Electroencephalography Signatures for Conditioned Pain Modulation and Pain Perception in Nonspecific Chronic Low Back Pain-An Exploratory Study.

Conditioned pain modulation (CPM) can discriminate between healthy and chronic pain patients. However, its relationship with neurophysiological pain mechanisms is poorly understood. Brain oscillations measured by electroencephalography (EEG) might help gain insight into this complex relationship. OBJECTIVE: To investigate the relationship between CPM response and self-reported pain intensity in non-specific chronic low back pain (NSCLBP) and explore respective EEG signatures associated to these mechanisms. DESIGN: Cross-sectional analysis. PARTICIPANTS: Thirty NSCLBP patients participated. METHODS: Self-reported low back pain, questionnaires, mood scales, CPM (static and dynamic quantitative sensory tests), and resting surface EEG data were collected and analyzed. Linear regression models were used for statistical analysis. RESULTS: CPM was not significantly correlated with self-reported pain intensity scores. Relative power of EEG in the beta and high beta bands as recorded from the frontal, central, and parietal cortical areas were significantly associated with CPM. EEG relative power at delta and theta bands as recorded from the central area were significantly correlated with self-reported pain intensity scores while controlling for self-reported depression. CONCLUSIONS: Faster EEG frequencies recorded from pain perception areas may provide a signature of a potential cortical compensation caused by chronic pain states. Slower EEG frequencies may have a critical role in abnormal pain processing.

A fast, cost-saving and sensitive method for determination of cefuroxime in plasma by HPLC with ultraviolet detection.

Cefuroxime (CFX) is a broad-spectrum second-generation cephalosporin and one of the best choices for antibiotic prophylaxis. However, when used in critically ill patients, it may present changes in its pharmacokinetic properties. Therefore, therapeutic drug monitoring of CFX is necessary for effective dosing strategies. A simple, rapid and sensitive liquid chromatographic method with UV detection was developed and validated for the quantification of CFX in plasma. The method involved a single-step precipitation of proteins with methanol and trifluoroacetic acid. Cefuroxime was analyzed on a Brisa LC2 C18 column in isocratic mode consisting of 0.1% trifluoroacetic acid in water and acetonitrile (75:25) with UV detection at a wavelength of 280 nm. The retention times of CFX and cephazolin (internal standard) were 9.8 and 7.4 min, respectively. The calibration curve was linear over a concentration range of 0.25-50 µg/ml. The limits of detection and quantification were 0.1 µg/ml and 0.25 µg/ml, respectively. The accuracy and precision were always <10%. The mean recovery was 93.52%. This fast and simple method could be applied in routine analysis and pharmacokinetic studies.

Effect of recombinant human nerve growth factor treatment on corneal nerve regeneration in patients with neurotrophic keratopathy.

Introduction: Neurotrophic Keratopathy (NK) is a neurodegenerative corneal disease that results in diminished corneal sensation. Previous studies have found that Cenegermin 0.002%, a recombinant human nerve growth factor (rhNGF), improves corneal epithelial healing in stage 2 and 3 NK patients. However, rhNGF effect on corneal sensation and nerve regeneration has not been well established. Thus, this study aims to analyze the effect of rhNGF on corneal nerve regeneration using in vivo confocal microscopy (IVCM) and on corneal sensitivity in NK patients. Methods: This is a retrospective, longitudinal, case-control study that included patients with NK, treated with rhNGF for at least 4 weeks, with pre- and post-treatment IVCM images available for analysis. Chart reviews were conducted documenting prior medical and surgical history, clinical signs and symptoms, and corneal sensation using Cochet-Bonnet esthesiometry. Corneal nerve parameters were assessed by IVCM. Sex- and age-matched reference controls were selected from a database of healthy subjects for comparison. Results: The study included 25 patients, with 22 (88%) stage 1, two (8%) stage 2, and 1 (4%) stage 3 NK patients, with a median age of 64 years (range: 30-93 years). Total, main, and branch nerve densities [median (range) in mm/mm2] were lower in the NK group pre-treatment [2.3 (0.0-21.1); 1.7 (0.0-13.0); 0.5 (0.0-10.2); respectively] vs. controls [22.3 (14.9-29.0); 10.1 (3.2-15.4); and 12.1 (6.2-18.4), (p < 0.0001 for all), respectively]. Post-treatment nerve densities increased compared to pre-treatment to 5.3 (0.0-19.4, p = 0.0083) for total, 3.5 (0.0-13.2, p = 0.0059) for main, and 2.0 (0.0-10.4, p = 0.0251) for branch nerves, but remained lower than controls (p < 0.0001 for all). Corneal sensation increased from 2.3 ± 1.1 cm pre-treatment to 4.1 ± 1.4 cm post-treatment (p = 0.001). Median best corrected visual acuity significantly increased following rhNGF treatment from 0.4 (0.0-1.6) to 0.12 (-0.1 to 1.6) (p = 0.007). Conclusion: Patients with NK treated with at least 4 weeks of rhNGF, showed a significant increase in corneal nerve densities after treatment. A significant increase in corneal sensation, as well as best corrected visual acuity, was observed following treatment.

Long-Term Survival After Implantable Cardiac Defibrillator Therapy According to Sex: A Propensity Matched Study.

Background: Whether the sex factor influences the benefit of the implantable cardioverter-defibrillator (ICD) for the prevention of sudden death remains a subject of debate. Using a prospective registry, we sought to analyze the survival and time to first ICD therapy according to sex. Materials and Methods: Retrospective analysis of a prospective cohort of patients undergoing an ICD implant from 2008 to 2019. Data about time to first appropriate therapy, type of therapy administered, and incidence and causes of mortality were collected. Results: Among 756 ICD patients, 150 (19.8%) were women. Women were younger (51 ± 15 years vs. 61 ± 14 years; p < 0.001) and showed a lower rate of ischemic cardiomyopathy (23% vs. 54%; p < 0.001) and atrial fibrillation (12% vs. 19%; p = 0.05). Women had higher left ventricular ejection fraction (39% ± 17% vs. 35% ± 13%) and showed more frequently left bundle branch block (39% vs. 28%, p = 0.027). The rate of primary prevention (68% vs. 59.6%; p = 0.058) and cardiac resynchronization therapy (27% vs. 19%, p = 0.02) were higher in women. After a median follow-up of 46 months (3382 patient-years), the incidence of both the primary combined endpoint of mortality/transplant (20% vs. 29%; logrank = 0.031) and ICD therapies (27% vs. 34%; p = 0.138) were lower in women. According to the propensity score-matching analysis, no differences were observed between both sexes with respect to the incidence of mortality/transplant (24.8% vs. 28.6%; logrank = 0.88), ICD therapies (28% vs. 27%; logrank = 0.17), and main cause of death (heart failure [HF]). Conclusions: The clinical characteristics at the moment of ICD implant are different between sexes. After adjusting them, both sexes equally benefit from the ICD. HF is the main cause of mortality both in men and women.

Barriers and facilitators for clinical trial participation of underrepresented and non-underrepresented fibromyalgia patients: A cross-sectional internet survey.

BACKGROUND: There is a need of well-powered randomized clinical trials in fibromyalgia. However, challenges for recruitment are presented. This study aims to describe and assess the perception of barriers and facilitators and the associated factors for the participation of underrepresented and non-underrepresented fibromyalgia patients. METHODS: We performed an online survey through REDCap (Research Electronic Data Capture) targeting fibromyalgia patients from April 7 to July 3, 2020 during the COVID-19 stay home mandate and it was restricted to the United States of America. We described and compared the survey characteristics between underrepresented and non-underrepresented participants, and we performed logistic regression models to assess the associated factors with clinical trial participation. RESULTS: In total, 481 completed the survey including 168 underrepresented fibromyalgia patients. Only (1) 11.09 % reported previous participation in clinical trials and the significant perceived barriers were investigator-related (lack of friendliness of research staff and the opportunity to receive the results) and center-related (privacy and confidentiality policies, and the institution's reputation); (2) the participation rate and perceived barriers and facilitators were similar between underrepresented and non-underrepresented patients; and was positively associated with low income, higher age, and clinical trial awareness from their physician; and negatively associated with the perception of investigator-related barriers; and (4) for the underrepresented population, the presence of emotional support. CONCLUSION: Our findings suggest low rates of participation, regardless of underrepresented population status. Strategies as involving their physician as liaison to increase the awareness of clinical trials, as well as improving patient-researcher communication should be considered in this population.

[Pharmacoeconomic results of introducing antimicrobial prophylaxis in surgery at a university hospital]. / Resultados farmacoeconómicos de una intervención para implantar un programa de profilaxis antibiótica quirúrgica en un hospital universitario.

OBJECTIVES: The introduction of antimicrobial prophylaxis in surgery was designed and pre-intervention (controls) and post-intervention (cases) evaluations were carried out at a university tertiary hospital. PATIENTS AND METHOD: Prospective recording of information on prophylaxis in all patients undergoing non-emergency abdominal surgery was analysed during a 3-week period before and after implementing an antimicrobial prophylaxis program. Adequacy of prophylaxis was defined as prescription of antibiotics (type, dose and duration of treatment) according to the Guidelines. RESULTS: In the pre-intervention study: included 36 patients; prophylaxis was inadequate in all patients (long-term in 22 cases; antibiotic class and long-term in 2 cases; antibiotic class, dose and long-term in 12 cases); mean duration of prophylaxis was 6 days (range 1 to 10 days); mean antibiotic cost per patient was 77 euro (range 9 to 412 euro); overall antibiotic cost for the 36 patients was 2770 euro. In the post-intervention study: included 37 patients: prophylaxis was inadequate in 11 patients (long-term in 10 cases; antibiotic class and long-term in 1 case); mean duration of prophylaxis was 2 days (range 1 to 9 days); mean antibiotic cost per patient was 16 euro (range 2 to 78 euro); overall antibiotic cost for the 37 patients was 593 euro. In the pre-intervention period antibiotic cost was 38 times higher than expected. In the post-intervention period it was 1.6 times higher than expected. CONCLUSIONS: The most common reason of prophylaxis inadequacy is prolonged antibiotic treatment. A multidisciplinary intervention that comprises infectious diseases, surgical and pharmacy departments improves prophylaxis prescribing practice and avoids erroneous prescribing of antibiotics with both microbiological and economical cost savings.

[Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?]. / Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.

Epidemiologia de cáncer de ovario en el Hospital Nacional Guillermo Almenara Irigoyen entre enero 2007 y diciembre 2011 / Ovarian cancer epidemiology at the National Hospital Guillermo Almenara Irigoyen between January 2007 and December 2011

OBJETIVO: Conocer la prevalencia, incidencia hospitalaria y epidemiologia del cáncer de ovario en el HNGAI entre enero 2007 y diciembre 2011. PACIENTES Y MÉTODO: Estudio retrospectivo, descriptivo, transversal, epidemiológico de 46 pacientes con tumoraciones malignas de ovario atendidas entre 2007 y 2011 con expedientes completos. RESULTADOS: Los resultados mostraron que la mayor incidencia de Cáncer de Ovario fue entre las edades de 51 y 60 años, asimismo el Adenocarcinoma fue el tipo de neoplasia que se encontró con mayor frecuencia, siendo el subtipo cistoadenocarcinoma mucinoso el más común. En cuanto a los exámenes auxiliares para la ayuda diagnóstica, la ecografía y tomografía pudieron discernir entre maligno y benigno en la mayoría de los casos. (Figura 10 y 11) La mayoría de las pacientes permanecieron entre 6-10 días hospitalizadas luego de la cirugía. El promedio de tiempo operatorio fue entre 2 a 3 horas. En la mayoría de los casos, el resultado anatomopatologico del tumor extraído durante la cirugía estuvo disponible dentro del día de la operación.CONCLUSIONES: Se observó dos picos de edades más frecuentes relacionadas al cáncer de ovario, entre: 10-20 años y 51-60 años. La menarquía temprana no constituyo un factor de riesgo para cáncer de ovario. De todos los casos revisados, no se encontró antecedentes personales ni familiares de cáncer de ovario. Se observó que las complicaciones intraoperatorias y post operatorias fueron muy escasas. El tiempo de hospitalización fue en promedio entre 6-10 días. El tiempo operatorio promedio fue entre 2-3 horas. El resultado anatomopatologico del tumor de ovario fue determinado con mayor frecuencia dentro del día de la cirugía.

OBJETIVE: Determine the prevalence, incidence and epidemiology of ovarian cancer in HNGAI between January 2007 and December 2011. PATIENTS AND METHODS: Retrospective, descriptive, transversal, epidemiological study of 46 patients with ovarian malignancies treated between 2007 and 2011 with complete records. RESULTS: Results showed that the highest incidence of ovarian cancer is between ages 51-60, and adenocarcinoma was the most frequent histological type, subtype mucinous cystadenocarcinoma being the most common. Respecting auxiliary exams for diagnostic help, ultrasound and CT scan could differentiate between malignity and benignity in most cases. (Figures 10 and 11). Most patients were hospitalized between 6-10 days after surgery. The average operating time was between 2 to 3 hours. In most cases, the histopathology of the tumor removed during surgery was available in a day or less of the operation date. CONCLUSIONS: Two peaks were observed for relationship between age and ovarian cancer: 10-20 years old and 51-60 years old. Early menarche did not constitute a risk factor for ovarian cancer. From all reviewed cases, we didnÆt find personal or family history related to ovarian cancer. Intraoperative and postoperative complications were rare. The length of hospital stay was on average between 6-10 days. Mean operative time was between 2-3 hours. The pathology of the ovarian tumor was identified most frequently in the day of surgery.

Adherence to aspirin in secondary prevention of ischemic stroke.

OBJECTIVE: Compliance with antiplatelet therapy is essential for the efficiency of secondary prevention of ischemic stroke. The objective of this study was to evaluate adherence to aspirin treatment in patients with ischemic stroke. PATIENTS AND METHODS: We studied outpatients of 5 neurological ambulatory centers in an urban city, Valencia, all with a history of ischemic stroke who had received aspirin for at least 6 months. A personal interview was carried out in all cases, during which the patients were questioned about adherence to treatment. Platelet thromboxane A2 synthesis was assessed in a single laboratory for the biochemical determination in all patients. RESULTS: A total of 73 patients (mean age 67) were studied, with a mean duration of aspirin therapy of 25.4 months (range 6-144 months). Sixty-six patients (90.4%) were included in laboratory tests. All showed inhibition of thromboxane A2 synthesis, consistent with adherence to treatment. CONCLUSIONS: Aspirin compliance was found to be excellent. All the patients who presented themselves for laboratory tests were taking aspirin. Even if the patients who failed to show up for laboratory testing are regarded as noncompliants, at least 90% of all patients were compliants--in agreement with the findings of the recent literature. Personal interview plus biochemical determination of platelet thromboxane A2 synthesis seem adequate for assessing adherence to aspirin.

Precisa el síndrome Tako-Tsubo una anatomía coronaria en la región apical como sustrato predisponente? / Does the Tako-Tsubo syndrome need a certain coronary anatomy in the apical ventricular region as predisposing factor?

The Tako-Tsubo transient left ventricular apical ballooning was born as a clinical profile in the year 2001. This syndrome occurs mainly in women older than 60 years and it is frequently preceded by a physical or emotional stress. Its presentation simulates a myocardial infarction, although with some differences: the pain is not always typical, and its intensity is moderate. The electrocardiogram reveals an elevation of ST in the anterior face in 90% of the cases; from the second day on, negative T waves in V2 through V6 leads are present, along with prolongation of the QTc interval. Enzymes are poorly elevated as expected from the electrical alterations. The alteration that defines the syndrome is the hypokinesis or akinesis of the apical segments with hyperkinesis of the basal ones. The main uncertainty of the Tako-Tsubo syndrome is its pathogenesis, its elucidation will provide advances in the practical handling of this syndrome2. We present the clinical case of a patient with this syndrome and a review of the existing medical literature on the possible association with a predisposing coronary anatomy in the apical segment.

Resultados farmacoeconómicos de una intervención para implantar un programa de profilaxis antibiótica quirúrgica en un hospital universitario / Pharmacoeconomic results of introducing antimicrobial prophylaxis in surgery at a university hospital

Objetivo. La eficacia de un programa de profilaxis preoperatoria está claramente documentada. Evaluamos la repercusión económica de la adecuada prescripción de antibióticos preoperatorios. Pacientes y método. Intervención para implantar un protocolo de profilaxis antibiótica preoperatoria(PAP). Recogimos de forma prospectiva la información al respecto correspondiente a todos los pacientes intervenidos por el servicio de cirugía general y digestiva de forma programada, en una fase previa a la implantación del PAP (P1) y en una fase posterior(P2). Se consideró que el cumplimiento era correcto cuando lo era la profilaxis antibiótica (PA) (fármaco concreto, dosis y duración).Resultados. En la P1 (n = 36) la PA fue inadecuada en todos los pacientes; coste medio de la PA por paciente,77 (9-412) euros; coste total, 2.770 euros. En laP2 (n = 37) la PA fue inadecuada en 11 pacientes; coste medio de la PA por paciente, 16 (2-78) euros; coste total, 593 euros. En la P1 el coste total de la prescripción antibiótica fue 38 veces mayor que lo esperado; en la P2 tan sólo fue 1,6 veces mayor que lo estipulado según el PAP. Conclusiones. La causa más frecuente de inadecuación en la profilaxis preoperatoria es alargar el tratamiento con antimicrobianos. Una intervención multidisciplinaria (servicio de enfermedades infecciosas, cirugía y farmacia) para implantar la prescripción de antibióticos preoperatorios según un PAP mejora los índices de cumplimiento del protocolo y evita la prescripción errónea de antibióticos, con el consiguiente ahorro en términos de coste económico y microbiológico (AU)

Objectives. The introduction of antimicrobial prophylaxis in surgery was designed and pre-intervention(controls) and post-intervention (cases) evaluations were carried out at a university tertiary hospital. Patients and method. Prospective recording of information on prophylaxis in all patients undergoing on-emergency abdominal surgery was analysed during a 3-week period before and after implementing an antimicrobial prophylaxis program. Adequacy of prophylaxis was defined as prescription of antibiotics(type, dose and duration of treatment) according to the Guidelines. Results. In the pre-intervention study: included36 patients; prophylaxis was inadequate in all patients(long-term in 22 cases; antibiotic class and long-term in 2 cases; antibiotic class, dose and long-term in 12 cases); mean duration of prophylaxis was6 days (range 1 to 10 days); mean antibiotic cost per patient was 77 euro (range 9 to 412 euro); overall antibiotic cost for the 36 patients was 2770 euro. In the post-intervention study: included 37 patients: prophylaxis was inadequate in 11 patients (long-term in 10cases; antibiotic class and long-term in 1 case);mean duration of prophylaxis was 2 days (range 1 to9 days); mean antibiotic cost per patient was 16 euro(range 2 to 78 euro); overall antibiotic cost for the 37patients was 593 euro. In the pre-intervention period antibiotic cost was 38 times higher than expected. In the post-intervention period it was 1.6 times higher than expected. Conclusions. The most common reason of prophylaxis inadequacy is prolonged antibiotic treatment. A multidisciplinary intervention that comprises infectious diseases, surgical and pharmacy departments improves prophylaxis prescribing practice and avoids erroneous prescribing of antibiotics with both microbiological and economical cost savings (AU)