Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19.

SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.

Practical recommendations for the management of the patient with chronic pain during the pandemic of COVID-19. / Recomendaciones prácticas para el manejo del paciente con dolor crónico durante la pandemia de COVID-19.

SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.

[Cardiovascular safety of non-insulin anti-diabetic drugs. Scientific position statement of SEMERGEN]. / Seguridad cardiovascular de los antidiabéticos no insulínicos. Posicionamiento científico SEMERGEN.

Diabetes increases the risk of both microvascular and macrovascular complications. Although reducing plasma glucose levels to recommended targets decreases the risk of microvascular outcomes, the effects of anti-diabetic drugs on macrovascular complications and cardiovascular death are of concern. In fact, it has been suggested that some anti-diabetic agents could even be harmful for cardiovascular outcomes. In this context, several health care regulatory agencies have established the need for performing clinical trials specifically designed to assess the cardiovascular safety of anti-diabetic drugs. The results of 2 clinical trials have recently been published that provide important information on the cardiovascular safety of dipeptidyl peptidase 4 (DPP-4) inhibitors. The aim of this document was to review the available evidence on the cardiovascular safety of non-insulin anti-diabetic drugs and provide practical recommendations on their use in this context.

Prevención de la diabetes mellitus 2 / Prevention of diabetes mellitus 2

La diabetes mellitus tipo 2 –DM2- es una enfermedad metabólica caracterizada por hiperglucemia. Este defecto es capaz de producir alteraciones vasculares y nerviosas que son el sustrato de sus complicaciones. La DM2 por su doble componente etiológico y su amplio período preclínico permite establecer estrategias que prevengan o demoren su aparición (prevención primaria), o que permitan su detección precoz (prevención secundaria), o que una vez diagnosticada, retrasen o eviten la aparición de las complicaciones (prevención terciaria). Del mismo modo que la aplicación o no de pruebas de cribado de la enfermedad es aún hoy un asunto controvertido, la utilización de tratamientos higiénico dietéticos o farmacológicos en prediabéticos podría recomendarse en algunas situaciones para disminuir la incidencia de esta enfermedad (AU)

Diabetes mellitus type 2, DM2-is a metabolic disorder characterized by hyperglycaemia. This feature causes vascular and nerve disorders that are the basis of long-term complications. The twin-DM2 due to both its aetiology and its broad preclinical period allows strategies to be made that prevent or delay its onset (primary prevention) or to allow early detection (secondary prevention), or once diagnosed, delay or prevent the onset of complications (tertiary prevention). The application or screening tests for the disease is still a controversial issue and hygienic use of dietary or pharmacological treatments in pre-diabetics is recommended to decrease the incidence of this disease (AU)

Dissecting the molecular damage to stallion spermatozoa: the way to improve current cryopreservation protocols?

We review recent developments in the technology of freezing stallion sperm, paying special attention to the molecular lesions that spermatozoa suffer during freezing and thawing, such as osmotic stress, oxidative damage, and apoptotic changes. We also discuss the applicability of colloidal centrifugation in stallion sperm cryobiology. Increased knowledge about the molecular injuries that occur during cryopreservation may lead to improved protective techniques and thus to further improvements in fertility in the current decade.

[Postoperative pain management for patients who are long-term users of opioid]. / Manejo perioperatorio del dolor en el paciente en tratamiento crónico con opiáceos.

Pain is one of the most common reasons for seeking medical care and the frequency of prescription of opioid analgesics by both primary care physicians and specialists has increased. It is therefore unsurprising that many patients with chronic pain who must undergo scheduled or emergency surgery will be on long-term medication, including opioids. Managing postoperative pain, even with high doses of drugs, seems to be more difficult in regular users of such analgesics, possibly because of an apparent association of opioid use with increased tolerance and hyperalgesia. Postoperative pain relief should be carefully tailored in these cases by means of a management plan worked out along with the patient. Adjuvants may be particularly useful; the most thoroughly studied adjuvants are nonsteroidal anti-inflammatory drugs and ketamine. Regional anesthesia offers a particularly attractive approach when long-term users of opioids must undergo surgery.

Manejo perioperatorio del dolor en el paciente en tratamiento crónico con opiáceos / Postoperative pain management for patients who are long-term users of opioid

El dolor representa uno de los motivos más frecuentes de demanda de atención médica entre la población. Se ha producido un notable incremento en la prescripción de opiáceos tanto por parte de los médicos de atención primaria como por parte de los especialistas en el tratamiento del dolor. No es de extrañar pues que muchos de los pacientes que se nos presentan a día de hoy para cirugía electiva o de urgencia estén en tratamiento por dolor crónico y entre los fármacos que toman se encuentren los opiáceos. El manejo del dolor postoperatorio parece ser más difícil en los pacientes consumidores crónicos, incluso cuando las dosis de los mismos no son muy altas. La explicación a estos fenómenos parece encontrarse en los fenómenos de tolerancia e hiperalgesia inducida por opioides. El manejo perioperatorio del dolor en los pacientes consumidores crónicos de opiáceos debe hacerse de manera individualizada y cuidadosa. Por ello es recomendable, conjuntamente con el paciente, crear un plan para el manejo perioperatorio del dolor antes de la cirugía. En este grupo de pacientes el uso de adyuvantes juega un papel especialmente útil. Entre los de tipo farmacológico los más investigados son los AINEs y la ketamina. Las técnicas de anestesia regional son una elección especialmente atractiva en el paciente que consume opiáceos de manera crónica(AU)

Pain is one of the most common reasons for seeking medical care and the frequency of prescription of opioid analgesics by both primary care physicians and specialists has increased. It is therefore unsurprising that many patients with chronic pain who must undergo scheduled or emergency surgery will be on long-term medication, including opioids. Managing postoperative pain, even with high doses of drugs, seems to be more difficult in regular users of such analgesics, possibly because of an apparent association of opioid use with increased tolerance and hyperalgesia. Postoperative pain relief should be carefully tailored in these cases by means of a management plan worked out along with the patient. Adjuvants may be particularly useful; the most thoroughly studied adjuvants are nonsteroidal anti-inflammatory drugs and ketamine. Regional anesthesia offers a particularly attractive approach when long-term users of opioids must undergo surgery(AU)

Techniques for the insemination of low doses of stallion sperm.

CONTENTS: In the last decade, there has been a significant increase in the quality and commercial use of frozen equine semen. The emergence of new reproductive technologies, coupled with the high prices for an insemination dose from some stallions, the increasing costs of import and export and the marketing policies of stallion agents or owners in the sport horse industry has stimulated the fractionation of doses for insemination. Consequently, the sperm number and the volume of an insemination dose are significantly reduced. To deliver lower doses of sperm in lower volumes compared to the standard dose, two techniques are used in clinical practice. Semen can be delivered hysteroscopically (HI) or by rectally guiding a flexible pipette to the tip of the desired uterine horn (RI). Both techniques have been described with good success and have triggered an incentive to further reduce the number of spermatozoa without having a negative effect on fertility. This article will review the expected success of both techniques in clinical settings and will highlight their advantages and disadvantages both for the mare and stallion. In addition, some of the implications of reducing sperm numbers on the industry will be discussed. From the available information, it is evident that lower sperm numbers deposited by RI or HI to deliver the inseminate can result in acceptable pregnancy rates with fresh or frozen semen in commercial settings. These methods of insemination could have major implications in the implementation and commercialization of new and emerging technologies in the equine industry.

Ultrasound-guided transversus abdominis plane block for spinal infusion and neurostimulation implantation in two patients with chronic pain.

OBJECTIVE: This case report describes an ultrasound approach to the transversus abdominis plane (TAP) local anesthetic block. This block induces sensory blockade in the lower half of the abdomen where the pulse generator or the infusion pump is to be housed in a subcutaneous pocket, and therefore provides an alternate to general anesthesia or administration of high-dose local anesthetics. CASE REPORT: We report two cases of neuromodulation procedures-implantation of an internal morphine pump for severe somatic pain refractory to other therapies and placement of a double-stimulator generator for dorsal column stimulation in a patient diagnosed with postoperative failed-back syndrome. We successfully used ultrasound-guided TAP block to achieve ipsilateral sensory block of dermatomes T9-L1 in the context of a monitored anesthesia care multimodal approach. CONCLUSION: TAP block can be a potentially useful substitute to general anesthesia or local anesthesia for the pocket formation in neuromodulation techniques, and it provides adequate anesthesia of the abdominal wall. This block is potentially an important addition to the monitored anesthesia care protocol.

Iontoforesis en el abordaje del paciente con dolor crónico / Iontophoresis in the approach to patients with chronic pain

Objetivos: Con este trabajo se pretende evaluar la técnica en los diferentes diagnósticos en los que se ha empleado durante un año en nuestra unidad. Material y métodos: Se realizó un estudio retrospectivo analizando las historias clínicas de 50 pacientes que, durante el año 2005, recibieron tratamiento con iontoforesis y que cumplían los criterios de inclusión/exclusión. Se evaluó la efectividad analgésica del tratamiento mediante la escala analógica visual (EVA) al inicio del tratamiento y una vez finalizado este. Para la evaluación de la técnica se calculó la media, con un intervalo de confianza (IC) del 95% pretratamiento y postratamiento, y se compararon los resultados, valorando su consistencia con la prueba de la t de Student (mediante el programa informático SPSS v.13.1). Resultados: Valorando la consistencia de los datos, comparando la EVA pretratamiento y postratamiento con la prueba de la t de Student para datos apareados, podemos afirmar que el tratamiento con iontoforesis consigue una reducción de la EVA estadísticamente significativa en las siguientes afecciones: osteoartritis (media + desviación estándar [DE] pretratamiento 7,28 ± 1,69 y postratamiento 4,80 ± 2,64) y síndrome del túnel carpiano (media + DE pretratamiento 7,57 ± 0,83 y postratamiento 6,35 ± 0,74). Conclusiones: La iontoforesis parece ser una técnica apropiada y muy segura para el tratamiento del dolor crónico en afecciones como la osteoartritis o el síndrome del túnel carpiano (AU)

Objective: To evaluate the technique of iontophoresis in the distinct entities in which it was used during a 1-year period in our unit. Material and method: We performed a retrospective study. The medical records of 50 patients who received iontophoresis in 2005 and who met the inclusion and exclusion criteria were analyzed. The analgesic effectiveness of treatment was evaluated through a visual analog scale (VAS) at the beginning and end of treatment. To evaluate the technique, the pre-treatment and post-treatment means of VAS scores were calculated with 95% confidence intervals and the results were compared. Student’s t-test was used to evaluate the consistency of the data (the SPSS v. 13.1 statistical package was used). Results: Evaluation of the consistency of the data by comparing pre-treatment and posttreatment VAS results through Student’s t-test for paired data showed that treatment with iontophoresis produced statistically significant reductions in VAS scores for the following entities: osteoarthritis (pretreatment mean ± standard deviation 7.28 ± 1.69,post-treatment mean ± standard deviation 4.80 ± 2.64) and carpel tunnel syndrome(pretreatment mean ± standard deviation 7.57 ± 0.83, post-treatment mean ± standard deviation 6.35 + 0.74). Conclusions: Iontophoresis seems to be an appropriate and highly safe technique for the treatment of chronic pain in diseases such as osteoarthritis and carpel tunnel syndrome (AU)

Induction of estrus and ovulation: why some mares respond and others do not.

The two most common procedures for breeding management of mares involve induction of luteolysis and induction of ovulation. Although both of these events are usually achieved, physiologic conditions affect the timing of the response. In a diestrus mare treated with prostaglandin F(2alpha) (PGF), or a PGF analogue, it is well documented that, on average, the interval from treatment to the onset of estrus is 3-4 days, whereas ovulation occurs 8-10 days after treatment. However, the diameter of the ovulatory follicle, as well as its status at the time of PGF treatment, determines the intervals from treatment to onset of estrus and to ovulation; these intervals can range from 48h to 12 days. Ovulation is routinely induced with human chorionic gonadotropin (hCG), recombinant LH (rLH), or the GnRH analogue Deslorelin. On average, ovulation occurs approximately 36h after treatment, but the effectiveness of any of these treatments can be affected by the stage of the estrus cycle, follicle size and maturity.

Empleo de la ecografía en el manejo de llenado de una bomba de infusión interna. A propósito de un caso / No disponible

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