Descripción de la Cronología del Dolor de las Contracciones Uterinas para Analgesia del Trabajo de Parto, una tarea pendiente / Description of the chronology of the pain of uterine contractions for analgesia of labor, a pending task

Propósito: Describir la periodicidad del momento de máxima intensidad del dolor de las contracciones uterinas (CUs) durante el trabajo de parto (TDP) para eventualmente permitir el desarrollo de nuevos modelos de administración de analgesia endovenosa. Material y método: Embarazadas de término en TDP, reclutadas desde marzo 2014 por 18 meses, de manera no probabilística consecutiva. Se obtuvo el momento de máximo dolor por autoreporte de las pacientes con cronómetros, previa capacitación. Análisis: Regresión para medidas repetidas de efectos mixtos a los 3-5, 6-7 y 8-10cm de dilatación. La variable respuesta es el intervalo de tiempo desde el momento de máximo dolor de la CU basal al de la contracción siguiente. Resultados: En 64 pacientes, se obtuvo 5 intervalos de tiempo. Para la dilatación de 3-5cm una mediana=140.92 segundos y los coeficientes de regresión (CR) en 4 intervalos de tiempo con respecto al basal de 4.2, 15.9, -2.7 y -5.8 segundos. Para 67cm una mediana=131.16 seg y CR 13.4, 11.3, 2 y -10 seg. Para 8-10cm una mediana=129.3 seg y CR -6.7, 0.49, -2.5 y -7.7 seg. No hubo diferencias significativas entre los coeficientes de regresión. Conclusiones: Con los datos obtenidos podemos señalar que no hubo diferencias estadísticas significativas entre los intervalos de tiempo de los momentos de máximo dolor durante el TDP en fase activa. Esta información es relevante para apoyar el desarrollo de un modelo predictivo del dolor.

Aim: To describe the timing of the moment of maximum intensity of uterine contraction (UC) pain in labor to possibly enable the development of new models for administering endovenous analgesia. Materials and Methods: Full-term pregnant women in labor, recruited from March 2014 for 18 months, using consecutive nonprobability sampling. The moment of maximum pain was ascertained as self-reported by patients previously trained with chronometers. Analysis: Regression for repeated measurements from mixed results at 3-5, 6-7 and 8-10cm of dilation. The response variable was the time interval from the moment of maximum pain of the baseline UC to the following contraction. Results: In 64 patients, 5 time intervals were obtained. For the dilation of 3-5cm, a median=140.92 seconds and regression coefficients (RC) in 4 time intervals relative to the baseline of 4.2, 15.9, -2.7 and -5.8 seconds. For 6-7cm, a median =131.16 sec and RC 13.4, 11.3, 2 and -10 sec. For 8-10cm, a median =129.3 sec and RC -6.7, 0.49, -2.5 and -7.7 sec. There were no significant differences among the regression coefficients. Conclusions: With the data collected we can report that there were no statistically significant differences between the time intervals of the moments of maximum pain during active labor. This information is relevant to support the development of a predictive model for this pain.

Iloperidone – A Newer Antipsychotic.

The optimal treatment of schizophrenia poses a challenge to develop more effective treatments and safer drugs, to overcome poor compliance, discontinuation and frequent switching with available antipsychotics. Iloperidone is a new antipsychotic developed to overcome some of the limitations in the drug treatment of schizophrenia. It has been approved by regulating agencies for use in treatment of adult schizophrenia.

Effect of pitavastatin in different SLCO1B1 backgrounds on repaglinide pharmacokinetics and pharmacodynamics in healthy Chinese males

The effect of pitavastatin and SLCO1B1 genetic background on the pharmacokinetic and pharmacodynamic properties of repaglinide was investigated. In this randomized, placebo-controlled, crossover study, twelve healthy Chinese males were administered with pitavastatin 4 mg/d or the placebo for 5 d followed by repaglinide 4 mg given orally on d 5. Plasma repaglinide and glucose levels were measured by liquid chromatography-tandem mass spectrometry [LC/MS/MS] and the glucose oxidase method, respectively. Treatment with pitavastatin significantly increased the peak plasma concentration [C[max]] of repaglinide [P=0.003] in SLCO1B1[asterisk]1b homozygotes [P=0.015] and SLCO1B1[asterisk]15 carriers [P=0.031]. Treatment with pitavastatin led to a marginal increase in the area under plasma concentration-time curve from 0 h to infinity [AUC[0][rightwards arrow][infinity]] of repaglinide [P=0.091]. There was no significant difference in pharmacokinetic parameters or hypoglycemic effects of repaglinide among SLCO1B1 genotypes in either the pitavastatin or control group. Pitavastatin increased the C[max] of the plasma concentration of repaglinide in an SLCO1B1 genotype dependent manner, but had no apparent effect on the pharmacodynamics of repaglinide in healthy volunteers. The p values for this statement were not reported

Remifentanil in critically ill cardiac patients.

Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal). In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.

Tissue distribution & elimination of capsaicin, piperine & curcumin following oral intake in rats.

Background & objectives: Curcumin, capsaicin and piperine - the bioactive compounds present in spices-turmeric (Curcuma longa), red pepper (Capsicum annuum) and black pepper (Piper nigrum) respectively, have a considerable portion of structural homology. Tissue distribution and elimination of these three structurally similar bioactive compounds was examined following their oral intake in rats. Methods: Separate sets of animals (150 - 160 g) were orally administered the three spice principles at dosages of 30 mg (capsaicin), 170 mg (piperine) and 500 mg (curcumin) / kg body weight. The tissue concentrations of administered spice compounds were determined by HPLC. Results: Maximum distribution of 24.4 per cent of administered capsaicin was seen at 1 h, while no intact capsaicin was detectable after 4 days. Absorption of capsaicin was about 94 per cent and very rapid relative to other two compounds. A maximum of 10.8 per cent of administered piperine was seen in tissues at 6 h. Absorption of the administered piperine was about 96 per cent. Curcumin concentration was maximum in the intestine at 1 h; maximum in blood at 6 h and remained at significantly higher level even at 24 h. About 63.5 per cent of the curcumin dose was absorbed. Only a small portion of the administered dose of capsaicin (< 0.1%) and curcumin (0.173 %) was excreted in urine, whereas piperine was not detectable in urine. Enhanced bioavailability of curcumin was evidenced when the same was orally administered concomitant with piperine. Intestinal absorption of curcumin was relatively higher when administered concomitantly with piperine, and it stayed significantly longer in the body tissues. Intact curcumin was detected in brain at 24, 48 and 96 h with a maximum at 48 h. Conclusions: Considerable difference exists in the bioavailability of the three test compounds. Curcumin could be traced in the brain following its administration. Bioavailability of curcumin can be improved by co-administration with piperine.