Hospital Casa de Salud

Background and ImportanceFibromyalgia is a pathology with a widespread pain whose control is sometimes inadequate. This may involve the prescription of opioids, which may develop a pattern of dependence known as Opioid Use Disorder (OUD).Furthermore, clinical guidelines expose the lack of benefit of opioids in fibromyalgia, and none make recommendations in favour of their use in these cases.Aim and ObjectivesCarry out a procedure developed in our Public Health System to address opioid deprescription in patients with fibromyalgia and therefore with chronic non-oncological pain through creation of a multidisciplinary team.Material and MethodsDescriptive study of interventions on active opioid prescriptions in patients with fibromyalgia. These lists were provided by our Health System in January 2023, with actions being carried out until September 2024. Sex, age, treatment duration, communication to the responsible Primary Care (PC) doctor were collected.A Multidisciplinary Team for Opioid Deprescription was formed: Medical Director, PC Pharmacist and Hospital Pharmacist, Addiction Treatment Centre Doctor, PC doctor, Mental Health Doctor and Pain Unit Doctor.This team developed a clinical deprescribing protocol that established that only one PC doctor would prescribe opioids to a patient, avoiding redundancies or paper prescriptions and with whom communication would be established.The interventions carried out by the PC and AH pharmacists were:Analyse the list of patients and exclude those who, due to their clinical situation (cancer, end of treatment, death), were not candidates for this intervention.Inform the responsible doctors by telephone/email so that they, after assessing the patient’s clinical situation, could begin the gradual deprescribing process.Carry out evolution periodic monitoring of these patients.ResultsThe list contained 48 patients. Two were excluded due to death. Of the 46 patients reviewed,44 were women, with an average age of 65 years. The median duration of treatment was 28 months (1–127).During the study period,73.9% of the prescriptions (34) were communicated to prescribing physicians. 24 patients (70.1%) began a deprescribing process, two of them without prior communication from Pharmacy Service. Two patients continued with opioid treatment due to developing oncological pathology.Conclusion and RelevanceTo address opioid misuse by patients with fibromyalgia, there must be joint collaborative action between professionals involved, in order to achieve optimal control of chronic non-oncological pain, highlighting the work of pharmacists as a link between health professionals.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Ankle fractures commonly affect mobility and quality of life. Although unstable fractures typically require surgery, post-treatment protocols vary widely, including both surgical and conservative approaches. This systematic review and meta-analysis evaluated the effects of early weight-bearing after ankle fracture treatment on functional outcomes and quality of life. Following the PRISMA guidelines and the PICOS strategy, we performed a meta-analysis across multiple databases (PubMed, Embase, Scopus, and Cochrane Library). Analysis was conducted using Review Manager 5.4, calculating the mean and standard mean differences with 95% confidence intervals (CIs). Eleven studies (n = 939) showed favorable outcomes with weight-bearing. Significant functional improvements were observed at 6 weeks (MD 7.88, 95% CI 3.14-12.61), 3 months (MD 5.79, 95% CI 4.41-7.17), and 12 months (MD 4.74, 95% CI 3.01-6.46). RAND scores favored the weight-bearing group at 6 weeks (SMD 0.48, 95% CI 0.26-0.70) and 12 months (SMD 0.31, 95% CI 0.07-0.55), with no significant differences at 3 months (SMD 0.18, 95% CI -0.10-0.46). The outcomes obtained indicated statistically significant differences in favor of the early weight-bearing group regarding ankle function and quality of life.

ABSTRACTIntroductionIn addition to an increased risk of thromboembolic complications, patients with atrial fibrillation (AF) are at risk for vascular events. Consequently, complete vascular protection is warranted in these patients.Areas coveredA narrative search was conducted on PubMed (MEDLINE), using the MeSH terms [Rivaroxaban] + [Atrial fibrillation] + [Cardiovascular] + [Vascular] + [Treatment]. Original data from clinical trials, prospective and retrospective studies, useful reviews and experimental studies, were selected.Expert opinionThe ROCKET-AF trial showed that rivaroxaban is effective in reducing the risk of stroke, with a lower risk of fatal and intracranial bleeding compared to warfarin. Remarkably, experimental data have provided a number of pathogenic mechanisms through which rivaroxaban could provide beneficial vascular properties beyond its antithrombotic activity. Moreover, in the AF population, additional to its ability to reduce the risk of thromboembolic complications, rivaroxaban is associated with a lower risk of myocardial infarction, major adverse cardiac and limb events, and vascular mortality in patients with diabetes, also attenuating renal impairment during follow-up. These findings suggest that rivaroxaban may provide a comprehensive vascular protection in patients with AF.

The high prevalence of trapeziometacarpal arthritis has resulted in the development of several surgical techniques intended to treat patients failing conservative treatment. However, there is no scientific evidence of the superiority of one technique over others. Open arthrodesis has up to now been successfully used to treat this condition. We believe that performing the technique using a minimally invasive approach with long and short Shannon burrs together with the tapered burr included in the MIS foot instrument set can yield satisfactory results. This article provides a description of this minimally invasive technique performed on a seventy-year-old woman with rhizarthrosis and an anatomical description of the approach in a human cadaver.

Topical α1- and α2-adrenoreceptor (ADRA1 and 2) agonists are effective in alleviating permanent vasodilation and facial erythema associated with rosacea by inducing skin vasoconstriction. Although β-adrenoreceptor (ADRB) antagonists are used off-label for rosacea, pharmacological and pharmacodynamic data pertaining to these receptors in skin micro-vessels are lacking. Objectives: To analyse the expression of different adrenergic receptors and their contribution to vasoreactivity in skin micro-vessels. Small arteries (500-800μm) and arterioles (<200μm) were studied in human foreskin tissue. Specifically, ADR-A1, -A2, -B1 and -B2 expression was assayed by immunofluorescence, polymerase chain reaction (PCR), and western blotting. Small skin artery reactivity was evaluated using ex vivo myography (500-800μm) or a visible microscope perfusion system with precision-cut skin slices (<200μm). ADRB2 was the most highly expressed receptor in small skin arteries and arterioles, followed by ADRA2. ADRA2 activation via brimonidine-induced vasoconstriction was greater in skin arterioles than in small skin arteries, and more potent than that with norepinephrine (NE). The use of prazosin (ADRA1 inhibitor) partially attenuated brimonidine-induced vasoconstriction, indicating some activation of ADRA1 by brimonidine, at least at 10-μM concentrations. Small skin arteries and arterioles, pre-treated with prazosin and stimulated with NE, exhibited ADRB2-mediated vasodilation, which was inhibited by the beta blockers, propranolol or timolol. This study shows that ADRB2 is predominantly expressed in small skin arteries and arterioles, and that ADRBs plays a functional role in vasodilation. The data presented here indicate that ADRBs can be a therapeutic target for the treatment of rosacea.