109 research outputs found
Non-Cognitive Behavioral Therapy Psychological Interventions May Not Make the Difference in Children and Adolescents With Chronic Pain
No full textLauren Perlman,1,* Naomi Malka,1,* Oliver Terry,1,* Alex Nguyen,1 Lucas Guimarães Ferreira Fonseca,2 Juan I Ingelmo,3 Pablo Ingelmo2,4– 7 1Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; 2Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada; 3Department of Mental Health, Jose de San Martin Clinical Hospital, University of Buenos Aires, Buenos Aires, Argentina; 4Department of Anesthesia, McGill University, Montreal, QC, Canada; 5Division of Pediatric Anesthesia Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada; 6Research Institute, McGill University Health Center, Montreal, QC, Canada; 7The Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada*These authors contributed equally to this workCorrespondence: Pablo Ingelmo, Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital A02-3525.1, 1001 Boul, Decarie, Montreal, QC, H41 3J1, Canada, Tel +1 514 412 4448, Fax +1 514 412 4341, Email [email protected] and Aim: Chronic pain in pediatric populations presents a multifaceted challenge with biopsychosocial impact, requiring a multidisciplinary approach including psychological treatment. At our interdisciplinary pain center, the SARS-CoV-2 pandemic-related disruptions led to the cessation of cognitive-behavioral therapy (CBT) and other psychological interventions during the pandemic. The aim of this retrospective cohort study with secondary retrospective matched case–control analysis was to evaluate the impact of interruption of non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, on children and adolescents with chronic pain conditions during the SARS-CoV-2 pandemic.Materials and Methods: We included pediatric patients with primary and secondary chronic pain conditions evaluated by our team during the SARS-CoV-2 pandemic. We excluded patients who did not receive psychological intervention when available, those with incomplete data on initial evaluation or follow-up, and those who received outside psychiatric care or individual or group CBT. The primary outcome was a Patients’ Global Impression of Change (PGIC) score of 6– 7. Secondary outcome measures were pain intensity, use of pain medication, sleep, physical function, school attendance, the incidence of suicidality, and the reason for end of treatment.Results: The study included 146 patients, 77 who received non-CBT psychological interventions and 69 who did not receive any psychological interventions. We found no meaningful difference between the use of non-CBT psychological intervention and no treatment in the incidence of PGIC 6– 7 points, pain intensity, school attendance, physical function, suicidality, and cause of end of treatment. Patients not receiving any psychological interventions were more likely to have normalized sleep at the end of treatment.Conclusion: Non-CBT psychological interventions, namely psychoanalysis and psychodynamic psychotherapy, were not associated with meaningful benefits for children and adolescents with chronic pain during the COVID-19 pandemic. Patients who did not receive psychological interventions reported normalization of their sleep at the end of treatment compared to those who participated in non-CBT interventions.Keywords: psychotherapy, adolescents, children, chronic pain, cognitive behavioral therap
The association of neural axis and craniovertebral junction anomalies with scoliosis in Rubinstein-Taybi syndrome
No full textRubinstein-Taybi syndrome (RSTS) is a rare condition with characteristic genetic and clinical features. The presence of variable vertebral and neural axis abnormalities has been reported in the literature. We describe the possible association of multiple different spinal anomalies in these patients
A comparison of differences between the systemic pharmacokinetics of levobupivacaine and ropivacaine during continuous epidural infusion: A prospective, randomized, multicenter, double-blind controlled trial
No full textBACKGROUND:
Epidural infusion of levobupivacaine and ropivacaine provides adequate postoperative pain management by minimizing side effects related to IV opioids and improving patient outcome. The safety profile of different drugs can be better estimated by comparing their pharmacokinetic profiles than by considering their objective side effects. Because levobupivacaine and ropivacaine have different pharmacokinetic properties, our aim was to investigate whether there is a difference in the pharmacokinetic variability of the 2 drugs in a homogeneous population undergoing continuous epidural infusion. This double-blind, multicenter, randomized, controlled trial study was designed to compare the pharmacokinetics of continuous thoracic epidural infusion of levobupivacaine 0.125% or ropivacaine 0.2% for postoperative pain management in adult patients who had undergone major abdominal, urological, or gynecological surgery. This study is focused on the evaluation of the coefficient of variation (CV) to assess the equivalence in the systemic exposure and interindividual variability between levobupivacaine and ropivacaine and, therefore, the possible differences in the predictability of the plasmatic concentrations of the 2 drugs during thoracic epidural infusion.
METHODS:
One hundred eighty-one adults undergoing major abdominal surgery were enrolled in the study. Patients were randomized to receive an epidural infusion of levobupivacaine 0.125% + sufentanil 0.75 μg/mL or of ropivacaine 0.2% + sufentanil 0.75 μg/mL at 5 mL/h for 48 hours. The primary end point of this study was to analyze the variability of plasma concentration of levobupivacaine and ropivacaine via an area under the curve within a range of 15% of the CV during 48 hours of continuous epidural infusion. The CV shows how the concentration values of local anesthetics are scattered around the median concentration value, thus indicating the extent to which plasma concentration is predictable during infusion. Secondary end points were to assess the pharmacologic profile of the local anesthetics used in the study, including an analysis of mean peak plasma concentrations, and also to assess plasma clearance, side effects, pain intensity (measured with a verbal numeric ranging score, i.e., static Numeric Rating Scale [NRS] and dynamic NRS]), and the need for rescue doses.
RESULTS:
The comparison between the 2 CVs showed no statistical difference: the difference between area under the curve was within the range of 15%. The CV was 0.54 for levobupivacaine and 0.51 for ropivacaine (P = 0.725). The plasma concentrations of ropivacaine approached the Cmax significantly faster than those of levobupivacaine. Clearance of ropivacaine decreases with increasing patient age. There were no significant differences in NRS, dynamic NRS scores, the number of rescue doses, or in side effects between groups.
CONCLUSIONS:
Considering the CV, the interindividual variability of plasma concentration for levobupivacaine and ropivacaine is equivalent after thoracic epidural infusion in adults. We found a reduction in clearance of ropivacaine depending on patient age, but this finding could be the result of some limitations of our study. The steady-state concentration was not reached during the 48-hour infusion and the behavior of plasma concentrations of ropivacaine and levobupivacaine during continuous infusions lasting more than 48 hours remains to be investigated, because they could reach toxic levels. Finally, no differences in the clinical efficacy or in the incidence of adverse effects between groups were found for either local anesthetic
Marketing en el Fútbol. Importancia de las marcas en la industria futbolística
No full textEl presente trabajo tratará de analizar la importancia del marketing en el mundo del fútbol
y la influencia que tienen las marcas que existen él, para ello, se estudiará la evolución
que se ha dado en este sector desde sus comienzos hasta el día de hoy.
En primer lugar, se ha entendido la actualidad que vive el mundo del fútbol,
comprendiendo su pasado y cómo ha evolucionado hasta llegar al lugar en el que se
encuentra hoy en día. Se ha observado que hoy en día juega un papel muy importante en
la sociedad, fomentando la relación entre personas.
El poder del fútbol no se queda solo ahí, ya que cuenta además con un gran poder
económico, el cual sirve para crear nuevos puestos de trabajo, atrayendo a más
empresas, moviendo cada vez una mayor cantidad de dinero.
Todo esto ha dado lugar a la inclusión del marketing en el mundo del deporte, teniendo un
gran impacto en el fútbolGrado en Comerci
Comentarios al artículo Anestesia en tumores supratentoriales, publicado en la ReAR, Volumen 15, Nº 3, 2023 https://doi.org/10.30445/rear.v15i5.1145
No full textThe purpose of a comment is to draw attention to one or several aspects of an article published in the ReaR journal, with the aim of arousing the interest of the reader and bringing them closer to a critical reflection that adds value to the medical literature. It can also serve to show new and challenging ideas based on scientific evidence.We publish below, with the authorization of the author, the comments that were made on her day about the article:Rodríguez Contreras, R., Vega Salvador, A., Reche Navarro, E., & Estévez Santiago, J. (2023). Anesthesia in supratentorial tumors. Electronic Journal AnestesiaR, 15(5). https://doi.org/10.30445/rear.v15i5.1145The Editorial Team is not responsible for the points of view and opinions expressed by the authors.La finalidad de un comentario es llamar la atención sobre uno o varios aspectos de un artículo publicado en la revista ReaR, con el objetivo de despertar el interés del lector y acercarlo a una reflexión crítica que añada valor a la literatura médica. También puede servir para mostrar ideas nuevas y desafiantes basadas en la evidencia científica.
Publicamos a continuación, con la autorización de la autora, los comentarios que se realizaron en su día sobre el artículo:
Rodríguez Contreras, R., Vega Salvador, A., Reche Navarro, E., & Estévez Santiago, J. (2023). Anestesia en tumores supratentoriales. Revista Electrónica AnestesiaR, 15(5). https://doi.org/10.30445/rear.v15i5.1145
El Equipo editorial no se hace responsable de los puntos de vista y opiniones expresadas por los autores
Markers of Tissue Deterioration and Pain on Earth and in Space
No full textMadalina Patron,1,2,* Mattias Neset,1,2,* Mariia Mielkozorova,2,* Daniel G Bisson,1,3,* Marie Vigouroux,4 Juan Pablo Cata,5,6 Pablo M Ingelmo,4,7,8 Jean A Ouellet,1,3 Lisbet Haglund,1,3,* Svetlana V Komarova1,2,* 1Shriners Hospital for Children, Montreal, Canada; 2Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; 3Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montreal, Canada; 4Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada; 5Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA; 6Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA; 7Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 8Research Institute, McGill University Health Center, Montreal, Canada*These authors contributed equally to this workCorrespondence: Svetlana V Komarova, Shriners Hospital for Children, 1003 Decarie Boulevard, Montreal, Quebec, H4A 0A9, Canada, Tel +1 514 282-7153, Email [email protected]: Pain is an understudied physiological effect of spaceflight. Changes in inflammatory and tissue degradation markers are often associated with painful conditions. Our aim was to evaluate the changes in markers associated with tissue deterioration after a short-term spaceflight.Patients and Methods: Plasma levels of markers for systemic inflammation and tissue degeneration markers were assessed in two astronauts before and within 24 h after the 17-day Axiom Space AX-1 mission.Results: After the spaceflight, C-reactive protein (CRP) was reduced in both astronauts, while INFγ, GM-CSF, TNFα, BDNF, and all measured interleukins were consistently increased. Chemokines demonstrated variable changes, with consistent positive changes in CCL3, 4, 8, 22 and CXCL8, 9, 10, and consistent negative change in CCL8. Markers associated with tissue degradation and bone turnover demonstrated consistent increases in MMP1, MMP13, NTX and OPG, and consistent decreases in MMP3 and MMP9.Conclusion: Spaceflight induced changes in the markers of systemic inflammation, tissue deterioration, and bone resorption in two astronauts after a short, 17-day, which were often consistent with those observed in painful conditions on Earth. However, some differences, such as a consistent decrease in CRP, were noted. All records for the effect of space travel on human health are critical for improving our understanding of the effect of this unique environment on humans.Keywords: spaceflight, astronaut, cytokine, interleukin, chemokine, bone turnove
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