Minerva medica
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Chronic or acute pain related to skin ulcers or their management (medication, debridement) is a typical case of mixed pain, both neuropathic and nociceptive. It represents a disabling clinical condition that deteriorates the patient's quality of life. The pharmaceutical therapy must be based on both, intensity and the type of pain. ⋯ Besides, since its opioid action is rather weak, it does not induce the severe side effects typical of traditional opioids. The benefit of such combination comes from their complementary pharmacokinetic profile, since the first has a quick action insurgence, while tramadol has a more prolonged effect. Therefore, this combination allows to obtain a quick and long lasting effect with a high tolerability profile also when treating skin ulcer pain.
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Idiopathic membranous nephropathy is the most common cause of nephrotic syndrome. In patients who present with nephrotic range proteinuria the clinical course is variable, with 50% of patients developing end stage renal disease after extended follow-up without therapy. We review the various immunosuppressive treatment modalities. ⋯ However, the efficacy of these agents must be confirmed in randomized trials with adequate renal end points. Immunosuppressive treatment should be restricted to high risk patients. The use of immunosuppressive therapy has improved outcome of patients with iMN, with nowadays less than 10% of patients progressing to end stage renal disease (ESRD).
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The OPG/RANKL has identified role in immune system via T-cell-activating cytokines. Considering that immune mechanisms play a key role in the pathogenesis of MS, OPG/RANKL might be importance in the underlying mechanism of the disease. The aim of this study is to measure plasma levels of OPG and RANKL as well as to analyze VDR FokI polymorphism (rs2228570) in MS patients and healthy individuals to detect any potential correlation. ⋯ This might define a role for FokI polymorphism and OPG/RANKL system in the pathogenesis and progression of multiple sclerosis with further practical applications.
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Comparative Study
[Study of codeine-paracetamol combination treatment compared with tramadol-paracetamol in the control of moderate-to-severe low back pain].
The objective of this study was to compare the analgesic efficacy and tolerability of tramadol hydrochloride compared with codeine phosphate in combination with paracetamol in patients with moderate-to-severe low back pain caused by osteoarthritis. In fact, while paracetamol is the analgesic of choice for this disease, in cases where this treatment may be ineffective, the therapeutic choice involves the addition of weak opioids. Due to the chronic nature of the disease, these drugs represent a safer alternative compared to anti-inflammatory drugs (NSAIDs) and selective inhibitors of cyclooxygenase 2 (COX-2). ⋯ The study, although conducted on a limited number of patients and for a relatively short time, demonstrates the greater efficacy and tolerability of the association codeine-paracetamol compared to tramadol-paracetamol.
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Patent foramen ovale (PFO) is a common finding in healthy subjects and has not been associated with increased risk of ischemic stroke in population-based cohort studies. Nevertheless, case-control studies have consistently shown an increased prevalence of PFO in cryptogenic stroke, suggesting that PFO might be a cause of stroke. The risk of stroke recurrence in patients with cryptogenic stroke and PFO is low under aspirin therapy but may be substantially higher in patients with an associated atrial septal aneurysm (ASA). ⋯ The optimal treatment for secondary prevention in patients with cryptogenic stroke and PFO is still uncertain and debated. A randomized controlled trial failed to demonstrate the superiority of transcatheter PFO closure over medical therapy. Whether anticoagulation is superior to aspirin should be tested in a randomized controlled trial.