The gate control theory of pain proposed by Melzack and Wall in 1965 is revisited through two mechanisms of neuronal regulation: NMDA synaptic plasticity and intrinsic plasticity. The Melzack and Wall circuit was slightly modified by using strictly excitatory nociceptive afferents (in the original arrangement, nociceptive afferents were considered excitatory when they project to central transmission neurons and inhibitory when projecting to substantia gelatinosa). The results of our neurocomputational model are consistent with biological ones in that nociceptive signals are blocked on their way to the brain every time a tactile stimulus is given at the same locus where the pain was produced. In the computational model, the whole set of parameters, independently of their initialization, always converge to the correct values to allow the correct computation of the circuit. To test the model, other painful conditions were analyzed: phantom limb pain, wind-up and wind-down pain, breakthrough pain, and demyelinating syndromes like Guillain-Barré and multiple sclerosis.

Introduction: The initial palliative care includes pharmacological palliative treatment of pain, depression, anxiety , delirium, nausea and dyspnea. Objective: To study the drugs administered to oncologic patients in initial palliative care and its possible side effects. Methods: This retrospective study included 40 oncologic patients with mean age of 69+14.12 under initial palliative care. Results: Opioids, benzodiazepines, neuroleptics, non-steroidal anti-inflammatory drugs (NSAID), corticosteroids had been prescribed in initial palliative care. Opioids such as fentanyl 0.007 mg/kg/day (3.3%), meperidine 0.64 mg/kg/day (3.3%), tramadol 7.4 mg/kg/day (3.3%), methadone 0.2 mg/kg/day (6.70%) and morphine 0.05 mg/kg/day (70.0%) were given for pain control. For anxiolytic and sedative effects, benzodiazepines such as bromazepam 0.092 mg/kg/day (3.3%), diazepam 0.31 mg/kg/day (3.3%), lorazepam 0.012 mg/kg/day (6.7%), alprazolam 0.006 mg/kg/day (6.7%), midazolam 0.014mg/kg/day (13.0%), clonazepam 0.67 mg/kg/day (20.0%), were administered. Levomepromazine 0,65 mg/kg/day (6,70%), quetiapine 0,25mg/kg/day (6,7%), haloperidol 0,06 mg/kg/day (26,7%), chlorpromazine 0,13 mg/kg/day were the neuroleptics prescribed for delirium/hallucination. In pain adjuvant therapy, NSAID such as dipyrone 3.7 mg/kg/day (90.00%), ketoprofen 2.7 mg/kg/day (6.70%) and tenoxicam 0.79mg/kg/day (3.3%) were administered. To treat nausea/vomiting dexamethasone 0.11 mg/kg/day was given to 53.40% patients. Constipation (66,60%), urinary retention (33,30%), nausea/vomiting (33,30% and hypotension (16,60%), motor agitation (33,30%) were described in this study as pharmacological side effects. Conclusions: Drug-related agranulocytosis and hypotension should be observed with the administration of dypirone. Respiratory depression with the association of opiods and benzodiazepines; extrapyramidal side effect (akathisia) due to administration of neuroleptics and dexamethasone immunosuppression should be considered in these patients' drug prescription.

Introduction: Patients' compliance to illicit drugs addiction´s treatment, is a limiting factor for the effectiveness of these patients' treatment. Objective: The aim of this research was to study the pharmacological therapy and its side effects, in patients undergoing addiction treatment. Results: This study selected 31 patients with mean age of 33,61± 1,90 years old enrolled in a public mental health service with psychotic disorder related to the use of cocaine, crack an alcohol. Patients under this study were addicted to alcohol (61,29%), cocaine, crack or the association of both (38,71%). Effects related to the use of cocaine were delirium/hallucination (50%), cardiovascular effects (27,76%), psychomotor agitation (11,12%). (No effects reported 11,10%). Patient-reported, crack-related effects were delirium and hallucination (50%), cardiovascular effects (37,50%). (No effects reported 12,50%). Psychosis (73,08%), aggressive behavior (7,69%), abstinence syndrome (11,54%), were associated to the use of alcohol. (No side effects reported 7,69%) The pharmacological treatment to these patients were typical neuroleptics (41,94%), atypical neuroleptics (22,58%), typical and atypical neuroleptics associated (29,03%), (No treatment 6,45%). Side effects related to pharmacological treatment were extrapyramidal effects (56,24%), delirium/hallucination (43,74%), memory impairment (34,37%), anxiety(31,25%),attention deficit (21,87%), psychotic depression (12,50%), verbal communication deficit (3,12%). These effects were treated with biperiden (58,34%), promethazine or benzodiazepines (25,00%). (No treatment was done in16,67%). Conclusions: The use of neuroleptics in the treatment of psychotic disorders due to the use of illicit drugs should be evaluated. The side effects related to the neuroleptics must be carefully controlled in order to guarantee the patientsć ompliance to the treatment.

IntroductionDifficulties in controlling symptoms such as pain, breathlessness or delirium in palliative care patients, may require sedation as therapeutic strategy.ObjectiveTo study the drugs administered to patients under Palliative Care Sedation (PCS) and its possible side effects.MethodsOur retrospective study included 40 oncological patients with mean age of 69+14.12 years old, under PCS.ResultsMorphine 0.35mg/kg/day, administered to 22,5% (9) patients, caused reduction of systolic blood pressure in 23.61%, diastolic blood pressure in 27.08%, heart rate in 6.09%, body temperature in 2.59%, respiratory rate in 18.26%. Morphine 0.35mg/kg/day associated with midazolam 0.42mg/kg/day, given to 35%(14) patients, caused reduction of systolic blood pressure in 24.63%, diastolic blood pressure in 27.58%, heart rate in 1.56%, body temperature in 1.58%, respiratory rate in 27.66%. The association of chlorpromazine 0.62mg/kg/day to morphine 0.35mg/kg/day and midazolam 0.42mg/kg/day administered to 42,5% (17) patients, also caused reduction of systolic blood pressure in 22.38%, diastolic blood pressure 20.00%, body temperature 1.79%, respiratory rate 22.00%, but the heart rate increased in 15.88%. The variations of vital signs were obtained by records registered right before the palliative care sedation had initiated and the values recorded in patients’ last day of life. The sedation period was 2,40+0,23days.ConclusionThe association of neuroleptics could conduct to extrapyramidal motor agitation, in this case of deeply sedated patients it could be signed by the incresase of the heart rate. Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

IntroductionThe sedation could consist in a therapeutic strategy in advanced cancer conditions.ObjectiveTo study the drugs administered to patients under Palliative Care Sedation (PCS) audits effects on vital signs.MethodsOur retrospective study included 101 oncological patients with mean age of 66.5 ± 13.4 years old and mean weight of 48.5 ± 3.36 kg, under PCS. The data were analysed applying the test of Wilcoxon.ResultsThe drugs administered to these patients under PCS were morphine 55 mg/kg/day associated to midazolam 52.5 mg/kg/day (Morph/Midazo) or the association of morphine 55 mg/kg/day, midazolam 52.5 mg/kg/day and neuroleptics such as chlorpromazine 54.5 mg/kg/day or haloperidol 13.25 mg/kg/day (Morph/Midazo/Neurol). The values of vital signs of these patients when the sedation was initiated were: systolic blood pressure 116.55 ± 16.98 mmHg, diastolic bloodpressure73.17 ± 10.55 mmHg, heart rate 83.41 ± 16.25bpm, respiratory rate 19.39 ± 3.97 rpm and body temperature 35.91 ± 0.57 °C. No significant differences between these groups were observed. Vital signs measures were collected 48 hours before the patient's death. Significant reduction in systolic blood pressure 77.5 mmHg, diastolic blood pressure 43.3 mmHg were observed in the group (Morph/Benzo/Neurol). The Wilcoxon test for independent samples to a significance level of 5% we obtain a P-value of 0.01. The sedation period was 2.56 ± 0.23 days.ConclusionNeuroleptic, a central nervous system (CNS) depressant drug, when associated to other two depressants (morphine/midazolam), conducted to the patient's vital signs reduction.Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sevoflurane anaesthesia is often related to emergence agitation. This study investigates the drugs administered to treat this side effect. Methods Our retrospective study included 100 oncologic paediatric patients with mean age of 33.67 ± 2.12 months, weight mean 15.22 ± 0.44 kg, height 94.68 ± 2.24 cm undergoing anaesthesia for radiotherapy immobilisation purpose. Results Sevoflurane 8% was administered to 100% of the patients for anaesthesia induction/maintenance. The number of radiotherapy session were 22.43 ± 1.01 days and the period of anaesthesia was 33.09 ± 1.81 min. Emergence agitation was observed during anaesthesia recovery in 73% patients and was treated with propofol 0.5–4.4 mg/kg (29 patients), midazolam 0.35–79 mg/kg (12 patients), nalbuphine 0.1–0.15 mg/kg (4 patients), haloperidol 1,5 mg/kg (4 patients) and fentanyl 2–3.6 mg/kg (1 patient). All these central depressant drugs controlled the emergence agitation except haloperidol which induced extrapyramidal side effect (akathisia). Conclusions Respiratory depression should be considered in sevoflurane association with central nervous system depressants. Although midazolam has flumazenil as antagonist, midazolam high dosages should be administered with caution. Neuroleptics, such as haloperidol, is not an appropriated choice for agitation considering the possibility of akathisia.

on the enjoyment of life. It is suggested that the endogenous opioid systems may be impaired in patients with temporomandibular joint disorders (TMJ). It has been shown that TMJ patients have lower pain thresholds in the hand and increased pain sensitivity on the contralateral hand. We hypothesized that higher plasma bendorphin levels would be a correlated to lower pain thresholds in patients with TMJ. Methods: Twenty-one consecutive patients with TMJ, visiting the division for a preoperative control before surgery were included. The control group consisted of twelve healthy individuals of similar age and sex. Clinical assessment of sensory and pain thresholds were performed using the PainMatcher®. b-endorphin were measured in venous-blood. Results: In patients with TMJ low peripheral pain thresholds, both ipsilateral and contralateral were associated with higher b-endorphin levels (p < 0.05). Further, significantly higher bendorphin levels, 22.8 pmol/L were present in patients with TMJ compared to 14.5 pmol/L in healthy individuals (p < 0.005). Conclusion: The inverse association between b-endorphin levels and pain-thresholds supports the theory of a pronounced sensitization and an impaired pain inhibitory system in patients with temporomandibular joint disorder.

Fever was noted in 110 patients, 44 patients complained of urinary symptoms. The gross hematuria was observed in 07 patients. leukocytosis was present in 84.62% of cases; an ESR above 30 in the first hour in 34.61% cases. CRP was positive in 65.38% of patients. E coli in 22.38% cases, followed in descending order of pneumoniedans klebsiella, pseudomonas aeroginosa, Proteus, enterococcus. Ultrasound renal disease 17.16% (7.58% urétérohydronephrose). The UCR pathological in 9.70% (6% RVU). Pathological IVU 5.22% (3% urétérohydronéphrose). Conclusion This study confirmed the frequency of UTI in a pediatric setting. However, great efforts are still needed to better support her. Better knowledge of bacteriology Local: prevalence of germs, sero-typing, with ATB resistance; The long-term prophylactic treatment of UI also remains to be defined. Supprimer RépondreRépondre Faire suivreDéplacerImprimer Actions Suivant Précédent.