REPRODUCTIVE CYCLE STAGE ASSESSMENT IN THE TWO-TOED SLOTH (CHOLOEPUS HOFFMANNI), PRELIMINARY RESULTS.

The number of two-toed sloths (Choloepus hoffmanni) has significantly decreased in the last years. Deepening the knowledge of this tropical mammal's reproductive physiology is essential to improve captive breeding within conservation programs for this species. However, several aspects of its reproductive biology remain unexplored and have not been described sufficiently. The aim of this work was to describe the estrous cycle and reproductive physiology of two adult female C. hoffmanni by vaginal cytology, appearance of the external genitalia, and behavior. Vaginal cytology assay showed that the average duration of the estrous cycle was 15.1 ± 4.53 d. Positive correlations (P < 0.05) were found between the peak presence of superficial cells (estrous phase) and four parameters: aggressive behavior, pursuing behavior, vulvar swelling, and vaginal discharge. This pilot study, conducted on just two animals, forms a basis for a study design that may be employed for a more comprehensive assessment of the two-toed sloth reproductive physiology and behavior.

Microbiology and Biochemistry of Pesticides Biodegradation.

Pesticides are chemicals used in agriculture, forestry, and, to some extent, public health. As effective as they can be, due to the limited biodegradability and toxicity of some of them, they can also have negative environmental and health impacts. Pesticide biodegradation is important because it can help mitigate the negative effects of pesticides. Many types of microorganisms, including bacteria, fungi, and algae, can degrade pesticides; microorganisms are able to bioremediate pesticides using diverse metabolic pathways where enzymatic degradation plays a crucial role in achieving chemical transformation of the pesticides. The growing concern about the environmental and health impacts of pesticides is pushing the industry of these products to develop more sustainable alternatives, such as high biodegradable chemicals. The degradative properties of microorganisms could be fully exploited using the advances in genetic engineering and biotechnology, paving the way for more effective bioremediation strategies, new technologies, and novel applications. The purpose of the current review is to discuss the microorganisms that have demonstrated their capacity to degrade pesticides and those categorized by the World Health Organization as important for the impact they may have on human health. A comprehensive list of microorganisms is presented, and some metabolic pathways and enzymes for pesticide degradation and the genetics behind this process are discussed. Due to the high number of microorganisms known to be capable of degrading pesticides and the low number of metabolic pathways that are fully described for this purpose, more research must be conducted in this field, and more enzymes and genes are yet to be discovered with the possibility of finding more efficient metabolic pathways for pesticide biodegradation.

Percepción de las fuentes de apoyo que facilitan la adherencia a los tratamientos / Perception of sources of support that facilitate adherence to the treatments

Introducción: La falta de adherencia a los tratamientos aumenta la probabilidad de fracaso terapéutico y complicaciones innecesarias. Objetivo: Explorar las fuentes de apoyo percibidas por los pacientes con enfermedades crónicas que les facilitan la adherencia a los tratamientos. Método: Estudio cualitativo descriptivo con enfoque fenomenológico, en el que se reclutaron ocho pacientes crónicos complejos, sin distinción de género, ni edad, residentes en Barcelona, y que tras evaluar la adherencia farmacológica con los test de Morisky-Green y el test de Batalla diera como resultado ser adherente al régimen terapéutico. Tras lo cual se efectuaron dos preguntas abiertas que fueron grabadas en un dispositivo de audio y transcritas textualmente. Para el análisis de los datos, se utilizó el método Colaizzi. Resultados: Surgieron tres grupos temáticos: 1) Tener el apoyo familiar; 2) Comprensión de la enfermedad y estrategias que facilitan la adhesión a los tratamientos; y 3) Relación con los profesionales de referencia. Conclusiones: La fuente más importante de apoyo percibida por los participantes, es la familia, coincidiendo con otros autores. El hallazgo de este estudio, es que se evidencia a medicina y enfermería como instigadores que fomentan su empoderamiento y como fuente de influencia reconocida que ha permitido su asimilación y capacitación para adoptar medidas que les ayudan a seguir las pautas farmacoterapéuticas. (AU)

Introduction: Non-adherence to treatments increases the probability of therapeutic failure and unnecessary complications. Objective: To explore the sources of support perceived by patients with chronic diseases that facilitate adherence to treatment. Method: Qualitative descriptive study with a phenomenological approach, in which eight complex chronic patients were recruited, without distinction of gender or age, residents of Barcelona, and who, after evaluating pharmacological adherence with the Morisky-Green test and the test of Batalla resulted in being adherent to the therapeutic regimen.After which, two open questions were asked that were recorded on an audio device and transcribed verbatim. For data analysis, the method Colaizzi was used. Results: Three thematic groups emerged: 1) Having family support; 2) Understanding of the disease and strategies that facilitate adherence to treatments; and 3) Relationship with reference professionals. Conclusions: The most important source of support perceived by the participants is the family, coinciding with other authors. The finding of this study is that shows medicine and nursing are evidenced as instigators that promote their empowerment and as a recognized source of influence that has allowed their assimilation and training to adopt measures that help them follow the pharmacotherapeutic guidelines. (AU)

Carcinoma de mama triple negativo. Estudio anatomo-estadístico / Triple- negative breast cancer. An anatomical and statistical study

Introducción: El carcinoma de mama triple negativo se asocia a un comportamiento biológico más agresivo y de desfavorable pronóstico. Objetivo: Determinar la incidencia del subtipo molecular triple negativo en carcinomas mamarios y su relación con otras variables clínico-patológicas de valor pronóstico. Método: Se realizó un estudio descriptivo y retrospectivo, en el Hospital Universitario Docente «Celestino Hernández Robau» de Villa Clara, en el período comprendido de enero de 2017 a junio de 2019, con el fin de determinar la incidencia de los tumores triples negativos y su relación con las variables edad, talla tumoral, tipo y grado histológicos e índice de proliferación. Resultados: Se determinó la incidencia del subtipo molecular triple negativo en carcinomas mamarios y su relación con las formas histológicas moderada y poco diferenciadas. Conclusiones: El subtipo molecular triple negativo en carcinomas mamarios está asociado con frecuencia a: la edad posmenopáusica, el tipo histológico ductal, el grado histológico alto, altos índices de Ki-67 y talla tumoral mayor de 2 cm.

Introduction: triple-negative breast cancer has a more aggressive biological behaviour and is associated with an unfavourable prognosis. Objective: to determine the incidence of triple- negative breast cancer molecular subtypes and its relationship with other clinical and pathological variables of prognostic value. Methods: a descriptive and retrospective study was carried out at "Celestino Hernández Robau" University Teaching Hospital from Villa Clara between January 2017 and June 2019 in order to determine the incidence of triple- negative tumors and its relationship with the variables: age, tumor size, histological type and grade as well as proliferative index. Results: the incidence of triple- negative breast cancer molecular subtype and its relationship with moderate and poorly differentiated histological forms were determined. Conclusions: triple- negative breast cancer molecular subtype is frequently associated with postmenopausal age, ductal histological type, high histological grade, high Ki-67 indices and tumor size greater than 2 cm.

Microsporidia as a Potential Threat to the Iberian Lynx (Lynx pardinus).

Lynx pardinus is one of the world's most endangered felines inhabiting the Iberian Peninsula. The present study was performed to identify the presence of microsporidia due to the mortality increase in lynxes. Samples of urine (n = 124), feces (n = 52), and tissues [spleen (n = 13), brain (n = 9), liver (n = 11), and kidney (n = 10)] from 140 lynxes were studied. The determination of microsporidia was evaluated using Weber's chromotrope stain and Real Time-PCR. Of the lynxes analyzed, stains showed 10.48% and 50% positivity in urine and feces samples, respectively. PCR confirmed that 7.69% and 65.38% belonged to microsporidia species. The imprints of the tissues showed positive results in the spleen (38.46%), brain (22.22%), and liver (27.27%), but negative results in the kidneys. PCR confirmed positive microsporidia results in 61.53%, 55.55%, 45.45%, and 50%, respectively. Seroprevalence against Encephalitozoon cuniculi was also studied in 138 serum samples with a positivity of 55.8%. For the first time, the results presented different species of microsporidia in the urine, feces, and tissue samples of Lynx pardinus. The high titers of anti-E. cuniculi antibodies in lynx sera confirmed the presence of microsporidia in the lynx environment. New studies are needed to establish the impact of microsporidia infection on the survival of the Iberian lynx.

Moral sensitivity of nursing students. Adaptation and validation of the moral sensitivity questionnaire in Spain.

Ethical sensitivity is a requirement for people care as well as for decision-making in everyday practice. The aim is to present an adaptation and transcultural validation -in Spanish- of the Moral Sensitivity Questionnaire by Lützén et al. in Spain. In addition to that, we provide a practical implementation analysing the degree of moral sensitivity of nursing students. The data used for data collection were moral Sensitivity Questionnaire, socio-demographic data and a self-report questionnaire. The psychometric properties of the questionnaire were assessed, including validity and reliability. Fit indices of the overall model were computed. The fit indices of the Confirmatory Factor Analysis (CFA) indicate a poor fit, although the Exploratory Factor Analysis (EFA) revealed two dimensions that show a better fit of its indices. Women and those women with more experience in the clinical setting have a higher mean score, as well as those who study in centers where the strategic lines are the humanization of care. Female nursing students with more experience in the clinical setting and with more educational training present higher sensitivity indexes, as well as those who study in centers where the strategic lines are the humanization of care. The findings confirm that the Lützén et al. questionnaire is multidimensional. In the Spanish sample, it was necessary to group the three initial factors into two: sense of moral burden and moral strength-grouping the moral responsibility items into the above items to make the instrument more resilient.

Population-Based COVID-19 Screening in Mexico: Assessment of Symptoms and Their Weighting in Predicting SARS-CoV-2 Infection.

Background and Objectives: Sentinel surveillance in the early stage of the COVID-19 pandemic in Mexico represented a significant cost reduction and was useful in estimating the population infected with SARS-CoV-2. However, it also implied that many patients were not screened and therefore had no accurate diagnosis. In this study, we carried out a population-based SARS-CoV-2 screening in Mexico to evaluate the COVID-19-related symptoms and their weighting in predicting SARS-CoV-2 infection. We also discuss this data in the context of the operational definition of suspected cases of COVID-19 established by the Mexican Health Authority's consensus. Materials and Methods: One thousand two hundred seventy-nine subjects were included. They were screened for SARS-CoV-2 using RT-PCR. The weighting of COVID-19 symptoms in predicting SARS-CoV-2 infection was evaluated statistically. Results: Three hundred and twenty-five patients were positive for SARS-CoV-2 and 954 were negative. Fever, asthenia, dysgeusia, and oxygen saturation predicted SARS-CoV-2 infection (odds ratios ranged from 1.74 to 4.98; p < 0.05). The percentage of asymptomatic COVID-19 patients was 36% and only 38.15% met the Mexican operational definition. Cq-values for the gene N of SARS-CoV-2 were significantly higher in asymptomatic subjects than in the groups of COVID-19 patients with neurological, respiratory, and/or musculoskeletal manifestations (p < 0.05). Conclusions: Dysgeusia, fever, and asthenia increased the odds of a positive result for COVID-19 1.74-4.98-fold among the study population. Patients with neurological, respiratory, and/or musculoskeletal manifestations had higher viral loads at COVID-19 diagnosis than those observed in asymptomatic patients. A high percentage of the participants in the study (61.85%) did not meet the operational definition for a suspected case of COVID-19 established by the Mexican Health Authority's consensus, representing a high percentage of the population that could have remained without a COVID-19 diagnosis, so becoming a potential source of virus spread.

The role of close contacts of COVID-19 patients in the SARS-CoV-2 transmission: an emphasis on the percentage of nonevaluated positivity in Mexico.

OBJECTIVES: To determine the percentage of positivity of close contacts of coronavirus disease 19 (COVID-19) patients to depict the importance of asymptomatic infections in the patient-to-patient transmission of COVID-19. METHODS: One hundred subjects were included. Nineteen index COVID-19 cases and 81 traced close contacts were screened for coronavirus 2 of severe acute respiratory syndrome (SARS-CoV-2) using real-time reverse transcription-polymerase chain reaction. Immunoglobulin M and G against SARS-CoV-2 were evaluated by rapid test. RESULTS: Thirty-four (42%) contacts in the study were positive for SARS-CoV-2. Twenty-three (67.6%) manifested less than 2 respiratory symptoms, and 5 (14.7%) remained asymptomatic. The average of positive contacts by index COVID-19 case (R0) was 4.3 and the mean of time of positive COVID-19 test at sampling time was 18.9 days. Positive antibody test against SARS-CoV-2 was observed in 16% of the participants. CONCLUSION: The proportion of close contacts of COVID-19 patients infected with SARS-CoV-2 (42%) and with less than 2 or with no respiratory symptoms (82.4%) was high in the study population. A low proportion of COVID-19 patients had a positive test for antibodies against SARS-CoV-2. The screening for SARS-CoV-2 in close contacts of COVID-19 positive patients should be encouraged to avoid spreading the infection and the expansion of the disease.

First Cases of Natural Infections with Borrelia hispanica in Two Dogs and a Cat from Europe.

Canine cases of relapsing fever (RF) borreliosis have been described in Israel and the USA, where two RF species, Borrelia turicatae and Borrelia hermsii, can cause similar clinical signs to the Borrelia persica in dogs and cats reported from Israel, including fever, lethargy, anorexia, thrombocytopenia, and spirochetemia. In this report, we describe the first clinical cases of two dogs and a cat from Spain (Cordoba, Valencia, and Seville) caused by the RF species Borrelia hispanica. Spirochetes were present in the blood smears of all three animals, and clinical signs included lethargy, pale mucosa, anorexia, cachexia, or mild abdominal respiration. Laboratory findings, like thrombocytopenia in both dogs, may have been caused by co-infecting pathogens (i.e., Babesia vogeli, confirmed in one dog). Anemia was noticed in one of the dogs and in the cat. Borrelia hispanica was confirmed as an infecting agent by molecular analysis of the 16S rRNA locus. Molecular analysis of housekeeping genes and phylogenetic analyses, as well as successful in vitro culture of the feline isolate confirmed the causative agent as B. hispanica.

Actitud del odontopediatra en la clínica dental ante la pandemia del COVID-19 / Paediatric dentist’s approach in the surgery to the covid-19 pandemic

INTRODUCCIÓN: La aparición del nuevo virus del síndrome respiratorio agudo severo Coronavirus 2 (SARS-CoV-2) ha causado una pandemia mundial llamada enfermedad del coronavirus (COVID-19) y se ha convertido en uno de los desafíos más grandes entre los profesionales dedicados a la salud. Dado que el sector sanitario bucodental es una de las poblaciones de riesgo, se debe tener especial cuidado para minimizar dicho riesgo de infección así como evitar el contagio entre profesionales y pacientes. Los síntomas respiratorios de esta enfermedad en los niños parecen ser más leves que los que experimentan los adultos, se conoce que transmiten la enferme-dad, pero los datos emergentes sobre la propagación en niños afectados por CO-VID-19 no es conocida aún en detalle. El propósito de este artículo es analizar a través de una encuesta online si los odontopediatras prevén cambios en la forma habitual de trabajo para evitar el riesgo de contagio por COVID-19 durante el trata-miento dental con pacientes infantiles. MATERIAL Y MÉTODO: se realizó una en-cuesta online dirigida a odontopediatras y odontólogos que trabajaran con niños, con preguntas sobre el conocimiento y actitud frente al COVID-19 en la consulta dental. Se registraron las variables sexo, edad, años de profesión y posesión de título en Odontopediatría. RESULTADOS: se recogieron 93 cuestionarios y se analizaron los resultados estadísticamente para cada ítem del cuestionario, representados en gráficas de porcentajes de respuesta. La mayoría de los encuestados fueron mujeres, edad media de 34,5 años, que utilizan a diario instrumental rotatorio, pero a favor de tratamientos mínimamente invasivos; cumplen con las medidas de protección, pero a veces para el manejo de la conducta infantil no es posible. CONCLUSIONES: en general, el odontopediatra deberá adaptarse a la nueva situación con el niño con respecto a las técnicas de tratamiento, así como todos los miembros del equipo dental, ya que tienen la responsabilidad profe-sional de mantenerse informados y actualizados respecto a los nuevos datos que vayan surgiendo sobre COVID-19, no solo para protegerse de posibles contagios sino tam-bién para evitar la propagación a los pacientes infantiles que acudan a realizarse un tratamiento odontológico

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has been caused by appearance of a new virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); and has become one of the greatest challenges for health professionals. The oral health sector is one of the populations at risk, so special care must be taken to minimise the risk of infection and prevent contagion between professionals and patients.The respiratory symptoms of this disease in children appear to be milder than those experienced by adults. Children are known to transmit the disease, but emerging data on the spread in children affected by COVID-19 is not yet known in detail.The purpose of this article is to analyse whether paediatric dentists foresee changes in their usual way of working to minimise the risk of COVID-19 infection during treatment of their patients through conducting an online survey. MATERIAL AND METHOD: An online survey was conducted of paediatric dentists and dentists working with children, with questions about their knowledge of and attitude towards COVID-19 in the dental clinic. The variables of sex, age, years of profession and having a paediatric dentistry qualification were recorded. RESULTS: 93 questionnaires were collected, the results for each item on the questionnaire were represented graphically with the percentage response and analysed statistically. Most of the respondents were women, mean age 34.5 years, who used rotary instruments daily, but were in favour of minimally invasive treatments; they usually complied with the protective measures, but sometimes this was not possible when managing child behaviour. CONCLUSIONS: In general, paediatric dentists are adapting to the new situation with children regarding treatment techniques and with other dental team members, as they have the professional responsibility to keep themselves informed and updated regarding new information about COVID-19; not only to protect themselves from possible infection but also to prevent spreading the infection to children undergoing dental treatment

Canine Dracunculus Nematode Infection, Toledo, Spain.

A fragment of a Dracunculus-like worm was extracted from the hind limb of a 2-year-old dog from Toledo, Spain. Cytochrome oxidase I and rRNA sequences confirmed an autochthonous mammalian Dracunculus worm infection in Europe. Sequence analyses suggest close relation to a parasite obtained from a North American opossum.

Emotions and feelings in critical and emergency caring situations: a qualitative study.

BACKGROUND: Moral emotions are a key element of our human morals. Emotions play an important role in the caring process. Decision-making and assessment in emergency situations are complex and they frequently result in different emotions and feelings among health-care professionals. METHODS: The study had qualitative deductive design based on content analysis. Individual interviews and focus groups were conducted with sixteen participants. RESULTS: The emerging category "emotions and feelings in caring" has been analysed according to Haidt, considering that moral emotions include the subcategories of "Condemning emotions", "Self-conscious emotions", "Suffering emotions" and "Praising emotions". Within these subcategories, we found that the feelings that nurses experienced when ethical conflicts arose in emergency situations were related to caring and decisions associated with it, even when they had experienced situations in which they believed they could have helped the patient differently, but the conditions at the time did not permit it and they felt that the ethical conflicts in clinical practice created a large degree of anxiety and moral stress. The nurses felt that caring, as seen from a nursing perspective, has a sensitive dimension that goes beyond the patient's own healing and, when this dimension is in conflict with the environment, it has a dehumanising effect. Positive feelings and satisfaction are created when nurses feel that care has met its objectives and that there has been an appropriate response to the needs. CONCLUSIONS: Moral emotions can help nurses to recognise situations that allow them to promote changes in the care of patients in extreme situations. They can also be the starting point for personal and professional growth and an evolution towards person-centred care.

Endoscopic Ultrasound (EUS)-Guided Drainage of a Postsleeve Gastrectomy Subphrenic Collection Using a Lumen Apposition Stent.

Sleeve gastrectomy is currently the most frequently performed bariatric surgery. Postoperative leaks represent the main cause of morbidity in up to 8% of patients with a mortality rate ranging between 0.1 and 5%. However, management of these leaks remains controversial. We report the case of a patient presenting with sepsis 2 weeks after surgery. A subphrenic collection and a leak were found on CT. Despite medical treatment, the patient did not show clinical improvement. Hence, we considered a transgastric endosonographic-guided drainage of the collection using an electrocautery-enhanced lumen-apposing metal stent (LAMS). The procedure underwent uneventfully, and the patient status improved rapidly. Two weeks later, the stent was withdrawn. A follow-up endoscopy 6 weeks later showed closure of the gastric wall defect.

Collaboration Between Maternal and Child Health and Chronic Disease Epidemiologists to Identify Strategies to Reduce Hypertension-Related Severe Maternal Morbidity.

INTRODUCTION: Maternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida Department of Health, increased epidemiologic capacity, and informed both programs. METHODS: We collaborated to assess hypertension-related severe maternal morbidity (H-SMM) and hypertensive disorders (preexisting hypertension, gestational hypertension, and preeclampsia) among women at delivery of their live birth to help determine the burden on health care systems in Florida. We identified ways to improve the health of women before they conceive and to help them manage any chronic diseases during the perinatal period. RESULTS: We found differences by maternal characteristics in H-SMM rates among 979,660 women who delivered live births. We proposed strategies to support collaboration between state MCH and chronic disease staff. First, increase the screening, monitoring, and management of hypertension before, during, and after pregnancy. Second, examine H-SMM concurrently with maternal mortality to help find prevention strategies. Third, include reproductive-aged women in ongoing hypertension prevention and intervention efforts. Fourth, expand team-based care to include obstetricians, midwives, and doulas who can work together with primary care providers for hypertension management. And fifth, create and share data products that guide various groups about hypertension and related risk factors among reproductive-aged women. CONCLUSION: The collaboration between the Florida Department of Health MCH and chronic disease epidemiologists produced 1) a program-relevant indicator, H-SMM and 2) strategies for enhancing program and clinical activities, communication, and surveillance to reduce H-SMM rates.

Efectos secundarios metabólicos de los antipsicóticos de segunda generación / Metabolic side effects of second-generation antipsychotics

Resumen: Los antipsicóticos se prescriben ampliamente para el tratamiento de un gran número de problemas neuropsiquiátricos. Los antipsicóticos se dividen en dos clases de acuerdo con su estructura química, los típicos o de primera generación y los atípicos o de segunda generación. Estos últimos tienen mayores beneficios que los primeros porque producen menos efectos secundarios extrapiramidales; sin embargo, diversos estudios efectuados en humanos y en animales han relacionado su administración con efectos secundarios metabólicos, como obesidad, aumento de peso, diabetes, dislipidemias, síndrome metabólico y resistencia a la insulina. Debido a estos efectos se han establecido guías clínicas para el control y la vigilancia de los pacientes con algún tratamiento con este tipo de fármacos. El objetivo de este artículo es revisar algunos efectos secundarios metabólicos producidos por los antipsicóticos de segunda generación, así como su posible mecanismo de acción y el seguimiento o control metabólico que los pacientes en tratamiento con estos fármacos deben llevar. La búsqueda de los artículos se realizaron en las bases de datos PubMed, EBSCOHOST, DynaMed e IntraMed.

Abstract: Antipsychotics are widely prescribed to treat a large number of neuropsychiatric problems. Antipsychotics are divided in two classes according to their chemical structure, typical or first generation and the atypical or second generation. The second-generation antipsychotics have greater benefits because they produce less extrapyramidal side effects; however, several studies in both humans and animals have related their administration to metabolic side effects, such as obesity, weight gain, diabetes, dyslipidemia, metabolic syndrome and insulin resistance. Because of the effects, clinical guidelines for the control and monitoring of patients with a treatment with these drugs have been established. The aim of this paper is to review some metabolic side effects produced by the second-generation antipsychotics and its possible mechanism of action, as well as the metabolic control or monitoring that patients treated with these drugs should have. The research of the articles was made in the databases: PubMed, EBSCOHOST, DynaMed and IntraMed.

Gestión de los servicios de dolor agudo postoperatorio en México, requerimientos y consideraciones económicas para su implementación / Management of acute postoperative pain services in Mexico, requirements and economic considerations for their implementation

Resumen: En los 80 surgieron los Servicios de Dolor Agudo (SDA), con el objetivo de disminuir la intensidad del dolor postoperatorio y sus complicaciones; estos servicios son responsables de los protocolos analgésicos de los pacientes, algunos SDA extienden la atención a otros tipos de dolor agudo. La educación y capacitación continua del paciente y todo el personal involucrado con el manejo del dolor fortalecen los resultados en el ámbito de la seguridad y eficacia. La fármaco-economía favorece la implementación de los SDA, los cuales no son factibles si no se cuenta con los recursos necesarios. La gestión de los Servicios de Dolor Agudo es posible en México.

Abstract: In the 80 the acute pain services (APS) were created with the objective of decreasing the intensity of postoperative pain and related complications, responsible for analgesic protocols for patient. Some APS extend their attention to other types of acute pain as well. Education and continuous training for the patient and all personnel involved in the handling of pain brings better results in safety and efficiency. Pharmacoeconomics encourage APS implementation which means investing in the required resources for its success. Acute pain service management is achievable in Mexico.

Recomendaciones de la analgesia perioperatoria del donador de trasplante renal / Recommendations for perioperative renal transplant donor analgesia

Resumen: Actualmente a nivel global se recomienda que la realización del tratamiento médico de los donadores en el trasplante renal sea estandarizado, ya que estas acciones incrementan la seguridad y disminuyen la morbimortalidad del donador y receptor renal. La evaluación preoperatoria incluye la elaboración de una historia clínica con exploración física, laboratorio, estudios de imagen, pruebas especiales y pruebas para enfermedades infecciosas. El manejo analgésico debe ser cuidadoso y debe orientarse a fármacos y maniobras que no modifiquen la fisiología del paciente (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: Nowadays, it is globally recommended that the realization of medical treatment for renal transplant donor patients be standardized as it increases safety and decreases donor and renal recipient mortality and morbidity factors. The preoperative evaluation includes a clinical history elaborated with a physical examination, laboratory tests, imaging studies, specialized tests and infectious disease tests. The analgesic management must be carefully considered and must be focussed on drugs and manoeuvring them so that it doesn't modify the physiology of the patient (visit http://www.painoutmexico.com to see the full article and recommendations).

Recomendaciones en la analgesia del receptor de trasplante renal / Recommendations for kidney transplant recipient analgesia

Resumen: En el año 2012 se realizaron alrededor de 77,818 trasplantes según estimaciones de la Organización Mundial de la Salud. El trasplante renal es la mejor terapia de reemplazo en pacientes con enfermedad renal crónica, ya que mejora la calidad de vida y la posibilidad de supervivencia. El dolor postoperatorio en el trasplante renal es generalmente de leve a moderado y es de especial consideración debido a la existencia de diversas comorbilidades y la variabilidad en las respuestas que puede presentar el injerto. El manejo efectivo del dolor postoperatorio contribuye a un resultado exitoso después del trasplante renal (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: In 2012, 77,818 kidney transplants were performed in the world according to the World Health Organization. Kidney transplantation is the best replacement therapy in patients with advanced chronic kidney disease as it improves the quality of life and survival possibilities. Postoperative pain is usually from mild to moderate after a kidney transplantation and it's of special consideration because of underlying comorbidities and variable graft responses. Effective postoperative pain management contributes to a successful outcome after kidney transplantation (visit http://www.painoutmexico.com to see the full article and recommendations).

Análisis de los índices predictores de respuesta al tratamiento con ácido ursodeoxicólico en pacientes con colangitis biliar primaria / Analysis of predictive response scores to treatment with ursodeoxycholic acid in patients with primary biliary cholangitis

Antecedentes y objetivos: La colangitis biliar primaria (CBP) es una enfermedad autoinmunitaria que afecta a los conductos biliares de pequeño y mediano tamaño. Los únicos tratamientos aprobados actualmente en nuestro país son el ácido ursodeoxicólico (AUDC) y el ácido obeticólico. Diversos índices evalúan la respuesta al año de tratamiento. El objetivo de nuestro estudio fue evaluar los diferentes índices predictivos de respuesta al tratamiento con AUDC. Material y métodos: Estudio unicéntrico retrospectivo en el que se recogieron los datos clínicos y analíticos de los pacientes diagnosticados de CBP desde enero de 1987 hasta diciembre de 2015. Se calculó la respuesta al año de inicio del tratamiento utilizando los diferentes índices de respuesta y se evaluó su grado de concordancia mediante el índice Kappa. Se calculó el area under the receiver operating characteristic curve (AUROC, «área bajo la curva ROC») para determinar la capacidad predictiva de los índices. Asimismo, se analizaron los factores pronósticos basales. Resultados: Se incluyeron 153 pacientes. El análisis bivariante demostró una relación estadísticamente significativa entre los niveles altos iniciales de fosfatasa alcalina y colesterol y la mala respuesta al tratamiento. La mejor AUROC fue del índice París-I (0,81). La concordancia entre los diferentes índices fue baja. El índice pronóstico GLOBE fue válido para evaluar el pronóstico. Conclusión: La fosfatasa alcalina y el colesterol basales fueron factores predictores de mala evolución. El índice cualitativo que mejor predijo la supervivencia fue el París-I. Se obtuvo una mala concordancia entre los diferentes índices predictivos. El índice GLOBE es válido para evaluar el pronóstico de la CBP

Background and objectives: Primary biliary cholangitis (PBC) is an autoimmune disease that affects the small bile ducts. The only treatments currently approved in our country are ursodeoxycholic acid (UDCA) and obeticholic acid. Different indices evaluate the response after one year of treatment. The aim of our study was to evaluate the different predictive scores and prognostic factors of response to UDCA. Material and methods: Retrospective single-centre study in which clinical and analytical data of patients diagnosed with PBC were collected from January 1987 to December 2015. The response after one year of treatment was evaluated using the different response scores and their concordance degree using the Kappa index. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the predictive capacity of the scores. Likewise, the prognostic factors of response to treatment were analysed. Results: We included 153 patients. The bivariate analysis showed a statistically significant relationship between the initial high levels of alkaline phosphatase and cholesterol and the poor response to treatment. The best AUROC was in Paris-I score (0.81). The concordance between the different scores was low. The GLOBE score was valid to evaluate the prognosis. Conclusion: Basal alkaline phosphatase and cholesterol were predictors of poor outcome. The best predictive qualitative score in our cohort patients was Paris-I. There was a poor concordance between the different predictive scores. GLOBE score is valid to evaluate prognosis