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    Use of an Advanced Hybrid Closed Loop System During Marathon Running: Case Examples and Clinical Implications
    (Wiley, 2025-02-28)
    María T. Onetto
    ;
    Denise Montt‐Blanchard
    ;
    Cari Berget
    ;
    Kristel Strodhoff
    ;
    Bruno Grassi
    Maintaining glucose levels in the target range during aerobic training and athletic competition is especially difficult. The use of Automated Insulin Delivery (AID) technology is increasing, but exercise continues to be a challenge for persons with type 1 diabetes (T1D). In this case report series, we present 3 cases (C1, C2 and C3) of persons with T1D who used the MiniMed 780G during marathon races. We describe the strategies they used before, during and after the race to manage their glycaemia as well as the results of these strategies on their glycaemic control during the race.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The Medtronic CareLink platform was employed to remotely access insulin pump settings and glycaemic outcomes. Race parameters were obtained from sport watches. Supplemental data were obtained through interviews.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Carelink data for Cases 1, 2, and 3 before the race were downloaded: Time in range (TIR) 70–180 mg/dL 89%, 76%, 82%; time above range (TAR) &gt; 180 mg/dL, 9%, 20%, 16%; time below range (TBR) &lt; 70 mg/dL, 1%, 4%, 1%, respectively. The breakfast insulin reduction percentages were −25%, 0%, and 0% for C1, C2, and C3, respectively. In all three cases, insulin dose reduction was applied to the pre‐race snack at percentages of −50%, −100% and −83%. The consumption of carbohydrates during the race was 0.39 g/kg/hour, 0.42 g/kg/hour, and 0.5 g/kg/hour, respectively. The total amount of carbohydrates consumed was 101 g, 120 g, and 115 g, respectively. Throughout the race, a temporary target was used for all cases.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These cases provide insights for healthcare professionals who assist athletes with T1D using AID systems during prolonged physical activities. Highlighting the significance of specialised education, planning, and personalised approaches.</jats:p></jats:sec>
      4
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    Manejo del dolor agudo y crónico en pacientes ancianos
    (Asociacion de Medicos Anestesiologos de Chile, 2024)
    Josefina Yates
    ;
    Martín Lacassie
    ;
    Eduardo Vega Pérez
    ;
    Antonia Cárdenas
    ;
    Cristóbal Pedemonte
      6
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    Scopus© Citations 1
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    Opioid prescribing for cancer pain in Latin America: systematic review
    (2024)
    ofelia Leiva
    ;
    Emeka Chukwusa
    ;
    Kennedy Nkhoma
    ;
    Mariana Dittborn
    ;
    Pamela Turrillas
    <jats:sec><jats:title>Objective</jats:title><jats:p>To explore opioid prescribing patterns for cancer pain in Latin America (LA).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Relevant databases, including MEDLINE, EMBASE, PubMed, LILACS and Scielo, were searched from inception to June 2023. Empirical studies of opioid prescription patterns in adult palliative care patients with cancer pain were included. Methodological quality was assessed using the Effective Public Health Practice Project tool. Data were analysed using narrative synthesis. Descriptive statistical analyses were conducted using SPSS V.28 (IBM). Categorical variables were summarised using frequencies and percentages and continuous variables as means or medians.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventeen studies from six countries were included. Ten were observational, while seven were experimental, including five randomised controlled trials (RCT) and two non-RCT. Most were low or moderate methodological quality. Out of 7809 patients, morphine (54%) and tramadol (18%) were the most prescribed opioids. The median of morphine equivalent daily dose was 26 mg (IQR 26–41).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Latin America shows lower opioid consumption rates compared with high-income countries for control pain management (CPM). More rigorous research on CPM in LA is needed. Additionally, a comprehensive review of opioid prescription patterns, including non-cancer diagnoses, is necessary.</jats:p></jats:sec>
      2
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    Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
    (2023)
    Jason W Busse
    ;
    Rodrigo Casassus
    ;
    Alonso Carrasco-Labra
    ;
    Justin Durham
    ;
    David Mock
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Clinical question</jats:title> <jats:p>What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)?</jats:p> </jats:sec> <jats:sec> <jats:title>Current practice</jats:title> <jats:p>TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations.</jats:p> </jats:sec> <jats:sec> <jats:title>Recommendations</jats:title> <jats:p>For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids.</jats:p> </jats:sec> <jats:sec> <jats:title>How this guideline was created</jats:title> <jats:p>An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective.</jats:p> </jats:sec> <jats:sec> <jats:title>The evidence</jats:title> <jats:p>Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD.</jats:p> </jats:sec> <jats:sec> <jats:title>Understanding the recommendation</jats:title> <jats:p>These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future.</jats:p> </jats:sec>
      15Scopus© Citations 63
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      10
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    The impact of lumbar scoliosis on pain, function and health-related quality of life in postmenopausal women
    (2011)
    Julio Urrutia
    ;
    Julio Espinosa
    ;
    Claudio Diaz-Ledezma
    ;
    Carlos Cabello
      1Scopus© Citations 13
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    Latin-American guidelines for opioid use in chronic nononcologic pain
    (2017)
    Argelia Lara-Solares
    ;
    Carlos Aguayo Zamora
    ;
    César Amescua García
    ;
    João Batista Santos Garcia
    ;
    María del Rosario Berenguel Cook
    <jats:p>Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.</jats:p>
      3Scopus© Citations 18
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      1
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      25Scopus© Citations 3