Phenolic compounds and antioxidant activity in Cucurbita ficifolia fruits, an underrated fruit.

The fruits and seeds of Cucurbita ficifolia Bouché are sources of minerals, vitamins, and functional compounds with nutraceutical and preventive potential against cardiovascular diseases and diseases derived from eating disorders. C. ficifolia is native from Mesoamerica and is currently cultivated in temperate zones from Mexico to South America and Asia. This study evaluated the fruit mesocarps of C. ficifolia for physicochemical parameters, antioxidant activity, and phenolic compound contents in a collection of farmers' landraces. Germplasm is cultivated by traditional farmers in the temperate zones of two municipalities from Oaxaca, Mexico. The results show that the content of soluble solid contents (SSC), pH, total sugars (TS), and flavonoids are influenced by the fruit geographical origin (municipalities) and implicitly by their agroecological cultivation conditions (Huamelúlpam: SSC = 6.22 °Brix, pH = 5.44, TS = 0.52 mg G g-1, flavonoids = 1.24 mg CE g-1; Yanhuitlán: SSC = 6.69, pH = 5.33, TS = 0.55, flavonoids = 1.30). Among populations preserved by traditional farmers, significant differences, and wide variability were found for all parameters evaluated (Huamelúlpam: SSC = 4.9-7.3, pH = 5.5-5.8, TS = 0.4-0.7, protein = 5.8-11.4, polyphenols = 1.9-4.8, flavonoids = 1.0-1.5, DPPH = 4.3-10.6, and FRAP = 4.8-11.8; Yanhuitlán: SSC = 4.3-8.9, pH = 4.8-5.6, TS = 0.4-0.7, protein = 5.0-15.3, polyphenols = 1.9-4.9, flavonoids = 0.8-1.9, DPPH = 5.3-10.5, and FRAP = 4.5-12.6). Eight compounds were identified by UPLC-MS: L-phenylalanine, an amino acid that is regularly associated with proteins; vanillin, a phenolic aldehyde with its functional groups including aldehyde, hydroxyl, and ether; and six phenolic acids: 4-hydroxybenzoic acid, 4-hydroxyphenylacetic acid, vanillic acid, 4-coumaric acid, ferulic acid, and salicylic acid, all with potential health effects. The C. ficifolia fruit mesocarp has bioactive compounds with high antioxidant activity with the potential to both improve diet and to obtain other benefits against nontransmissible diseases derived from food and its associated risk factors.

Diagnósticos Enfermeros prevalentes en pacientes mayores con úlceras por presión: estudio transversal / Prevalent nursing diagnoses in elderly with pressure ulcers: cross-sectional study / Diagnósticos Enfermeiros prevalentes em pacientes idosos com úlceras por pressão: estudo transversal

Resumen Objetivo Determinar la prevalencia de los diagnósticos enfermeros en pacientes adultos mayores hospitalizados con úlceras por presión e identificar los diagnósticos enfermeros reales, potenciales, de salud y síndrome por patrón funcional de salud. Material y métodos Estudio Transversal, descriptivo conformado por una muestra de pacientes adultos mayores hospitalizados en diferentes servicios de un Hospital de Acapulco, Guerrero, México. Para su evaluación, se diseñó un instrumento de acuerdo con los patrones funcionales de Marjory Gordon. Se utilizó la plataforma de mejores prácticas de enfermería E-cuidados® para el análisis. Resultados El presente estudio identificó 36 diagnósticos relevantes, de los cuales 23 (63.9 %) fueron diagnósticos centrados en el problema, 10 (27.8 %) diagnósticos de riesgo y 3 (8.3 %) de promoción a la salud. Los patrones funcionales más afectados son; Actividad-Ejercicio, Nutricional-Metabólico y Valores-Creencias. Conclusiones El presente estudio ayuda a enfatizar la importancia de adoptar estrategias preventivas y de atención integral, así como la mejora de la planificación de la atención para evitar el deterioro de las condiciones en los pacientes adultos mayores.

Abstract Objective To determine the prevalence of diverse nursing diagnostics in hospitalized older patients with pressure ulcers, identifying the real, potential, and health-related ones, as well as syndrome by health functional pattern. Methods and material This is a transversal and descriptive study with a sample of older patients in different services in a hospital of Acapulco, Guerrero, Mexico. An assessment instrument was designed following the Functional Patterns of Marjory Gordon. The E-cuidados® best nursing practices platform was used for the analysis. Results 36 relevant diagnostics were identified: 23 (63.9 %) were problem-centered; 10 (27.8 %) were risk related; and 3 (8.3 %) were health promoting. The most affected functional patterns were: Activity-Exercise; Nutrition-Metabolism; and Values-Beliefs. Conclusions This study supports the need to highlight the importance of adopting preventive and integral attention strategies, as well as improving the attention planning process in order to avoid the deterioration of health conditions of older patients.

Resumo Objetivo Determinar a prevalência dos diagnósticos enfermeiros em pacientes idosos hospitalizados com úlceras por pressão e identificar os diagnósticos enfermeiros reais, potenciais, de saúde e síndrome por padrão funcional de saúde. Material e métodos Estudo Transversal, descritivo conformado por uma amostra de pacientes idosos hospitalizados em diferentes serviços de um Hospital de Acapulco, Guerrero, México. Para sua avaliação, desenhou-se um instrumento conforme com os padrões funcionais de Marjory Gordon. Utilizou-se a plataforma de melhores práticas de enfermagem E-cuidados® para a análise. Resultados O presente estudo identificou 36 diagnósticos relevantes, dos quais 23 (63.9 %) foram diagnósticos centrados no problema, 10 (27.8 %) diagnósticos de risco e 3 (8.3 %) de promoção à saúde. Os padrões funcionais mais afetados são; Atividade-Exercício, Nutricional-Metabólico e Valores-Crenças. Conclusões O presente estudo ajuda a enfatizar a importância de adotar estratégias preventivas e de atenção integral, assim como a melhora da planificação da atenção para evitar a deterioração das condições nos pacientes idosos.

High-resolution HLA allele and haplotype frequencies in majority and minority populations of Costa Rica and Nicaragua: Differential admixture proportions in neighboring countries.

The HLA system shows the most extensive polymorphism in the human genome. Allelic and haplotypic frequencies of HLA genes vary dramatically across human populations. Due to a complex history of migration, populations in Latin America show a broad variety of admixture proportions, usually varying not only between countries, but also within countries. Knowledge of HLA allele and haplotype frequencies is essential for medical fields such as transplantation, but also serves as a means to assess genetic diversity and ancestry in human populations. Here, we have determined high-resolution HLA-A, -B, -C, and -DRB1 allele and haplotype frequencies in a sample of 713 healthy subjects from three Mestizo populations, one population of African descent, and Amerindians of five different groups from Costa Rica and Nicaragua and compared their profiles to a large set of indigenous populations from Iberia, Sub-Saharan Africa, and the Americas. Our results show a great degree of allelic and haplotypic diversity within and across these populations, with most extended haplotypes being private. Mestizo populations show alleles and haplotypes of putative European, Amerindian, and Sub-Saharan African origin, albeit with differential proportions. Despite some degree of gene flow, Amerindians and Afro-descendants show great similarity to other Amerindian and West African populations, respectively. This is the first comprehensive study reporting high-resolution HLA diversity in Central America, and its results will shed light into the genetic history of this region while also supporting the development of medical programs for organ and stem cell transplantation.

The effects of pastoral intensification on the feeding interactions of generalist predators in streams.

Land-use change can alter trophic interactions with wide-ranging functional consequences, yet the consequences for aquatic food webs have been little studied. In part, this may reflect the challenges of resolving the diets of aquatic organisms using classical gut contents analysis, especially for soft-bodied prey. We used next-generation sequencing to resolve prey use in nearly 400 individuals of two predatory invertebrates (the Caddisfly, Rhyacophila dorsalis, and the Stonefly Dinocras cephalotes) in streams draining land with increasingly intensive livestock farming. Rhyacophila dorsalis occurred in all streams, whereas D. cephalotes was restricted to low intensities, allowing us to test whether: (i) apparent sensitivity to agriculture in the latter species reflects a more specialized diet and (ii) diet in R. dorsalis varied between sites with and without D. cephalotes. DNA was extracted from dissected gut contents, amplified without blocking probes and sequenced using Ion Torrent technology. Both predators were generalists, consuming 30 prey taxa with a preference for taxa that were abundant in all streams or that increased with intensification. Where both predators were present, their diets were nearly identical, and R. dorsalis's diet was virtually unchanged in the absence of D. cephalotes. The loss of D. cephalotes from more intensive sites was probably due to physicochemical stressors, such as sedimentation, rather than to dietary specialization, although wider biotic factors (e.g., competition with other predatory taxa) could not be excluded. This study provides a uniquely detailed description of predator diets along a land-use intensity gradient, offering new insights into how anthropogenic stressors affect stream communities.

Novel alleles of the transforming growth factor ß-1 regulatory region and exon 1.

Transforming growth factor ß-1, encoded by the TGFB1 gene, is a cytokine that plays a central role in many physiologic and pathogenic processes with pleiotropic effects. Regulatory activity for this gene has been shown for 3.0 kb between positions -2665 and +423 from its translational start site. At least 17 TGFB1 regulatory region and exon 1 alleles have been defined on the basis of 18 polymorphic sites. Polymorphisms in TGFB1's regulatory region have been associated with differential levels of expression of this cytokine and to genetic risk in cancer and transplantation. In this report, we present 19 novel TGFB1 regulatory region and exon 1 alleles: p018-p036. Amplification of TGFB1's regulatory region was performed with an in-house protocol, and novel alleles were defined by either allele-specific amplification and/or molecular cloning of the amplicons, followed by sequencing in isolation. Three of these novel alleles (p018, p019, and p020) are shown to be formed by novel combinations of the aforementioned known polymorphic positions. Another 16 novel alleles are shown to carry additional known and unknown single-nucleotide polymorphisms. Polymorphism in TGFB1's regulatory region could have an impact on important processes, including embryogenesis, hematopoiesis, carcinogenesis, angiogenesis, fibrosis, immune responses, and transplantation, making its characterization necessary.

A novel HLA-A allele, A*74:23, identified in an individual from Costa Rica.

The new HLA-A*74:23 allele differs from the closest allele A*74:01 by a nucleotide change in exon 3 at codon 97.

Mood disturbance in glioma patients.

Patients diagnosed with primary brain tumors such as glioma experience psychological distress throughout the illness trajectory. Determining which patient characteristics are associated with more severe mood disturbance throughout the illness trajectory can help identify patients at risk and assist in developing targeted interventions based on these factors. Adult glioma patients were eligible for participation. Data collection tools included an investigator completed clinician assessment tool, patient completed demographic form and the Profile of mood states-short form. A multiple regression model was used to describe the relationship between the patient groups and clinical factors. The study enrolled 186 glioma patients of various tumor grades, who were categorized in three groups (newly diagnosed, on-treatment, follow-up) based on disease status at time of visit. Newly diagnosed patients experienced more total mood disturbance than all the other groups. Characteristics associated with more severe mood disturbance varied by patient group: newly diagnosed patients who were not on corticosteroids and were not married were more likely to have higher mood disturbance [R(2) = 0.27, F (2, 29) = 5.31, p < 0.02]. For those on treatment, the use of concomitant medications, having more than 1 recurrence and low income predicted higher mood disturbance [R(2) = 0.417, F (4, 67) = 11.98, p < 0.001]. For those not on active treatment, female sex, anti-depressant use and having a lower income was associated with higher mood disturbance [R(2) = 0.183, F (3, 55) = 4.11, p < 0.02]. Additionally, when compared to other cancer groups, glioma patients reported similar mood disturbance to those with breast cancer. Factors other than disease characteristics are associated with higher mood disturbance and vary according to current disease status. The use of concomitant medications, demographic factors, recurrence and income are associated with mood disturbance and interventions may need to be tailored to these underlying factors.

Transforming growth factor-ß1 polymorphisms and the outcome of hematopoietic stem cell transplantation.

Hematopoietic stem cell transplantation (HSCT) is a medical procedure used to treat malignant and nonmalignant haematological diseases, congenital immunodeficiency syndromes, solid tumours and metabolic diseases. Despite its usefulness, several major complications, such as graft-versus-host disease, can negatively affect patients treated with HSCT. Apart from clinical factors well known to affect the outcome of HSCT, patient and donor genetics have been shown to play an important role in the susceptibility to post-transplant complications. Histocompatibility as determined by the human leucocyte antigen (HLA) system has been a major genetic determinant of the success of HSCT. Non-HLA immunogenetics are increasingly recognized to play a part in the events related to transplantation. Cytokine genes, and their receptors, bear a considerable amount of polymorphism. One of the genes that may play an important role on the outcome of allogeneic HSCT is TGFB1, which encodes transforming growth factor, ßeta 1 (TGF-ß1). TGF-ß1 is a pleiotropic cytokine, which plays a central role in the development, homeostasis and responses of the immune system. Several functional polymorphisms in TGFB1 have been identified, and these are known to cause alterations in cytokine secretion in several settings. The present review will focus on the current knowledge surrounding the effect of polymorphisms within TGFB1 on the outcome of HSCT.

Prevalence and geographic distribution of haemophilia in Costa Rica.

Haemophilia is the most frequent hereditary haemorrhagic illness and it is due to the deficiency of coagulation factors VIII (haemophilia A, HA) or IX (haemophilia B, HB). The prevalence of this disease varies according to the country, those having better survival rates having also higher prevalences. Specifically in Costa Rica, there are around 130 HA and 30 HB families. This study reports the prevalence and a spatial distribution analysis of both types of the disease in this country. The prevalence of haemophilia in this country is 7 cases per 100000 men, for HA it is 6 cases per 100000 and for HB it is 1 case per 100000 male inhabitants. The prevalence of this disease is low when compared with other populations. This low prevalence could be due to the many patients that have died because of infection with human immunodeficiency virus during the 1980s. The prevalence of haemophilia in Costa Rica is almost one half of that present in developed countries. Nevertheless, the ratio between HA and HB follows world tendency: 5:1. In this study, nationwide geographical distribution maps were drawn in order to visualize the origin of severe cases and how this influences the pattern of distribution for both types of haemophilia. By means of these maps, it was possible to state that there is no association between the sites of maximum prevalence of mutated alleles and ethnicity. With this study, haemophilia prevalence distribution maps can be used to improve efforts for the establishment of hemophilia clinics or specialized health centers in those areas which hold the highest prevalences in this country. Also, this knowledge can be applied to improve treatment skills and offer the possibility of developing focused genetic counseling for these populations.

[Spanish physicians point of view on irritable bowel syndrome (IBS). Results of a Delphi survey]. / Opinión de los médicos españoles sobre el síndrome de intestino irritable: resultados de un estudio utilizando el método Delphi.

INTRODUCTION: lack of evidence in most clinical situations regarding irritable bowel syndrome (IBS) enhances the importance of an expert s opinion, which will guide management and even the concept underlying the disease. OBJECTIVE: to delve into the knowledge and degree of agreement on main clinical skills for this syndrome among physicians involved in its management. MATERIAL AND METHOD: two rounds of a Delphi survey were conducted on 100 physicians: general practitioners (GPs) and gastroenterologists. The questionnaire evaluated agreement among participants in some aspects regarding the definition, diagnosis, and treatment of IBS. RESULTS: fifty-five percent of participants completed the two-round survey. Agreement was achieved regarding the definition of typical symptoms and red flags characterizing IBS. Although there was no consensus regarding the appropriate management of patients without alarm symptoms, the performance of a colonoscopy on any patient presenting red flags was suggested. Patients were thought to require a wider examination when older than 40. A well defined line of IBS treatment was not found, albeit most physicians tended to choose it depending on the main complaint. CONCLUSION: interviewed physicians showed adequate theoretical knowledge of IBS, but lack of uniformity on diagnosis and treatment approach reflects the controversial day-by-day management of this syndrome.

Opinión de los médicos españoles sobre el síndrome de intestino irritable: resultados de un estudio utilizando el método Delphi / Spanish physicians’ point of view on irritable bowel syndrome (IBS). Results of a Delphi survey

Introducción: el síndrome del intestino irritable (SII) es una patología controvertida, donde ante la escasez de evidencia científica las recomendaciones sobre su manejo clínico y su definición vienen determinadas por métodos de consenso de expertos. Objetivo: obtener la opinión de los médicos de nuestro país implicados en el manejo de pacientes con SII y conocer los puntos de acuerdo en las principales cuestiones clínicas que plantea. Material y métodos: se realizó un estudio Delphi a nivel nacional mediante dos envíos a 100 médicos de atención primaria y gastroenterólogos. El cuestionario incluía preguntas sobre el concepto, diagnóstico y tratamiento del SII, evaluando el grado de acuerdo entre los participantes. Resultados: el 55% de los encuestados completó los dos envíos. Se obtuvo acuerdo respecto a los síntomas que caracterizan al SII y los de alarma. No existió una actitud clara ante el paciente sin síntomas de alarma, pero sí acuerdo respecto a la realización de colonoscopia en su presencia. Se señaló la necesidad de realizar estudios complementarios en mayores de 40 años. En el tratamiento no encontramos una actitud uniforme, aunque parece existir una orientación diferente según el síntoma predominante. Conclusiones: los médicos participantes en el estudio demuestran a través de sus respuestas un buen conocimiento conceptual del SII, si bien las discrepancias observadas en las cuestiones sobre diagnóstico y tratamiento demuestran la complejidad y falta de uniformidad que existe en el manejo diario de este síndrome

Introduction: lack of evidence in most clinical situations regarding irritable bowel syndrome (IBS) enhances the importance of an expert’s opinion, which will guide management and even the concept underlying the disease. Objective: to delve into the knowledge and degree of agreement on main clinical skills for this syndrome among physicians involved in its management. Material and method: two rounds of a Delphi survey were conducted on 100 physicians: general practitioners (GPs) and gastroenterologists. The questionnaire evaluated agreement among participants in some aspects regarding the definition, diagnosis, and treatment of IBS. Results: fifty-five percent of participants completed the tworound survey. Agreement was achieved regarding the definition of typical symptoms and red flags characterizing IBS. Although there was no consensus regarding the appropriate management of patients without alarm symptoms, the performance of a colonoscopy on any patient presenting red flags was suggested. Patients were thought to require a wider examination when older than 40. A well defined line of IBS treatment was not found, albeit most physicians tended to choose it depending on the main complaint. Conclusion: interviewed physicians showed adequate theoretical knowledge of IBS, but lack of uniformity on diagnosis and treatment approach reflects the controversial day-by-day management of this syndrome

Evaluación de la posible adulteración de mieles de abeja comerciales de origen costarricense al compararlas con mieles artesanales provenientes de apiarios específicos / Evaluation of the potential adulteration of commercial honey distributed in Costa Rica compared with artesanian honey samples coming from specific apiaries

Honey is the principal apiculture product, produced by Apis mellifera bee. This, as any other food product, has to accomplish certain quality standards, including physicochemical, organoleptic and microbiological properties. Within these parameters, different measures are considered as adulteration indicators, including hydroxymethylfurfural and diastase enzyme activity which are associated to overheating, and the sucrose, glucose and fructose content. In this study, a determination of previous parameters, additional to glucose, fructose and fructose/glucose index was performed to 35 artisan samples, obtained directly from beekeeper, previously characterized as having good productive practices and 25 commercial samples. Same time, the results obtained were compared and interpreted, in order to determine the kind of adulteration present in the honey sample. The 89% of artesian samples accomplished the parameters established by the Codex Alimentarius for HMF content, diastase activity, sucrose and simple sugars content. Nevertheless, only 20% (5) of the commercial samples accomplished the international and national normative. 24% of these samples presented succrose addition, 32% overheating or inverted sugar syrup addition, and 24% were adulterated with inverted sugar syrup.

La miel es el principal producto de la apicultura, generado por la abeja Apis mellifera. Éste, como cualquier producto alimenticio, debe cumplir con ciertas normas de calidad, propiedades fisicoquímicas, organolépticas y microbiológicas. Entre estos parámetros se encuentran el contenido de hidroximetilfurfural (HMF), indicador de adulteración, sobrecalentamiento y envejecimiento de la miel, la actividad de la enzima diastasa, indicador de sobrecalentamiento, y la determinación de contenido de sacarosa y azúcares simples, indicadores de adulteración. En el presente estudio, se procedió a determinar los anteriores parámetros, además del contenido de glucosa, fructosa e índice fructosa/glucosa a 35 muestras de mieles artesanales obtenidas directamente del apicultor, previamente catalogado como productor con buenas prácticas y 25 de mieles distribuidas en expendios. A su vez, se compararon los resultados poblacionales obtenidos y se les interpretó, con el objetivo de determinar el tipo de alteración que presentara la miel. Se determinó que 89% de las mieles control cumplieron con los parámetros establecidos por el Codex Alimentarius para su contenido de HMF, actividad de diastasa, contenido de sacarosa y de fructosa y glucosa. Contrario, sólo el 20% (5) de las mieles comerciales logró cumplir los estándares internacionales y la normativa nacional. Se destaca que un 24% de las muestra comerciales presentan adición de sacarosa y glucosa, 32% sobrecalentamiento o adulteración con sirope de azúcar invertido, y 24% adición de jarabe de azúcar invertido.

[Guidelines for the clinical management of neuropathic pain (II)]. / Guías de práctica clínica del dolor neuropático (II).

INTRODUCTION: Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients' quality of life. AIMS: The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. DEVELOPMENT: First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. CONCLUSIONS: There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication.

[Guidelines for the clinical management of neuropathic pain (I). Protocol]. / Guías de práctica clínica del dolor neuropático (I). Protocolo.

AIMS: The aim of this study is to develop a set of guidelines for the clinical management of neuropathic pain (NP), a disorder suffered by up to 5% of the population, specifically for use by the Spanish-speaking community, in order to improve the quality of medical care and to standardise the treatments offered in medical centres. DEVELOPMENT: The paper describes the methodology used to search for guidelines concerning the clinical management of NP in databases, written communications and other resources, and the results of this search are presented. The research group is split into three groups: anatomical-physiological, diagnosis and therapeutic approach, each of which defines the nature of the papers that used to design the protocol.

Guías de práctica clínica del dolor neuropático (II) / Guidelines for the clinical management of neuropathic pain (II)

Introducción. El dolor neuropático (DN) se presenta hasta en el 5% de la población. Después de una búsqueda bibliográfica en varias bases de datos, se determinó que hasta la fecha no existen protocolos que orienten al médico que no es especialista en dolor para tratar el DN y mejorar la calidad de vida de los pacientes. Objetivo. Presentar unas guías de tratamiento del DN dirigidas a médicos no especialista en dolor de habla hispana. Se realizó una búsqueda bibliográfica para fundamentar los resultados y las conclusiones con la metodología de la medicina basada en la evidencia. Desarrollo. En primera instancia se revisan los métodos clínicos y paraclínicos más eficaces para el diagnóstico del DN y se describe la escala de LANSS como la opción más adecuada para la evaluación clínica del DN. Posteriormente, se describen las vías anatómicas y la fisiología del dolor y se revisan las variables moleculares involucradas. Finalmente, se señalan las opciones terapéuticas actuales y se propone un algoritmo de tratamiento del DN. Conclusiones. No existe un esquema específico para el tratamiento del DN. Actualmente, los antidepresivos y los anticonvulsionantes son la piedra angular del tratamiento. Se requieren ensayos clínicos que evidencien la eficacia del uso de medicamentos combinados

Introduction. Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients’ quality of life. Aims. The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. Development. First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. Conclusions. There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication

Guías de práctica clínica del dolor neuropático (I). Protocolo / Guidelines for the clinical management of neuropathic pain (I). Protocol

Objetivo. Desarrollar unas guías de práctica clínica para el dolor neuropático (DN), un trastorno que se manifiesta hasta en el 5% de la población, específicamente para la comunidad de habla hispana, con el fin de mejorar la calidad del cuidado médico y estandarizar los tratamientos en los centros clínicos. Desarrollo. Se describe la metodología de búsqueda de guías de práctica clínica de DN en bases de datos, comunicaciones escritas y otros recursos, y se muestran los hallazgos. El grupo investigador se distribuye en tres grupos: aproximación anatomofisiológica, aproximación diagnóstica y aproximación terapéutica, cada uno de los cuales define la pertinencia de los artículos que se utilizarán para diseñar el protocolo

Aims. The aim of this study is to develop a set of guidelines for the clinical management of neuropathic pain (NP), a disorder suffered by up to 5% of the population, specifically for use by the Spanish-speaking community, in order to improve the quality of medical care and to standardise the treatments offered in medical centres. Development. The paper describes the methodology used to search for guidelines concerning the clinical management of NP in databases, written communications and other resources, and the results of this search are presented. The research group is split into three groups: anatomical-physiological, diagnosis and therapeutic approach, each of which defines the nature of the papers that used to design the protocol

[Perspective of patients on type-2 diabetes and their relationship with primary care health professionals: a qualitative study]. / Perspectiva de los pacientes sobre la diabetes tipo 2 y relación con los profesionales sanitarios de atención primaria: un estudio cualitativo.

AIM: The objective of this study is to investigate the perception that people with type 2 diabetes have about the disease and about their relationship with the primary healthcare professionals. DESIGN: Qualitative research, carried out between September-November 2000. SETTING: Primary healthcare center Barrio del Pilar from Madrid. PARTICIPANTS: 15 persons with type 2 diabetes. Variables considered to design the profiles of the interviewed were: age, gender, educational level, and time since diagnosis. METHOD: Structural sampling and open interviews. RESULTS: Patients express having scarce information regarding the consequences of diabetes. As diabetes is symptom free represents a difficulty for being perceived as a severe disease. The most valued aspects of the relationship with health professionals are that they provide with clear and tailored information, build a trust context, support changes and take account their perspectives and living circumstances. CONCLUSIONS: It is essential to recognize how patients understand and shape the disease. Information provided by professionals have to be tailored to patients necessities, and take place in a trusting environment. Decisions related with diabetes management have to be aligned with patients perspectives. Effective communication could be considered as a useful tool to encourage adherence and improve healthcare quality.