Fascia-iliaca compartment block vs intra-articular hip injection for preoperative pain management in intracapsular hip fractures: A blind, randomized, controlled trial.

BACKGROUND: The aim of this study was to compare the fascia-iliaca compartment block and the intra-articular hip injection in terms of pain management and the need for additional systemic analgesia in the preoperative phase of intracapsular hip fractures. METHODS: Patients >65 years old with an intracapsular hip fracture were randomized in this prospective, blind, controlled, parallel trial in a Level-I trauma center. Patients were randomly assigned to receive either the fascia-iliaca compartment block (cohort FICB) or the intra-articular hip injection (cohort IAHI) upon admission to the emergency department. The primary outcome was pain relief at 20 min, 12 h, 24 h and 48 h after the regional anesthesia, both at rest and during internal rotation of the fractured limb. The Numeric Rating Scale was used. Residual pain was managed with the same protocol in all patients. Additional analgesic drug administration during the 48 h from admission was recorded. RESULTS: A total of 120 patients with comparable baseline characteristics were analyzed in this study: the FICB group consisted of 70 subjects, while the IAHI group consisted of 50 subjects. Pain was significantly lower in the IAHI group during movement of the fractured limb at 20 min (p < 0.05), 12 h (p < 0.05), 24 h (p < 0.05) and 48 h (p < 0.05). In the FICB cohort 72.9% of patients needed to take oxycodone, in contrast to 28.6% of the IAHI cohort (p < 0.05). In the FICB cohort 14.09 ± 11.57 mg of oxycodone was administered, while in the IAHI cohort 4.38 ± 7.63 mg (p < 0.05). No adverse events related to either technique were recorded. CONCLUSIONS: Intra-articular hip injection provides better pre-operatory pain management in elder patients with intracapsular hip fractures compared to the fascia-iliaca compartment block. It also reduced the need for supplementary systemic analgesia. LEVEL OF EVIDENCE: Therapeutic Level I.

Mejora de los síntomas del autismo y evaluación alimentaria nutricional luego de la realizacion de una dieta libre de gluten y caseína en un grupo de niños con autismo que acuden a una fundación / Improvement in symptoms and nutritional assessment after following a gluten - and casein - free diet in a group of children with autism from an especialised institution

Introducción: Se ha sugerido que los péptidos del gluten y la caseína pueden tener alguna participación en los orígenes del autismo y que la fisiología y psicología de dicho trastorno pueden ser explicadas por medio de la excesiva actividad opioide vinculada a dichos péptidos. Objetivos: Conocer la modificación del comportamiento en relación al contacto visual, interacción social, hiperactividad y problemas GI (gastrointestinales) según la percepción de los padres de niños con autismo luego de la incorporación de la dieta libre de gluten y caseína (DLGC). Métodos: Estudio mixto, exploratorio-descriptivo, transversal en 30 padres de niños con autismo que realicen (DLGC). Se relevó mediante una encuesta los cambios y/o mejoras de los síntomas clásicos del autismo evidenciado posteriormente a la implementación de la dieta libre de gluten y caseína y la intensidad de dichos cambios, según percepción de los padres. Resultados: En promedio, el 86.75% (n=26) presentó mejoras (cambios moderados e intensos) en alguno de los síntomas (gastrointestinal, hiperactividad, interacción social y contacto ocular). El 60% presenta mejoras conjunta en los cuatro síntomas y el 30% de tres síntomas. La mejora es mayor, a mayor tiempo de estar realizando la DLGC, evidenciado por el aumento de la proporción de niños que mejoraron los cuatro síntomas característicos del autismo a medida que aumenta el tiempo de dieta. Entre los que reciben intervención de un nutricionista hay un RR 1,9 (IC95%= 1,1-1,3) más probabilidades de mejorar los cuatro síntomas. Conclusiones: La DLGC puede considerarse como efectiva para mejorar uno o más de los síntomas característicos del autismo (AU)

Introduction: It has been suggested that peptides from gluten and casein may have a role in the origins of Autism Spectrum Disorders (ASD), which physiology and psychology manifestations might be explained by excessive opioid activity linked to these peptides. Objectives: To determine the behavior modifications in relation to eye contact, social interaction, hyperactivity and gastrointestinal symptoms after the introduction of gluten - and casein- free diet (GFCF), perceived by parents of children with ASD. Methods: Mixed, exploratory-descriptive, cross- sectional design. Sample: 30 parents of children with ASD and GFCF intervention. Survey: changes and/or improvements of the classic symptoms of autism and intensity of these changes after the implementation of a GFCF, based on parental report. Results: 86.75 % (n= 26) showed improvement (moderate to severe changes) in any of the symptoms (gastrointestinal, hyperactivity, social interaction and eye contact). 60% joint features improvements in four symptoms and 30% in three symptoms. The proportion of children who improved the four characteristic symptoms of autism was higher among those who were longer time under this diet. Those receiving a nutritionist intervention were more likely to improve the four symptoms compared to those who had not (RR 1.9; CI95%= 1.1-1.3). Conclusion: GFCF could be considered effective for improving one or more of the characteristic symptoms of autism (AU)

Psychosocial dimensions of BRCA testing: an overshadowed issue.

Routine cancer susceptibility testing will soon be feasible in clinical practice. However, to date, this new technology has entailed many limitations, including potential adverse psychosocial consequences. Empirical studies examining these psychosocial aspects are strikingly scarce, especially in continental European countries. Are we prepared for managing the psychosocial problems that emerge from widespread introduction of this practice? Current research do not take into account cross-cultural variations in attitudes and reactions towards genetic testing. This paper points to the urgent need for obtaining a more accurate picture on the psychosocial aspects of breast cancer gene testing and disclosure in order to design recommendations for implementation in populations with highly variable cultural and legal background.