Capsaicin 8% Dermal Patch for Neuropathic Pain in a Pain Unit.

AIMS: Pain units manage approximately 20% of the patients with neuropathic pain, usually presenting with severe uncontrolled pain associated with substantial impairment of quality-of-life and disability. We aimed to analyze the experience with the capsaicin 8% dermal patch for managing patients with neuropathic pain in a pain unit. DESIGN: This was a post-authorization observational and retrospective study conducted at a single pain unit on patients with peripheral neuropathic pain under routine clinical care. METHODS: Diagnosis of neuropathic pain was based on the Douleur Neuropathique 4 (DN4) questionnaire. Evaluations included pain intensity according to a visual analog scale and the quality-of-life as evaluated with the European Quality of Life-5 Dimensions (EQ-5D). RESULTS: We included 66 patients with neuropathic pain lasting for a median of 24 months. The most frequent diagnosis was iatrogenic neuropathic pain (47%) and two thirds of patients exhibited extreme pain or discomfort. Pain intensity was reduced significantly from a mean (standard deviation [SD]) of 7.20 (1.95) at baseline to 6.02 (2.77) at month 3, leading to a mean change from baseline of 1.19 (95% confidence interval [CI], 0.59 to 1.78; p < .001; Cohen's d 0.49). The extent of the pain area was also significantly reduced from a median (interquartile range [IQR]) of 169.5 cm2 (69.3-299.9) at baseline to 121.2 cm2 (35.4-183.9) at month 3 (p < .001). There was an improvement in most dimensions of quality-of-life, especially regarding "usual activities," "pain/discomfort," and "anxiety/depression." Tolerability was consistent with the known profile. CONCLUSIONS: Our results suggest that the capsaicin 8% dermal patch is a useful and well-tolerated treatment option for managing peripheral neuropathic pain in pain units.

Theoretical spectroscopic study of acetyl (CH 3CO), vinoxy (CH 2CHO), and 1-methylvinoxy (CH 3COCH 2) radicals. Barrierless formation processes of acetone in the gas phase.

Background: Acetone is present in the earth´s atmosphere and extra-terrestrially. The knowledge of its chemical history in these environments represents a challenge with important implications for global tropospheric chemistry and astrochemistry. The results of a search for efficient barrierless pathways producing acetone from radicals in the gas phase are described in this paper. The spectroscopic properties of radicals needed for their experimental detection are provided.   Methods: The reactants were acetone fragments of low stability and small species containing C, O and H atoms. Two exergonic bimolecular addition reactions involving the radicals CH 3, CH 3CO, and CH 3COCH 2, were found to be competitive according to the kinetic rates calculated at different temperatures. An extensive spectroscopic study of the radicals CH 3COCH 2 and CH 3CO, as well as the CH 2CHO isomer, was performed. Rovibrational parameters, anharmonic vibrational transitions, and excitations to the low-lying excited states are provided. For this purpose, RCCSD(T)-F12 and MRCI/CASSCF calculations were performed. In addition, since all the species presented non-rigid properties, a variational procedure of reduced dimensionality was employed to explore the far infrared region. Results: The internal rotation barriers were determined to be V 3=143.7 cm -1 (CH 3CO), V 2=3838.7 cm -1 (CH 2CHO) and V 3=161.4 cm -1 and V 2=2727.5 cm -1 (CH 3COCH 2).The splitting of the ground vibrational state due to the torsional barrier have been computed to be 2.997 cm -1, 0.0 cm -1, and 0.320 cm -1, for CH 3CO, CH 2CHO, and CH 3COCH 2, respectively. Conclusions: Two addition reactions, H+CH 3COCH 2 and CH 3+CH 3CO, could be considered barrierless formation processes of acetone after considering all the possible formation routes, starting from 58 selected reactants, which are fragments of the molecule. The spectroscopic study of the radicals involved in the formation processes present non-rigidity. The interconversion of their equilibrium geometries has important spectroscopic effects on CH 3CO and CH 3COCH 2, but is negligible for CH 2CHO.

Serum leptin levels in community acquired pneumonia (CAP) are related to nutritional status and not to acute phase reaction.

To determine whether leptin in patients with CAP acts as a nutritional or as an inflammatory marker and whether leptin plays any role regarding survival, we included 222 patients diagnosed of CAP, 142 men and 80 women, median age 74 years. We did not find significant differences in serum leptin levels between CAP patients and healthy controls, even after adjusting by BMI. Serum leptin levels were directly related with BMI, body fat and muscle mass and inversely related with inflammatory markers, including pro- and anti-inflammatory cytokines. Patients with positive blood cultures showed lower serum leptin and raised inflammatory markers. Although patients who died showed lower values of serum leptin, multivariate analysis showed that the prognostic value of low serum leptin levels depends on impaired nutritional status. In conclusion, we suggest that in CAP patients, leptin does not act as an inflammatory reactant but as a nutritional marker.

Prognosis of community acquired pneumonia (CAP): value of triggering receptor expressed on myeloid cells-1 (TREM-1) and other mediators of the inflammatory response.

UNLABELLED: TREM-1 is an activating receptor expressed on the surface of neutrophils and mature monocytes when stimulated by bacteria or fungi, leading to amplification of the inflammatory response. Our objective is to analyze the prognostic value of serum sTREM-1 levels and other mediators of the inflammatory response, in patients hospitalized for CAP, and to compare its prognostic value with those of advanced age, pneumonia severity scores, Charlson index, nutritional status and severity of sepsis. METHODS: We included 226 patients with CAP, 145 males and 81 females, median age of 74 years. The following tests were performed: arterial blood gases and chest radiography, nutritional assessment, assessment of the severity of the sepsis, Pneumonia Severity Index (PSI) and CURB-65, and mediators of inflammation: TNF alfa, IL-6, IL-10, IL-1ra, LBP, sCD14, CRP, and sTREM-1. Mortality during admittance was defined as the sole end point. RESULTS: Twenty-eight of the two-hundred and twenty-six patients died (12.4%). On univariate analysis advanced age, dehydration, increased Na, low BMI, handgrip strength, serum albumin, prealbumin, IGF-1, lymphocyte count, conscious drowsiness, tachypnea, decreased PaO2, hypotension, creatinine, ASAT, LDH, severity of sepsis, a high PSI or CURB65, TNFalpha, IL-6, IL-10, IL-1ra, and sTREM-1 were related to mortality. Variables with an independent value were IGF-1, CURB-65, TREM-1, advanced age and IL-6. CONCLUSIONS: This study confirms the usefulness of TREM-1 in the diagnosis and prognosis of patients with CAP, which is independent of advanced age, other inflammation markers such as IL-6, severity index for CAP such as CURB-65 or PSI, severity of sepsis and nutritional status including IGF-1.