Search

Introduction: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms., Patients and Methods: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography., Results: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales., Conclusions: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

Thermoregulation in ectotherms may be modulated by climatic variability across geographic gradients. Environmental temperature varies along latitudinal clines resulting in heterogeneous thermal resource availability, which generally induces ectotherms to use compensatory mechanisms to thermoregulate. Lizards can accommodate to ambient temperature changes through a combination of adaptive evolution and behavioral and physiological plasticity. We studied the thermal ecology of the endangered endemic lizard Liolaemus multimaculatus at six different sites distributed from the northern to southern areas of the distribution (700 km) in the Atlantic dune barriers of Argentina, and even including the borders areas of the distribution range. Environmental temperatures and relative humidity showed a strong contrast between northern and southern limits of the distribution range. The northern localities had operative temperatures (Te) above the range of preferred temperatures (Tset), instead, the southern localities had large proportion of Tes within the Tset. Although these different climatic conditions may constrain the thermal biology of L. multimaculatus, individuals from all localities maintained relatively similar field body temperatures (XTb = 34.07 ± 3.02 °C), suggesting that this parameter is conservative. Thermal preference partially reflected latitudinal temperature gradient, since lizards from the two southernmost localities showed the lowest Tsel and Tset. Thermoregulatory efficiency differed among localities, since E values in the northern localities (E = 0.53-0.69) showed less variability than those of southern localities (E = 0.14-0.67). Although L. multimaculatus employed a strategy of having a conservative Tb and being able to acclimatize the thermal preference to copes with latitudinal changes in the thermal environment, other local factors, such as ecological interactions, may also impose limitations to thermoregulation and this may interfered in the interpretation of results at wider spatial scale., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

We report the reversion of fetal paroxysmal atrial tachycardia with 2:1 atrioventricular block obtained by vagal maneuvers during week 35 of gestation in a 31-year-old woman. All events were documented by fetal echocardiography.