Minerva medica
-
Some authors have proposed an updating of the therapeutic recommendations for some kinds of pain, such as musculoskeletal, post-traumatic and post-surgical pain for which a multimodal approach is being increasingly considered. With regard to this, an association of analgesics belonging to different pharmacological classes becomes an important option, given that analgesic efficacy can be ensured using lower dosages of single components, improving the tolerability of the drugs. The fixed combination of paracetamol (325 mg) and tramadol (37.5 mg) has a precisely dose ratio to obtain an additive analgesic effect, improving both the analgesic efficacy, which is more stronger and complete, and the duration of the action, guaranteeing a quick analgesic effect over time. ⋯ Rigorous studies were conducted also for chronic pain; in the 6 studies considered the duration of treatment was 4-13 weeks and a total of 1 890 patients, affected by chronic musculoskeletal pain, were admitted. The mean daily dose of paracetamol/tramadol was between 3.5 and 4.2 tablets/day, showing itself to be constant and independent of the disease considered. In conclusion, the fixed association paracetamol/tramadol is a new therapeutic option, particularly useful in mild-moderate pain where paracetamol is inadequate.
-
The present article relates to the Italian Ministerial Decree (DM) 18/04/2007 referring to what was established by the Financial Law 2007 on the matter of the use of drugs for the so called ''off-label'' uses. This law introduces three cannabinoid substances, with the common name of Delta 9 and Trans-delta 9 tetrahydrocannabinol and Nabilone, within the possible therapies for the treatment of ''severe pain''. The authors underline the absence of a sufficient pharmacokinetical and pharmacodynamical knowledge supporting the use of cannabinoid substances in the ''severe pain'' therapy. Further more the professional prescriber could go against judicial consequences if the drugs causes as verified the onset of collateral effects even severe that, for the scientific knowledge in possess at the present state, the authors know could take place.
-
The disease mechanism of multiple sclerosis (MS) involves inflammation, demyelination and neurodegeneration. The relation between these components is not completely understood, but recent experiences with aggressive anti-inflammatory treatment suggest that inflammation drives neuronal damage in patients with relapsing remitting MS. Although infiltration of lymphocytes into the brain parenchyma was recognized as a key event in the pathogenesis of MS more than 120 years ago, important aspects of the mechanisms triggering and sustaining this immune response remain unknown. ⋯ The understanding of MS as an autoimmune disease targeting myelin proteins is shaped by the animal model experimental autoimmune encephalomyelitis (EAE), but translation from EAE to MS has proven to be difficult. Although both the EAE model and the prominent association to HLA class II molecules suggest a key role for CD4+ T helper cells, it is not known if or how their tolerance to myelin proteins or other putative autoantigens are broken in MS. This paper reviews some important concepts and controversies in the understanding of the immunological basis for MS and its treatment.
-
Glucocorticoids, often regarded as ancient drugs, are still frequently used in modern medicine because of their strong anti-inflammatory and immunosuppressive properties. Nowadays, the side effects of glucocorticoids are well-known and physicians often anticipate on these side effects. Bone loss is one of the most important side effects of glucocorticoid use, even in low doses. ⋯ Calcium and plain vitamin D3 supplementation are considered as important support for prevention and treatment of glucocorticoid-induced osteoporosis. Despite the increased knowledge on bone loss and fracture risk during glucocorticoid use and the possibilities of pharmacological intervention of it, studies made clear that the care given by physicians in prevention and treatment of glucocorticoid-induced osteoporosis needs to be optimized in future years. Further training of health care workers in pathophysiology, general measurements and pharmacological intervention for prevention and treatment of glucocorticoid-induced osteoporosis, is needed.
-
Two months after monolateral adrenalectomy, a 47-year-old woman stopped taking corticosteroid replacement therapy in the first 15 days of therapy. She was admitted to the Department of Internal Medicine because of hypertension, severe hypercalcemia, uncompensated metabolic alkalosis and clinical symptoms of acute adrenal insufficiency. The presence of hypokalemia and hypernatremia precluded a diagnosis of hypocortisolism, therefore no corticosteroids were given during the time required to investigate the cause of hypercalcemia, which resulted negative. ⋯ This case report confirms that, though rare, hypercalcemia may be a finding in acute adrenal insufficiency and can be rapidly corrected by corticosteroid administration. Furthermore, excessive liquorice intake can induce a clinical picture resembling that of primary hyperaldosteronism. In patients with adrenal insufficiency, it can, at least in part, disguise its metabolic effects and delay diagnosis and treatment.