Preoperative Gabapentin for Pain Control: A Randomized, Placebo-controlled Clinical Trial in Patients Undergoing Inguinal Hernioplasty.

PURPOSE: The perioperative use of gabapentin has been suggested to reduce postoperative pain and opioid consumption. However, there is a variation in clinical practice, the type of surgery and the administration time seem to be distinct between the available studies. We assess whether gabapentin administered before surgery reduces postoperative pain in patients who have undergone inguinal hernioplasty. DESIGN: This is a double-blind, randomized, and placebo-controlled trial. METHODS: Seventy-seven patients scheduled for inguinal hernioplasty were randomized in two groups to receive gabapentin (900 mg) or placebo in the perioperative period. The primary outcome was analgesia measured by visual analog scale up to 30 days after surgery. The secondary outcomes such as morphine consumption, nausea, headache, and sedation have been also described. FINDINGS: Patients who received gabapentin had lower postoperative pain scores compared to the control group, P < .001. The postoperative morphine use was significantly lower in the gabapentin (5.3%) versus placebo group (74.4%), P < .001. No significant difference between groups was observed for the occurrence of adverse events. CONCLUSIONS: The perioperative administration of gabapentin was effective in reducing postoperative pain and had an important effect in decreasing morphine use. Together, our data reveal a long-lasting opioid-sparing effect of gabapentin in patients who underwent inguinal hernioplasty.

Torsion of the inferior vena cava: An unprecedented variant of post-pneumonectomy syndrome.

Post-pneumonectomy syndrome (PPS) is a rare complication after pneumonectomy defined by mediastinum shift toward the vacated pleural space with compression of the distal trachea or mainstem bronchi, resulting in dyspnea. This report describes a 32-year-old woman who presents with limiting symptoms of progressive dyspnea and chest pain 2 years after a right pneumonectomy. In computed tomography scan, there was no evidence of airway compression but suggested torsion of the inferior vena cava with preload compromise, confirmed during the surgical mediastinum repositioning using a transesophageal echocardiography-guided approach. This case report presents this unprecedented variant of PPS syndrome, highlighting the diagnostic and peri-operative management challenges.

Preclinical study in a postoperative pain model to investigate the action of ketamine, lidocaine, and ascorbic acid in reversing fentanyl-induced, non-glutamate-dependent hyperalgesia.

Introduction: Opioid-induced hyperalgesia (OIH) is a paradoxical phenomenon in which exposure to opioids can increase sensitivity to painful stimuli. Currently, several drugs have been used in an attempt to prevent OIH. We design this study to address the effect of preemptive treatment with ketamine, lidocaine, and ascorbic acid in a rat preclinical model of perioperative opioid-induced hyperalgesia. Methods: To reproduce OIH in a model of postoperative pain, rats received successive doses of fentanyl subcutaneously and underwent an incision in the paw. In an attempt to prevent OIH, ketamine, lidocaine, and ascorbic acid were administered before treatment with fentanyl. The von Frey test and the hot-plate test were used to evaluate mechanical allodynia and thermal hyperalgesia, respectively, with a follow-up period from 1 hour up to 7 days after surgery. Spinal cord nerve terminals (synaptosomes) were used to assess glutamate release under our experimental conditions. Results: Consecutive fentanyl injections increased the postoperative pain as indicated by increased thermal hyperalgesia and allodynia 48 hours after incision. Ketamine, lidocaine, and the combination of ketamine + lidocaine were able to prevent thermal hyperalgesia but not mechanical allodynia. Ascorbic acid did not prevent the hyperalgesia induced by fentanyl. We found no correlation between spinal glutamate release and the pharmacological treatments. Conclusion: Fentanyl induced a hyperalgesic effect that last few days in a postoperative model of pain. Hyperalgesic effect was not totally inhibited by ketamine and lidocaine in rats. Increased glutamate release was not the main molecular mechanism of fentanyl-induced hyperalgesia.

Central pontine myelinolysis after liver transplant: A case report and an updated review.

Based on brain magnetic resonance imaging results, the second and third most frequent causes of central pontine myelinolysis (CPM) were liver transplant (LT) and cirrhosis, which together accounted for 13.7% and 12.5% of all diagnoses of CPM. Medical diseases including cirrhosis, LT, malnutrition, and alcoholism are well-known conditions associated with CPM in addition to hyponatremia. The prognosis is poor and depends on early diagnosis and treatment to achieve better outcomes. This is a case report of CPM occurring after a deceased donor LT in a patient presenting many risk factors such as chronic hyponatremia, previous episodes of encephalopathy, and tacrolimus immunosuppression. We briefly discuss the pathophysiology, risk factors, diagnosis, and treatment, highlighting the role and challenges of the anesthesiologist in managing this kind of patient and preventing the syndrome in the context of major surgery.

Anaesthetic management of a patient with Gerbode defect.

Gerbode defect is a rare left ventricle to right atrium shunt that can be acquired or congenital. The incidence of acquired defects has been growing and is caused by previous cardiac surgery, endocarditis, trauma and myocardial infarct. It can be challenging and the anesthesiologist should maintain a suspicion when there is circulatory failure after a cardiac surgery. It can be diagnosed by trans-esophageal echocardiography. In this case we presented the anesthetic management and the successful surgical correction of an acquired ventricular-atrial defect secondary to a previous mitral valve replacement.

A Case Report of Cerebral Hypoperfusion During Liver Transplant with a Focus on the Role of Intraoperative Neuromonitoring.

Acute hepatic failure is characterized by rapid deterioration of hepatic function with encephalopathy in a patient without pre-existing liver disease. Bispectral index values had a significant correlation with cerebral perfusion. Transcranial Doppler can assess changes in cerebrovascular function and has the advantages of being noteworthy and widely available. This is a case report of a hepatic encephalopathy occurring during a deceased donor liver transplant in a patient presenting fulminant hepatitis. We briefly discuss some diagnostic methods highlighting the challenges of the anesthesiologist in managing this kind of patient in the context of a major surgery.

Managing Anesthesia for a Patient with Takayasu Illness.

This article intended to provide an overview of the anesthetic management for a patient with Takayasu arteritis, an uncommon and challenging disease. Despite the limited literature, it becomes more evident that there is no right answer for all patients. Considering that, it is important to take into account the severity and specific features of the underlying disease to decide the best anesthetic approach. In this context, an adequate preoperative assessment focusing on cardiovascular function becomes essential. Adequate cardiovascular monitoring is also essential in the intraoperative period. A multidisciplinary team should be involved in the perioperative period to provide the best care possible and improve patient outcomes. This case illustrates a successful hysterectomy in a patient with Takayasu arteritis, pointing out the pathophysiologic considerations and discussing the means to reduce the perioperative risk. The particularities described in this case report may help other physicians choose the best strategy when facing challenging patients similar to the one described.

Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position.

Intraoperative cardiac arrest is one of the most feared events by anesthesiologists and surgeons. Although there are many possible causes, three differential diagnoses stand out in the presented scenario: pulmonary embolism, gas embolism, and acute myocardial infarction. A 61-year-old female patient was admitted in the hospital to C2-C5 arthrodesis. Despite no major bleeding during surgery, immediately after supination the patient developed refractory hypotension, a decrease in end tidal CO2, progressive bradycardia that ultimately led to pulseless electrical activity. Resuscitation maneuvers were promptly performed, sustained return of spontaneous circulation was attained after 50 minutes, and the patient was transferred to the ICU. This paper discusses the main causes for an episode of cardiac arrest in the context of cervical arthrodesis, with a markedly prolonged resuscitation time, in which the patient survived.

Anesthetic management in bilateral video-assisted thoracoscopic sympathectomy for refractory ventricular arrhythmias: A case report.

Cardiac Sympathetic Denervation (CSD) has been shown to reduce shocks and subsequent pain of implantable cardiac defibrillator (ICD) in patients with heart diseases and recurrent Ventricular Tachycardia (VT) who did not respond properly to oral therapy and ablation. A 68-year-old man who presented an idiopathic dilated cardiomyopathy with impaired ejection fraction was treated for VT. A bilateral cardiac sympathetic denervation was performed under general anesthesia. Patient was extubated in the operating room and transferred to ICU where he presented hypotension. He was discharged after five days and remained symptom-free without any incident of VT during hospital stay. Currently no definite anesthetic management is available to treat such patients. This report discusses an approach that made heart rate control and safe patient discharge possible.

Antinociceptive synergism upon the joint use of methadone and Phα1ß in a model of cancer-related pain in C57BL/6J mice.

Opioids are the first-line treatment for cancer pain. Incomplete pain relief and the high rate of adverse effects of these compounds bring a need to combine them with other drugs acting on different targets. AIMS: We here evaluate the antinociceptive interaction and adverse events of methadone combined with recombinant Phα1ß, an analgesic toxin from Phoneutria nigriventer. MAIN METHODS: Melanoma was produced by intraplantar inoculation of B16-F10 cells into the right paw. von Frey filaments measured the paw-withdrawal threshold after administration of methadone, Phα1ß, and their combination. The degree of interaction was evaluated using isobolographic analysis. Spontaneous performance and forced motor performance were assessed with the open-field and rotarod tests, respectively. Intestinal function was evaluated by the distance traveled by charcoal and opioid tolerance was induced by daily morphine injections. KEY FINDINGS: Co-administration of Phα1ß with methadone synergistically reverses the melanoma-induced mechanical hypersensitivity. No motor alterations were observed but mild alterations on intestinal function after treatment with the combination that was also capable of restoring morphine analgesia in the tail-flick test after an opioid-induced tolerance. SIGNIFICANCE: Combinatorial treatment with Phα1ß and methadone produces synergistic analgesic potentiation with potential implications to pain treatment even under opioid tolerance conditions.

Comparación de la capacidad predictiva de dos escalas para el diagnóstico de tuberculosis en niños / Comparison of the predictive ability of two scoring systems for the diagnosis of tuberculosis in children

El diagnóstico de tuberculosis en la infancia exige una fuerte presunción diagnóstica por su forma de presentación paucibacilar. Distintos sistemas de puntuación y algoritmos se han desarrollado para sortear esta dificultad. Entre ellos, la escala diagnóstica de Keith Edwards y la de Stegen modificada por Toledo (Stegen-Toledo). Objetivos. Comparar la capacidad predictiva de la escala diagnóstica de Keith Edwards con la de la escala de Stegen-Toledo. Estimar la capacidad predictiva diagnóstica de la radiografía de tórax en forma individual. Población, material y métodos. Pacientes atendidos en un Servicio de Neumonología Pediátrica de la Ciudad de Buenos Aires entre 2009 y 2012. Para el análisis de la capacidad predictiva diagnóstica, se utilizó el test de chi-cuadrado y, para comparar su desempeno, la prueba de Mc Nemar extendida. Resultados. Keith Edwards: sensibilidad de 19,62%, especificidad de 97,62% (p < 0,0001). Stegen-Toledo: sensibilidad de 43,54%, especificidad de 97,82% (p < 0,0001). La sensibilidad entre ambas escalas presentó una diferencia significativa (p < 0,05), sin diferencias en la especificidad. Radiografía de tórax: sensibilidad de 91,15%, especificidad de 87,72% (p < 0,0001). Conclusión. La escala de Keith Edwards presentó una menor sensibilidad diagnóstica que la de Stegen-Toledo en este grupo de pacientes, sin diferencias en la especificidad. La radiografía de tórax presentó una sensibilidad de 91,15% para el diagnóstico de tuberculosis en este grupo de pacientes.

Diagnosing childhood tuberculosis requires a strong diagnostic suspicion due to its paucibacillary manifestation. Different scoring systems and algorithms have been developed to deal with such challenge skillfully. These include the Keith Edwards diagnostic score and Stegen's criteria modified by Toledo (Stegen-Toledo). Objectives. To compare the predictive ability of the Keith Edwards diagnostic score to that of the Stegen-Toledo scoring system. To estimate the predictive diagnostic ability of chest X-rays individually. Population, Material and Methods. Patients seen at the Department of Pediatric Pulmonology of the City of Buenos Aires between 2009 and 2012. A² test was used to analyze the predictive diagnostic ability, and performance was compared using the extended McNemar test. Results. Keith Edwards: 19.62% sensitivity, 97.62% specificity (p < 0.0001). Stegen-Toledo: 43.54% sensitivity, 97.82% specificity (p < 0.0001). Sensitivity was significantly different between both scoring systems (p < 0.05), but no differences were observed in terms of specificity. Chest X-ray: 91.15% sensitivity, 87.72% specificity (p < 0.0001). Conclusion. The Keith Edwards scoring system showed a lower diagnostic sensitivity than the Stegen-Toledo score in this group of patients, with no differences observed in terms of specificity. The chest X-ray showed a 91.15% sensitivity to diagnose tuberculosis in this group of patients.

[Comparison of the predictive ability of two scoring systems for the diagnosis of tuberculosis in children]. / Comparación de la capacidad predictiva de dos escalas para el diagnóstico de tuberculosis en niños.

UNLABELLED: Diagnosing childhood tuberculosis requires a strong diagnostic suspicion due to its paucibacillary manifestation. Different scoring systems and algorithms have been developed to deal with such challenge skillfully. These include the Keith Edwards diagnostic score and Stegen's criteria modified by Toledo (Stegen-Toledo). OBJECTIVES: To compare the predictive ability of the Keith Edwards diagnostic score to that of the Stegen-Toledo scoring system. To estimate the predictive diagnostic ability of chest X-rays individually. POPULATION, MATERIAL AND METHODS: Patients seen at the Department of Pediatric Pulmonology of the City of Buenos Aires between 2009 and 2012. A² test was used to analyze the predictive diagnostic ability, and performance was compared using the extended McNemar test. RESULTS: Keith Edwards: 19.62% sensitivity, 97.62% specificity (p < 0.0001). Stegen-Toledo: 43.54% sensitivity, 97.82% specificity (p < 0.0001). Sensitivity was significantly different between both scoring systems (p < 0.05), but no differences were observed in terms of specificity. Chest X-ray: 91.15% sensitivity, 87.72% specificity (p < 0.0001). CONCLUSION: The Keith Edwards scoring system showed a lower diagnostic sensitivity than the Stegen-Toledo score in this group of patients, with no differences observed in terms of specificity. The chest X-ray showed a 91.15% sensitivity to diagnose tuberculosis in this group of patients.

El diagnóstico de tuberculosis en la infancia exige una fuerte presunción diagnóstica por su forma de presentación paucibacilar. Distintos sistemas de puntuación y algoritmos se han desarrollado para sortear esta dificultad. Entre ellos, la escala diagnóstica de Keith Edwards y la de Stegen modificada por Toledo (Stegen-Toledo). Objetivos. Comparar la capacidad predictiva de la escala diagnóstica de Keith Edwards con la de la escala de Stegen-Toledo. Estimar la capacidad predictiva diagnóstica de la radiografía de tórax en forma individual. Población, material y métodos. Pacientes atendidos en un Servicio de Neumonología Pediátrica de la Ciudad de Buenos Aires entre 2009 y 2012. Para el análisis de la capacidad predictiva diagnóstica, se utilizó el test de chicuadrado y, para comparar su desempeño, la prueba de Mc Nemar extendida. Resultados. Keith Edwards: sensibilidad de 19,62%, especificidad de 97,62% (p < 0,0001). Stegen-Toledo: sensibilidad de 43,54%, especificidad de 97,82% (p < 0,0001). La sensibilidad entre ambas escalas presentó una diferencia significativa (p < 0,05), sin diferencias en la especificidad. Radiografía de tórax: sensibilidad de 91,15%, especificidad de 87,72% (p < 0,0001). Conclusión. La escala de Keith Edwards presentó una menor sensibilidad diagnóstica que la de Stegen-Toledo en este grupo de pacientes, sin diferencias en la especificidad. La radiografía de tórax presentó una sensibilidad de 91,15% para el diagnóstico de tuberculosis en este grupo de pacientes.

Mobbing en trabajadores españoles y peruanos: un estudio exploratorio con el LIPT-60 / Workplace bullying in spanish and peruvian workers: an exploratory study with the LIPT-60

El presente estudio piloto tiene como objetivo general describir el acoso laboral percibido por parte de trabajadores españoles y trabajadores inmigrantes peruanos que han acudido en busca de orientación a la ®Plataforma contra los Riesgos Psicosociales y la Discriminación Laboral de la Comunidad de Madrid¼ (PRIDICAM) durante el periodo 2002-2012. El diseño utilizado es descriptivo y el muestreo fue intencional. Se ha contado con una muestra de 50 trabajadores españoles y 44 peruanos. Se utilizó la adaptación española del ®Cuestionario de Estrategias de Acoso en el Trabajo¼ de Leymann (LIPT-60). Los resultados obtenidos indican que los trabajadores peruanos perciben mayor número de conductas de acoso, así como una mayor intensidad en el acoso laboral percibido que los trabajadores españoles. En cuanto al tipo de acoso laboral percibido, los trabajadores peruanos informan sobre mayores niveles de intimidación manifiesta, desprestigio laboral y desprestigio personal...

The present pilot-study has the general aim to describe the perceived mobbing in Spanish workers and Peruvian immigrant workers who requested professional orientation to the ôPlatform against the Psychosocial Factors and the Labor Discrimination of the Community of Madridõ (PRIDICAM) during the period 2002-2012. The used design is descriptive and the sampling was international. A sample of 50 Spanish victims and other of 44 Peruvian victims are considered. The Spanish version of the Leymann Inventory of Psychological Terrorization (LIPT-60) has been used. The obtained results indicate that the Peruvian workers perceived major number of bullying behaviors as well as major intensity than the Spanish workers. With regard to the type of perceived bullying, the Peruvian workers report on higher levels of manifest intimidation, loss of professional prestige and loss of personal prestige...

El burnout como forma de estrés laboral y su dimensión forense / Burnout as a work stress and its forensic dimension

El presente trabajo analiza la delimitación conceptual del síndrome de burnout o de quemarse por el trabajo, como forma de estrés laboral, y las dimensiones relevantes para su evaluación desde el punto de vista clínico, organizacional y forense. Se analizan las implicaciones legales del burnout desde la perspectiva de la prevención de riesgos laborales y sobre las limitaciones que impone en la capacidad laboral y las repercusiones forenses que ha generado en España. Para ello, se elabora un análisis sistemático de 160 resoluciones judiciales (85 de ellas relevantes) relacionadas con el burnout y dictadas por tribunales españoles desde finales de los años 90. Se concluye que el síndrome ha generado un volumen constante de jurisprudencia en la jurisdicción laboral, alcanzando la categoría de accidente de trabajo y diversos grados de incapacidad laboral. Los datos analizados sugieren la importancia de una adecuada evaluación de este fenómeno, dadas sus repercusiones, tanto desde el plano prevencionista, como pericial o forense(AU)

Data mining and mall users profile / Minería de datos y perfiles de usuarios en los centros comerciales

Marketing scholars have suggested a need for more empirical research on consumer response to malls, in order to have a better understanding of the variables that explain the behavior of the consumers. The segmentation methodology CHAID (Chi-square automatic interaction detection) was used in order to identify the profiles of consumers with regard to their activities at malls, on the basis of socio-demographic variables and behavioral variables (how and with whom they go to the malls). A sample of 790 subjects answered an online questionnaire. The CHAID analysis of the results was used to identify the profiles of consumers with regard to their activities at malls. In the set of variables analyzed the transport used in order to go shopping and the frequency of visits to centers are the main predictors of behavior in malls. The results provide guidelines for the development of effective strategies to attract consumers to malls and retain them there.

Recientes estudios del ámbito del marketing ponen de manifiesto la necesidad de incrementar la investigación empírica sobre las actividades desarrolladas por los consumidores en los centros comerciales, con el objeto de obtener una mejor comprensión de las variables que explican el comportamiento de estos. La metodología de segmentación CHAID (chi-square automatic interaction detection) se ha utilizado con el objeto de identificar los perfiles de los consumidores en relación con las actividades que desarrollan en los centros comerciales, con base en variables sociodemográficas y de comportamiento (cómo y con quién van a los centros comerciales). Una muestra de 790 sujetos contestaron un cuestionario on-line. El análisis CHAID de los resultados permite identificar los perfiles de los consumidores con respecto a sus actividades en dichos centros. Del conjunto de variables analizadas, el transporte utilizado y la frecuencia de las visitas son los principales pre-dictores de la conducta en los centros comerciales. Los resultados obtenidos proporcionan directrices para el desarrollo de estrategias que faciliten la atracción y fidelización de los consumidores a los centros comerciales.

Estrategias de afrontamiento en víctimas de mobbing: diferencias entre trabajadores Españoles e inmigrantes latinoamericanos y consideraciones clínicas / Coping strategies in harassed victims: differences between Spanish and latin-american immigrant workers and clinical considerations

En este artículo se presenta un estudio-piloto sobre el empleo de estrategias de afrontamiento por parte de trabajadores españoles e inmigrantes latinoamericanos víctimas de mobbing que han acudido en busca de ayuda a la Plataforma contra los Riesgos Psicosociales y la Discriminación Laboral de la Comunidad de Madrid (PRIDICAM) durante el periodo 2007-2012. El objetivo del presente estudio es comprobar si existen diferencias significativas entre ambos grupos a la hora de afrontar el estresor del acoso laboral. Para ello, se ha realizado un estudio transversal y se han comparado las puntuaciones obtenidas. Se ha contado con una muestra de 75 víctimas españolas y otra de 75 víctimas latinoamericanas. Todos ellos cumplimentaron el CSI (Coping Strategies Inventory). Los resultados obtenidos indican que los trabajadores latinoamericanos utilizan de forma más evidente estrategias adecuadas centradas en la emoción y en menor medida estrategias inadecuadas centradas en la emoción que los trabajadores españoles. Además, los trabajadores latinoamericanos alcanzan mayor puntuación en relación al manejo inadecuado centrado en el problema. Pese a ello, no se encuentran diferencias significativas globales en relación al manejo adecuado o inadecuado del mobbing entre las muestras de estudio. Por último, se discuten distintas consideraciones clínicas en relación a las estrategias de afrontamiento y su relación con el acoso psicológico en el lugar de trabajo así como su relevancia para la salud de los trabajadores.

In this article a pilot-study is carried out on the use of coping strategies of Spanish and Latin-American harassed workers who have come in search of help to the "Platform against the Psychosocial Factors and the Labour Discrimination of the Community of Madrid" (PRIDICAM) during the period 2007-2012. The aim of the present study is to verify if significant differences exist in both groups at the moment of confronting the workplace harassment. A transverse study has been realized and the obtained averages have been compared. A sample of 75 Spanish victims and other one of 75 Latin-American victims are considered. All of them completed the SCI (Coping Strategies Inventory). The obtained results indicate that the Latin-American workers use major number of positive emotion-focused strategies and minor negative ones. In addition, the Latin-American workers reach major average in relation to the negative problem-focused strategies. However, the differences in relation to the positive or negative coping are not significant between the studied samples. Finally, different clinical considerations are discussed in relation to the coping strategies and their relation with the workplace bullying as well as their relevancy for the health of the workers.