Recomendaciones para la prescripción segura de opioides en pacientes con historia o riesgo de abuso / Recommendations for the safe prescription of opioids in patients with a history or risk of abuse

El dolor crónico es uno de los problemas médicos más frecuentes y su alivio debe ser una meta terapéutica prioritaria. Los analgésicos opioides constituyen la piedra angular. Sin embargo, en dolor crónico y el potencial adictivo de estos fármacos, así como su uso indebido y el preocupante aumento de muertes por sobredosis en algunos países como EE. UU., han obligado a las autoridades de salud a implementar estrategias coordinadas para promover la prescripción segura y respon­sable para mitigar los riesgos en el uso de opioides.(AU)

Chronic pain is one of the most frequent medical pro­blems and its relief should be a priority therapeutic goal; Opioid analgesics constitute the cornerstone, however, in chronic pain and the addictive potential of these drugs, as well as their misuse and the worrying increase in overdose deaths in some countries such as the US, have forced health authorities to implement coordinated stra­tegies to promote safe and responsible prescribing, to mitigate risks in the use of opioids.(AU)

Critical-sized mandibular defect reconstruction using human dental pulp stem cells in a xenograft model-clinical, radiological, and histological evaluation.

PURPOSE: This research evaluated clinical, histological, and radiological osseous regeneration in a critical-sized bilateral cortico-medullary osseous defect in model rabbits from New Zealand after receiving a hydroxyapatite matrix and polylactic polyglycolic acid (HA/PLGA) implanted with human dental pulp stem cells (DPSCs). METHODS: Eight New Zealand rabbits with bilateral mandibular critical-sized defects were performed where one side was treated with an HA/PLGA/DPSC matrix and the other side only with an HA/PLGA matrix for 4 weeks. RESULTS: An osseointegration was clinically observed as well as a reduction of 70% of the surgical lumen on one side and a 35% on the other. Histologically, there was neo-bone formation in HA/PLGA/DPSC scaffold and angiogenesis. A bone radiodensity (RD) of 80% was radiologically observed achieving density levels similar to mandibular bone, while the treatment with HA/PLGA matrix achieves RD levels of 40% on its highest peaks. CONCLUSIONS: HA/PLGA/DPSC scaffold was an effective in vivo method for mandibular bone regeneration in critical-sized defects induced on rabbit models.

Psychometric analysis of questions associated with radiological images in the competitive examination for access to residency programs in Spain. / Análisis psicométrico de las preguntas asociadas a imágenes radiológicas en el examen para médico interno residente en España.

BACKGROUND AND OBJECTIVE: Psychometrics is a simple, intuitive approach used in educational research and in multiple-choice questionnaires. Since 2009, the competitive examination through which access to residency programs in Spain is determined (MIR) has included questions related to radiological images. The objective of this paper is to show the results of the psychometric analysis of these questions with the aim of comparing their degree of difficulty, discriminative capacity, and internal structure with respect to those of the other questions on the examination. MATERIAL AND METHODS: We analyzed all questions on the examination since 2009, classifying them as clinical cases with and without radiological images, clinical cases with and without non-radiological images, multiple choice questions, and negative questions. We used classical test theory and item response theory to assess the difficulty and degree of discrimination of the questions. RESULTS: Of 225 questions, between 11% and 15% of the questions included in the examinations were associated with images. The questions associated with radiological images were more difficult (corrected difficulty index, 0.51) and had worse discriminative capacity. The increased difficulty of radiological questions was associated with worse discriminative capacity, especially if the clinical information provided was inadequate or if the clinical information was contrary to the radiological concept or if there had never been any questions about the concept in previoous MIR examinations. CONCLUSIONS: To equalize the standards of the MIR examination, it is necessary to maintain an appropriate structure in devising radiology questions, with terms from the clinical context, appropriate use of distracters, and a lower level of difficulty, which could be achieved by using radiological images with typical radiological findings.

Exploratory Study of Low Resolution Electromagnetic Tomography (LORETA) Real-Time Z-Score Feedback in the Treatment of Pain in Patients with Head and Neck Cancer.

Acute pain from mucositis in patients with head and neck cancer (HNC) undergoing radiation therapy (RT) is common, and may not respond well to narcotics. We used low resolution electromagnetic tomography z-score neurofeedback (LFBz) to investigate whether patients could modify brain wave activity associated with acute pain and whether this would reduce the experience of pain. HNC patients scheduled for RT had baseline pre-pain onset measures (EEG and numeric rating scale) collected before RT and then at pain onset before using analgesics, after each LFBz session and at the end of RT. Up to six sessions of LFBz training were offered over the remaining RT. Up to six 20-min sessions of LFBz were offered over the remaining RT. Data were collected before and after each LFBz session and at the end of RT. Seventeen patients recruited; fourteen were treated and reported decreased pain perception. LFBz allowed patients to modify their brain activity in predesignated areas of the pain matrix toward the direction of their baseline, pre-pain condition (including Brodmann areas (BAs) 3, 4, 5, 13, 24, and 33). LFBz can modify brain regions relevant for pain and these changes were associated with self-reported decreases in pain perception.

Choice of the specialty of diagnostic radiology by results of the competitive examination to assign residency positions from 2006 to 2015. / Análisis de la elección de la especialidad de radiodiagnóstico en el examen MIR desde el año 2006 hasta 2015.

OBJECTIVE: To analyze the profile of residency candidates choosing the specialty of diagnostic radiology in function of variables related to the positions available in different years. MATERIAL AND METHODS: We compiled the data published on the Spanish Ministry of Health's website during the acts celebrated to allow residency candidates to choose positions based on the results of the competitive examinations held from 2006 to 2015, comparing the specialty of diagnostic radiology with the other specialties available in terms of positions available, net questions, sex, nationality, and order of choice of the position. RESULTS: The specialty of diagnostic radiology occupied the 16th position in the ranking of specialties according to the median number of order in the choice for each of the positions offered in the years studied. The first diagnostic radiology residency position was usually assigned after 75 candidates had chosen other specialties, and the last position was usually assigned after 3700 to 4100 candidates had chosen their positions. During the period studied, of those who chose diagnostic radiology 58% were women and 76% were Spanish nationality. Candidates preferred hospitals in the Autonomous Community of Madrid, and the hospital chosen with the lowest median position (highest score on the competitive examination) was the Hospital Clínic de Barcelona. CONCLUSIONS: Diagnostic radiology is chosen by candidates with good positioning in the ranking according to official examination results, is less likely than other specialties to be chosen by women, and is chosen mostly by Spanish physicians. Candidates prefer large hospitals in provincial capitals.

Biomarkers of exposure to metal dust in exhaled breath condensate: methodology optimization.

In occupational assessments where workers are exposed to metal dust, the liquid condensate of exhaled breath (EBC) may provide unique indication of pulmonary exposure. The main goal of this study was to demonstrate the quality of EBC to biological monitoring of human exposure. A pilot study was performed in a group of metal dust-exposed workers and a group of nonexposed individuals working in offices. Only metal dust-exposed workers were followed along the working week to determine the best time of collection. Metal analyses were performed with inductively coupled plasma mass spectrometry (ICP-MS). Analytical methodology was tested using an EBC sample pool for several occupationally exposed metals: potassium, chromium, manganese, copper, zinc, strontium, cadmium, antimony, and lead. Metal contents in EBC of exposed workers were higher than controls at the beginning of the shift and remained augmented throughout the working week. The results obtained support the establishment of EBC as an indicator of pulmonary exposure to metals.

Infrahepatic terminolateral cavocavostomy: a case report.

Infrahepatic vena cavocavostomy has been reported to be a rescue therapy when venous outflow from a liver allograft is obstructed due to stenosis of a piggyback anastomosis. The authors have described herein two consecutive adult liver transplantations using this technique as the primary venous anastomosis. Using a caval clamp positioned above the retrohepatic portion, partial hemodynamic obstruction of caval flow was well tolerated, avoiding use of a venovenous bypass. Although additional studies regarding this technique are needed, we believe that an infrahepatic vena cavocavostomy should be considered to be an alternative technique in carefully selected cases.

Genome activation and developmental block in bovine embryos.

The ultimate goal of in vitro embryo culture systems is to perfectly mimic the condition of oocyte maturation, fertilization and embryo development. These systems are far more complex than standard in vitro cell culture because of the various environments through which the gametes and embryos pass during in vivo development. Improvement of the medium and other culture conditions has allowed for full development of a percentage of the fertilized oocytes but the great majority of bovine zygotes stop developing within a few cell cycles after initiating cleavage. This developmental block arises in the bovine embryo at the eight-cell-stage and is likely correlated with the cytoplasmic quality of the oocyte. Oocytes harbor all mRNAs and proteins needed to reach the fourth or fifth cell cycle, however, embryos that fail to transcribe their own genome fail to further develop. In this article, we review some of the advances in developmental block knowledge and describe a possible role of active embryo transcription that drives incompetent embryos to block and death.

La red nacional de laboratorios SUMA: soporte tecnológico en el pesquisaje seroepidemiológico del VIH-SIDA en Cuba / SUMA laboratories National Net: technological support for the HIV-AIDS

Formação de um sistema de laboratório semi-automático com um suporte analítico-instrumental sem afetar os critérios de reprudutibilidade estabelecidos para os ensaios clássicos e os níveis essenciais de qualidade interna e externa

Regionalization of oviducts in Boophilus microplus (Canestrini, 1887) (Acari: Ixodidae) and its potential significance for fertilization.

The structural analysis of oviducts in Boophilus microplus (Canestrini, 1887) in different stages of ingurgitation has indicated that they are constituted primarily of an internal cylinder and an external cylinder with different cell types being found between them. Copulated females in active ingurgitation process show typical variations along the internal cylinder, and three regions can be defined: anterior, ring-like and transitional. Based on such regionalization, hypotheses were raised about where and how fertilization takes place, a process yet to be clarified for the acari.

[Seroepidemiology of toxoplasmosis and ocular evaluation by Amsler grid in patients from the rural area treated at the Jaguapitã county health center, Paraná State, Brazil]. / Soroepidemiologia da toxoplasmose e avaliação ocular pela Tela de Amsler, em pacientes da zona rural, atendidos na unidade de saúde do município de Jaguapitã, PR, Brasil.

In this study, we collected serum from 82 randomly selected patients from a rural area in Jaguapitã county, Paraná State. All sera were subjected to indirect immunofluorescence assay (IFA) to detect IgG antibodies against T. gondii. Serum titers >/=+ 16 were considered positive. Of the 82 evaluated sera, 68 (82.9%) were positive to toxoplasmosis and 14 (17.1%) were non-reactive. The most common titers found were 64 (23/33.8%) and 256 (16/23.5%), the highest titer being 4096 (8/11.8%). The 82 patients were also evaluated by the Amsler Grid test, with 22 (26.8%) patients presenting at least one alteration in this test. Masculinity was found to be a protection factor in the Amsler grid test (OR = 0.21 0.04 < OR < 0. 86 chi2 = 4,98 p = 0,02). There were no significant statistical differences related to the epidemiological investigation. We concluded that T. gondii has a wide distribution in the population studied.

[Latino age: holistic techniques with a Latin flavor]. / Latino age: tecnicas holisticas con sabor Latino.

AIDS: There is a daily need to be in tune with the health of our bodies and understand what our bodies are telling us. Taking a doctor's advice without any question is being complacent. The greatest strength is within ourselves. Millions of people use holistic medicine, which treats the whole person, including mental, physical, emotional and spiritual needs. An exercise is described to open communication with one's body.^ieng

Perniosis: Estudio clinico e histologico de 5 casos / Perniosis: Histological and Clinical study of 5 cases

Incluimos en este trabajo 5 casos de perniosis(2 superficiales,2 profundas,1 mixta)observados durante el invierno de 1990 en nuestro servicio. Clinicamente se presentaron como maculas o pequenias placas dolorosas de coloracion rojo-violacea localizada en miembros inferiores(4 casos) y cara (1 caso). La histologia revelo la tipica angeitis linfocitaria con edema de la pared vascular. Referimos otras variantes histologicas y consideramos sus principales diagnosticos diferenciales

Perniosis: Estudio clinico e histologico de 5 casos / Perniosis: Histological and Clinical study of 5 cases

Incluimos en este trabajo 5 casos de perniosis(2 superficiales,2 profundas,1 mixta)observados durante el invierno de 1990 en nuestro servicio. Clinicamente se presentaron como maculas o pequenias placas dolorosas de coloracion rojo-violacea localizada en miembros inferiores(4 casos) y cara (1 caso). La histologia revelo la tipica angeitis linfocitaria con edema de la pared vascular. Referimos otras variantes histologicas y consideramos sus principales diagnosticos diferenciales

Acantona de celulas grandes: estudios de 18 casos / Large cell acanthoma: study of 18 cases

Presentamos 18 casos de acantoma de células grandes. Se trata de una neoplasia epitelial benigna relacionada con la queratosis actínica o lentigo solar sin tendencia a la malignidad. Su aspecto clínico no es característico por lo que no se sospecha en la práctica diaria, pero su histopatología es diagnóstica

Cuerno cutaneo: estudio histologico de 100 casos / Cutaneous horn: histologic study of 100 case

Presentamos 100 casos correspondientes a biópsias de cuernos cutáneos efectuadas en el Servicio de Dermatología del Hospital Ramos Mejía en un lapso de trece años. El cuerno cutáneo es un término clínico que describe una lesión cónica hiperqueratósica que se proyecta como una columna por encima de la superficie cutánea. Se asocia a múltiples patologías benignas y malignanas de variables etiologías. El 70% de nuestros casos se localizó en áreas fotoexpuestas (cara, dorso de mano), y la edad de presentación osciló entre los 14 y 94 años. En aquellos cuernos cutáneos en los cuales la lesión subyacentes correspondió a una lesión maligna o pre-maligna la edad de los pacientes superó los 60 años en un 30%. Su extitpación quirúrgica y posterior estudió anatomopatológico nos permite señalar que como se describe clásicamente, se asocia principalmente con queratosis solares (40%) y/o epiteliomas espinocelulares (14%), pero además pueden verse: verrugas vulgares (17%), queratosis seborreicas (7%), nevo epidérmico verrugoso (5%), triquilemomas (3%), etc. También hemos encontrado dos fibroqueratomas digitales adquiridos, un quiste mucoide digital, un neuroma de amputación secundario a dedo supernumerario y un siringocistoadenoma papilífero, patologías no referidas en la bibliografía consultada

Acantona de celulas grandes: estudios de 18 casos / Large cell acanthoma: study of 18 cases

Presentamos 18 casos de acantoma de células grandes. Se trata de una neoplasia epitelial benigna relacionada con la queratosis actínica o lentigo solar sin tendencia a la malignidad. Su aspecto clínico no es característico por lo que no se sospecha en la práctica diaria, pero su histopatología es diagnóstica (AU)