4 research outputs found
Efficacy of L-acetylcarnitine on chronic pain
No full textopenObiettivo: L-acetilcarnitina (LAC) è una molecola di origine naturale con proprietà analgesiche ed
antidepressive, neurotrofiche e neuroprotettive. Scopo di questo studio era valutare l’efficacia di
LAC in pazienti con dolore cronico.
Metodi: Lo studio è un analisi retrospettiva su 55 pazienti trattati con LAC per dolore cronico da
radicolopatia cervicale o lombare, o neuropatia. LAC è stata somministrata per 4 mesi al dosaggio
di 500 mg 2 volte al giorno, inizialmente per via intramuscolare e successivamente per via orale. I
pazienti sono stati valutati, alla visita basale pretrattamento e, successivamente, al follow up dopo
4 mesi di terapia con LAC utilizzando una scala numerica verbale per il dolore (NRS, Numerical
Rating Scale), il questionario PainDetect per il dolore neuropatico (PDQ), l’Hamilton Depression
Scale (HAMD) per l’intensità di sintomi depressivi, la Pain Catastrophizing Scale (PCS) per la
catastrofizzazione nel dolore cronico e gli indici fisico e mentale del questionario 12-item Short
Form (PCS12 e MCS12) per la qualità di vita.
Risultati: Alla visita basale i pazienti presentavano una sintomatologia dolorosa medio-severa; il
PDQ era compatibile con dolore neuropatico nel 44% e con dolore misto o nocicettivo nel 56% dei
pazienti. Il 64% dei pazienti presentava inoltre sintomi depressivi di intensità medio-lieve e il 4%
dei pazienti di intensità grave.
La somministrazione di LAC ha determinato un significativo miglioramento della sintomatologia
dolorosa e un rapido e significativo miglioramento del tono dell’umore. Al follow up a 4 mesi di
trattamento, la somministrazione di LAC aveva migliorato significativamente i sintomi neuropatici
e la catastrofizzazione del dolore.
Conclusioni: LAC è ben tollerata ed ha effetti positivi sulla sintomatologia dolorosa cronica e sui
disturbi dell’umore associati.Aim: L-acetylcarnitine (LAC) is a naturally occurring compound with analgesic and antidepressant,
and neurotrophic and neuroprotective properties. Aim of this study was to determine the efficacy
of LAC in patients with chronic pain.
Methods: This is a retrospective analysis on 55 patients treated with LAC for chronic pain due to
cervical or lumbar radiculopathies or neuropathies. LAC 500 mg has been given twice a day for 4
months, initially as im injections and then as tablets po. Patients have been assessed at the
pretreatment baseline visit and at a 4 month follow for pain intensity with a Numerical Rating
Scale for pain (NRS), for neuropathic pain symptoms with the PainDetect Questionnaire (PDQ), for
depressive symptoms with the Hamilton Depression Scale (HAMD), for pain catastrophizing with
the Pain Catastrophizing Scale (PCS), and for the quality of life with Physical and Mental score of
the 12-item Short Form (PCS12, MCS12).
Results: At baseline, patients presented with a moderate-to-severe pain; the PDQ score was
consistent with neuropathic pain in 44% of patients and with mixed or nociceptive pain in 56%; at
baseline HAMD, 64% of patients had symptoms of mild or moderate depression and 4% of severe
depression.
LAC administration determined a significant improvement of pain NRS scores and a rapid and
significant improvement of mood level. At the 4 month follow up, LAC improved also neuropathic
pain as assessed by PDQ and pain catastrophizing by PCS.
Conclusions: LAC was well tolerated with positive effects on chronic pain and on associate
depressive symptoms
Can CHA(2)DS(2)-VASc and HAS–BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat–AF Study
No full textAnticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65–74 years and sex category (CHA(2)DS(2)-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS–BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of “asymptomatic” brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA(2)DS(2)-VASc and HAS–BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA(2)DS(2)-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar–infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification
Data_Sheet_1_Can CHA2DS2-VASc and HAS–BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat–AF Study.PDF
No full textAnticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65–74 years and sex category (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS–BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of “asymptomatic” brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA2DS2-VASc and HAS–BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA2DS2-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar–infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.</p
Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial
No full textBACKGROUND:
The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes.
METHODS:
TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea (5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856.
FINDINGS:
Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74-1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0·0001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups.
INTERPRETATION:
In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events
