Plosker G.L.,Wolters Kluwer |
Barkin R.L.,Pain Centers of Evanston and Skokie Hospitals |
Breivik H.,University of Oslo |
Gordon A.,Wasser Pain Management Center |
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. Source
Becerra A.T.,University of Almeria |
Botta G.F.,University of Buenos Aires |
Botta G.F.,National University of Lujan |
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. Source
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. Source
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. Source
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. Source