Opioids Switching with Transdermal Systems in Chronic Cancer Pain

<p>Abstract</p> <p>Background</p> <p>Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy</p> <p>Objective</p> <p>To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment.</p> <p>Methods</p> <p>A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks</p> <p>Results</p> <p>Pain relief as assessed by VAS, PPI, and PRI significantly improved (p < 0.0001) in all patients at all 3 follow up visits. After 3 weeks of treatment, the reduction in the mean VAS, PPI, and PRI scores in the fentanyl and buprenorphine groups was 68, 77, 74, and 69, 79, and 62%, respectively. Over the same time period the use of oral morphine as rescue medication was reduced from 27.5 ± 20.5 (mean ± SD) to 3.75 ± 8.06, and 33.8 ± 18.9 to 3.75 ± 10.9 mg/day in the fentanyl and buprenorphine groups, respectively. There was no significant difference in either pain relief or rescue medication use between the two patient groups The number of patient with adverse events fell during the study. After the third week of the treatment the number of patients with constipation was reduced from 11 to 5, and 10 to 4 patients in the fentanyl and buprenorphine groups, respectively. There was a similar reduction in the incidence of nausea and vomiting. No sedation was seen in any patient after one week of treatment.</p> <p>Conclusion</p> <p>Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.</p

A complex interaction between glycine/NMDA receptors and serotonergic/noradrenergic antidepressants in the forced swim test in mice

Both clinical and preclinical studies demonstrate the antidepressant activity of the functional NMDA receptor antagonists. In this study, we assessed the effects of two glycine/NMDA receptor ligands, namely L-701,324 (antagonist) and d-cycloserine (a partial agonist) on the action of antidepressant drugs with different pharmacological profiles in the forced swim test in mice. Swim sessions were conducted by placing mice individually in glass cylinders filled with warmed water for 6 min. The duration of behavioral immobility during the last 4 min of the test was evaluated. The locomotor activity of mice was measured with photoresistor actimeters. L-701,324 and d-cycloserine given with reboxetine (administered in subeffective doses) did not change the behavior of animals in the forced swim test. A potentiating effect was seen when both tested glycine site ligands were given concomitantly with imipramine or fluoxetine in this test. The lesion of noradrenaline nerve terminals produced by DSP-4 neither altered the baseline activity nor influenced the antidepressant-like action of L-701,324 or d-cycloserine. The depletion of serotonin by p-CPA did not alter baseline activity in the forced swim test. However, it completely antagonized the antidepressant-like action produced by L-701,324 and d-cycloserine. Moreover, the antidepressant-like effects of imipramine, fluoxetine and reboxetine were abolished by d-serine, a full agonist of glycine/NMDA receptors. The present study demonstrates that glycine/NMDA receptor functional antagonists enhance the antidepressant-like action of serotonin, but not noradrenaline-based antidepressants and such their activity seems to depend on serotonin rather than noradrenaline pathway

NCCN Guidelines® Insights: Survivorship, Version 2.2025

The NCCN Guidelines for Survivorship include screening, evaluation, and treatment recommendations for common physical and psychosocial problems resulting from adult-onset cancer and its treatment and provide a framework for coordination of survivorship care. They also include recommendations to help cancer survivors enhance their wellness and maintain a healthy lifestyle. These NCCN Guidelines Insights summarize the panel’s current recommendations and recent updates regarding physical activity, nutrition, and weight management for cancer survivors

Estimation of groundwaters quality in area of power station and mine "Turow" on the base of metals contents study

W pracy przedstawiono wyniki badań jakości wód podziemnych przeprowadzone w dwóch rejonach badawczych. Pierwszy zlokalizowany był w pobliżu Elektrowni i Kopalni „Turów” (Bogatynia, Działoszyn, Wolanów, Bratków). Drugi, stanowiący grupę kontrolną, usytuowany był na terenie gmin położonych w centralnej i północnej części powiatu zgorzeleckiego (Jerzmanki, Sławnikowice, Łagów, Gronów, Jagodzin). W próbkach wód, pobranych do analizy, oznaczano zawartość żelaza, manganu, ołowiu, kadmu, glinu, arsenu, cynku, miedzi i chromu oraz wskaźniki fizyko-chemiczne jakości wód tj. odczyn, przewodność, amoniak, azotany, azotyny, siarczany, fosforany, chlorki, twardość ogólną. Nie stwierdzono istotnych różnic w zawartości wymienionych składników w próbkach wód z obu rejonów badawczych. Kryterium zawartości metali ciężkich pozwala zaliczyć próbki wód podziemnych do I lub II klasy jakości. Wyjątek stanowi zawartość glinu (III lub IV klasa). Przy uwzględnieniu pozostałych parametrów fizykochemicznych, ogólna ocena jakości wód podziemnych wypada znacznie słabiej. Próbki wód znajdują się w klasie II, III, a nawet V (Jagodzin). Spowodowane jest to zwiększoną zawartością azotanów, amoniaku, manganu, glinu i arsenu. Z tego powodu próbki wód nie spełniają normy jakości wody do picia.Results of research works carried in two investigative areas are presented in the paper. The first was situated near Power Station and Mine “Turów” (Bogatynia, Działoszyn, Wolanów, Bratków). The second, presenting check group, was situated in central and northern districts of Zgorzelec administrative district (Jerzmanki, Sławnikowice, Łagów, Gronów, Jagodzin). In samples of water, collected for analysis, contents of iron, manganese, lead, cadmium, aluminium, arsenic, zinc, copper, chromium, physical and chemical parameters of groundwater quality such as pH, conductivity, ammonia, nitrates, nitrites, sulphates, phosphates, chlorides, total hardness was determined. It was not affirmed important differences in contents of mentioned components in samples of waters in both investigative areas. Criterion of metals contents allows to include samples of groundwaters for I or II class of quality. Exceptions presents contents of aluminium (III or IV class). Taking into consideration remaining physical and chemical parameters, general estimate of groundwater quality falls out considerably weakly. Samples of water locates in II, III and even V class (Jagodzin). It is caused by increased contents of nitrates, ammonia, manganese, aluminium and arsenic. For this reason samples of waters do not meets conditions for drinking water quality norm

Fostering Trust With a Young Man Experiencing Homelessness and Advanced Cancer

Persons experiencing homelessness (PEH) face countless barriers to equitable health, social, and palliative care across all settings. Brandon was a 23-year-old male, well-spoken, groomed, and polite despite difficult circumstances. He was severely abused then abandoned as a child, living in multiple foster homes until 18. With no consistent caring adult figure, he predictably fell into a chaotic lifestyle, had 3 children by different mothers, and became homeless in New York City. He presented with newly diagnosed renal cell carcinoma metastatic to lung, lymph nodes, and bone. Spine and pelvic metastases caused paralyzing somatic pain that interfered with walking and sitting and prevented Brandon from performing the activities of daily living essential for his survival on the streets and safekeeping of opioids. Lack of basic social support and a history of multiple abandonments made a care plan for this young, homeless, and truly isolated man very challenging. The inpatient and outpatient interdisciplinary team members partnering with Brandon each earned his trust with time. A “safe place” opened hearts on all sides of the therapeutic relationship and led to a plan that was acceptable for both the patient and the palliative care team. Clinicians are often challenged to provide sustained and pragmatic palliative care services for PEH due to complex barriers. Continued advocacy for equitable and tailored services that ensure high-quality palliative care for PEH is critical at individual, institutional, and system levels to promote health equity and dignified care. </jats:p