Recenti progressi in medicina
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Neuropathic pain is usually considered an "hard pain" both for the intrinsic difficulties in a correct diagnosis, and for the modest efficacy of the most part of conventional treatments. The most frequently used drugs in clinical practice are tricyclic antidepressants and anticonvulsants, while a minor role is reserved to NSAIDs or to strong opiates. ⋯ On the basis of our review and the NNT and NNH ratio, gabapentin, pregabalin and strong opiates seem to be the most effective and well tolerated options against neuropathic pain in oncology, while carbamazepine, amitryptiline, tramadol and NSAIDs do not seem to be valid options in front line approach against oncologic neuropathic pain, either for a minor efficacy or for an unfavorable safety profile. Further trials comparing the different effective options are needed to better define the correct approach against neuropathic pain in oncology.
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The interaction of ADP with its platelet receptor P2Y12 plays a crucial role in platelet activation and thrombogenesis. This article reviews the pharmacology and clinical trials of specific antagonists of P2Y12. Clopidogrel is a thienopyridine with proven antithrombotic efficacy, but it has some important drawbacks: i) it is a pro-drug that needs to be metabolized to its active metabolite; ii) it has a delayed onset and offset of action; iii) there is high inter-individual variability in pharmacological response. ⋯ Cangrelor did not prove superior to clopidogrel in preventing thrombotic events in patients undergoing PCI. Ticagrelor proved to be superior to clopidogrel in preventing major adverse cardiac events in ACS patients, but was, like prasugrel, was associated with higher frequency of non-CABG-related bleeding complications. A shorter period of drug discontinuation before surgery was necessary in ticagrelor-treated patients compared to clopidogrel-treated patients to limit the severity of post-surgical bleeding.
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Randomized Controlled Trial Comparative Study
[Continuous positive airway pressure in acute pulmonary edema. application in a general medical ward].
The application of a Continuous Positive pressure to Patient's airway (CPAP) represents one of the most important respiratory treatments during Acute Respiratory Failure (ARF) due to Acute Cardiogenic Pulmonary Edema (ACPE). Thanks to its hemodynamic and ventilatory effects, CPAP improves clinical and gasanalytic parameters and lead to a decrease of mortality and need of intubation in these patients. CPAP can be applied with different devices: ventilators, Venturi-like flow generators and Boussignac's device. ⋯ The two CPAP's devices resulted similar in term of effectiveness. Boussignac's device has shown a better tolerability: this characteristic, together with the simple use, should stimulate the diffusion of this device where a flow generator or a ventilator are not present (outside Intensive Care Units, for example in General Medical Wards).
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Obesity has reached epidemic proportions, predisposing to the development of type 2 diabetes and cardiovascular diseases. Weight loss is a major objective, although often difficult to achieve with medical treatments. ⋯ We examined the long-term effect of Roux-en-Y gastric bypass (RYGB, a predominantly restrictive procedure) in a patient with uncontrolled type 2 diabetes. One year after surgery, the patient had lost 30% of initial weight with a significant improvement in blood pressure, withdrawal of cholesterol-lowering therapy, complete remission of diabetes.
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The authors report a case of valproate-induced hyperammononemic encefalopathy whose initial clinical features were represented by increase of pre-existing disturbed-aggressive behaviour.