laboratory, Naucalpan, Mexico; 3Universidad Nacional Autónoma de México, Faculty of Medicine, Mexico City, Mexico; 4Instituto Nacional de Cancerología, Clínica de dolor, Tlalpan, Mexico; 5Universidad Anahuac Norte, Faculty of Medicine, Huixquilucan Mexico, Huixquilucan, Mexico; 6Universidad La Salle, Mexican Faculty of Medicine, Mexico City, MexicoIntroduction: Chemotherapy (CT) is one of the most commonly used pharmacological approaches in cancer treatment. However, CT induces damage to several tissues causing significant deleterious effects in cancer survivors being chemotherapy-induced neuropathic pain (CINP) among the most commonly reported. CINP is thought to be present in up to 68.1% of the patients within 1 month of receiving CT. Due to the fact that reliable statistic information is scarce in several Latin American countries’ diagnosis and treatment of this side-effect may be delayed directly affecting patients. Therefore, the aim of the present study was to determine and present the incidence and features of CINP in patients with cancer attending the Pain Management Clinic at Mexicos’ National Institute of Cancerology in Mexico City.Methods: We performed a retrospective, file-based analysis of all the patients treated in the Pain Management Clinic at the National Institute at Cancer in Mexico from January 2016 to January 2017.Results: CINP was found in 30.9% of the patients. The basal VAS was on average 2.5 upon arrival to the Pain Management Unit and 2.4 at the end of treatment (p>0.05). The patients with the highest risk of developing CINP were those treated with paclitaxel Odds ratio 8.3 (p<0.01), followed by platins OR 4 (p<0.01), vincristine OR 1.5 (p=0.01) and thalidomide OR 1.1 (p=0.01).Conclusion: Incidence of CINP was similar to previous reports; however, the number of variables related to this type of pain in our cohort may open a new line of research and highlight the importance of this particular issue to our health system. It is necessary to develop a mechanism to predict the risk of patients to suffer CINP and to search the mechanism to control and reduce the suffering related to the current treatments.Keywords: Pain, chemotherapy, neuropathy, paclitaxe

Ceftriaxone and clavulanic acid induce antiallodynia and anti-inflammatory effects in rats using the carrageenan model

Abraham Ochoa-Aguilar,1,2 Rosa Ventura-Martinez,1 Marco Antonio Sotomayor-Sobrino,1 Ruth Jaimez,1 Ulises Coffeen,3 Ariadna Jiménez-González,2 Luis Gerardo Balcázar-Ochoa,1 Rafael Pérez-Medina-Carballo,2 Rodolfo Rodriguez,1 Ricardo Plancarte-Sánchez4 1Pharmacology Department, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, México; 2Research Department, Mexican Faculty of Medicine, La Salle University, Mexico City, México; 3Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, México; 4Pain Clinic, National Cancer Institute of Mexico, Mexico City, México Introduction: Ceftriaxone (CFX) and clavulanic acid (CA) are 2 β-lactam molecules widely used as antibiotics. However, several reports of their antiallodynic properties have been published in recent years. Although this effect has been considered mostly due to a GLT1 overexpression, these molecules have also been proven to induce direct immunomodulation. In this work, we determine the acute analgesic effect of CFX and CA in an inflammatory pain model and assess if their administration may induce anti-inflammatory effects. Methods: The carrageenan (Carr) test was used as an inflammatory pain model. Both mechanical and thermal responses were analyzed after CFX and CA administration at different times. A plethysmometer was used to determine inflammation. Also, TNF-α and IL-10 serum concentrations were determined by enzyme-linked immunosorbent assay. Results: Both CFX and CA induced a significant thermal antiallodynic effect 3 and 24 h after administration. Furthermore, CA induced a mechanical antiallodynic effect 30, 60, and 90 min after administration. Moreover, a significant anti-inflammatory effect was found for both molecules 24 h after Carr injection. Also, both CA and CFX modulated TNF-α and IL-10 serum concentrations at different times. Conclusion: Our results provide evidence that both CFX and CA cause an analgesic effect on a Carr inflammatory pain model and that said analgesic effect differs between each β-lactam molecule. Furthermore, this effect may be related to an anti-inflammatory effect of both molecules and a direct TNF-α and IL-10 serum concentration modulation. Keywords: ceftriaxone, clavulanic acid, inflammatory pain, TNF-α concentration, β-lactam molecules, analgesic effect, antiallodynic propertie

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc