Lege Artis Medicinae

[Pain and opportunities for non-pharmacological pain management in intensive neonatological care]

ANDREK Andrea

JANUARY 20, 2011

Lege Artis Medicinae - 2011;21(01)

[Neonatal intensive care and therapeutic process is accompanied with a range of painful interventions. Research data from the past decades revealed that repeated and/or prolonged pain has long-term consequences on the neurobiological development of the premature infant, which has led to an increased attention to the measurement and alleviation of pain. In addition to pharmacological pain relief, more and more alternative pain management methods of varying efficacy are appearing in the provision of care for premature infants. In this study, we introduce non-pharmacological pain treatment methods with proven efficiency that can be applied to complement the pharmacological pain management or as a therapy before any painful interventions in intensive neonatological care. These methods include heart sound and music therapy, nutritive and non-nutritive sucking, swaddling, touching and kangaroo care.]

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[In vitro activities of micafungin against invasive clinical isolates of Candida species]

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[INTRODUCTION - Micafungin is a new member of the antifungal class echinocandin exhibiting a broad-spectrum activity against Candida spp. MATERIAL AND METHODS - In this study, we collected 246 invasive clinical Candida isolates obtained from 4 diverse medical centers between 01.04.2009 and 01.04.2010. In these isolates we determined the minimum inhibitory concentrations (MIC) of micafungin. RESULTS - Among the 246 isolates 156 (62%) were C. albicans, 26 (11%) C. glabrata, 24 (10%) C. parapsilosis, 16 (7%) C. krusei, 14(6%) C. tropicalis and 10 (4%) other, less frequently isolated Candida spp. Micafungin had good in vitro activity against all Candida spp. tested (except C. parapsilosis), MIC90 range 0,016-0,125 mg/L. According to CLSI criteria, all isolates (except C. parapsilosis MIC90 2 mg/L) can be interpreted as susceptible. CONCLUSIONS - In vitro MIC90 values measured in this study were substantially lower than the maximum serum concentrations that can be achieved after administration of micafungin (8 mg/L after a 75-mg dose). This fact and the fungicid effect of micafungin against Candida species make this compound, which is licenced for the treatment of invasive candidiasis, a promising systemic antifungal agent.]

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[Effective adalimumab treatment of a steroid-dependent Crohns’ disease patient suffering from general, abdominal and joint symptoms of multiple etiology]

JUHÁSZ Márk, TÓTH Zsuzsanna, MIHELLER Pál, SZŰTS Ildikó, GAÁL Ramóna, PÁPAY Judit, PREGUN István, TULASSAY Zsolt, RÁCZ Károly, MŰZES Györgyi

[The 69-year-old male patient had been suffering from periodically relapsing rheumatological symptoms involving variable localisations (knee, ankle, MTP, sternoclavicular and hip joint) since 1964. On the basis of his joint symptoms, load-independent lower back pain, sacroileitis, recurrent iridocyclitis, urethroprostatitis and oral aphtous lesions, Reiter disease was diagnosed in 2000. The patient had Lyme-disease (confirmed Borrelia burgdorferi seropositivity) with peripheral facial paresis in 2003. The patients joint problems relapsed in 2006, accompanied by diarrhoea and fever, independent of any infecions. The possibility of IBD could not be confirmed either by macroscopic examination using colonoscopy or hystology. The patient was admitted to our department in March 2008 for the first time, presenting again with joint pain and disability of gait, 7-8 bowel movements a day, and fever. Taken together the clinical symptoms, the typical radiological findings and HLA-B27 positivity, Bechterew disease was diagnosed. Colonoscopy performed because of diarrhea revealed multiple segmental aphtoid lesions and irregular ulcers, suggesting Crohn disease that was confirmed by histology (cryptal abscess formation and microgranulomas). Sulfasalazin, 5-ASA, and other NSAIDs applied to treat rheumatological symptoms could not eliminate either the gastrointestinal or the rheumatological symptoms of the patient, which necessitated regular steroid therapy. Because of the patient’s steroid dependency, and considering his rheumatological symptoms, in June 2008 he was treated with adalimumab (ADA) induction therapy (80-40-40 mg s.c.). In two weeks, his gastrointestinal as well as extraintestinal symptoms substantially improved, and completely diminished through the course of maintenance ADA therapy (40mg weekly). The patient is still asymptomatic and is excercising (jogging) regularly.]

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Background and purpose - There is a lack of data on the impact on health related quality of life of peripheral neuropathic pain in Hungary. The main aims of the study were to assess the health related quality of life of nondiabetic PeNP patients identified in general practices through screening, and to assess the relationship between condition specific pain scores and health state utilities. Methods - Non-diabetic patients aged ≥30 years were recruited in 10 general practices in Hungary. At first, patients filled in the PainDETECT Questionnaire (PD-Q) and those who have achieved ≥13 PD-Q score (unclear or possible neuropathic pain) were further assessed by the DN4 questionnaire. Patients with PD-Q score >18 or DN4 score ≥4 were considered to have PeNP and they completed the EQ-5D health questionnaire. Results - Among the 111 patients identified as non-diabetic PeNP patients the mean age was 62 (SD=14) years, 69% were women. Average EQ-5D score was 44% lower than the gender and age matched Hungarian norm (0.42 vs. 0.75, p<0.001) and it worsened with increasing pain intensity. The pain/discomfort and anxiety/depression were the most affected EQ-5D dimensions. Strong relationship was demonstrated between the PD-Q and EQ- 5D score. Most of the PeNP patients (86%) were undiagnosed. Conclusions - Non-diabetic PeNP pain has a huge negative impact on health related quality of life. Although PeNP is a serious chronic condition, the disease burden is seriously underestimated, both on the level of individuals and society, due to the fact that patients are rarely identified.