Plosker G.L.,Wolters Kluwer |
Barkin R.L.,Pain Centers of Evanston and Skokie Hospitals |
Breivik H.,University of Oslo |
Gordon A.,Mount Sinai Hospital |
And 2 more authors.
Drugs | Year: 2011
This article reviews the pharmacology, therapeutic efficacy and tolerability profile of the 7-day lower-dose (5, 10 and 20μgh) buprenorphine transdermal patch (BuTrans®, Norspan®) in the management of chronic non-malignant pain, with a focus on European labelling for the drug. Buprenorphine is a semi-synthetic opioid analgesic that acts primarily as a partial agonist at the mu opioid receptor. The transdermal formulation provides continuous delivery of buprenorphine, resulting in relatively consistent plasma drug concentrations throughout the 7-day dosing interval.The analgesic efficacy of transdermal buprenorphine in patients with osteoarthritis of the hip andor knee has been demonstrated in several randomized controlled trials, which have shown the formulation to be equivalent to sublingual buprenorphine, noninferior to prolonged-release tramadol tablets, noninferior to codeine plus paracetamol (acetaminophen) combination tablets (when transdermal buprenorphine was used together with regularly scheduled oral paracetamol) and generally superior to a matching transdermal placebo patch. Transdermal buprenorphine was significantly more effective than placebo in reducing chronic low back pain of at least moderate severity in two randomized, double-blind, crossover trials. Other clinical trials, including a randomized, double-blind, maintenance-of-analgesia study, have also demonstrated the analgesic efficacy of transdermal buprenorphine in patients with chronic non-malignant pain of various causes.In general, serious adverse events with transdermal buprenorphine are similar to those for other opioid analgesics. Transdermal buprenorphine has a ceiling effect for respiratory depression, and the main risk is when it is combined with other CNS depressants. The most frequently reported adverse events with transdermal buprenorphine are headache, dizziness, somnolence, constipation, dry mouth, nausea, vomiting, pruritus, erythema, application site pruritus and application site reactions. Transdermal buprenorphine was better tolerated than sublingual buprenorphine in a 7-week, randomized, double-blind trial in patients with osteoarthritis pain. Nevertheless, as with other opioids, persistence with transdermal buprenorphine therapy is difficult for many patients because of adverse events or other reasons.Thus, transdermal buprenorphine has generally demonstrated good efficacy and tolerability in clinical trials in chronic non-malignant pain, providing effective background analgesia as part of pain management strategies for patients with osteoarthritis, low back pain and other persistent pain syndromes of at least moderate severity. It also has favourable pharmacodynamic and pharmacokinetic properties, which have beneficial clinical implications, most notably the convenience of once-weekly administration and no need for dosage adjustments in the elderly or those with compromised renal function, making it an opioid of choice in these patients, and a useful therapeutic option overall in the management of chronic non-malignant pain. © 2011 Adis Data Information BV. All rights reserved.
Rojas-Villarraga A.,Rosario University |
Toro C.-E.,Hospital Clinic |
Espinosa G.,Hospital Clinic |
Rodriguez-Velosa Y.,Rosario University |
And 5 more authors.
Autoimmunity Reviews | Year: 2010
Objective: Since characterization of the extent to which particular combinations of autoimmune diseases (ADs) occur in excess of that expected by chance may offer new insights into possible common pathophysiological mechanisms, polyautoimmunity (i.e., ADs co-occurring within patients) in systemic lupus erythematosus (SLE) and its associated factors were investigated. Methods: This was a cross-sectional study in which 335 consecutive patients with SLE and the history of 22 ADs were investigated. A multivariate analysis was performed. A systematic literature review was done and results were grouped by hierarchical cluster procedure analysis. Results: There were 136 (41%) SLE patients presenting with at least one other AD. A total of 191 ADs were observed, of which the most frequent were autoimmune thyroid disease (AITD), antiphospholipid syndrome (APS) and Sjögren's syndrome (SS), registered in 60 (18%), 48 (14%) and 47 (14%) cases, respectively. Out of a total number of 1515 SLE patients with polyautoimmunity (1379 reported previously and 136 informed here) there were 77 (5.1%) cases with multiple autoimmune syndrome (i.e., two or more ADs in addition to SLE). Female gender, articular involvement, familial autoimmunity, anti-Ro positivity and patient's origin were risk factors for polyautoimmunity while the presence of anti-RNP antibodies was protective. Four clusters of ADs were found. The most hierarchical one was composed of AITD, APS, SS, and systemic sclerosis. Conclusion: Polyautoimmunity is frequent in SLE, and it is influenced by clinical and immunological features. These findings support that clinically different autoimmune phenotypes might share common susceptibility variants. © 2009 Elsevier B.V. All rights reserved.
Paez M.-C.,Autonomous University of Bucaramanga |
Paez M.-C.,Cellular Biology and Immnunogenetics Unit |
Matsuura E.,Okayama University |
Diaz L.A.,Autonomous University of Bucaramanga |
And 4 more authors.
Autoimmunity | Year: 2013
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of antibodies. SLE has been associated with placental pathology, a finding that is also the determinant in preeclampsia (PE). Genetic evidence and serologic reports suggest laminin-1 (LM-111) as an immunogenic molecule and its polymorphic gene as a candidate gene for both disorders. Objective: To evaluate the association between LAMA1 (rs543355) and LAMC1 (rs20563) polymorphisms and the presence of SLE and PE as well as to determine serum levels of anti-LM-111 autoantibodies in the PE group. Methods: Group A: 169 women with PE and 172 healthy pregnant women. Group B: 204 women with SLE and 204 healthy women. Anti-LM-111 for group A was measured by ELISA and the genotyping was done by using a PCR system. Results: Group A: Levels of anti-LM-111 was similar in women with PE and the control group (p = 0.3). The allelic frequencies and genotypes did not show statistically significant differences for LAMA1 and LAMC1 polymorphisms. Group B: Significant differences between SLE patients and controls for rs543355 polymorphism were not observed. Nevertheless, LAMC1 rs20563 A-allele provided protection against the development of SLE (OR 0.73, 95%CI 0.55-0.96). Conclusions: Serum levels of anti-LM-111 at the third trimester of gestation do not seem to have any direct relationship with the presence of PE, and the SNPs evaluated are not associated with the risk of developing this disorder. LAMC1 polymorphism could be a protective factor for SLE. © Informa UK, Ltd.
Becerra A.T.,University of Almeria |
Botta G.F.,University of Buenos Aires |
Botta G.F.,National University of Luján |
Bravo X.L.,University of Almeria |
And 6 more authors.
Soil and Tillage Research | Year: 2010
Almond orchards in Almería require frequent traffic with farm machinery, about 1-8 times a year. Our main objective was to evaluate the vertical distribution of soil compaction induced by traffic of two tractors with different weights, one light (LT = 15 kN) and one heavy (HT = 50 kN), passing 0, 1, 3, 5 and 8 times over the same track on Aridisol soil. The work was performed in the Vélez Blanco District of Almería in southeast Spain. Outlined hypothesis were: (a) subsoil compaction distribution due to tractor traffic on recently tilled soils in almond orchard depends on total axle load and tractor passes, (b) topsoil compaction produced by tractor traffic depends on tractor passes and ground pressure. Variables measured were (CI) cone index, (BD) bulk density, (TSP) total soil porosity and (RD) rut depth. The relevant results were: in topsoil (0-200 mm), 1, 3, 5 and 8 passes of a LT caused mean values of CI of 1420, 1825, 1950 and 2050 kPa respectively, while for the HT with the same number of passes the values were of 1235, 1520, 1630 and 2510 kPa respectively. BD mean values had a similar behavior: 1.35, 1.38, 1.51 and 1.55 Mg m-3 for 1, 3, 5 and 8 passes of a LT and 1.30, 1.32, 1.41 and 1.52 for the HT with the same number of passes. In the subsoil (200-600 mm) the HT caused higher CI and BD values than the LT. CI mean values of the LT were between 1705 and 2490 kPa, while the HT produced 2100-2790 kPa of CI. BD mean values were between 1.58 and 1.7 Mg m-3 for the LT and 1.65-1.77 Mg m-3 for the HT. Hence, the data support both hypotheses. No significant differences were found in RD between HT and LT when they passed 1, 3 or 5 times, but there was a difference when traffic raised up to 8 passes (143 mm RD for HT). The main conclusions were: (a) this work has shown that soil compaction resulting from tractor traffic increases CI and BD and decreases total soil porosity. The data of CI and BD indicated that Almond orchard soil is unable to limit subsoil compaction under moderate traffic intensity. (b) Up to the fifth pass of either a FWA or 2WD tractor, ground pressure is responsible for topsoil compaction. © 2010 Elsevier B.V. All rights reserved.
Gutierrez-Pelaez M.,Pontifical Xavierian University |
Gutierrez-Pelaez M.,Rosario University
Contemporary Psychoanalysis | Year: 2015
The work of Sándor Ferenczi anticipates various challenges of contemporary psychoanalysis - clinical, technical, and theoretical. Among the most novel is his elaboration of the concept of trauma. Ferenczi's 1930s writings were mostly read by the psychoanalysts of his time, including Freud, as a return to Freud's seduction theory. Nevertheless, in Ferenczi, there is an innovation that distinguishes him from Freud. Although today's psychoanalytic community expresses a growing interest in Ferenczi's trauma theory, the field pays less attention to his focus on the traumatic dimension of language itself and the effects language has on the subject. In fact, Ferenczi's later work uniquely explores the relationship between trauma and language. In part, what makes Ferenczi's trauma theory unique is that it anticipates Jacques Lacan's work on the traumatic dimension of language, which the French psychoanalyst referred to in his final theoretical production through the concept of lalangue. © William Alanson White Institute of Psychiatry, Psychoanalysis & Psychology and the William Alanson White Psychoanalytic Society.
PubMed | CONICET, University of Toronto, Pontifical Xavierian University and Rosario University
Type: | Journal: International braz j urol : official journal of the Brazilian Society of Urology | Year: 2016
To evaluate prevalence trends of hypospadias in South-America it is essential to perform multicenter and multinational studies with the same methodology. Herein we present systematic data as part of an international multicenter initiative evaluating congenital malformations in South America over a 24-year period.A nested case-control study was conducted using the Latin American Collaborative Study of Congenital Malformations (ECLAMC), between January 1989 and December 2012. Cases were stratified as isolated (IH) and non-isolated hypospadias (NIH). Global prevalence was calculated and discriminated by country. Associations between birth weight and gestational age, and NIH distribution by associated abnormality and severity of hypospadias, were analyzed.A total of 159 hospitals from six countries participated, reporting surveillance on 4.020.384 newborns. A total of 4.537 hypospadias cases were detected, with a global prevalence of 11.3/10.000 newborns. Trend analyses showed in Chile, Brazil and Uruguay a statistically significant increase in prevalence. Analysis of severity and associated anomalies did not to find an association for distal cases, but did for proximal (RR=1.64 [95% CI=1.33-2.03]).This is one of only a few Latin American multicenter studies reporting on the epidemiology of hypospadias in South America in the last two decades. Our data adds to evidence suggesting an increase in some countries in the region at different times. There were also variations in prevalence according to severity. This study adds to literature describing associated anomalies at a hospital-based level.
Ruiz A.M.,Rosario University |
Ruiz J.E.,Rosario University |
Ruiz J.E.,Sharp Corporation |
Gavilanes A.V.,Rosario University |
And 7 more authors.
Journal of Infectious Diseases | Year: 2012
Background We assessed if risk of developing cervical intraepithelial neoplasia grade 2/3 (CIN2/3) or adenocarcinoma in situ (AIS) is associated with a short interval between menarche and first sexual intercourse (FSI).Methods A total of 1009 Colombian and 1012 Finnish females, aged 16-23, who were enrolled in the phase 3 trials of a quadrivalent human papillomavirus (HPV) 6/11/16/18 vaccine had nonmissing data for age of menarche and FSI. The impact of menarche interval on the odds of developing CIN2-3/AIS was evaluated in placebo recipients who were DNA negative to HPV 6/11/16/18/31/33/35/39/45/51/52/56/58/59 and seronegative to HPV 6/11/16/18 at day 1, and had a normal Pap result at day 1 and month 7, thus approximating sexually naive adolescents (n = 504).Results The mean age of menarche and FSI was 12.4 and 16.0 years, respectively. Among the women approximating sexually naive adolescents, 18 developed CIN2-3/AIS. Compared with women who postponed FSI beyond 3 years of menarche, those with FSI within 3 years of menarche had a greater risk of cytologic abnormalities (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.02-2.68; P =. 04) and CIN2-3/AIS (OR, 3.56; 95% CI, 1.02-12.47; P =. 05).Conclusions A short interval between menarche and FSI was a risk factor for cytologic abnormalities and high-grade cervical disease. These data emphasize the importance of primary prevention through education and vaccination.Clinical Trials Registration. NCT00092521 and NCT00092534. © 2012 The Author.
PubMed | Maastricht University and Rosario University
Type: | Journal: Value in health regional issues | Year: 2016
There has rarely been any reporting on health-related quality of life (HRQOL) of patients with HIV/AIDS in developing countries.To estimate the health utilities of people with HIV/AIDS in Bogot, Columbia.A cross-sectional survey was conducted for 181 patients receiving antiretroviral therapy from an outpatient HIV/AIDS clinic in Bogot. The five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-VAS) were used to estimate HRQOL scores. To derive utilities on the basis of the EQ-5D-5L, the Spanish value set was used. Subgroup analyses were performed according to sex, age, the Centers for Disease Control and Prevention classification, and CD4 cell count.The mean utility of the EQ-5D-5L was estimated at 0.85 0.21 and the EQ-VAS score was estimated at 84 14. Pain/discomfort and anxiety/depression were the two EQ-5D-5L dimensions associated with the poorer outcomes. Subgroup analyses revealed significantly higher utilities (using the EQ-5D-5L) for men than for women (0.88 vs. 0.76; P = 0.002) and lower utilities for patients with severe HIV (0.83 for CD4 < 200 vs. 0.87 for CD4 500; P = 0.024).The HRQOL scores of patients with HIV/AIDS receiving antiretroviral therapy were relatively high in Bogot, Colombia, using the EuroQol questionnaire. The utility data could be useful, in combination with cost data, for future economic evaluations.
Delgado-Vega A.M.,Rosario University |
Delgado-Vega A.M.,Cellular Biology and Immunogenetics Unit |
Castiblanco J.,Cellular Biology and Immunogenetics Unit |
Gomez L.M.,Cellular Biology and Immunogenetics Unit |
And 5 more authors.
Annals of the Rheumatic Diseases | Year: 2010
Objective: Bcl-2 antagonist killer 1 (BAK1) is a Bcl-2 family proapoptotic member suggested as a candidate gene for autoimmune diseases. The influence of BAK1 polymorphisms on the risk of developing autoimmune rheumatic diseases (AIRDs) in women was investigated. Methods: A total of 719 Colombian women were included in the present study: 209 had systemic lupus erythematosus, 99 primary Sjögren syndrome, 159 rheumatoid arthritis and 252 were healthy matched controls. Tag single nucleotide polymorphisms (SNPs) and potentially functional variants were typed by TaqMan allele discrimination assays. HLA-DRB1 and HLA-DQB1 typing was performed by reverse dot-blot hybridisation and linkage disequilibrium (LD) with BAK1 SNPs was assessed. Results: SNPs rs513349 (odds ratio (OR) 0.57, 95% CI 0.46 to 0.72, p=<0.001) and rs5745582 (OR 1.61, 95% CI 1.26 to 2.04, p=<0.001) were associated with the AIRDs included in this study. There was a significant increase of the rs513349G-rs561276C-rs5745582A (GCA) haplotype in each patient cohort as compared to controls (OR 1.95, 95% CI 1.50 to 2.54, p=<0.001). These SNPs were not in LD with HLA-DRB1 or HLA-DQB1 genes. Conclusions: The results indicate that the BAK1 polymorphisms influence the risk of acquiring AIRDs in the population studied and are consistent with the paradigm that autoimmune diseases are likely to share common susceptibility variants.
PubMed | Rosario University
Type: Journal Article | Journal: Annals of the rheumatic diseases | Year: 2010
Bcl-2 antagonist killer 1 (BAK1) is a Bcl-2 family proapoptotic member suggested as a candidate gene for autoimmune diseases. The influence of BAK1 polymorphisms on the risk of developing autoimmune rheumatic diseases (AIRDs) in women was investigated.A total of 719 Colombian women were included in the present study: 209 had systemic lupus erythematosus, 99 primary Sjgren syndrome, 159 rheumatoid arthritis and 252 were healthy matched controls. Tag single nucleotide polymorphisms (SNPs) and potentially functional variants were typed by TaqMan allele discrimination assays. HLA-DRB1 and HLA-DQB1 typing was performed by reverse dot-blot hybridisation and linkage disequilibrium (LD) with BAK1 SNPs was assessed.SNPs rs513349 (odds ratio (OR) 0.57, 95% CI 0.46 to 0.72, p = <0.001) and rs5745582 (OR 1.61, 95% CI 1.26 to 2.04, p = <0.001) were associated with the AIRDs included in this study. There was a significant increase of the rs513349G-rs561276C-rs5745582A (GCA) haplotype in each patient cohort as compared to controls (OR 1.95, 95% CI 1.50 to 2.54, p = <0.001). These SNPs were not in LD with HLA-DRB1 or HLA-DQB1 genes.The results indicate that the BAK1 polymorphisms influence the risk of acquiring AIRDs in the population studied and are consistent with the paradigm that autoimmune diseases are likely to share common susceptibility variants.