Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools.

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

Adenosine A2B receptor agonist improves epidermal barrier integrity in a murine model of epidermal hyperplasia.

Adenosine regulates multiple physiological processes through the activation of four receptor subtypes, of which the A2B adenosine receptor (A2BAR) has the lowest affinity for adenosine. Being the adenosine receptor subtype most prominently expressed in epidermis, we recently described the antiproliferative and anti-inflammatory effect of the selective A2BAR agonist BAY60-6583 (BAY) in human keratinocytes stimulated with 12-O-tetradecanoylphorbol-13-acetate (TPA), so we sought to establish the effect of topical application of BAY in a model of murine epidermal hyperplasia. Topical application of BAY (1 or 10 µg/site) prevented the inflammatory reaction and skin lesions induced by TPA, minimizing hyperproliferation and acanthosis, as well as the expression of specific markers of proliferative keratinocytes. On the other hand, pre-treatment with the selective A2BAR antagonist, PSB-1115 (PSB, 5 or 50 µg/site) reversed these beneficial effects. Additionally, BAY application normalized the expression of epidermal barrier proteins, whose integrity is altered in inflammatory skin diseases, while treatment with the antagonist alone worsened it. Our results, besides confirming the anti-inflammatory and antiproliferative effects of the A2BAR agonist, further demonstrate a role of A2BAR activation to preserve the epidermal barrier. Therefore, the activation of A2BAR may constitute a possible new pharmacological target for the treatment of skin inflammatory diseases such as psoriasis.

Generation, establishment and characterization of a pluripotent stem cell line (CVTTHi001-A) from primary fibroblasts isolated from a patient with activated PI3 kinase delta syndrome (APDS2).

APDS2 is caused by mutations in PIK3R1 gene resulting in constitutive PI3Kδ activation. PI3Kδ is predominantly expressed in leukocytes and plays critical roles in regulating immune responses. Here we first derived fibroblast primary cells from a skin biopsy of a patient carrying a heterozygous single T deletion in intron 11 of the PIK3R1 gene. We next present the derivation of an induced pluripotent stem cell (iPS) line using a non-integrative reprogramming technology. Pluripotent-related hallmarks are further shown, including: iPSCs self-renewal and expression of pluripotent and differentiation markers after in vitro differentiation towards embryonic germ layers, assessed by RT-PCR and immunofluorescence.

Treating primary immunodeficiencies with defects in NK cells: from stem cell therapy to gene editing.

Primary immunodeficiency diseases (PIDs) are rare diseases that are characterized by genetic mutations that damage immunological function, defense, or both. Some of these rare diseases are caused by aberrations in the normal development of natural killer cells (NKs) or affect their lytic synapse. The pathogenesis of these types of diseases as well as the processes underlying target recognition by human NK cells is not well understood. Utilizing induced pluripotent stem cells (iPSCs) will aid in the study of human disorders, especially in the PIDs with defects in NK cells for PID disease modeling. This, together with genome editing technology, makes it possible for us to facilitate the discovery of future therapeutics and/or cell therapy treatments for these patients, because, to date, the only curative treatment available in the most severe cases is hematopoietic stem cell transplantation (HSCT). Recent progress in gene editing technology using CRISPR/Cas9 has significantly increased our capability to precisely modify target sites in the human genome. Among the many tools available for us to study human PIDs, disease- and patient-specific iPSCs together with gene editing offer unique and exceptional methodologies to gain deeper and more thorough understanding of these diseases as well as develop possible alternative treatment strategies. In this review, we will discuss some immunodeficiency disorders affecting NK cell function, such as classical NK deficiencies (CNKD), functional NK deficiencies (FNKD), and PIDs with involving NK cells as well as strategies to model and correct these diseases for further study and possible avenues for future therapies.

Monopolar dielectric diathermy by emission of radiofrequency in Patellofemoral pain. A single-blind-randomized clinical trial.

Despite the high incidence of patellofemoral pain syndrome (PFPS), few studies show the effects of radiofrequency on pain and functionality in these patients. For this reason, the aim of this study was to determine the efficacy of monopolar dielectric diathermy by emission of radiofrequency (MDR) in dynamic applications aimed at treating pain and improving function in patients with PFPS. For this purpose, a single-blind randomized clinical trial was conducted. Eighty-four participants with PFPS were evenly divided into an experimental group (EG) and a control group (CG). All subjects receive 10 min of daily home exercises along 3 weeks, and in addition, the subjects of the EG received 10 sessions based on the dynamic application of MDR. Variables measured included Visual Analogue Scale (VAS), DN4 questionnaire, Lower Extremity Functionality Scale (LEFS), Kujala scale, Range of Movement (ROM) in knee flexion and extension and drug intake. The EG showed a statistically significant reduction in pain (VAS = 4.8 [5.5-4.1] [p < .001]; DN4 = 3.8 [4.4-3.2] [p < .001]), and an increase in functionality (LEFS = 16 [19-13] [p < .001]; Kujala = 19 [23-14] [p < .001]) and in ROM (flexion 18º [21º-16º] [p < .001]). No statistically significant changes in drug intake were found. Based on this data, the dynamic application of MDR seems effective in reducing pain and increasing functionality and flexion in patients with PFPS. Diathermy by emission of radiofrequency could be recommended as complement or main therapy in the treatment of PFPS.

Reactive Oxygen Species Production Is a Major Factor Directing the Postantibiotic Effect of Fluoroquinolones in Streptococcus pneumoniae.

We studied the molecular mechanisms involved in the postantibiotic effect of the fluoroquinolones levofloxacin and moxifloxacin in Streptococcus pneumoniae Wild-type strain R6 had postantibiotic effects of 2.05 ± 0.10 h (mean ± standard deviation [SD]) and 3.23 ± 0.45 h at 2.5× and 10× MIC of levofloxacin, respectively. Moxifloxacin exhibited lower effects of 0.87 ± 0.1 and 2.41 ± 0.29 h at 2.5× and 10× MIC, respectively. Fluoroquinolone-induced chromosome fragmentation was measured at equivalent postantibiotic effects for levofloxacin (2.5× MIC) and moxifloxacin (10× MIC). After 2 h of drug removal, reductions were approximately 7-fold for levofloxacin and 3-fold for moxifloxacin, without further decreases at later times. Variations in reactive oxygen species production were detected after 4 to 6 h of drug withdrawals, with decreases ≥400-fold for levofloxacin and ≥800-fold for moxifloxacin at 6 h. In accordance, after 4 to 6 h of drug withdrawal, the levofloxacin-induced upregulation of the fatCDEB operon, introducing iron in the bacteria, decreased up to 2- to 3-fold, and the moxifloxacin-induced upregulation of several genes involved in the production of pyruvate was reduced 3- to 7-fold. In accordance, lower postantibiotic effects (up to 1 h) were observed in strain R6 ΔspxB, lacking the main enzyme involved in oxygen peroxide production, than in R6. Although no change in the recovery of chromosome fragmentation was observed between R6 and R6 ΔspxB, 3.5 × 103-fold lower reactive oxygen species production was observed in R6 ΔspxB, without changes after drug removal. These results show that reactive oxygen species are the main factors directing the postantibiotic effect of levofloxacin and moxifloxacin in S. pneumoniae.

Targeted drug distribution in tumor extracellular fluid of GD2-expressing neuroblastoma patient-derived xenografts using SN-38-loaded nanoparticles conjugated to the monoclonal antibody 3F8.

Neuroblastoma is a pediatric solid tumor with high expression of the tumor associated antigen disialoganglioside GD2. Despite initial response to induction therapy, nearly 50% of high-risk neuroblastomas recur because of chemoresistance. Here we encapsulated the topoisomerase-I inhibitor SN-38 in polymeric nanoparticles (NPs) surface-decorated with the anti-GD2 mouse mAb 3F8 at a mean density of seven antibody molecules per NP. The accumulation of drug-loaded NPs targeted with 3F8 versus with control antibody was monitored by microdialysis in patient-derived GD2-expressing neuroblastoma xenografts. We showed that the extent of tumor penetration by SN-38 was significantly higher in mice receiving the targeted nano-drug delivery system when compared to non-targeted system or free drug. This selective penetration of the tumor extracellular fluid translated into a strong anti-tumor effect prolonging survival of mice bearing GD2-high neuroblastomas in vivo.

Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial.

OBJECTIVE: To investigate the effects of a Pilates exercise program on disability, pain, lumbar mobility, flexibility and balance in patients with chronic non-specific low back pain. DESIGN: Randomized controlled trial. SETTING: University laboratory. PARTICIPANTS: A total of 54 patients with chronic non-specific low back pain. INTERVENTION: Patients were randomly allocated to an experimental group ( n=27) included in a Pilates exercise program or to a control group ( n=27) receiving information in a form of a leaflet. MAIN OUTCOME MEASURES: Disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), current, average and pain at it least and at its worst (Visual Analogue Scales), lumbar mobility (modified Shober test), flexibility (finger-to-floor test) and balance (single limb stance test) were measured at baseline and after the intervention. RESULTS: A between-group analysis showed significant differences in the intervention group compared to the control group for both disability scores, the Rolland-Morris questionnaire (mean change±standard deviation of 5.31±3.37 and 2.40±6.78 respectively and between-groups mean difference of 3.2 ± 4.12, p=0.003) and the Oswestry Disability Index ( p<0.001), current pain ( p=0.002) and pain at it least ( p=0.033), flexibility (0.032) and balance (0.043). CONCLUSIONS: An 8-week Pilates exercise program is effective in improving disability, pain, flexibility and balance in patients with chronic non-specific low back pain.

Efecto de un programa de capacitación en competencias de investigación en estudiantes de ciencias de la salud / Effects of an educational training program on health science students’ research capacity

El Espacio Europeo de Educación Superior implica un cambio en la formación universitaria de Ciencias de la Salud en España. El sistema universitario debe promover desde el grado la adquisición de competencias básicas en investigación, como la gestión de información y la comunicación científica. Este artículo presenta los hallazgos de un estudio cuyo objetivo fue evaluar el nivel de eficacia y satisfacción de un programa de capacitación educativa en competencias de investigación dirigido a estudiantes de Ciencias de la Salud. Se diseñó un estudio cuasiexperimental en el que participaron ciento ocho estudiantes de grado de Fisioterapia, Terapia ocupacional y Enfermería. En una primera fase se detectaron las necesidades educativas en competencias de investigación a través de un cuestionario; a continuación se implementó un programa de capacitación semipresencial y se evaluó el efecto alcanzado en las necesidades antes detectadas. Este programa mejoró significativamente la percepción de los participantes en relación a su conocimiento y habilidad en competencias de investigación. Del mismo modo, las destrezas cognitivas y prácticas mejoraron considerablemente tras el programa. Estos hallazgos evidencian que la puesta en marcha de programas específicos de capacitación en investigación es efectiva para mejorar la adquisición de competencias a este respecto en estudiantes de Ciencias de la Salud (AU)

The European Higher Education Area implies a change to the Health Science education in Spain. Spanish university system must promote the acquisition of competences in research habits, such as the information management or scientific dissemination. This article presents the findings of a study to evaluate the level of effectiveness and satisfaction of an educational training program on research skills geared towards Health Science students. A hundred and eight students of Physical Therapy degree, Occupational Therapy degree and Nursing degree were participated into a quasi-experimental study. Educational needs were first detected by a questionnaire based on different research skills. A semi-distance educational training program was designed and implemented after defining the above-mentioned needs. This program significantly improved the perception of knowledge and skills in research competences. As well as the level of theory and practical content assimilated by the students significantly increased after the program. These findings suggest that incorporation of specific training that allow for students to come in contact with research, are effective at improving research competences for Health Sciences students (AU)

Reactive Oxygen Species Contribute to the Bactericidal Effects of the Fluoroquinolone Moxifloxacin in Streptococcus pneumoniae.

We studied the transcriptomic response of Streptococcus pneumoniae to the fluoroquinolone moxifloxacin at a concentration that inhibits DNA gyrase. Treatment of the wild-type strain R6, at a concentration of 10× the MIC, triggered a response involving 132 genes after 30 min of treatment. Genes from several metabolic pathways involved in the production of pyruvate were upregulated. These included 3 glycolytic enzymes, which ultimately convert fructose 6-phosphate to pyruvate, and 2 enzymes that funnel phosphate sugars into the glycolytic pathway. In addition, acetyl coenzyme A (acetyl-CoA) carboxylase was downregulated, likely leading to an increase in acetyl-CoA. When coupled with an upregulation in formate acetyltransferase, an increase in acetyl-CoA would raise the production of pyruvate. Since pyruvate is converted by pyruvate oxidase (SpxB) into hydrogen peroxide (H2O2), an increase in pyruvate would augment intracellular H2O2. Here, we confirm a 21-fold increase in the production of H2O2 and a 55-fold increase in the amount of hydroxyl radical in cultures treated during 4 h with moxifloxacin. This increase in hydroxyl radical through the Fenton reaction would damage DNA, lipids, and proteins. These reactive oxygen species contributed to the lethality of the drug, a conclusion supported by the observed protective effects of an SpxB deletion. These results support the model whereby fluoroquinolones cause redox alterations. The transcriptional response of S. pneumoniae to moxifloxacin is compared with the response to levofloxacin, an inhibitor of topoisomerase IV. Levofloxacin triggers the transcriptional activation of iron transport genes and also enhances the Fenton reaction.

A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency.

OBJECTIVES: To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency. DESIGN: A double-blinded randomized clinical trial. SETTING: Clinical setting. PARTICIPANTS: One hundred and twenty postmenopausal women with mild-moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping. MAIN OUTCOMES VARIABLES: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment. RESULTS: The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness (F = 22.99, p = 0.002), claudication (F = 8.57, p = 0.004), swelling (F = 22.58, p = 0.001), muscle cramps (F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity (F = 18.47, p = 0.001), physical function (F = 9.15, p = 0.003) and body pain (F = 3.36, p = 0.043). Both groups reported significant reduction in pain. CONCLUSION: Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

Recomendaciones para la utilización clínica del estudio de potenciales evocados motores en la esclerosis múltiple / Recommendations for the clinical use of motor evoked potentials in multiple sclerosis

Objetivo: Establecer una guía clínica para la utilización clínica del estudio de potenciales evocados motores (PEM) en el diagnóstico y el seguimiento de la esclerosis múltiple (EM). Disponer de unas recomendaciones para la utilización clínica de los PEM contribuye a racionalizar y optimizar los recursos en el proceso diagnóstico y de seguimiento en los pacientes con EM. Método: Hemos llevado a cabo una extensa revisión de la literatura médica y puesto en común nuestros propios datos para consensuar recomendaciones para el uso clínico de los PEM en el estudio de la EM. Resultados: Los PEM contribuyen, junto con la resonancia magnética medular o cerebral, al diagnóstico y evaluación de los pacientes cuyo inicio clínico es un síndrome medular, que presentan hallazgos de neuroimagen poco específicos o que presentan criterios clínicos de EM con neuroimagen cerebral normal. Conclusiones: Es aconsejable realizar un estudio de potenciales evocados multimodales en pacientes con sospecha de EM para documentar la afectación de la vía motora como apoyo al diagnóstico de diseminación en espacio (AU)

Objective: To establish clinical guidelines for the clinical use and interpretation of motor evoked potentials (MEP) in diagnosing and monitoring patients with multiple sclerosis (MS). Recommendations for MEP use and interpretation will help us rationalise and optimise resources used in MS patient diagnosis and follow up. Method: We completed an extensive literature review and pooled our own data to produce a consensus statement with recommendations for the clinical use of MEPs in the study of MS. Results: MEPs, in addition to spinal and cranial magnetic resonance imaging (MRI), help us diagnose and assess MS patients whose disease initially presents as spinal cord syndrome and those with non-specific brain MRI findings, or a normal brain MRI and clinical signs of MS. Conclusions: Whenever possible, a multimodal evoked potential study should be performed on patients with suspected MS in order to demonstrate involvement of the motor pathway which supports a diagnosis of dissemination in space (AU)

[Recommendations for the clinical use of motor evoked potentials in multiple sclerosis]. / Recomendaciones para la utilización clínica del estudio de potenciales evocados motores en la esclerosis múltiple.

OBJECTIVE: To establish clinical guidelines for the clinical use and interpretation of motor evoked potentials (MEP) in diagnosing and monitoring patients with multiple sclerosis (MS). Recommendations for MEP use and interpretation will help us rationalise and optimise resources used in MS patient diagnosis and follow up. METHOD: We completed an extensive literature review and pooled our own data to produce a consensus statement with recommendations for the clinical use of MEPs in the study of MS. RESULTS: MEPs, in addition to spinal and cranial magnetic resonance imaging (MRI), help us diagnose and assess MS patients whose disease initially presents as spinal cord syndrome and those with non-specific brain MRI findings, or a normal brain MRI and clinical signs of MS. CONCLUSIONS: Whenever possible, a multimodal evoked potential study should be performed on patients with suspected MS in order to demonstrate involvement of the motor pathway which supports a diagnosis of dissemination in space.

Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria / Prescripción potencialmente inapropiada en ancianos institucionalizados en España: los criterios STOPP-START comparados con los criterios de Beers

Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people. Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more) by pharmacists in a nursing home in the Lleida region (Spain). Results: The mean patients’ age was 84 (SD=8) years, with an average of 5 drugs per resident (total prescriptions: 416 medicines). The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%), but omissions corresponding to the cardiovascular system implied 23% of patients. Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP) is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes (AU)

Objetivo: Este estudio está orientado a identificar la prescripción potencialmente inapropiada usando los criterios de Beers y STOPP. Las omisiones de prescripciones se detectan en esta población geriátrica aplicando los criterios START. Se compara la utilidad de estos criterios en ancianos institucionalizados. Métodos: Estudio descriptivo de revisión de la medicación y las historias clínicas por farmacéuticos, de 81 pacientes (con 65 o más años) ingresados en una residencia en la provincia de Lleida (España). Resultados: La media de edad de los pacientes fue de 84 años (DE=8), con cinco medicamentos de promedio de tratamiento por residente (prescripciones totales: 416 medicamentos). Los criterios de Beers detectaron el uso de medicación potencialmente inapropiada en el 25% de los pacientes. Los criterios STOPP identificaron una posible medicación inapropiada en el 48% de los pacientes. La mayor frecuencia de uso de medicamentos potencialmente inapropiados para ambos criterios correspondió a las benzodiacepinas de larga duración y los AINE. Los criterios START detectaron 58 prescripciones potencialmente omitidas en el 44% de los pacientes. Entre ellas, la ausencia de suplementos de Calcio-vitamina D en osteoporosis fue la regla más frecuentemente implicada (15% de los pacientes); sin embargo, las omisiones relacionadas con el sistema cardiovascular asociadas a elevado riesgo cardiovascular son las que implicaron hasta un 23% de pacientes. Conclusión: La aplicación de los criterios STOPPSTART ha detectado una elevada proporción de prescripciones potencialmente inapropiadas en pacientes ancianos en una residencia sanitaria en España, con una significativa correlación positiva entre el número de medicamentos prescritos al paciente y el número de prescripciones potencialmente inapropiadas. Los criterios STOPP identificaron más medicación potencialmente inapropiada que los criterios de Beers. Las omisiones detectadas por los criterios START son relevantes y requiere una intervención. La revisión de la medicación por un farmacéutico puede ayudar a identificar potenciales prescripciones inapropiadas y, con un abordaje interdisciplinario, en colaboración con los médicos se podría mejorar la prescripción en pacientes ancianos de residencias geriátricas (AU)

[Opioids for chronic noncancer pain: recommendations based on clinical practice guidelines]. / Uso de opioides en el tratamiento del dolor crónico no oncológico. Recomendaciones basadas en las guías de práctica clínica.

OBJECTIVE: The need for major opioids in the treatment of chronic pain unrelated to cancer is increasing. We therefore appraised available clinical practice guidelines in order to identify recommendations for good practice in the use of these drugs. MATERIAL AND METHODS: By searching the main guideline repositories as well as resources provided by medical associations, we identified clinical practice guidelines on the use of major opioids published up to 2007. Fourteen of the 28 guidelines we found met the inclusion criteria. To appraise the guidelines we applied the criteria for scientific evidence of the AGREE collaboration (Appraisal of Guidelines Research and Evaluation). The AGREE instrument consists of 23 items organized in 6 areas for appraisal. RESULTS: Of the 14 guidelines appraised, 5 were judged to be of high quality. In each of the 5 selected guidelines, the relation between a recommendation and the evidence it was based on was stated explicitly; all 5 had overall quality scores over 60%. The recommendations drawn from these guidelines deal with 3 sequential moments in the use of opioids: start of treatment, maintenance therapy, and withdrawal of the drug. CONCLUSION: The use of opioids to treat chronic noncancer pain is controversial in terms of effectiveness, safety, and the possibility of addiction or abuse. The opioid should be indicated for the pain and prescribed with caution; each case should be assessed individually. Following the recommendations drawn from these guidelines will be important for achieving control of both pain and the accompanying symptoms. The use of major opioids to relieve chronic pain unrelated to cancer, and therefore to improve the quality of life of patients who experience this type of pain, is a legitimate treatment approach.

Uso de opioides en el tratamiento del dolor crónico no oncológico. Recomendaciones basadas en las guías de práctica clínica / Opioids for chronic noncancer pain: recommendations based on clinical practice guidelines

Objetivo: Debido a la necesidad creciente del uso de opioides mayores en el tratamiento del dolor crónico no oncológico (DCNO), se evalúan las guías de práctica clínica (GPC) existentes y se sugieren unas recomendaciones prácticas específicas de buen uso de estos fármacos. Material y método: La búsqueda de las GPC publicadas hasta el año 2007 relacionadas con el uso de opioides mayores en el tratamiento del DCNO se realizó en los principales centros de recogida y almacenamiento de GPC y en las sociedades científicas. Catorce de los veintiocho documentos encontrados cumplían criterios de inclusión y fueron incluídas en el estudio. Para la evaluación de su validez con criterios de evidencia científica se utilizó el instrumento Agree que consiste en 23 apartados distribuidos en 6 áreas. Resultados: De las catorce GPC evaluadas 5 fueron seleccionadas por su alta calidad metodológica. En todas ellas había una relación entre cada recomendación y la evidencia en la cual estaban basadas y todas tenían una puntuación superior al 60%. Las recomendaciones sugeridas se agrupan en 3 apartados referente al uso secuencial del uso de opioide: Inicio del tratamiento, durante el mantenimiento y criterios y retirada del mismo. Conclusión: El uso de opioides en el tratamiento de pacientes con DCNO es tema controvertido debido a lo que concierne a su eficacia, seguridad y posibilidad de adicción y/o abuso. Tiene que ser indicado y prescrito con precaución y siempre valorando a cada paciente de forma individual. El seguimiento de las recomendaciones expuestas es importante tanto para un buen control del dolor como de los síntomas acompañantes. El uso de opioides mayores para el alivio del DCNO y por tanto, para mejorar la vida de los pacientes que lo padecen, es una alternativa totalmente legítima(AU)

Objective: The need for major opioids in the treatment of chronic pain unrelated to cancer is increasing. We therefore appraised available clinical practice guidelines in order to identify recommendations for good practice in the use of these drugs. Material and methods: By searching the main guideline repositories as well as resources provided by medical associations, we identified clinical practice guidelines on the use of major opioids published up to 2007. Fourteen of the 28 guidelines we found met the inclusion criteria. To appraise the guidelines we applied the criteria for scientific evidence of the AGREE collaboration (Appraisal of Guidelines Research and Evaluation). The AGREE instrument consists of 23 items organized in 6 areas for appraisal. Results: Of the 14 guidelines appraised, 5 were judged to be of high quality. In each of the 5 selected guidelines, the relation between a recommendation and the evidence it was based on was stated explicitly; all 5 had overall quality scores over 60%. The recommendations drawn from these guidelines deal with 3 sequential moments in the use of opioids: start of treatment, maintenance therapy, and withdrawal of the drug. Conclusion: The use of opioids to treat chronic noncancer pain is controversial in terms of effectiveness, safety, and the possibility of addiction or abuse. The opioid should be indicated for the pain and prescribed with caution; each case should be assessed individually. Following the recommendations drawn from these guidelines will be important for achieving control of both pain and the accompanying symptoms. The use of major opioids to relieve chronic pain unrelated to cancer, and therefore to improve the quality of life of patients who experience this type of pain, is a legitimate treatment approach(AU)

Elaboración de videos didácticos como alternativa a los ensayos in vivo en las prácticas de farmacología / Didactic video as an alternative to in vivo assays in practical lessons of pharmacology

La Farmacología es una ciencia eminentemente práctica, en la que tiene gran relevancia la investigación "in vivo" con animales de experimentación. Los conocimientos impartidos en las clases teóricas, seminarios y tutorías, se completan con la enseñanza en las sesiones prácticas. Sin embargo, algunos aspectos importantes de esta enseñanza práctica, que incluyen la realización de ensayos “in vivo”, resulta problemático impartirlos correctamente con la normativa actual sobre la utilización de animales de laboratorio. Por ello, nos planteamos la realización de unos vídeos demostrativos de las técnicas experimentales utilizadas en algunas de las sesiones prácticas de las asignaturasde Farmacologia I y II del Grado en Farmacia. En cada sesión el profesor realiza una breve introducción del modelo experimental, indicando los objetivos que se plantea el investigador asi como las posibilidades de dicha técnica. A continuación en los vídeos, los estudiantes ven el desarrollo completo del experimento, los materiales necesarios y las condiciones experimentales adecuadas para su realización, asi como los diferentes parámetros y variables que se pueden medir. Al finalizar la proyección del vídeo se plantean dos tipos de tareas a los estudiantes:- diseño de un protocolo de evaluación de un fármaco con la metodología descrita- análisis, presentación y discusión de resultados, tras proporcionarles ejemplos de datos obtenidos en el ensayo.El procedimiento seguido para la elaboración de los vídeos es: 1) Diseño del ensayo de laboratorio. 2) Preparación del material necesario y las condiciones para una correcta grabación. 3) Grabación. Montaje de las imágenes (incluye fotografías, esquemas) y del sonido. 4) Edición del material filmado (una versión para Video- DVD y otra para incluirla en el Servidor Multimedia de la plataforma de la Universitat de València)(AU)

Pharmacology is a primarily practical science, in which “in vivo” research using experimental animal models plays a relevant role. The topics covered in the theoretical classes, seminars and tutorials are complemented with learning in practical sessions. However, certain important aspects of the practical learning, which include performing “in vivo” assays, represents a challenge given the actual regulations regarding laboratory animal utilization. Therefore, we proposed to produce didactic videos for various practical sessions. The teacher gives a brief introduction of the selected experimental animal model, indicating the intended objectives to be achieved. The students can see in the video the complete experiment progression, necessary materials and the proper experimental conditions toperform the assay, as well as the different parameters and variables to be measured.- a protocol design to evaluate a drug with the described methodology- analysis, result presentation and discussion of given example data obtained with the assay.The procedure used for the video elaboration was: 1) Design of the laboratory assay. 2) Preparation of the necessary materials and conditions for a correct recording. 3) Recording. Image (including photographs, schemes, figures) and sound download. 4) Editing of the filmed material (one version for Video- DVD and another one to be included in the virtual platform Multimedia Server of the University of Valencia)(AU)

Aspectos vasculares relacionados con el síndrome del túnel carpiano / Vascular aspects related with the carpal tunnel syndrome

El síndrome del túnel carpiano se produce cuando el nervio mediano se comprime por alguna causa a nivel de la muñeca. Sobre la base de ello, el objetivo de este artículo es describir los aspectos vasculares de dicho síndrome. Nos hemos centrado en tres partes de esta neuropatía compresiva distal del nervio mediano, que son la etiología, la fisiopatología y la sintomatología. Dentro de la etiología hemos considerado las enfermedades relacionadas con una alteración del sistema vascular que provocan un compromiso continente-contenido del carpo.ResumenLa metodología empleada en la elaboración de este estudio ha sido la realización de una revisión bibliográfica en las bases de datos: Medline, Cochrane, PEDro, ClusterMed y Pubgle. En la base de datos Medline es donde se han revisado un mayor número de artículos del tema analizado. A modo de conclusión, podemos establecer que esta patología aparentemente de causa nerviosa tiene un fuerte componente vascular(AU)

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist due to any cause. Thus, this article has aimed to describe the vascular aspects of this syndrome. Three parts of this distal median nerve neuropathy compression are discussed, that is its etiology, pathophysiology and symptoms. Within the etiology, diseases related with an alteration of the vascular system that affect the carpal-continent have been considered.AbstractThe methodology used in preparing this study included conducting a review of the literature in the following databases: MEDLINE, Cochrane, Peter, ClusterMed and Pubgle. The largest number of articles on the subject discussed was found in the Medline database. In conclusion, we can establish that this disease, which is apparently linked to a nerve, has a strong vascular component(AU)