Semergen
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We provide an updated review of the pharmacological treatment of neuropathic pain, with emphasis on the latest evidence-based recommendations. Drugs proposed as first line include tricyclic antidepressants (particularly amitriptyline), serotonin-noradrenaline reuptake inhibitors (particularly duloxetine), pregabalin and gabapentin. Second-line treatments include 5% lidocaine medicated plasters and capsaicin 8% patches, only for peripheral neuropathic pain and tramadol; whereas potent opioids and botulinum toxin A (for peripheral neuropathic pain) are considered third-line treatments. Future perspectives include the development of new drugs and a more personalised therapeutic approach, which is made possible by recent progress in the assessment and understanding of neuropathic pain.
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Thoracentesis is a simple test with few complications that provides relevant information in the diagnosis of a pleural effusion, through a correct interpretation of the pleural fluid analysis. An interesting initiative would be to incorporate this technique by those Primary Care teams that treat serious and complex patients, with difficulties in moving to specialised centres far from their homes. In this context, a good knowledge of the diagnostic possibilities offered by the pleural fluid analysis could be very useful in the hands of well trained staff to establish the aetiology of a pleural effusion and be able to initiate, as quickly as possible, its treatment. This article aims to contribute to this, by suggesting guidelines on how a simple technique can provide relevant information in order to determine the aetiology of pleural effusion, and which could be implemented within a given Primary Care framework.
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Multicenter Study Observational Study
Profiling of patients with non-valvular atrial fibrillation and moderate-to-high risk of stroke not receiving oral anticoagulation in Spain.
In non-valvular atrial fibrillation (NVAF) with embolic risk, the guidelines recommend oral anticoagulation (OAC), although not all patients receive it. In this study, an attempt is made to identify these patients, and to study factors related to non-anticoagulation. ⋯ About 20% of Spanish NVAF patients do not receive OAC in the clinical practice and are treated with antiplatelet agents, which do not reduce haemorrhagic risk. Most patients do not clearly show a contraindication to OACs, particularly considering that there are other available options (direct oral anticoagulant drugs [DOACs]).
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Overweight and obese patients have an increased risk of cardiovascular disease and general mortality. It is not clear which obesity index should be used in the clinic. The objective is to compare the relationship between body mass index (BMI), waist circumference (WC), waist-height ratio (WHR), and conicity index (Conicity-I) with 10-year Framingham cardiovascular risk (CVR). ⋯ The central obesity indexes (WC and WHR) discriminated better than the BMI the CVR. In women, all the indices had greater AUCs than in men, except for the I-Conicity.
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Review
[Regulatory requirements; What steps must be taken before starting a biomedical research study?]
Studies of research with human beings, their biological specimens, or their personal data in the field of biomedicine have been subject to regulation since the middle of the last century. Initially a regulation based on recommendations such as the Nuremberg Code, the Belmont Report or the first versions of the Declaration of Helsinki. ⋯ Subsequently, it went through a clearly regulatory period in which the premises of these recommendations were progressively incorporated into the legal system of the different countries, and with this, arose the external control of the investigation by the administrations and other bodies, such as the Research Ethics Committees. The purpose of this article is to serve as a guide to professionals whose main activity is care in the field of Primary Care and who, in turn, are interested in initiating research studies to respond to uncertainties in the context of their daily activity that may arise.