[Description of the hemodynamic and respiratory effects of hemoperfusion treatment with polymyxin B in patients with abdominal septic shock]

The objective of this study is to describe the hemodynamic effects, inotropic and vasoactive drug dependence, and to analyze the PO2/FiO2 ratio in 13 patients with septic shock of abdominal origin after hemoperfusion treatment with polymyxin-B. Treatment with polymyxin hemoperfusion therapy is indicated for patients with severe sepsis/septic shock of abdominal origin who do not respond adequately to conventional therapy. Two complete cycles with polymyxin cartridge were performed on 11 of the 13 patients, and a single cycle on the other O2. After treatment, the mean airway pressure (MAP) was increased (P=.003), the need for norepinephrine decreased (P=.003), and the PO2/FiO2 ratio increased (P=.02). The use of polymyxin hemoperfusion in patients with septic shock of intra-abdominal origin can significantly improve hemodynamic and respiratory functions.

Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring

We evaluated a telemedicine system in patients with type 1 diabetes who had optimized treatment with an insulin pump and a real-time continuous glucose monitoring system. We conducted a prospective, one-year study of 15 subjects. Three medical visits took place: pre-baseline, baseline and at 6 months. Each month the subjects transmitted information from the glucose meter, glucose sensor and insulin pump. We adjusted the treatment and returned the information by email. We evaluated psychological and metabolic variables, including HbA(1c), hypoglycaemia, hyperglycaemia and glucose variability. At baseline the mean age of the subjects was 40 years and the mean duration of diabetes was 22 years. There was a significant reduction in HbA(1c) (7.50 to 6.97%) at 6 months, a significant increase in the number of self-monitoring blood glucose checks per day (5.2 to 6.2), and significant improvements in variability: MODD, mean of daily difference (67 to 53) and MAGE, mean amplitude of glycaemic excursions (136 to 102). There were significant improvements in quality of life (92 to 87), satisfaction with the treatment (34 to 32) and less fear of hypoglycaemia (36 to 32). Adult subjects with type 1 diabetes on treatment with a continuous insulin infusion system and a real time glucose sensor and who have acceptable metabolic control and optimized treatment can benefit from the addition of a telemetry system to their usual outpatient follow-up.

[Evaluation of contractility and postloading in the intensive care unit]

Cardiovascular failure is a common disorder in critical care medicine. When admitted to the ICU, patients with hemodynamic deterioration should be examined rapidly to correctly assess the main determinants of cardiovascular function (preload, afterload and contractility). This review examines the assessment of contractility and afterload involving the combined use of several hemodynamic monitors, which allows different approaches to the same problem, with a view to improving the efficiency of management and treatment in critically ill patients.

Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method

Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades.

Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain.

Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias.

Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously.

Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.

Gene expression in IFNß signalling pathway differs between monocytes, CD4 and CD8 T cells from MS patients

IFNß exerts its activity through the interaction with IFNAR, through activation of the JAK/STAT pathway. We analyzed the changes in IFNAR1, IFNAR2, STAT1, STAT2, Tyk2, JAK1, IRF9 and MxA gene expressions after prolonged IFNß treatment, in isolated mononuclear-cell subpopulations from MS patients, by real time PCR. The effect of IFNß on gene expression differed depending on the subpopulation assessed. The data suggest that CD8+ T cells are the most influenced by prolonged IFNß therapy as IFNAR2, Tyk2, IRF9 and Jak1 expressions were decreased, whereas MxA expression was increased in these cells.

A prospective, open-label, multicentre study of pregabalin in the treatment of neuropathic pain in Latin America

AIMS

The objective of this study was to evaluate the safety and efficacy of pregabalin at flexible doses of 150-600 mg/day in Latin American patients with neuropathic pain.

METHODS

A prospective, multicentre, open-label, non-comparative study included patients age >or= 18 years diagnosed with neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, chemotherapy-induced peripheral neuropathic pain (PNP), or human immunodeficiency virus-related PNP. Eligible patients (N = 121) had a score of >or= 40 mm on the visual analogue scale and a daily pain rating scale (DPRS) score of >or= 4 throughout screening. Patients received flexible-dose pregabalin (150-600 mg/day) for 12 weeks, which included a 4-week dose-adjustment phase. The primary efficacy measure was change from baseline to end of treatment/last observation carried forward (EOT/LOCF) in weekly mean pain score on the DPRS. Secondary efficacy measures included pain, anxiety, sleep interference, treatment satisfaction and Patient and Clinician Global Impression of Change.

RESULTS

Pregabalin significantly reduced the weekly mean pain score on DPRS from baseline to EOT/LOCF [-3.8 (95% CI: -4.2 to -3.3); p < 0.0001]. Reductions from baseline to EOT/LOCF were observed for all secondary efficacy outcomes (p < 0.0001). Pain and sleep interference were significantly improved compared with baseline across all weeks of the study, as early as 1 week after initiation of pregabalin (p < 0.0001). The most common adverse events (AEs) were somnolence, dizziness, weight gain and peripheral oedema. Nine (7.4%) patients discontinued the study because of AEs and 25 (20.7%) temporarily stopped or reduced their pregabalin dose because of AEs.

CONCLUSIONS

Flexible-dose pregabalin (150-600 mg/day) significantly reduced pain and anxiety and improved sleep and was generally well tolerated in Latin American patients with neuropathic pain.

[Assessment of the efficiency of the clinical management of neuropathic pain in specialist clinics compared to general clinics in neurology health care units in Spain]

OBJECTIVES

To analyse the cost-consequences of chronic neuropathic pain (NeP) outpatients care comparing management in general clinics (GC) versus specialised pain clinics (SPC) in neurology settings in Spain.

METHODS

A 6-month retrospective, cross-sectional, comparative observational study including NeP subjects was designed. Sociodemographics and clinical characteristics of subjects along with pain-related healthcare and non healthcare resources utilization were recorded. Lost-work-days equivalent missed as a consequence of pain were also collected to compute indirect costs. Costs to society were calculated in euros for the year 2008. Severity and interference of pain were used for the main effectiveness evaluation.

RESULTS

A total of 234 patients (53% in SPC), 56.8% women, and 59.3+/-14.7 years were included. Patients were allocated according to usual administrative procedures in each participant centre, consecutively and independently of the diagnosis and clinical status of patients. Yearly indirect costs were euro1,299+/-2,804 in SPC compared to euro1,483+/-3,452 in GC (p=0.660), while annual direct costs were, euro2,911+/-3,335 and euro3,563+/-4,797, respectively (p=0.239), with total costs of euro4,210+/-4,654 and euro5,060+/-6,250, respectively (p=0.249). Mean pain severity at the time of evaluation was 3.8+/-2.3 in subjects in SPC vs. 5.2+/-2 in GC (p<0.001), while the average interference of pain on daily activities were 3.3+/-2 and 4.7+/-2.5, respectively (p<0.001).

CONCLUSIONS

In neurology settings in Spain, the outpatient clinical management of chronic NeP in SPC was a dominant alternative compared with GC healthcare, since it has shown better patients healthcare outcomes with less severity and interference of pain on daily activities, while maintaining a similar level of costs. These results could help health decision makers when planning the use of health care resources.