Bibliotecas. Alerta

El Instituto de Arqueología Ibérica de la UJA nutre de información de ...
Europa Press
En este encuentro de trabajo han participado otras instituciones como la Subdirección General de Coordinación de Bibliotecas del Ministerio de Cultura, The Science and Technology in Archaeology Research Center (Chipre), el Instituto Andaluz de ...
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Europa Press



Las bibliotecas populares festejan su día en Tecnópolis
Télam
Personalidades de la cultura como Juan Sasturain, Lola Berthet, Tomás Fonzi, Darío Sztajnszrajber, Tom Lupo y Lito Cruz pusieron su voz a textos propios y de autores latinoamericanos para celebrar el Día de las Bibliotecas Populares en Tecnópolis, ...
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La Biblioteca Virtual Miguel de Cervantes incluirá revistas culturales ...
Asociación Revistas Culturales de España
Manuel Ortuño, Presidente de la Asociación de Editores de Revistas Culturales de España (ARCE), y Manuel Bravo, Director general de la Fundación Biblioteca Virtual Miguel de Cervantes, han suscrito un convenio de colaboración para la digitalización de ...
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Asociación Revistas Culturales de España



El top 5 de las bibliotecas más importantes
DESDElared
Aguascalientes, Ags.- Por su función, las bibliotecas son cruciales para el desarrollo del sistema educativo y de la investigación pues éstas contienen libros, textos y documentos valiosos para la humanidad. Dichos lugares datan de hace más de cuatro ...
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'Letragones en su tinta' divierte a los más pequeños en la biblioteca
segoviaudaz.es
'Letragones en su tinta' divierte a los más pequeños en la biblioteca. El nuevo blog de laBiblioteca Pública de Segovia está destinado a los pequeños de hasta 12 años, y puede utilizarse en la sala infantil.
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segoviaudaz.es



ebooks, tablets y smartphones se toman las bibliotecas de Duoc UC
TransMedia.cl
Éste consiste en el uso gradual de ebooks, tablets y smartphones en las bibliotecas de todas sus sedes. Así, en el transcurso del año, la institución ha implementado ebooks en sedes como Alonso de Ovalle, donde la adopción por parte de los estudiantes ...
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SEMINARIO “BIBLIOTECAS BARRIALES Y CULTURA POPULAR”
Periodico Noticias Paceñas
Se realizara este martes 25 de septiembre, el seminario “Bibliotecas barriales y cultura popular (Francia – Argentina)”, a cargo de Denis Merklen y Charlotte Desaux. El mismo se realizará en el SUM de la UBYD, Biblioteca de la Universidad Nacional de ...
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Periodico Noticias Paceñas


Invierten un millón 300 mil pesos para biblioteca modelo en Jerez
NTR Zacatecas .com
La Dirección General de Bibliotecas entregó un millón 300 mil pesos a la coordinación de la Red Estatal de Bibliotecas, para el equipamiento de la biblioteca modelo de Jerez. Eduardo Mendoza Villalpando, coordinador general de la red estatal, dijo que ...
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NTR Zacatecas .com



Registro de personas para votar en las bibliotecas públicas de ...
Voluntarios del programa Future Vote y del Comité de Enlaces Comunitario de la Junta Electoral del condado de Montgomery realizará una campaña los ...
metrolatinousa.com/.../registro-de-personas-para-votar-en-las-...




El congreso rinde homenaje a las bibliotecas populares - Yahoo ...
Un homenaje y reconocimiento a las Bibliotecas Populares de diversos puntos del país tendrá lugar mañana a las 17.30 en el Salón de los Pasos Perdidos del ...
ar.finanzas.yahoo.com/.../congreso-rinde-homenaje-biblioteca...




Bibliotecas sin libros | Letras Libres
Casi todas las bibliotecas de la Nueva España fueron conventuales, o de obispos y religiosos: para uso interno o personal. Hubo algunas abiertas al público.
www.letraslibres.com/blogs/articulos.../bibliotecas-sin-libros


Sesión Pública: Horario de Servicio de las Bibliotecas :: Biblioteca ...
El Library Preservation Fund, renovado en noviembre del 2007 en la Proposition D, requiere que la Comisión de la Biblioteca valore y modifique, si es ...
sfpl.org/index.php?pg=2000563502&sl=2

Health Situation in the Americas . Basic Indicators 2012

Health Situation in the Americas . Basic Indicators 2012


Pan American Health Organization/World Health Organization (PAHO/WHO) - 2012

presents the latest available information on health indicators for 48 countries/territories in the Region of the Americas.


Available online at: http://bit.ly/NxsA7Q


“…..This edition highlights the mortality due to external causes (EC); those causes of death different from natural causes and recognized as avoidable such as suicides, homicides and accidents. From the data reported by the countries, it is estimated that over 5.5 million people died from EC in the Region between 1999 and 2009.

Three and a half million deaths (64%) occurred among the young and adult population (10-49 years old) with an average of 319,000 deaths per year; 84% of the deaths happened among males, five times more deaths among men than women. The most frequent causes were homicides (33%) and land transport accidents (26%).


Mortality from land transport accidents and homicides might be associated with economic, educational, political, social, and cultural factors. Also, they overburden the health care systems and pose a high cost on society, in addition to the suffering of the victims and their families6. In several countries of the Region the proportion of population in productive ages regarding the number of the youngest and the oldest are increasing, favoring their economic growth.


The negative potential impact of these deaths over this “demographic bonus” is an important call to countries for action given the preventability of these outcomes.

The information presented in this brochure has been compiled, processed and reviewed by PAHO/WHO technical staff in collaboration with ministries of health and national statistics offices from countries of the Americas ….”



KMC/2012/HSD
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Más sobre analgesia con ketamina

Efecto de ketamina intravenosa en analgesia controlada por el paciente utilizando hidromorfona y ketorolaco después de cirugía de Nuss en infantes


Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients.
Min TJ, Kim WY, Jeong WJ, Choi JH, Lee YS, Kim JH, Park YC.
Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea.
Korean J Anesthesiol. 2012 Feb;62(2):142-7. Epub 2012 Feb 20.
Abstract
BACKGROUND: Nuss surgery is preferred in pectus excavatum repair because this procedure produces excellent cosmetic results and prevents postoperative distressed pulmonary function. However, the procedure causes severe pain due to thoracic expansion. This study was designed to investigate the analgesic effect of small doses of ketamine on an intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and ketorolac for pain control after Nuss surgery. METHODS: Forty-four patients undergoing elective Nuss surgery were randomly assigned to receive hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron 0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group HK, n = 22) via an IV-PCA pump after surgery. A blind observer evaluated each patient using the Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for the assessment of pain control. The total administered PCA volume, side effects and parents satisfaction with pain control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours. RESULTS: There were no significant differences in Modified CHEOPS between the groups during postoperative 48 hours. The total PCA volume in group HK was significantly lower than that in group HO (P < 0.05). The side effects in both groups did not significantly differ except for pruritus. The levels of satisfaction from the parents were not significantly different between the groups. CONCLUSIONS: A small dose of ketamine on IV-PCA reduced the total administered dose of IV-PCA with hydromorphone and ketorolac and reduced the incidence of pruritus after the Nuss procedure in pediatric patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284736/pdf/kjae-62-142.pdf


Efecto de dosis bajas de ketamina intravenosa sobre analgesia intercostal continua en toracotomía


The effect of low-dose intravenous ketamine on continuous intercostal analgesia following thoracotomy.
Yazigi A, Abou-Zeid H, Srouji T, Madi-Jebara S, Haddad F, Jabbour K.
Department of Anaesthesia and Surgical Intensive Care, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.ritalama@idm.net.lb
Ann Card Anaesth. 2012 Jan-Mar;15(1):32-8.
Abstract
Ketamine, a noncompetitive N-methyl-d-aspartate antagonist, provides analgesia and prevents chronic pain following thoracotomy. The study was aimed to assess the effect of intravenous low-dose ketamine on continuous intercostal nerve block analgesia following thoracotomy. The study was a prospective, randomized, double-blinded, and placebo-controlled clinical study, performed in a single university hospital. Sixty patients, undergoing elective lobectomy through an open posterolateral thoracotomy, were included. For postoperative pain, all patients received a continuous intercostal nerve block with bupivacaine plus intravenous paracetamol and ketoprofen. In addition, patients were randomized to have intravenous ketamine (0.1 mg/kg as a preincisional bolus followed by a continuous infusion of 0.05 mg/kg/h) in group 1 or intravenous placebo in group 2. Patients reporting a visual analog scale pain score at rest ≥40 mm received intravenous morphine sulfate as rescue analgesia. The following parameters were assessed every 6 hours for 3 postoperative days: Visual analog scale pain scores at rest and during coughing, requirement of rescue analgesia with morphine, Ramsay sedation scores and psychomimetic adverse effects. Both the groups were statistically comparable regarding visual analog scale pain scores at rest (P=0.75) and during coughing (P=0.70), number of morphine deliveries (P=0.17), cumulative dose of rescue morphine (P=0.2), sedation scores (P=0.4), and psychomimetic adverse effects (P=0.09). Intravenous low-dose ketamine, when combined with continuous intercostal nerve block, did not decrease acute pain scores and supplemental morphine consumption following thoracotomy.

http://www.annals.in/article.asp?issn=0971-9784;year=2012;volume=15;issue=1;spage=32;epage=38;aulast=Yazigi






Efectos benéficos de agregar ketamina intravenosa con fentanilo a la analgesia controlada por paciente después del procedimiento de Nuss en pediatría
Beneficial effects of adding ketamine to intravenous patient-controlled analgesia with fentanyl after the Nuss procedure in pediatric patients.
Cha MH, Eom JH, Lee YS, Kim WY, Park YC, Min SH, Kim JH.
Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea.
Yonsei Med J. 2012 Mar;53(2):427-32. doi: 10.3349/ymj.2012.53.2.427.
Abstract
PURPOSE: The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum. MATERIALS AND METHODS: Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 μg/kg/hr of fentanyl or 0.5 μg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery. RESULTS: The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups. CONCLUSION: We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282966/pdf/ymj-53-427.pdf





Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Anafilaxia perioperatoria

Anafilaxia perioperatoria

Peri-operative anaphylaxis.
Nel L, Eren E.
Department of Anaesthetics, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, United Kingdom.
Br J Clin Pharmacol. 2011 May;71(5):647-58. doi: 10.1111/j.1365-2125.2011.03913.x.
Abstract
Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093071/pdf/bcp0071-0647.pdf


Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Cetrería

La cetrería es el arte de cazar con aves rapaces, especialmente con halcones, azores y otras aves de presa, en esta entrada veremos una obra escrita en francés de 1853, con 16 grabados, que trata de este arte.

Enlace al post:
http://www.odisea2008.com/2012/09/cetreria.html

Telemedicina. Alerta

La Palma tendrá un sistema pionero en telemedicina
Diario de Avisos
La isla de La Palma contará en unos meses con un sistema puntero en España detelemedicina. Un programa que surge a raíz del acuerdo alcanzado entre el Cabildo y la empresa multinacional Cisco, en el contexto del proyecto Antares, que persigue ...
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Diario de Avisos


Jornada de telemedicina en la cárcel San Diego - YouTube
Jornada de telemedicina en la cárcel San Diego. eluniversalmedia. Subscribe Subscribed ...
www.youtube.com/watch?v=DK4gwc6UdQg


Telemedicina a la distancia en MSN Video
Un nuevo robot llamado 'Chico' sirve a los cirujanos para hacer diagnósticos a la distancia en ...
video.latino.msn.com/watch/video/telemedicina-a.../xojeeexl

Costa Rica - Mejora percepción en el uso de Telemedicina
Los servicios médicos en línea muestran aceptación en Costa Rica: de cada diez pacientes, nueve muestran satisfacción. Según un estudio realizado por la ...
www.signalstelecomnews.com/.../2587-costa-rica-mejora-perc...
Telemedicina - Ensayos
Tecnología Ensayos: Telemedicina. ... La telemedicina no es la manera de ver la medicina atreves de un monitor, mezclando las ciencias de la salud con la ...
clubensayos.com/Tecnología/Telemedicina/300120.html

Jets Lose Revis to Torn Knee Ligament

http://www.nytimes.com/2012/09/25/sports/jets-lose-darrelle-revis-to-torn-acl-in-left-knee.html?_r=1&nl=nyregion&emc=edit_ur_20120925

Jets Lose Revis to Torn Knee Ligament

Rhona Wise/Associated Press

After missing this previous week's game because of a concussion, Darrelle Revis suffered a knee injury against the Dolphins and is expected to have surgery in the coming weeks.

By BEN SHPIGEL

Published: September 24, 2012

FLORHAM PARK, N.J. — After uttering the words he hoped he would not have to say, Rex Ryan looked down at the lectern and away from the cameras. A second went by. Then two. Then three, as if by taking time to collect his thoughts Ryan would somehow reverse the harsh sentence rendered Monday, when tests confirmed that the All-Pro cornerback Darrelle Revis had torn the anterior cruciate ligament in his left knee and would require surgery, ending his season after three games.

Related

• Jets 23, Dolphins 20 (Overtime): Jets Make the Most of a Second Chance (September 24, 2012)

• N.F.L. Fast Forward: Coaches Taking Out Frustration on Officials (September 25, 2012)

• Sports of The Times: Helicopter Coaching Hurts Could-Be Leaders (September 24, 2012)

Lynne Sladky/Associated Press

Darrelle Revis after he was injured Sunday against the Dolphins.

Lynne Sladky/Associated Press

Kyle Wilson, who will start in place of Darrelle Revis, was called for interference against the Dolphins’ Davone Bess on this play.

“I don’t know what else to say about it,” Ryan said.

Ryan just stood there, his face ashen, but the words eventually flowed from the coach’s mouth like a lazy river. He spoke of resilience and teamwork and adversity, how he and his coaching staff accepted Revis’s injury as “a personal challenge” to revitalize a team that had lost its best and most indispensable player. But Ryan did not address, at least not directly, that murky area between popular perception and harsh reality — that Revis’s absence deals the 2-1 Jets a potentially devastating blow, weakening not only their defense but also their playoff hopes.

“I have all the respect in the world for Tom Brady and Aaron Rodgers and Peyton Manning, but Darrelle’s the best player in the league,” said the former San Francisco cornerback Eric Davis, an analyst on NFL Network. “No other player goes out with those expectations on him every single week and produces like he does. No one has a tougher assignment week in, week out than Revis. Brady and Rodgers and Manning throw interceptions. Revis doesn’t make mistakes.”

He didn’t, at least, before his knee buckled while he made a cut in the third quarter of the Jets’ 23-20 overtime victory against Miami on Sunday. Their aggressive defense relies heavily on Revis, a neutralizing force in one-on-one coverage; according to the statistical Web siteProFootballFocus.com, which last season rated him as the best cornerback in the N.F.L., receivers caught only a league-low 41.2 percent of passes thrown while Revis was covering them.

By erasing the opposition’s top receiving threat, effectively eliminating a huge swath of the field, Revis allows Ryan to deploy the other 10 defenders in exotic ways — in creative blitz packages, in bracket coverage and in space, prowling other areas of the field.

“All that changes dramatically moving forward,” said Brian Billick, the former Ravens coach who works as an analyst for Fox Sports and NFL Network.

In the coming weeks, some of the N.F.L.’s most dangerous receivers — including Larry Fitzgerald, Andre Johnson and Reggie Wayne — visit MetLife Stadium, where Revis would surely have shadowed them. Instead, that burden falls to Antonio Cromartie — or, more likely, to his fellow defensive backs and him because the Jets are unlikely to trust Cromartie the same way they did Revis. With Revis sidelined, opponents are almost certain to emphasize their No. 1 receivers, devising game plans that funnel passes toward them.

Tom Moore, the former Indianapolis offensive coordinator who worked as a consultant last season for the Jets, said he always took Revis into account when calling plays, telling his players to “play smart, not scared.” In the Jets’ 2011 playoff victory against the Colts, Revis held Wayne to one reception for a single yard. The details have faded for Moore, but he said of Revis, “You always knew he was there.”

To compensate, Billick said the Jets could start playing more zone coverage, which would alleviate the pressure on Cromartie and Kyle Wilson, elevated from nickel corner to starter in Revis’s absence. When injuries diluted the Ravens’ secondary heading into a 2007 game in Seattle, Ryan, reluctantly, kept the defensive backs in a two-deep zone for much of the game, Billick said, “even though it killed him.”

“To do anything else would have been a mistake,” said Billick, who was Ryan’s boss in Baltimore for nine seasons. “He’s not in that dire straits now, because he has good people behind Revis. Rex’s nature is always to bring pressure — that’s his answer to everything. But you might be a little bit more tentative about bringing five- or six- or seven-man pressure knowing that your back end’s going to be more vulnerable.”

Ryan disagreed. Instead of taking a more conservative approach, as many would probably expect, Ryan said he might be more aggressive, mentioning how his father, Buddy, coached teams in Chicago that harassed quarterbacks despite an anonymous secondary.

In theory, that strategy makes sense: if the Jets feel exposed at cornerback, increasing their pressure would be a way of preventing the quarterback from dissecting the diminished secondary. In practice, the counterargument is fierce; the Jets, supported by three weeks of evidence, have struggled at generating a consistent pass rush, recording 3 sacks and 10 quarterback hits — 5 across their last two games.

“We’ve got to get 1,000 times better,” said linebacker Calvin Pace, who lamented the Jets’ inability to stop the run (148.7 yards a game) and generosity in third-down situations, yielding a 55.8 percent conversion rate. “It’s hard to rush the passer when you get third-and-4. The offense can pretty much do what they want.”

Ryan said: “Maybe we play some opponents differently. There’s different ways to skin a cat. You can’t just take away their best receiver with one guy. Again, we’ll find a way.”

A version of this article appeared in print on September 25, 2012, on page B11 of the New York edition with the headline: Revis Will Miss the Rest of the Season.

El Capitulo de Residentes del Colegio Mexicano de Ortopedia y Traumatología A.C.

El Capitulo de Residentes del Colegio Mexicano de Ortopedia y Traumatología A.C., le invita a su reunión mensual que tendrá lugar el jueves 27 de septiembre del 2012 a las 20:00 horas en el WTC México, Montecito 38, piso 25, Oficinas 23 a 27, Col. Nápoles, C.P. 03810 México, D.F.
Atentamente
Dr. Eduardo Antonio Rodríguez Becerril
Titular del Capítulo

Una breve introduccion de los avances de la telemedicina

http://issuu.com/christianospino/docs/telemedicuina?mode=window&backgroundColor=%23222222

Open publication - Free publishing - More santamarta

Bibliotecarios. Alerta

Texcoco Autónoma Chapingo prepara Encuentro de Bibliotecarios
AlianzaTex
Texcoco, México.- (Texcoco Mass Media).- Como parte de las actividades de la XXVIII Feria del Libro de la Universidad Autónoma Chapingo (UACh), se llevará a cabo el 3er. Encuentro Nacional de Bibliotecarios los próximos días 4 y 5 de octubre, en el ...
Ver todos los artículos sobre este tema »
AlianzaTex

La asociación de bibliotecarios organiza la VII jornada de ...
La Asociación de Bibliotecarios y Documentalistas de Honduras (ABIDH) organizará las VII Jornadas de Bibliotecología en Honduras, que se llevarán a cabo ...
www.hondudiario.com/.../la-asociación-de-bibliotecarios-orga...


Horario extendido de servicios bibliotecarios invierno 2012 ...
Avisos Varios. La biblioteca amplía su horario en el periodo de exámenes finales . Tags: biblioteca. Organiza: Dirección de Servicios Bibliotecarios ...
eventos.itam.mx/.../horario-extendido-de-servicios-bibliotecari...

Miércoles Académicos de la Mixta!!!!

Ahora continuando con esta labor de difusión, tenemos los miércoles académicos del servicio de ortopedia mixta, esta semana, como saben el miércoles 26/09/2012 a las 6:30 pm, hora del centro de México, Tenemos a la Dra. Araceli Cabanillas con el tema de Resonancia Magnética de rodilla y hombro, así que los invitamos cordialmente a seguirnos a través de la siguiente liga:

www.livestream.com/ortopediamixta

Atentamente QBP Víctor Valdés/ Bibliomanazteca

Capitulo de Residentes del Colegio Mexicano de Ortopedia y Traumatología A.C.

Capitulo de Residentes del Colegio Mexicano de Ortopedia y Traumatología A.C.

El Capitulo de Residentes del Colegio Mexicano de Ortopedia y Traumatología A.C., le invita a su reunión mensual que tendrá lugar el jueves 27 de septiembre del 2012 a las 20:00 horas en el WTC México, Montecito 38, piso 25, Oficinas 23 a 27, Col. Nápoles, C.P. 03810 México, D.F.
Atentamente

Dr. Eduardo Antonio Rodríguez Becerril
Titular del Capítulo

Coursera añade cursos online gratuitos de 17 universidades más

	Aprendiendoaenseñar Curated by Wilmer Ramírez
Wilmer Ramírez - September 19, 12:47 PM
Coursera añade cursos online gratuitos de 17 universidades más
Son ya 33 las universidades que ofrecen cursos online gratuitos en coursera.org, con 17 nuevas en su base de datos, según anunciaron hoy en Wired...

Revisión de drogas: Dolor neuropático: Actualización final

Revisión de drogas: Dolor neuropático: Actualización final


Drug Class Review: Neuropathic Pain: Final Update 1 Report [Internet].
Editors
Selph S, Carson S, Fu R, Thakurta S, Low A, McDonagh M.
Portland (OR): Oregon Health & Science University; 2011 Jun.
Drug Class Reviews.
Excerpt
PURPOSE: We compared the effectiveness and harms of anticonvulsants, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), and the lidocaine patchin adults with neuropathic pain. DATA SOURCES: To identify published studies, we searched MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and reference lists of included studies. We also searched the US Food and Drug Administration Center for Drug Evaluation and Research website for additional unpublished data and dossiers of information submitted by 5 pharmaceutical manufacturers. REVIEW METHODS: Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods. RESULTS AND CONCLUSIONS: Overall, the strength of evidence evaluating the comparative benefits or harms of these drugs to treat neuropathic pain was low to moderate. Based on a small number of short-term trials directly comparing the drugs in patients with painful diabetic neuropathy and postherpetic neuralgia, the evidence did not support a statistically significant difference in response (50% reduction in pain) or withdrawal due to adverse events with gabapentin, pregabalin, and lamotrigine compared with tricyclic antidepressants. Oralpregabalin was similar to lidocaine 5% medicated patchin rate of response, but resulted in more patients withdrawing due to an adverse event. Adjusted indirect comparisons of placebo-controlled trials suggested that duloxetine, pregabalin, and gabapentin were superior to lacosamide and lamotrigine, but no difference in withdrawal from study due to adverse events was found. In these analyses, differences were not found between pregabalin, duloxetine, and gabapentin or comparisons of 5% lidocaine patch and amitriptyline or gabapentin. Tricyclic antidepressants caused more dry mouth than pregabalin or gabapentin while gabapentin and pregabalin resulted in higher rates of ataxia. In patients with cancer-related neuropathic pain who were taking opioids, there was no difference in pain relief with low-dose gabapentin compared with low-dose imipramine. Monotherapy with either drug was insufficient for pain relief. In patients with spinal cord injury, gabapentin was more effective for pain relief than amitriptyline. The difference was significant only in the subgroup of patients with the highest levels of depression. In patients with central poststroke pain, there was no difference between amitriptyline and carbamazepine. There was no direct evidence in patients with HIV-associated neuropathic pain, multiple sclerosis, complex regional pain syndrome, postmastectomy pain syndrome, phantom limb pain, or traumatic nerve injury pain. Evidence for comparative effectiveness in patients with types of neuropathic pain other than diabetic or postherpetic was insufficient to assess comparative safety. Post hoc analyses have not found older age to have an impact on response or treatment-emergent adverse events with duloxetine. Combination therapy with duloxetine and pregabalin; lidocaine patch and pregabalin; or gabapentin with imipramine, nortriptyline, or venlafaxine may have had a potential benefit compared with monotherapy, but there was an increased risk of adverse events.


http://www.ncbi.nlm.nih.gov/books/NBK61823/pdf/TOC.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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