Influence of support materials on the electroactive behavior, structure and gene expression of wild type and GSU1771-deficient mutant of Geobacter sulfurreducens biofilms.

Geobacter sulfurreducens DL1 is a metal-reducing dissimilatory bacterium frequently used to produce electricity in bioelectrochemical systems (BES). The biofilm formed on electrodes is one of the most important factors for efficient electron transfer; this is possible due to the production of type IV pili and c-type cytochromes that allow it to carry out extracellular electron transfer (EET) to final acceptors. In this study, we analyzed the biofilm formed on different support materials (glass, hematite (Fe2O3) on glass, fluorine-doped tin oxide (FTO) semiconductor glass, Fe2O3 on FTO, graphite, and stainless steel) by G. sulfurreducens DL1 (WT) and GSU1771-deficient strain mutant (Δgsu1771). GSU1771 is a transcriptional regulator that controls the expression of several genes involved in electron transfer. Different approaches and experimental tests were carried out with the biofilms grown on the different support materials including structure analysis by confocal laser scanning microscopy (CLSM), characterization of electrochemical activity, and quantification of relative gene expression by RT-qPCR. The gene expression of selected genes involved in EET was analyzed, observing an overexpression of pgcA, omcS, omcM, and omcF from Δgsu1771 biofilms compared to those from WT, also the overexpression of the epsH gene, which is involved in exopolysaccharide synthesis. Although we observed that for the Δgsu1771 mutant strain, the associated redox processes are similar to the WT strain, and more current is produced, we think that this could be associated with a higher relative expression of certain genes involved in EET and in the production of exopolysaccharides despite the chemical environment where the biofilm develops. This study supports that G. sulfurreducens is capable of adapting to the electrochemical environment where it grows.

Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24-48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03-2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18-26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3-5.07]) and major (OR: 4.2 [1.4-12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Manejo clínico y paliativo del sufrimiento en la COVID-19 / Clinical and palliative management of suffering in COVID-19

La COVID-19 ha representado un desastre humanitario que ha conmovido a nuestros sistemas sanitarios y a la economía global. Se revisa su presentación clínica, evaluación y triaje de los pacientes estables o inestables, la toma de decisiones, las ayudas respiratorias, comorbilidades asociadas, el control de síntomas, el papel de los cuidados paliativos en esta pandemia, y la necesidad de promover un cambio en la visión y organización del mundo y la necesidad de una gobernanza mundial sanitaria a cargo de la OMS.

COVID-19 has represented an humanitarian disaster that has shaken our healthcare systems and the global economy. We review the clinic presentation, assessment and triage of stable or unstable patients, decision making, respiratory aids, intubation, associated comorbidities, symptom control, the role of palliative care and family in this pandemic, and the need to promote a change in the vision and organization of the world and the need for a global health gobernance by WHO.

Prevalence and Characterization of Breakthrough Pain Associated with Chronic Low Back Pain in the South of Spain: A Cross-Sectional, Multicenter, Observational Study.

Chronic low back pain (CLBP) is highly prevalent in industrialized countries, where it is one of the main causes of disability. Patients with CLBP in treatment with opioids often experience episodes of breakthrough pain (BTP), but data on prevalence and treatment preferences are scarce. The objectives of this study were, first, the evaluation of the prevalence of BTP in patients with CLBP in the South of Spain (N = 1,868) and, second, the characterization of BTP in these patients (N = 295). Data was collected on presence of BTP, type and location of pain, treatment, compliance, and patient satisfaction. We found a prevalence of BTP in patients with CLBP of 37.5% (95% CI: 35.3%-39.7%), similar in men and women. 75% of the patients were older than 50 years. The preferred drug of patients who control BTP with opioids is fentanyl (78.3%) and its most common form of administration is nasal (53.2%). Therapeutic compliance was high and 46.3% of patients considered the control of their BTP very satisfactory. Our study showed that BTP is common in patients with CLBP and that current treatments seem adequate.

Evaluation of the quality of care of elderly patients with chronic and breakthrough pain treated with opioids: SAND study.

OBJECTIVE: The objective of this study was to evaluate the quality of care of elderly patients with treatment for chronic pain (CP) and breakthrough pain (BTP). METHODS: A cross-sectional observational study was conducted in 20 pain units, selecting patients aged 70 years or older with baseline controlled CP in treatment with opioids and a diagnosis of BTP. Patients were classified as first episode of BTP or patient in follow-up. The patients completed the SF-12 quality of life questionnaire, Brief Pain Inventory, Lattinen Index, and Edmonton Symptoms Assessment Scale. The patient's satisfaction with the treatment was evaluated through a visual analogue scale (VAS). RESULTS: A total of 199 patients were included with 67.7% women (132). There were 28.5% (55) attending the first visit for BTP and 71.5% (138) were on follow-up visits. On the physical component of the SF-12, 95% had a score below the mean for the Spanish general population and 44% had a score below the mean on the mental component. Worse scores were observed for women in the bodily pain dimension (p = .032) and in the overall physical component (p = .045). There were 62.9% (112) patients satisfied with the treatment for BTP. In the multivariate analysis, SF-12 physical component scores (p = .017) and patient's satisfaction with BTP treatment was better in follow-up visits (p = .031). CONCLUSIONS: All clinical parameters compared between first visit for the treatment of BTP and follow-up visits were improved, so the quality of care was also considered improved. Elderly women and non-oncologic patients were observed to be the population with worse symptom control.

Factors Influencing Cognitive Impairment in Neuropathic and Musculoskeletal Pain and Fibromyalgia.

Objective: To assess cognitive performance of chronic pain (CP) patients diagnosed with three types of pain-neuropathic pain (NP), musculoskeletal (MSK), and fibromyalgia (FM)-and to analyze the factors influencing cognitive difficulties in each group. Methods: Two hundred fifty-four CP patients-104 NP, 99 MSK, 51 FM-and 72 pain-free subjects were included in the study. The "Test Your Memory" (TYM) scale was used to assess cognitive performance. Pain intensity was measured by means of the visual analog scale (VAS); the Hospital Anxiety and Depression scale was used to assess mental status, and the Medical Outcome Study (MOS) sleep scale to assess sleep quality. The relationships between cognitive performance and these factors were analyzed using linear regression models. Results: The mean score in the TYM was significantly lower (worse cognitive function) in CP patients than controls (40.5 vs 43.9, P < 0.001). In the separate analysis of each group, depression was observed to have a negative impact on MSK pain patients (ß = -0.37, 95% confidence interval [CI] = -0.53 to -0.2, P < 0.001) and on FM subjects (ß =-1.01, 95% CI = -1.05 to -2.38, P = 0.022). A significant interaction between pain intensity and depression was observed in the FM patients. In addition, a U-shaped association was found between the duration of pain and cognitive performance in the NP patients. Neither anxiety nor sleep impairment affected cognitive performance in any of the CP patients. Conclusions: These results highlight the importance of taking into account the type of pain when assessing cognitive performance in CP patients and demonstrate the influence of the emotional state of the patient, especially if depression is present.

5% Lidocaine-medicated plaster for the treatment of chronic peripheral neuropathic pain: complex regional pain syndrome and other neuropathic conditions.

OBJECTIVES: Chronic neuropathic pain and chronic complex regional pain syndrome (CRPS), in particular, are debilitating and difficult-to-treat conditions that have a strong impact on patient's quality of life. The aim of this study was to evaluate the effectiveness of 5% lidocaine-medicated plaster as add-on therapy in patients with chronic peripheral neuropathic pain conditions, including CRPS. PATIENTS AND METHODS: This was a single-center, prospective, observational study set in a specialized pain unit of a tertiary hospital in Spain. A total of 56 patients with long-standing peripheral neuropathic pain, ten of them with CRPS, received 5% lidocaine-medicated plaster as add-on analgesic therapy for 6 months. RESULTS: After 6 months of treatment, a ≥50% reduction in pain intensity was attained by 75% of patients, as measured by numeric rating scale (NRS) for pain. The average NRS score was reduced by 61% (4.7 points), from a baseline mean score of 7.8 to an end point mean score of 3.1. Marked improvements were also observed in the CRPS group: six out of ten patients achieved a ≥50% reduction in NRS score, and the average NRS score for patients with CRPS was reduced by 51% (4.0 points), from a baseline mean score of 7.9 to an end point mean score of 3.9. The improvements in pain intensity were partially translated into a decrease in disability index and in anxiety levels. CONCLUSION: 5% Lidocaine-medicated plaster may be useful as add-on therapy for a number of peripheral neuropathic pain conditions, including CRPS.

Use and satisfaction with the Healthcare System of the chronic pain patients in Spain: results from a nationwide study.

OBJECTIVE: To analyze the use of healthcare resources by chronic pain (CP) patients in Spain and their satisfaction with them. RESEARCH DESIGN AND METHODS: A nationwide, cross-sectional study was carried out on a representative sample of 1957 Spanish adults. A telephone survey was conducted with the aim of analyzing the prevalence of CP, the characteristics and consequences of pain, the use of healthcare resources and patients' satisfaction with them. Descriptive, bivariate and multivariate analyses were performed. RESULTS: Of the 1957 subjects interviewed, 325 suffered CP. The mean duration of CP was 10 years (SD: 11.3) and 48.9% of the CP sufferers reported severe/unbearable pain. Moreover, about 30% felt sad/very sad or anxious/very anxious, 24.4% had been on sick leave, 12% had left/lost their jobs and 47.2% considered their pain affected their families. Likewise, 92.9% had consulted a healthcare professional due to their CP, on average 3.49 times (SD: 3.9), and 69.2% took medication. In addition, 67.3% and 63.8% were satisfied/very satisfied with the care and the healthcare information they received, respectively. Individuals who reported headache (OR = 0.34) and feeling sad (OR =0.38) were least satisfied with the care they received. In addition, CP sufferers who made greater use of consultations were those who had left/lost their jobs (ß = 1.44), those who took medication (ß = 1.67), those who considered their pain affected their families (ß = 0.97) and those with a shorter duration of pain (ß = -0.003). CONCLUSIONS: CP produces relevant demands on healthcare resources, conditioned by the consequences within the family and the effects on their employment. To achieve greater patient satisfaction, professionals need to pay particular attention to certain sites of pain and to patients' mental health.

Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications.

Study Design. Quasiexperimental study. Objective. To investigate whether radiofrequency treatment can preclude the need for spinal surgery in both the short term and long term. Background. Radiofrequency is commonly used to treat lumbosacral radicular pain. Only few studies have evaluated its effects on surgical indications. Methods. We conducted a quasiexperimental study of 43 patients who had been scheduled for spinal surgery. Radiofrequency was indicated for 25 patients. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment (pulsed radiofrequency of dorsal root ganglion, 76%; conventional radiofrequency of the medial branch, 12%; combined technique, 12%). The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment. In addition, we also evaluated adverse effects, ODI, NRS. Results. We observed after treatment with radiofrequency 80% of patients rejected spinal surgery in the short term and 76% in the long term. We conclude that radiofrequency is a useful treatment strategy that can achieve very similar outcomes to spinal surgery. Patients also reported a very high level of satisfaction (84% satisfied/very satisfied). We also found that optimization of the electrical parameters of the radiofrequency improved the outcome of this technique.

A nationwide study of chronic pain prevalence in the general spanish population: identifying clinical subgroups through cluster analysis.

OBJECTIVE: This study aims to assess the prevalence of chronic pain, its characteristics, and its impact on the general Spanish population. Also, to establish chronic pain patient subgroups according to the characteristics of pain and to identify variables specifically associated with each subgroup. DESIGN: Telephone-based, cross-sectional nationwide study. SUBJECTS: A sample of 1,957 individuals representative of the Spanish population. METHODS: Data were collected through telephone interviews. A subject was considered to have chronic pain if they had suffered pain (at least 4 days a week) during the last 3 months. The subjects were divided into two subgroups through a cluster analysis, and a regression model was established to determine the variables most specifically associated with these subgroups. RESULTS: The prevalence of chronic pain was 16.6% (95% confidence interval: 14.9-18.3) and among these subjects, more than 50% referred to limitations in their daily activities, 30% felt sad and/or anxious, and 47.2% indicated that their pain was affecting their family life. Two subgroups of subjects with pain were identified: 1) characterized by generalized pain in more than one location and of a long evolution (150 months); and 2) characterized by pain localized to only one site with a shorter duration (100 months). Individuals who felt anxious because of their pain and those who considered that their pain was affecting their family were more likely to belong to group 1. CONCLUSIONS: Pain affects an important proportion of the Spanish adult population and that it has a strong personal impact. Two pain groups were clearly distinguished by their clinical characteristics.

The impact of chronic pain: the perspective of patients, relatives, and caregivers.

To assess the impact of chronic pain on the family environment from the patient's, relative's and caregiver's perspective, we undertook cross-sectional study on a representative sample of Spanish adults who suffered pain at least 4 days a week for ≥3 months and on relatives and caregivers of patients that fulfilled these criteria. The characteristics of pain and the perception of its impact on the family environment were assessed, using logistic regression models to reveal the variables associated with the impact of pain on the family. From a total of 1,957 subjects, 325 experienced chronic pain and 34.6% of them perceived that their pain affected their family environment. These patients recognized a stronger impact when their relatives were sad (OR = 3.61; CI:1.57, 8.27) and had modified the leisure activities because of the pain (OR = 3.62; CI:1.56, 8.38). Among the 131 relatives, 51.2% perceived that pain was affecting the family, causing changes in their leisure activities (OR = 1.17; CI:1.04, 9.94) and sleep disturbance (OR = 1.40; CI:1.32, 12.58). Of the 36 caregivers, mainly women over 50 years of age, 66.7% indicated that pain affected the family, although 72.8% were satisfied with the help they provided. Chronic pain has a very strong impact on the family, although this is perceived distinctly by patients, relatives, and caregivers. Recognizing that factors related to pain affect the family's well-being, and adopting a global approach to pain that takes into consideration the family's experiences, should improve the therapeutic response, and enhance the patient's and relative's quality of life. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Código de buena práctica para el control del dolor oncológico / Good clinical practice guide for control of oncological pain

En muchas ocasiones, los pacientes con cáncer no expresan su dolor por miedo a que el médico desvíe su atención hacia este síntoma, en lugar de centrarse en el tratamiento de su enfermedad principal. No obstante, el paciente debe saber que el tratamiento de su dolor no sólo no interfiere con la terapia curativa, sino que colabora con ella. Entre los pacientes, es habitual el temor a que el avance de la enfermedad les lleve a situaciones de sufrimiento insostenible que supere todas las posibilidades médicas, pero es nuestro deber ayudarles a ser conscientes de que la medicina ofrece un abanico de tratamientos capaces de aliviar su dolor y evitar su sufrimiento. Este conocimiento es esencial para aumentar su confianza en el tratamiento y mejorar la relación médico-paciente. Frente a este desafío, la Sociedad Española de Cuidados Paliativos, la Sociedad Española del Dolor, la Sociedad Española de Oncología Médica y la Sociedad Española de Oncología (..) (AU)

Patients with cancer often do not mention their pain as they are afraid that the doctor will be distracted towards this symptom instead of focusing on the treatment of their primary disease. However, should know that the treatment of their pain not only does it not interfere with their remedial therapy, but also contributes to it. It is usual, among patients, to be afraid that the advance of the disease may lead to situations of unsustainable suffering which may exceed all the medical possibilities, but it is our duty to help them to be aware that medicine offers a wide range of treatments to relieve their pain and prevent them suffering. This knowledge is essential to increase their (..)(AU)

Fibromialgia / No disponible

No disponible

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Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries.

Surveys evaluating pain in hospitals keep on showing that postoperative pain (POP) remains undertreated. At the time when guidelines are edited and organisational changes are implemented, more recent data are necessary to check the impact of these measures on daily practice and needs for improvement. This prospective, cross-sectional, observational, multi-centre practice survey was performed in 2004-2005 in 7 European countries. It was conducted in surgical wards of a randomised sample of hospitals. Data on POP management practices following surgery in adult in-patients were collected anonymously via a standardised multiple choice questionnaire. Among 1558 questionnaires received from 746 European hospitals, 59% were provided by anaesthetists and 41% by surgeons. There are no regular on-site staff training programmes on POP management in the institution for 34% of the respondents, patients are systematically provided with POP information before surgery for 48% of respondents; balanced analgesia following major surgery and regular administration of analgesics are largely used; 25% of respondents have specific written POP management protocols for all patients in their ward; 34% of respondents say that pain is not assessed and 44% say that pain scores are documented in the patient's chart. This largest ever performed survey confirms the extensive body of evidence that current POP management remains suboptimal and identifies needs for improvement on European surgical wards. However, the wide use of balanced analgesia and the regular administration of analgesics are indicators of ongoing change.

Carcinoma anexial microquístico / Microcystic adnexal carcinoma

Se presenta el caso de una mujer de 77 años, con una tumoración en ceja izquierda. El estudio histopatológico de la lesión, demostró una neoplasia con características de carcinoma anexial microquístico. En dos años de seguimiento no ha habido recidiva ni metástasis.Presentamos un nuevo caso de dicha entidad y realizamos una revisión de la literatura (AU)

Fijación transaxial de apofisis odontoides por vía anterior percutánea guiada por estereotaxia / Transaxial fixation of odontoid apophysis via percutaneous anterior guided by stereotaxia

Se presenta la operación realizada a un paciente con fractura-luxación de odontoides tipo III según la clasificación de Alonso. Se le realizó una fijación transaxial del diente del axis (T cnica de Bohler), pero utilizando un acceso percutáne y guiado por técnica estereotáxica. Se utilizaron tornillos canulados de 3,5 mm fabricados por la AO e intrumental creado específicamente por los autores para este tipo de operación. Su evolución fue satisfactoria. No se presentaron complicaciones (AU)

Fijación transaxial de apofisis odontoides por vía anterior percutánea guiada por estereotaxia / Transaxial fixation of odontoid apophysis via percutaneous anterior guided by stereotaxia

Se presenta la operación realizada a un paciente con fractura-luxación de odontoides tipo III según la clasificación de Alonso. Se le realizó una fijación transaxial del diente del axis (T cnica de Bohler), pero utilizando un acceso percutáne y guiado por técnica estereotáxica. Se utilizaron tornillos canulados de 3,5 mm fabricados por la AO e intrumental creado específicamente por los autores para este tipo de operación. Su evolución fue satisfactoria. No se presentaron complicaciones