Insights into the Use of Peripherally Acting µ-Opioid Receptor Antagonists (PAMORAs) in Oncologic Patients: from Scientific Evidence to Real Clinical Practice.

OPINION STATEMENT: Management of chronic pain is crucial to improve the quality of life of cancer and palliative care patients. Opioid-based treatments used to control pain can be prolonged over time. Unfortunately, constipation is one of the most disturbing adverse effects of long-term use of opioids. Opioid-induced constipation (OIC) occurs when opioids bind to the specific receptors present in the gastrointestinal (GI) tract, and can affect any patients receiving chronic opioid therapy, including cancer patients. The limited efficacy of laxatives to treat OIC symptoms prompted the search for new therapeutic strategies. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have recently emerged as new effective drugs for OIC management due to their specific binding to enteric µ-receptors. Little information is available on the use of PAMORAs in real-life practice for OIC treatment in cancer patients. In this paper, a panel of experts specializing in cancer and palliative care pools their clinical experience with PAMORAs in cancer patients presenting OIC and highlights the importance of timing and choice of therapy in achieving prompt OIC management and benefitting patients.

Correlación entre glucemia capilar y venosa en urgencias: un apunte metodológico / Capillary and venous blood glucose readings in emergency care: correlation and methodological considerations

Objetivos: Comprobar la fiabilidad de la glucemia capilar y su correlación con la glucemiavenosa según las condiciones en las que se realice. Método: Se determinó la glucemia capilar en 100 en voluntarios sanos (glucómetro Optium Xceed) en cinco condiciones diferentes: A, previo al contacto con uvas; B, trastocar durante 10 segundos uvas enteras; C, tras contacto breve con el jugo de uva y posterior secado; D, después de limpieza superficial y E, después de limpieza profunda. Resultados: La edad media de los participantes fue de 35,4 años (DE 10,2) y el 72%eran mujeres. Los valores medios de glucemia capilar (mg/dl) en las cinco condiciones descritas fueron 90 para A, 115 para B (p < 0,001), 401 para C (p < 0,001), 198 paraD (p < 0,001) y 124 para E (p < 0,001). La especificidad para detectar glucemias alteradas(> 140 mg/dl) osciló entre el 99% en la situación A y el 7% en la situación C. En esta última situación, el 83% de los voluntarios serían considerados diabéticos mediante la determinación de la glucemia capilar. Conclusiones: Existe una buena correlación entre glucemia capilar y venosa cuando la primera se realiza en las condiciones adecuadas, aunque puede verse alterada por distintos factores si existe mala aplicación de la técnica, por lo que debe insistirse en su correcta realización en urgencias (AU)

Objectives: To ascertain the reliability of capillary blood glucose readings and their correlation with venous blood glucose levels according to the conditions under which capillary blood is tested. Method: Capillary blood glucose was measured in 100 healthy volunteers (Optium Xceed blood glucose meter) under 5conditions: A, before the subject had contact with grapes; B, after touching whole grapes for 10 seconds; C, after brief contact with grape juice and after drying the skin; D, after superficial cleaning; and E, after thorough cleaning. Results: The mean (SD) age of the participants was 35.4 (10.2) years and 72% were women. The mean capillary blood glucose levels were 90 mg/dL in condition A, 115 mg/dL in condition B, 401 mg/dL in C, 198 mg/dL in D, and 124mg/dL in E (P <.001, all comparisons). The specificity of the test for detecting abnormal glucose levels (> 140 mg/dL)ranged from 99% under condition A to 7% under condition C. Under condition E, 83% of the volunteers would have been considered diabetics according to the capillary blood glucose reading. Conclusions: The correlation between capillary and venous blood glucose levels is good if the capillary blood reading is taken under the proper conditions. The results of the test may change according to various factors if the technique is not applied correctly. Emergency staff should take care to carry out the test properly (AU)