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We review recent advances in medical management of acute pancreatitis. These are based on changes ranging from increased knowledge of the pathophysiology and clinical development of techniques for the management of complications. The recognition of poor prognosis given persistent organ failure (more than 48 hours) and the slow evolution without severity of patients with local complications, has redefined the classification of pancreatitis, stratifying the patient with mild, moderate and severe. Of the many available severity scores to predict severity, APACHE II and BISAP are demonstrating greater value on work done in Peru. Using vigorous hydration to avoid damage to the pancreatic microcirculation level, early enteral nutrition when it predicts a severe or prolonged disease in addition to narcotic analgesia, are some of the measures advocated in the present. I also discuss the evidence of refeeding with solid rather than liquid diet to patients with mild pancreatitis. Finally, evidence of safety and good outcomes of endoscopic necrosectomy is presented as an alternative to surgical necrosectomy. [ABSTRACT FROM AUTHOR]

El artículo analiza reglamentos y sentencias en Derecho de Salud y Alimentación de la Unión Europea (UE) y España emitidos entre octubre de 2012 y enero de 2013. Los temas discutidos incluyen el marco legal de la UE para la centralización de medidas de seguridad sobre el uso de medicinas, los requisitos para las recetas de prescripción de estupefacientes en España y sentencia sobre la distribución de medicamentos en Extremadura, España.

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Neuropathy is one of the most frequent complications of diabetes and pain, one of its more common and incapacitating symptoms. Recently there are reports of the use of opioids as an alternative of analgesic treatment. Objective: this work's objective has been to carry out a systematic review for determining the opioids power for managing pain in patients suffering from painful diabetic neuropathy. Methodology: a search and systematic selection was carried out of all clinical assays concerning the analgesic treatment of diabetic neuropathy using opioids published from January 1998 to June 2009. Randomized clinical trials compared with placebo were included which studied the analgesic effect of opioids in adults suffering from painful diabetic neuropathy; they were evaluated so that improvement of pain could be objectively classified. Results: there were nine randomized clinical trials identified. Only five were finally included: two with tramadol and three with oxycodone. The data provided by these studies did not allow to perform a meta-analysis. Conclusions: the improvement of pain in patients treated with tramadol or oxicodone was statistically significant superior when compared to placebo. It is necessary to make future clinical randomized studies to evaluate the analgesic effectiveness of opioids in painful diabetic neuropathy, including the magnitude of individual improvement, the previous definition of the percentage of improvement that is considered clinically significant and a longer time of follow-up. [ABSTRACT FROM AUTHOR]

En el Reino Unido es donde más se ha utilizado la prescripción médica de heroína en el tratamiento de la dependencia de opiáceos. Aunque esta práctica fue incrementándose hasta la década de los sesenta, varios factores provocaron la disminución de la misma, hasta la actualidad donde sólo supone el 1,6% de los programas de mantenimiento, siendo más importante la prescripción de metadona. En la última década se ha reactivado el debate alrededor de la idoneidad de esta práctica, principalmente por los estudios realizados en Suiza. En estos estudios parece que la prescripción de heroína favorece importantes mejorías en la evolución de los pacientes, tanto por obtenerse mejores retenciones, como por la disminución del consumo ilícito de sustancias, observándose mejoras tanto en la salud como en la esfera social de los pacientes. Pero la pobreza metodológica de estos estudios y la ambigüedad de otros realizados en diferentes países no permiten pronunciarse sobre la efectividad o eficacia de este tratamiento, siendo necesarios más estudios al respecto para que el uso de esta práctica esté justificada científicamente. [ABSTRACT FROM AUTHOR]