Drugs of today
-
Vilazodone hydrochloride belongs to a new class of antidepressants-the indolalkylamines-and has dual activity as a selective serotonin reuptake inhibitor (SSRI) and as a partial agonist of the serotonin 5-HT(1A) receptor. Its antidepressant activity has been demonstrated in two 8-week, double-blind, randomized, placebo-controlled trials and in a 1-year open-label study. ⋯ The most common adverse events were diarrhea and nausea, although these were mild to moderate in severity and rarely a cause for discontinuation. No important clinical changes in vital signs, laboratory values, ECG morphology and sexual function were observed or reported.
-
Catechol-O-methyltransferase (COMT) metabolizes catechol neurotransmitters dopamine, noradrenaline and adrenaline that are involved in various physiological functions including mood, cognition and stress response. Human pain is closely related to all these functions. ⋯ This review outlines pain symptoms and syndromes that are affected by COMT functional variation, summarizes findings of genetic association studies and provides critical outlook on reported results. Although the exact mechanism of the effect of COMT on human pain is currently uncertain, it has a clear potential to predict clinical outcomes and identify patients at risk for developing pain conditions.
-
Review Guideline
[Recommendations of the Latin-American network for the study and treatment of the neuropathic pain].
Neuropathic pain (NP) is a kind of pain which is distinct from the somatic or visceral pain that the GP is used to assessing; the clinical profile and the response to treatment of this kind of pain are different. Given its high incidence in the population, it is important that the non-specialized physician should be capable of identifying it early and start treatment. This work attempts to summarize the clinical, diagnostic, pathophysiological and therapeutic aspects of NP to guide the non-specialized physician in the identification and initial treatment of patients suffering from NP. ⋯ As background to this report, highly-respected professionals from our field published in 2008 an important article in Spanish. This material sets out clinical, pathophysiological and diagnostic concepts which the authors of this work mostly agree with. On the other hand, we differ significantly in the therapeutic aspects.
-
The objective of the current article is to review and evaluate the diagnostic and prognostic value of a new generation of sensitive assays for cardiac troponin I and troponin T. Cardiac-specific troponins I and T are the preferred diagnostic biomarker in patients presenting with suspected acute coronary syndromes. One important limitation of previous generation assays has been the relative insensitivity in detecting myocardial injury in patients with a short duration from symptom onset to presentation in the emergency room. ⋯ Not surprisingly, the relative benefit compared to previous generation assays is greatest for those patients presenting early after symptom onset. A number of cardiac conditions other than acute coronary syndromes, as well as several noncardiac conditions, are associated with elevation of circulating cardiac troponins. Thus, with the use of more sensitive assays, clinical context and serial testing to document a rise and/or fall in concentrations will be increasingly important for correct interpretation of troponin results.
-
Stroke is the number three cause of death and the most common cause of adult disability in the United States. Few patients receive the only established effective therapy, intravenous tissue plasminogen activator. Failure to treat may occur due to several reasons, a crucial one being the lack of acute neurologic coverage, particularly in rural settings. ⋯ We detail the emerging evidence for the safety and efficacy of these remote telestroke systems through observational studies (TEMPiS and REACH). Lastly, we discuss areas where telestroke could potentially expand to provide more complete stroke care beyond the acute thrombolysis phase, as well as its potential to improve clinical research and the need for cost-effective research. We conclude that telestroke is currently the most practical solution to any setback faced by stroke specialists with respect to low thrombolytic rates.