Comparison between the use of subdural and subgaleal drainage in treatment of chronic subdural hematoma.

BACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) is one of the most common pathologies in our daily practice. The standard treatment is the evacuation making a burr-hole and placement of a subdural drainage, which has shown to decrease its recurrence. However, this procedure can entail risks such as parenchymal damage, infection, or the onset of seizures, prompting the consideration of subgaleal drainage as an alternative. Our objective is to compare the use of subdural and subgaleal drainage in a cohort of patients undergoing intervention for CSDH, as well as to analyze the differences in complication rates and recurrence between the two groups. METHODOLOGY: A retrospective analytical observational study was conducted, analyzing 152 patients diagnosed with CSDH who underwent intervention at our center from January 2020 to April 2022. Patients in whom drainage was not placed were excluded. In all patients, a burr-hole was performed and the type of drainage was chosen by the neurosurgeon. RESULTS: Out of the 152 patients, subdural drainage was placed in 80 cases (52.63%), while subgaleal drainage was used in 72 cases (47.37%). There were no significant differences in the recurrence rate (30% in the subdural drainage group vs. 20.83% in the subgaleal drainage group; p = 0.134) or in the complication rate (7.5% in the subdural drainage group vs. 5.5% in the subgaleal drainage group; p = 0.749). CONCLUSIONS: Subgaleal drainage shows similar clinical outcomes with a recurrence and complication rate comparable to subdural drainage, suggesting it as a safe and effective alternative to subdural drainage in the treatment of CSDH.

Validación de test de flexión-relajación para definir un déficit lumbar con electrodos tetrapolares / Validation of the flexion-relaxation test to define a lumbar deficit with tetrapolar electrodes

Introducción y objetivo: Obtener un nuevo punto de corte (PC) para un test de flexión-relajación (FR) lumbar efectuado con electrodos (e.) tetrapolares, desde valores ya definidos con dispositivos bipolares.Materiales y métodosLa muestra del estudio consta de 47 pacientes en situación de incapacidad temporal por dolor lumbar (DL). Fueron evaluados mediante un test de dinamometría isométrica, una prueba cinemática y una valoración del fenómeno FR.Se plantean dos experimentos con curvas ROC. El primero, con 47 pacientes que efectuaron de modo consecutivo el test FR con ambos tipos de electrodos, utilizándose como variable de clasificación el punto de corte conocido para los e. bipolares (2,49uV). En el segundo, con los datos de la EMGs registrados con e. tetrapolares en 17 pacientes, se efectúa un test de DeLong que compara las 2 curvas ROC que construimos, por un lado, al clasificar la muestra desde pruebas de dinamometría y cinemática, y por el otro, al clasificarlos con los valores de la EMGs bipolar.ResultadosUn total de 34 pacientes completaron adecuadamente las valoraciones del primer experimento y 17 pacientes el segundo. El primer estudio arroja un punto de corte de 1,2uV, con un AUC del 87,7%; sensibilidad 84,2% y especificidad 80%. El segundo muestra un PC para los e. bipolares de 1,21uV (AUC 87,5%) y para los e. tetrapolares de 1,43 (AUC 82,5%) con un test de DeLong sin diferencias significativas entre ambas curvas (p>0,4065).ConclusionesLa metodología de validación con curvas ROC ha permitido obtener un nuevo PC para la prueba FR de modo práctico, simplemente simultaneando ambos test sobre el mismo grupo de pacientes hasta obtener una muestra significativa. (AU)

Introduction and objective: To obtain a new cut-off point (CP) for a lumbar flexion-relaxation (RF) test established with tetrapolar (e.) electrodes, from values already defined with bipolar devices.Materials and methodsThe study sample consists of 47 patients in a situation of temporary disability due to low back pain (DL). They were evaluated by means of an isometric dynamometry test, a kinematic test and an assessment of the FR phenomenon.Two experiments with ROC curves are proposed. The first, with 47 patients who consecutively performed the RF test with both types of electrodes, using the cut-off point (CP) known for the e. bipolar (2.49μV). In the second, with the EMG data recorded with e. tetrapolar in 17 patients, a DeLong test was performed that compares the 2 ROC curves that were constructed on the one hand, by classifying the sample from dynamometry and kinematic tests, and on the other, by classifying them with the bipolar EMG values.ResultsA total of 34 patients adequately completed the evaluations of the first experiment and 17 patients the second. The first study shows a cut-off point of 1.2μV, with an AUC of 87.7%; Sensitivity 84.2% and Specificity 80%. The second shows a PC for e. bipolars of 1.21μV (AUC 87.5%) and for e. tetrapolar values of 1.43 (AUC 82.5%) with a DeLong test without significant differences between both curves (p>0.4065).ConclusionsThe validation methodology with ROC curves has made it possible to obtain a new PC for the RF test in a practical way, simply by simultaneously performing both tests on the same group of patients until a significant sample is obtained. (AU)

Acteoside Attenuates Recognition Memory Impairment in CUMS Rats via Regulating Synaptic Plasticity and mTOR Signaling Pathway

SUMMARY: We evaluated the role and mechanism of acteoside in the regulation of memory impairment induced by chronic unpredictable mild stress (CUMS). CUMS was used to induce depression in rats and the successful establishment of CUMS model were verified by forced swimming test and sucrose preference test. The Y-maze test and novel object recognition test assessed memory functions. The structural changes in the cortex and hippocampus were observed by hematoxylin and eosin (HE) staining. Immunofluorescence staining and western blotting determined the protein levels. Y-maze test and novel object recognition test showed that there was memory performance impairment in rats of CUMS group, which was improved by the acteoside treatment. HE staining showed that CUMS exposure damaged the structure in the cortex and hippocampus, while the acteoside treatment alleviated the structural changes. Compared with the control group, the levels of BNDF and CREB in the cortex and hippocampus of the CUMS group were significantly decreased. Acteoside significantly reversed the expressions of these proteins in CUMS rats. Meanwhile, compared with the control group, the levels of p-mTOR and p- P70S6K in the cortex and hippocampus of the CUMS group were significantly increased, and these changes were significantly reversed by acteoside. Nevertheless, the effect of acteoside on mTOR signaling was markedly blocked by rapamycin, a specific inhibitor of mTOR signaling. Acteoside can attenuate memory impairment and ameliorate neuronal damage and synaptic plasticity in depression rats probably via inhibiting the mTOR signaling pathway. Acteoside may serve as a novel reagent for the prevention of depression.

Evaluamos el papel y el mecanismo del acteoside en la regulación del deterioro de la memoria inducido por estrés leve crónico impredecible (ELCI). Se utilizó ELCI para inducir depresión en ratas y el establecimiento exitoso del modelo ELCI se verificó mediante una prueba de natación forzada y una prueba de preferencia de sacarosa. La prueba del laberinto en Y y la prueba de reconocimiento de objetos novedosos evaluaron las funciones de la memoria. Los cambios estructurales en la corteza y el hipocampo se observaron mediante tinción con hematoxilina y eosina (HE). La tinción por inmunofluorescencia y la transferencia Western determinaron los niveles de proteína. La prueba del laberinto en Y y la prueba de reconocimiento de objetos novedosos mostraron que había un deterioro del rendimiento de la memoria en ratas del grupo ELCI, que mejoró con el tratamiento con acteósidos. La tinción con HE mostró que la exposición a ELCI dañó la estructura de la corteza y el hipocampo, mientras que el tratamiento con actósidos alivió los cambios estructurales. En comparación con el grupo de control, los niveles de BNDF y CREB en la corteza y el hipocampo del grupo ELCI disminuyeron significativamente. Acteoside revirtió significativamente las expresiones de estas proteínas en ratas ELCI. Mientras tanto, en comparación con el grupo control, los niveles de p-mTOR y p-P70S6K en la corteza y el hipocampo del grupo ELCI aumentaron significativamente, y estos cambios fueron revertidos significativamente ELCI por el acteoside. Sin embargo, el efecto del acteoside sobre la señalización de mTOR fue notablemente bloqueado por la rapamicina, un inhibidor específico de la señalización de mTOR. El acteoside puede atenuar el deterioro de la memoria y mejorar el daño neuronal y la plasticidad sináptica en ratas con depresión, probablemente mediante la inhibición de la vía de señalización mTOR. Acteoside puede servir como un reactivo novedoso para la prevención de la depresión.

FACTORS ASSOCIATED WITH ERC-5 IN PATIENTS OF AN EPS IN VALLE DEL CAUCA 2018-2020 / FACTORES ASOCIADOS A LA ERC-5 EN PACIENTES DE UNA EPS DEL VALLE DEL CAUCA 2018-2020

Introduction: Chronic Kidney Disease (CKD) involves a progressive deterioration in kidney function, affecting the ability to filter metabolic waste. Factors such as age, family history, ethnicity, sex, and unhealthy habits may contribute to progression to stage 5 (CKD-5). Methodology: Retrospective observational study analyzed patients with hypertension, diabetes, morbid obesity, dyslipidemia and CKD in Valle del Cauca from 2018 to 2020. Cases with CKD-5, previous dialysis, and significant changes were excluded. A census was used as a sampling method, consolidating quarterly data in 12 databases. The analysis addressed sociodemographic and clinical factors, evaluating associations with binary logistic regression, and the study was ethically approved. Results: In a cohort of 57,643 patients with CKD stages 1 to 4, the majority began follow-up in stages 2 and 3. The prevalent comorbidities were hypertension, overweight and obesity. The incidence of CKD-5 was 6 new cases per 1000 patients, being higher in the population aged 30 to 44 years, male, non-ethnic, not belonging to vulnerable groups and residing in certain municipalities. Factors such as uncontrolled blood pressure, lack of specific medication and follow-up in advanced renal stages were significantly associated with the incidence of CKD stage 5. In addition, a direct relationship was observed between the advancement of renal stage and the increase in creatinine in the blood, albumin in urine, total cholesterol and HDL cholesterol. Patients who advanced to stage 5 showed significantly higher levels of blood creatinine, albuminuria, total cholesterol, and LDL cholesterol compared to those who remained in stage 4 or lower.

Introducción: La Enfermedad Renal Crónica (ERC) implica un deterioro progresivo en la función renal, afectando la capacidad de filtrar desechos metabólicos. Factores como edad, antecedentes familiares, etnia, sexo, y hábitos poco saludables pueden contribuir a la progresión hacia el estadio 5 (ERC-5). Metodología: Estudio observacional retrospectivo analizó pacientes con hipertensión, diabetes, obesidad mórbida, dislipidemia y ERC en el Valle del Cauca de 2018 a 2020. Se excluyeron casos con ERC-5, diálisis previa, y cambios significativos. Se utilizó un censo como método de muestreo, consolidando datos trimestrales en 12 bases. El análisis abordó factores sociodemográficos y clínicos, evaluando asociaciones con regresión logística binaria, y el estudio fue éticamente aprobado. Resultados: En una cohorte de 57,643 pacientes con ERC estadios 1 a 4, la mayoría inició el seguimiento en estadios 2 y 3. Las comorbilidades prevalentes fueron hipertensión, sobrepeso y obesidad. La incidencia de ERC-5 fue de 6 casos nuevos por cada 1000 pacientes, siendo mayor en población de 30 a 44 años, sexo masculino, no étnica, no perteneciente a grupos vulnerables y residente en ciertos municipios. Factores como la presión arterial no controlada, falta de medicación específica y seguimiento en estadios renales avanzados se asociaron significativamente con la incidencia de ERC estadio 5. Además, se observó una relación directa entre el avance de estadio renal y el incremento de creatinina en sangre, albumina en orina, colesterol total y colesterol HDL. Los pacientes que avanzaron a estadio 5 mostraron niveles significativamente superiores de creatinina en sangre, albuminuria, colesterol total y colesterol LDL en comparación con los que permanecieron en fase 4 o inferior.

Consensus on the diagnostic algorithm for chronic nodular prurigo. / Consenso sobre el algoritmo diagnóstico del prurigo crónico nodular.

Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities). We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.

Dolor crónico tras la cirugía de mama: incidencia, factores de riesgo e impacto en la calidad de vida / Chronic pain after breast surgery: Incidence, risk factors and impact on quality of life

Introducción y objetivos: El cáncer de mama es la neoplasia más frecuentemente diagnosticada y el dolor crónico postoperatorio (DCPO) es un problema relacionado con la terapia crecientemente reconocido. Evaluamos la incidencia del DCPO, sus características, factores asociados e impacto en la calidad de vida (CdV) del paciente.Materiales y métodosSe realizó un estudio prospectivo observacional de 6meses en pacientes tratados mediante cirugía de mama en un hospital universitario terciario. Los datos se recopilaron utilizando diversos cuestionarios: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire y Breast Cancer Module.ResultadosUn total de 112 pacientes completaron el estudio, de los cuales aproximadamente un tercio (34,8%) desarrollaron DCPO y casi todos ellos dolor neuropático potencial. El DCPO interfirió con la vida diaria de los pacientes y redujo su CdV. La diabetes (p=0,028), la catastrofización (p=0,042) y la gravedad del dolor posoperatorio agudo (p<0,001) se asociaron a DCPO.ConclusionesEste estudio amplía nuestra comprensión sobre el DCPO y muestra el impacto de este síndrome. Los profesionales sanitarios deben ser conscientes del DCPO, y tomar medidas para prevenirlo y tratarlo, proporcionando a los pacientes la información suficiente. (AU)

Introduction and objectives: Breast cancer is the most frequently diagnosed malignancy, and chronic pain after breast surgery (CPBS) is an increasingly recognized therapy-related problem. We evaluated CPBS incidence, characteristics, associated factors, and impact on patient quality of life (QoL).Materials and methodsSix-month observational prospective study in patients undergoing breast surgery in a tertiary university hospital. Data were collected using several questionnaires: Pain Catastrophizing Scale, Brief Pain Inventory-Short Form, Douleur Neuropathique 4 Questionnaire, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module.ResultsA total of 112 patients completed the study. Approximately, one third (34.8%) developed CPBS, almost all with potentially neuropathic pain. CPBS interfered with patients’ daily life and reduced their QoL. Diabetes (p=.028), catastrophizing (p=.042), and acute postoperative pain severity (p<.001) were associated with CPBS.ConclusionsThis study broadens our understanding of CPBS and shows the impact of this syndrome. Healthcare workers need to be aware of CPBS and take steps to prevent and treat it, and provide patients with adequate information. (AU)

Tumor glómico causante de dolor de dedo crónico: la prueba de detección de isquemia es un signo clínico fiable para su diagnóstico. Informe de un caso y revisión de la literatura / Glomus tumor causing chronic finger pain: Ischemia test is a reliable clinical sign for the diagnosis. Case report and review of literature

Los tumores glómicos (TG) son neoplasias benignas raras, que se derivan de la estructura neuroarterial denominada cuerpo glómico, un shunt arteriovenoso especializado implicado en la regulación de la temperatura. Representan menos de 2% de los tumores del tejido blando, y entre 1 y 4,5% de los tumores de la mano. Aun cuando sus primeras descripciones aparecieron hace casi 100 años, son comunes la demora y la ausencia diagnósticas, las cuales originan un sufrimiento terrible. La tríada diagnóstica clásica consiste en dolor espontáneo, sensación de presión y sensibilidad, e hipersensibilidad al frío. La imagen de resonancia magnética (IRM) sigue siendo la modalidad de imagen más útil. La supresión del dolor tras inflar un esfigmomanómetro por encima de los niveles de la presión arterial sistólica (prueba de detección de isquemia) es altamente diagnóstica, por lo que sugerimos el uso rutinario de esta prueba simple en los casos de dolor en la extremidad superior de etiología desconocida. La resección quirúrgica es el tratamiento de elección, y es curativa. (AU)

Glomus tumors are a rare benign neoplasm arising from the neuroarterial structure called the glomus body, a specialized arteriovenous shunt involved in temperature regulation. They represent less than 2% of soft tissue tumors and between 1 and 4.5% of hand's tumors. Even though its first descriptions appeared almost 100 years ago, late and missed diagnoses are common, which leads to terrible suffering. The classic diagnostic triad consists of spontaneous pain, pressure sensation and tenderness, and cold hypersensitivity. Magnetic resonance imaging stills the most useful imaging modality. Abolition of pain after inflating a blood pressure cuff above systolic blood pressure levels (ischemia test) is highly diagnostic, so we suggest the routine use of this simple test in cases of upper limb pain of unknown etiology clear. Surgical excision is the treatment of choice and is curative. (AU)

Efectividad de los protocolos de fisioterapia para pacientes con dolor lumbar crónico. Una revisión sistemática / Effectiveness of physiotherapy protocols for patients with chronic low back pain: A systematic review

Introducción: El dolor lumbar crónico es una de las principales causas de incapacidad laboral en el mundo. Requiere un abordaje interdisciplinario para la evolución del paciente. Hasta el momento, no existe consenso en el manejo del dolor lumbar crónico, lo que generó la inquietud de esta revisión sistemática. Objetivo: Identificar la efectividad de los protocolos de fisioterapia en el manejo del dolor lumbar crónico. Metodología: Se realizó una búsqueda sistemática en las bases de datos Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari y LILACS, Google Scholar, Teseo y PROSPERO, desde el inicio de las bases hasta agosto de 2021. Los criterios de selección se definieron según la intervención y el tema del artículo. Resultados: Se incluyeron 26 estudios en la síntesis cualitativa, se excluyeron artículos que no cumplieran con los criterios de inclusión. Se encontró efecto en el control del dolor y la disminución de la discapacidad y las principales intervenciones son: fortalecimiento muscular del Core y miembros inferiores, estiramiento de miembros inferiores, movilidad lumbopélvica y educación o escuela de espalda. La frecuencia en el tratamiento osciló entre 2 y 3 veces por semana durante 5 semanas. Conclusiones: Se encontró mayor efectividad en el tiempo de control del dolor y la disminución de la discapacidad, relacionados principalmente con el fortalecimiento muscular del Core y las estrategias educativas.(AU)

Introduction: Chronic low back pain is one of the main causes of incapacity for work in the world. It requires an interdisciplinary approach for the evolution of the patient. Until now, there is no consensus on the management of chronic low back pain, which generated the concern of this systematic review. Aim: To identify the effectiveness of physiotherapy protocols in the management of chronic low back pain. Methodology: A systematic search was carried out in the Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari and LILACS, Google Scholar, Teseo and PROSPERO databases, from the beginning of the databases until August, 2021. The selection criteria were defined according to the intervention and topic of the article. Results: Twenty-six studies were included in the qualitative synthesis, articles that did not meet the inclusion criteria were excluded. An effect was found in the control of pain and the reduction of disability and the main interventions are: muscular strengthening of the core and lower limbs, stretching of the lower limbs, lumbopelvic mobility and education or back school. The treatment frequency ranged from 2 to 3 times per week for 5 weeks. Conclusions: Greater effectiveness was found in pain control time and disability reduction, mainly related to core muscle strengthening and educational strategies.(AU)

Collective effects of rising average temperatures and heat events on oviparous embryos.

Survival of the immobile embryo in response to rising temperature is important to determine a species' vulnerability to climate change. However, the collective effects of 2 key thermal characteristics associated with climate change (i.e., rising average temperature and acute heat events) on embryonic survival remain largely unexplored. We used empirical measurements and niche modeling to investigate how chronic and acute heat stress independently and collectively influence the embryonic survival of lizards across latitudes. We collected and bred lizards from 5 latitudes and incubated their eggs across a range of temperatures to quantify population-specific responses to chronic and acute heat stress. Using an embryonic development model parameterized with measured embryonic heat tolerances, we further identified a collective impact of embryonic chronic and acute heat tolerances on embryonic survival. We also incorporated embryonic chronic and acute heat tolerance in hybrid species distribution models to determine species' range shifts under climate change. Embryos' tolerance of chronic heat (T-chronic) remained consistent across latitudes, whereas their tolerance of acute heat (T-acute) was higher at high latitudes than at low latitudes. Tolerance of acute heat exerted a more pronounced influence than tolerance of chronic heat. In species distribution models, climate change led to the most significant habitat loss for each population and species in its low-latitude distribution. Consequently, habitat for populations across all latitudes will shift toward high latitudes. Our study also highlights the importance of considering embryonic survival under chronic and acute heat stresses to predict species' vulnerability to climate change.

Efectos colectivos del aumento de las temperaturas promedio y los eventos de calor en embriones ovíparos Resumen La supervivencia de los embriones inmóviles en respuesta al incremento de temperatura es importante para determinar la vulnerabilidad de las especies al cambio climático. Sin embargo, los efectos colectivos de dos características térmicas claves asociadas con el cambio climático (i. e., aumento de temperatura promedio y eventos de calor agudo) sobre la supervivencia embrionaria permanecen en gran parte inexplorados. Utilizamos mediciones empíricas y modelos de nicho para investigar cómo el estrés térmico crónico y agudo influye de forma independiente y colectiva en la supervivencia embrionaria de los lagartos en todas las latitudes. Recolectamos y criamos lagartos de cinco latitudes e incubamos sus huevos en un rango de temperaturas para cuantificar las respuestas específicas de la población al estrés por calor crónico y agudo. Posteriormente, mediante un modelo de desarrollo embrionario parametrizado con mediciones de tolerancia embrionaria al calor, identificamos un impacto colectivo de las tolerancias embrionarias al calor agudo y crónico en la supervivencia embrionaria. También incorporamos la tolerancia embrionaria crónica y aguda al calor en modelos de distribución de especies híbridas para determinar los cambios de distribución de las especies bajo el cambio climático. La tolerancia embrionaria al calor crónico (T­crónico) permaneció constante, mientras que la tolerancia al calor agudo (T­agudo) fue mayor en latitudes altas que en latitudes bajas. La tolerancia al calor agudo ejerció una influencia más pronunciada que la tolerancia al calor crónico. En los modelos de distribución de especies, el cambio climático provocó la pérdida de hábitat más significativa para cada población y especie en su distribución de latitudes bajas. En consecuencia, el hábitat para poblaciones en todas las latitudes se desplazará a latitudes altas. Nuestro estudio también resalta la importancia de considerar la supervivencia embrionaria bajo estrés térmico crónico y agudo para predecir la vulnerabilidad de las especies al cambio climático.

Ganglion impar block in chronic cancer-related pain - A review of the current literature.

Oncologic chronic pain is often difficult to control, especially in anatomical areas with multiple and complex innervation, such as the pelvic/perineal region. The ganglion impar block (GIB) is a procedure with growing interest and varied applicability. It has been used in several benign and malignant causes of pelvic and perineal pain refractory to pharmacological treatment. We conducted a review of all articles published in PUBMED® until the 30th of October 2022 regarding GIB in oncologic pain. 19 articles were identified with a total of 278 patients. Both chronic cancer pain and chronic postcancer treatment pain patients were included. We reviewed the various techniques, approaches, and therapeutic options that were employed. No serious adverse effects were reported. GIB appears to be an effective and safe procedure that should be considered in patients with intractable perineal cancer-related pain.

Consideraciones para el uso de tramadol en dolor crónico no oncológico en atención primaria de salud (APS)

Introducción: tramadol es un analgésico opioide usado frecuentemente para el manejo del dolor crónico no oncológico (DCNO). En Chile, es parte del arsenal farmacológico de los centros de atención primaria para el tratamiento de patologías como artrosis de cadera y rodilla. Es considerado seguro y efectivo, sin embargo, existen reportes de efectos adversos serios por polimorfismos hepáticos, interacciones farmacológicas, intoxicaciones, adicción y muerte. La dosis óptima de tramadol es paciente dependiente. Por esto, es necesario contar con orientaciones específicas para prescribir tramadol de manera segura y eficaz según las características de cada paciente. Materiales y métodos: se revisaron guías actualizadas, revisiones sistemáticas y guías de sociedades internacionales sobre el uso de opioides en DCNO y el uso de tramadol en patologías de DCNO como artrosis, lumbago crónico, dolor neuropático y fibromialgia. Resultados: tramadol no está indicado en el tratamiento de cuadros de dolor primario como fibromialgia y en DCNO secundario es un fármaco de segunda línea o no está recomendado. En dolor crónico neuropático (DCN) es segunda línea de tratamiento. En osteoartritis de cadera, rodilla y mano, se reporta efecto analgésico modesto. Sopesar riesgos versus beneficios en estos pacientes. En artritis reumatoide y lumbago crónico se desaconseja su uso. Conclusiones: tramadol es un medicamento seguro y efectivo si se indica, administra, supervisa y descontinúa adecuadamente. Sin embargo, puede asociarse a interacciones farmacológicas, efectos secundarios serios, conductas de abuso y usos ilícitos, por lo que es necesario conocer y manejar adecuadamente su farmacología e indicaciones.

Introduction: Tramadol is an opioid pain medicine commonly used for chronic non-cancer pain (CNCP) management. In Chile, it is part of the pharmacological arsenal available in primary care centers for treating specific CNCP pathologies, such as hip and knee arthrosis. Tramadol is considered a safe and effective drug. Nevertheless, there are reports of serious adverse effects of tramadol, such as poisoning, addiction, and death, probably caused by liver polymorphisms and drug interaction. The optimal dose of tramadol is patient-specific. Specific knowledge is needed to prescribe tramadol in a safe and effective way according to the patient's medical backward. Methods: We review updated guidelines, systematic reviews, and guidelines from international societies about the use of opioids and tramadol in CNCP pathologies such as osteoarthritis, chronic low back pain, neuropathic pain, and fibromyalgia. Results: Tramadol has no role in primary pain treatment, such as fibromyalgia, but is a second-line drug for chronic neuropathic pain (CNP) and some secondary pain syndromes. Tramadol has a modest analgesic effect in osteoarthritis patients. Clinicians should always weigh the risks and benefits before prescribing tramadol. Tramadol use is discouraged in rheumatoid arthritis and chronic lumbago. Conclusions: Tramadol is a safe and effective drug if correctly indicated, administered, supervised, and discontinued. However, it may be associated with pharmacological interactions, serious side effects, abuse behaviors, and illicit uses, and it is necessary that clinicians know and manage its pharmacology and indications appropriately.

[Management of chronic non-oncologic pain by multicomponent programs using non-pharmacologic therapies: A systematic review of the literature]. / Manejo del dolor crónico no oncológico con programas multicomponentes de terapias no farmacológicas: revisión sistemática de la literatura.

Chronic pain is a public health problem suffered by 20% of the world's population. Pharmacological approaches are insufficient, so a multi-therapeutic approach that also includes non-pharmacological therapies (psychological therapies, meditation, physical exercise, healthy habits, etc.) is proposed. The aim of this review was to review the existing scientific evidence on the effect of multicomponent programs with non-pharmacological therapies in people with chronic non-oncologic pain. To this end, a search for scientific articles was carried out in three databases (PubMed, Web of Science and PsycINFO) and 17 articles were selected, following the PRISMA recommendations. The patients who participated in these programs were mostly women, aged 18 to 80years, working or on sick leave due to pain, with secondary education or less and married. The most frequent pain was musculoskeletal, mainly low back pain. All the articles studied the effectiveness of two or more therapies, highlighting psychological therapies, physical exercise and education. Positive results were obtained in the reduction of different variables such as pain, pain catastrophizing, anxiety and depression, in addition to improving functionality and quality of life. It has also been shown that patients' prior expectations regarding the intervention influence its effectiveness. Although throughout the review there was great heterogeneity in the interventions, in the evaluation methods and in the results themselves, it can be concluded that multicomponent programs show positive results in the management of chronic pain, and should therefore be incorporated as a routine therapeutic treatment.

Alcohol use among children and adolescents with chronic pain. Scoping review.

AIM: To examine and map alcohol consumption in children and adolescents with chronic pain (CP). METHOD: A scoping review of international databases (CINAHL, WOS, PubMed, PsycINFO, Scopus, Embase, and MEDLINE) and grey literature was conducted between September 2022 and February 2023. Documents addressing the relationship between alcohol consumption and CP in children and adolescents, published in English and Spanish between 2012 and 2023, were included. Those papers with a population suffering from CP derived from neurodegenerative diseases, chronic infectious diseases or cognitive impairment were excluded. We assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines Network. Finally, 11 documents were considered out of the 479 reviewed. RESULTS: The relationship between substance consumption and CP in adolescents is a scarcely investigated topic. While there is a trend towards lower rates of alcohol consumption in youth with pain, there is evidence suggesting an association, particularly in cases of intense pain. The use of various substances, both legal and illegal, for pain management underscores the importance of comprehensively addressing this phenomenon in this population. CONCLUSIONS: Further research is needed to assess the relationship between alcohol consumption in children and adolescents with CP.

Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

Relation between neutrophil-to-lymphocyte ratio with epidural analgesia timing and thoracotomy pain.

OBJECTIVE: This study investigated the relationship of the pre-operative neutrophil/lymphocyte ratio (NLR) to the timing of epidural analgesia administration and post-operative acute and chronic pain in thoracotomy. MATERIALS AND METHODS: The study was conducted on 60 patients, with NLR ≥ 2 (Group A) and NLR < 2 (Group B). Each group was divided into subgroups pre-emptive analgesia (Group P) and control group (Group C). Epidural analgesic solution was administered as a bolus before the surgical incision in Group P and at the end of the operation in Group C. NRS was questioned postoperatively at the 2nd, 4th, 8th, 12th, 24th h, 1st, and 3rd months and also additional analgesic needs were recorded. RESULTS: In Group A, the pain scores of the patients who received pre-emptive epidural analgesia were lower at the post-operative 2nd, 4th, and 8th h and analgesic consumption was less in the post-operative first 24 h. CONCLUSION: It was observed that pre-emptive epidural analgesia reduced pain levels and additional analgesic consumption in the acute post-operative period in patients with pre-operative NLR ≥ 2.

OBJETIVO: Este estudio investigó la relación de la relación neutrófilos/linfocitos (NLR) preoperatoria con el momento de la administración de la analgesia epidural y el dolor agudo y crónico posoperatorio en la toracotomía. MATERIALES Y MÉTODOS: El estudio se realizó en 60 pacientes, como NLR ≥ 2 (Grupo A) y NLR < 2 (Grupo B). Cada grupo se dividió en subgrupos de analgesia preventiva (Grupo P) y grupo control (Grupo C). La solución analgésica epidural se administró en bolo antes de la incisión quirúrgica en el Grupo P y al final de la operación en el Grupo C. La NRS se cuestionó posoperatoriamente a las 2, 4, 8, 12, 24 horas, 1 y 3 meses también adicionales Se registraron las necesidades analgésicas. RESULTADOS: En el Grupo A, los puntajes de dolor de los pacientes que recibieron analgesia epidural preventiva fueron menores a las 2, 4 y 8 horas postoperatorias y el consumo de analgésicos fue menor en las primeras 24 horas postoperatorias. CONCLUSIÓN: Se observó que la analgesia epidural preventiva redujo los niveles de dolor y el consumo adicional de analgésicos en el postoperatorio agudo en pacientes con NLR preoperatorio ≥ 2.

[Impact of a multicomponent program with nonpharmacological therapies for patients with chronic pain]. / Impacto de un programa multicomponente con terapias no farmacológicas para pacientes con dolor crónico.

INTRODUCTION: 25.9% of Spanish people suffer from chronic pain. An integrated, interdisciplinary approach is recommended, with pharmacological and non-pharmacological therapies, involving patients in their self-care. OBJECTIVE: To evaluate the effectiveness and impact on resources of a program with non-pharmacological therapies in the control of non-oncological chronic pain in the short and medium term. MATERIAL AND METHODS: Quasi-experimental before-after study, follow-up 3-6 months, measuring: pain, well-being, quality of life, self-esteem, resilience, anxiety/depression (validated scales); patient-reported outcomes of workshop impact on pain management, habits and mood; ED and office visits; drug consumption and employment status. RESULTS: One hundred and forty-two patients completed the program; 131 (92.3%) were women, age: 56.0. Decreased: pain (scale 0-10) (start: 6.0; end of workshop: 4.0; 3 months: 5.0); anxiety (12.9; 10.4; 8.8) and depression (12.3; 7.23; 6.47) (scales 0-21). They increased: well-being (scale 0-10) (4.0; 6.0; 4.0); quality of life (scale 0-1) (0.418; 0.580; 0.536); health status (scale 0-100) (47.5; 60.0; 60.0); self-esteem (scale 9-36) (24.1; 27.5; 26.7); resilience (scale 6-30) (14.8; 17.4; 18.6). Patient-reported outcomes were performed by 136 patients at the end of the workshop and 79 at 3 months: pain decreased (end of program: 104, 76.5%; 3 months: 66, 83.5%); medication decreased (96, 76.2%; 60, 78.9%); habits improved (112, 88.2%; 69, 90.8%). Forty patients (37.4%) reduced visits to the emergency room, 40 (37.4%) reduced scheduled visits. Overall satisfaction: 9.8 out of 10. CONCLUSIONS: Patients learn to mitigate their pain, participate in their self-care and improve their quality of life, self-esteem and emotional state. The effects remained for 3-6 months.

Glomus tumor causing chronic finger pain: ischemia test is a reliable clinical sign for the diagnosis. Case report and review of literature.

Glomus tumors are a rare, benign neoplasm arising from the neuroarterial structure known as the glomus body, which is a specialized arteriovenous shunt involved in temperature regulation. They account for less than 2% of soft tissue tumors and between 1% and 4.5% of tumors in the hand.. Despite their first descriptions appearing almost 100 years ago, late and missed diagnoses are common, leading to significant suffering. The classic diagnostic triad includes spontaneous pain, a sensation of pressure and tenderness, and cold hypersensitivity. Magnetic resonance imaging remains the most useful imaging modality. The abolition of pain after inflating a blood pressure cuff above the systolic blood pressure level (ischemia test) is highly diagnostic.Therefore, we suggest the routine use of this simple test in cases of upper limb pain of unclear etiology . Surgical excision is the treatment of choice and is curative.

The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

El viaje del paciente con fibromialgia en Latinoamérica / The patient journey of fibromyalgia in Latin America

Objetivos: Explorar la experiencia de las personas con fibromialgia (FM) en países latinoamericanos con objeto de identificar problemas en la atención sanitaria y otros ámbitos potencialmente solucionables. Métodos: Estudio cualitativo con enfoque fenomenológico y de análisis de contenido a través de grupos focales y metodología de viaje del paciente (Ux del inglés User Experience). Se llevaron a cabo 9 grupos focales virtuales con pacientes con FM y profesionales sanitarios en Argentina, México y Colombia reclutados a partir de informantes clave y redes sociales. Resultados: Participaron 43 personas (33 clínicos y 10 pacientes). Los agentes que interaccionan con el paciente en la enfermedad se encuentran en 3 esferas: la de la atención sanitaria, la del apoyo y vida laboral y la del contexto socioeconómico. La línea del viaje presenta 2 grandes tramos, 2 bucles y una línea discontinua delgada. Los 2 grandes tramos representan los tiempos que van desde los primeros síntomas hasta la visita médica y desde el diagnóstico hasta el seguimiento. Los bucles incluyen: 1.°) sucesión de diagnósticos, tratamientos erróneos y derivaciones a especialistas y 2.°) nuevos síntomas cada cierto tiempo, visitas a especialistas y dudas diagnósticas. Pocos pacientes logran la fase final de autonomía. Conclusión: El viaje de una persona con FM en Latinoamérica está lleno de obstáculos. La meta deseada es que todos los agentes entiendan que el automanejo por parte del paciente con FM es una parte indispensable del éxito, y solo se puede lograr accediendo a recursos de forma precoz y guiado por profesionales.(AU)

Objectives: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. Methods: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. Results: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. Conclusion: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.(AU)

Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.