Integrating databases for spatial analysis of parasite-host associations and the novel Brazilian dataset.

Incomplete information on parasites, their associated hosts, and their precise geographical location hampers the ability to predict disease emergence in Brazil, a continental-sized country characterised by significant regional disparities. Here, we demonstrate how the NCBI Nucleotide and GBIF databases can be used as complementary databases to study spatially georeferenced parasite-host associations. We also provide a comprehensive dataset of parasites associated with mammal species that occur in Brazil, the Brazilian Mammal Parasite Occurrence Data (BMPO). This dataset integrates wild mammal species' morphological and life-history traits, zoonotic parasite status, and zoonotic microparasite transmission modes. Through meta-networks, comprising interconnected host species linked by shared zoonotic microparasites, we elucidate patterns of zoonotic microparasite dissemination. This approach contributes to wild animal and zoonoses surveillance, identifying and targeting host species accountable for disproportionate levels of parasite sharing within distinct biomes. Moreover, our novel dataset contributes to the refinement of models concerning disease emergence and parasite distribution among host species.

Moving towards a comprehensive view of the spatial processes in seed dispersal networks: Embracing metacommunities.

The current biodiversity crisis requires efficient approaches to address the ongoing impoverishment of natural communities and the depletion of ecosystem services and functions. In this sense, identifying key species that promote the functioning of ecological processes can be strategic to guide actions aiming at the conservation and restoration of biodiversity. Node-level metrics in interaction networks can be helpful to identify those key species, as they measure the role each species plays in organizing the interactions. Moreover, ecological correlates of species structural roles may vary between local and global networks of interactions, reflecting distinct mechanisms acting at different spatial scales. By studying local seed dispersal networks and one global meta-network combining those local networks, Moulatlet et al. identified the most important traits explaining bird species centrality at varying spatial scales. They found that body mass was the main trait explaining centrality at the local scale, whereas range size was the main predictor of species centrality at the global scale. In this contribution, besides assessing local interaction networks, Moulatlet et al. adopt a biogeographical perspective to seed dispersal systems, extending our knowledge about the possible mechanisms that underlie the organization of interacting assemblages when changing the spatial scale of observation. Future efforts on this field could include an intermediate scale, comprising the level of metacommunities, shedding light on the interplay between local and spatial processes, both embedded in biogeographical realms, when determining the organization of interactions and the ecological correlates of species roles.

A atual crise da biodiversidade requer abordagens eficientes para lidar com o empobrecimento contínuo das comunidades naturais e com o esgotamento das funções e dos serviços ecossistêmicos. Neste sentido, identificar espécies-chave que promovam o funcionamento dos processos ecológicos pode ser estratégico para guiar ações que visam a conservação e a restauração da biodiversidade. Métricas em nível dos nós em redes de interação podem ser úteis para identificar tais espécies-chave, já que quantificam o papel que cada espécie desempenha em organizar as interações. Além disso, os correlatos ecológicos dos papéis estruturais das espécies podem variar entre redes de interações locais e globais, refletindo os distintos mecanismos que atuam em diferentes escalas espaciais. Ao estudar redes de dispersão de sementes locais e uma meta-rede global que combina essas redes locais, Moulatlet et al. identificaram as características mais importantes para explicar a centralidade das espécies de aves em diferentes escalas espaciais. Eles encontraram a massa corporal como principal característica que explicava a centralidade na escala local, enquanto o tamanho da distribuição foi o principal preditor da centralidade das espécies na escala global. Nesta contribuição, além de avaliar redes de interação locais, Moulatlet et al. adotaram uma perspectiva biogeográfica ao tratar os sistemas de dispersão de sementes, ampliando nosso conhecimento sobre os possíveis mecanismos subjacentes à organização das interações quando mudamos a escala espacial de observação. Esforços futuros neste campo poderiam incluir uma escala intermediária, compreendendo o nível de metacomunidades, buscando esclarecer as relações entre processos locais e processos espaciais, ambos inseridos em domínios biogeográficos, ao determinar a organização das interações e os correlatos ecológicos dos papéis estruturais das espécies.

Elderly patients with nonconvulsive status epilepticus: Clinical-EEG data, hospital mortality, STESS and EMSE.

Purpose To assess the clinical-EEG aspects, characterization of subtypes, relationships with prognostic scales and the occurrence of death in elderly patients in the acute phase of nonconvulsive status epilepticus (NCSE). Methodology Clinical variables, EEG data, Status epilepticus severity score (STESS), and the Epidemiology-based mortality score in status epilepticus (EMSE) were related to the death of 96 patients who were over 60 years old, with NCSE. Results NCSE with coma was observed in 31 patients (19 non-subtle and 12 "subtle" SE) and focal NCSE with impairment of consciousness in 65 cases. There were no significant EEG differences according to the type of NCSE. Higher STESS scores occurred in the comatose NCSE patients when compared to those with focal NCSE and impairment of consciousness (4.8 ± 1.2 vs 3.7 ± 1.2; T-Test; p<0.001). It was observed that 25 (26%) elderly died, with a mean survival time of 19.3 days. Elderly people with a higher risk of death are those diagnosed with NCSE with coma (HR 2.76; 95% CI 1.15-6.65; p = 0.023), with STESS≥3 (HR 16.0; CI 1.77-45.08; p = 0.014), with EMSE≥64 (HR 3.67; CI 1.54-8.72; p = 0.003), and those with no history of recurrent SE (HR 6.80; CI 1.42-32.64; p = 0.017), in Cox regression. Conclusion The ictal EEG patterns did not distinguish the subtypes of NCSE. Thirty-day mortality rate was high in elderly patients with NCSE. The clinical variables are related to prognosis. Mortality in the elderly was associated with comatose NCSE patients, with STESS≥3, with EMSE≥64, and no history of recurrent SE.

Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT.

OBJECTIVE: This was a pre-post study in a network of hospitals in Mexico-City, Mexico. Participants developed and implemented Quality Improvement (QI) interventions addressing perioperative pain management. METHODS: PAIN OUT, an international QI and research network, provided tools for web-based auditing and feedback of pain management and patient-reported outcomes (PROs) in the clinical routine. Ward- and patient-level factors were evaluated with multi-level models. Change in proportion of patients reporting worst pain ≥6/10 between project phases was the primary outcome. RESULTS: Participants created locally adapted resources for teaching and pain management, available to providers in the form of a website and a special issue of a national anesthesia journal. They offered teaching to anesthesiologists, surgeons, including residents, and nurses. Information was offered to patients and families. A total of 2658 patients were audited in 9 hospitals, between July 2016 and December 2018. Participants reported that the project made them aware of the importance of: training in pain management; auditing one's own patients to learn about PROs and that QI requires collaboration between multi-disciplinary teams. Participants reported being unaware that their patients experienced severe pain and lacked information about pain treatment options. Worst pain decreased significantly between the two project phases, as did PROs related to pain interfering with movement, taking a deep breath/coughing or sleep. The opportunity of patients receiving information about their pain treatment options increased from 44% to 77%. CONCLUSIONS: Patients benefited from improved care and pain-related PROs. Clinicians appreciated gaining increased expertise in perioperative pain management and methods of QI.

Servicio de dolor agudo en un hospital privado, experiencias y recomendaciones / Acute pain service in a private hospital, experiences and recommendations

Resumen: Las bases de la medicina quirúrgica se deben establecer en el marco del cuidado perioperatorio donde el anestesiólogo es pieza fundamental para la toma de decisiones desde el ingreso hasta el alta y rehabilitación; por eso, el manejo del dolor agudo debe entenderse por todos nosotros como una extensión del cuidado que brindamos. Este artículo describe el esfuerzo por crear un Servicio de Dolor Agudo (SDA) en un hospital privado, donde los recursos se ven más limitados en cuestión de recursos humanos y organización. El modelo de la SDA de un hospital privado es una mezcla de tendencias ya descritas donde el principal actor es el residente de anestesia (bajo costo) y cuyos parámetros de actuación estuvieron basados en la iniciativa PAIN-OUT. Se encontraron áreas de oportunidad y se describió la manera de abordarlas; sin embargo, es innegable que la sensibilización de las autoridades es el paso más difícil e importante para lograr la implementación.

Abstract: Surgical medicine must be established within the framework of perioperative care where the anesthesiologist is a fundamental piece for decision-making from admission to discharge and rehabilitation; so the acute pain management should be taken as an extension of the care of this specialty. This paper describes the effort in developing an acute pain unit in a private hospital, where human resources and organization are constrained. The model of this private acute pain service is a mix of various models written in the literature where the residents of anesthesia are the main actors (low cost), and the standards used are based under the PAIN-OUT initiative. Many areas of opportunity were found along with different solutions, however at the end making authorities sensible about this topic is the hardest step.

Ketamina en el manejo del dolor agudo postoperatorio / Ketamine in acute postoperative pain management

Resumen: La ketamina es un inductor de anestesia disociativa conocida desde hace más de 50 años, y cuyo uso ha sido fluctuante en nuestro país. Más allá de sus propiedades anestésicas, su uso como fármaco para el manejo del dolor agudo, crónico y la depresión, le han conferido un nuevo auge; sin embargo, las dosis y el manejo en pacientes con dolor agudo difiere con las guías y las publicaciones establecidas. Este artículo pretende hacer una revisión de las indicaciones establecidas, las dosis recomendadas, así como el manejo de los efectos adversos dentro del marco de un Servicio de Dolor Agudo con respecto al uso de ketamina en el contexto de dolor agudo (para ver el artículo completo visite http://www.painoutmexico.com).

Abstract: Ketamine is an inductor of dissociative anesthesia used for more than 50 years, its use has been variable through the years in our country. Beyond its anesthetic properties, this drug is also use for acute and chronic pain alongside with refractory depression, making its use trendy again. This paper review the present indications in the acute pain field regarding patient selection, doses, adverse events and the safety precautions under an acute pain service scheme (full version visit http://www.painoutmexico.com).

El ABC de la analgesia controlada por el paciente / The ABCs of patient-controlled analgesia

Resumen La analgesia controlada por el paciente (PCA, por sus siglas en inglés: patient controlled analgesia) es la administración continua y/o intermitente de analgésicos opioides y no opioides a través de un dispositivo con dosis a demanda y control del paciente. Su mecanismo de acción antinociceptivo tiene efecto en la percepción del control del dolor por el propio paciente, en sinergia, con la acción de los medicamentos. Bajo el concepto de concentración mínima efectiva analgésica, las bombas PCA permiten mantener las concentraciones plasmáticas estables de los fármacos, particularmente de los opioides, disminuyendo la carga de atención al personal de enfermería y la administración de medicamentos «por razón necesaria¼. Las bombas de PCA cuentan con un intervalo de seguridad que impide la sobredosificación por intentos repetitivos de activación por el paciente de las dosis en bolos, y se ha demostrado que brindan mejores resultados en la analgesia durante las primeras 24 horas (nivel de evidencia moderada). Las rutas más utilizadas son la vía intravenosa y la vía epidural. En esta revisión se presentan los pasos básicos para el uso de estos dispositivos, preparación y programación de bolos o infusiones analgésicas, así como los pasos seguros que deben considerarse durante su empleo (visite http://www.painoutmexico.com para obtener el artículo completo y videos).

Abstract Patient-controlled analgesia (PCA) is the continuous and/or intermittent administration of opioid and non-opioid analgesics through a device with on-demand doses and patient control. Its mechanism anti-nociceptive has an effect on the perception of pain controlled by the patient himself, in synergy, with the action of the medications. Under the concept of minimum effective analgesic concentration, PCA pumps allow the stable plasma concentrations of the drugs, particularly opioids, to be maintained, reducing the nursing staff attention and the administration of drugs «for necessary reason¼. PCA pumps have a safety interval that prevents overdosing due to repetitive attempts by the patient to activate bolus and has been shown to provide better analgesia during the first 24 hours (moderate level of evidence). The most commonly routes are the intravenous and the epidural. In this review we present the basic steps for the use of these devices, preparation and programming of boluses or analgesic infusions, as well as safety steps during their use (visit http://www.painoutmexico.com to see the full article and videos).

Luxación bilateral del vientre medial del tríceps (snapping triceps) asociada a luxación del nervio cubital. presentación de un caso / Bilateral dislocation of the medial fold of the triceps tendon (snapping triceps) with ulnar nerve dislocation. a case report

Snapping triceps es la luxación del vientre medial del tríceps por encima de la epitróclea, asociada o no a la luxación del nervio cubital. En algunos casos publicados, los pacientes eran intervenidos por luxación del nervio cubital y, durante la cirugía, se diagnosticaba la luxación del vientre medial del tríceps, incluso algunos pacientes eran operados en varias oportunidades. Presentamos un paciente de 16 años que refiere un resalto en la región medial de ambos codos. En el examen físico, es evidente un doble resalto tanto del nervio cubital, como del vientre medial del tríceps. Estos hallazgos se confirman por ecografía comparativa bilateral. El tratamiento quirúrgico consistió en la transposición cubital transmuscular y la resección del vientre medial del tríceps que se luxaba anterior a la epitróclea. Los dos codos fueron operados con diferencia de un mes. El paciente tuvo una excelente evolución sin complicaciones a los dos meses de las operaciones. Esta patología poco frecuente debe ser considerada con atención, ya que puede llevar a errores de diagnóstico y de tratamiento. Nivel de Evidencia: IV.

Snapping triceps is the dislocation of the medial triceps belly above the medial epicondyle, with or without the ulnar nerve. In some cases described in the literature, patients were operated on by ulnar nerve dislocation and dislocation of the medial triceps belly was diagnosed during surgery; some patients were even operated on several occasions. We report the case of a 16-year-old patient with a snap in the medial region of both elbows. Physical examination reveals a clear doublé click of the ulnar nerve and the medial triceps belly. These findings are confirmed by bilateral comparative ultrasound. Surgical treatment consisted of transmuscular ulnar transposition and resection of dislocated medial triceps belly. Both elbows were operated on one month apart. Two months after surgeries, the patient achieved an excellent outcome without complications. This rare condition must be carefully considered since it may lead to diagnostic and therapeutic errors. Level of Evidence: IV.

[Palliative care regulation and assisted death]. / Regulación de los cuidados paliativos y muerte asistida.

This article analyzes the Mexican regulation on palliative care and its relationship with the public debate on assisted death or suicide. This paper focuses on the rights that people with incurable diseases have, given the current contents of the General Health Statute and other applicable rules. Its main purpose is to activate the public debate on these matters.

The robustness of plant-pollinator assemblages: linking plant interaction patterns and sensitivity to pollinator loss.

Most flowering plants depend on pollinators to reproduce. Thus, evaluating the robustness of plant-pollinator assemblages to species loss is a major concern. How species interaction patterns are related to species sensitivity to partner loss may influence the robustness of plant-pollinator assemblages. In plants, both reproductive dependence on pollinators (breeding system) and dispersal ability may modulate plant sensitivity to pollinator loss. For instance, species with strong dependence (e.g. dioecious species) and low dispersal (e.g. seeds dispersed by gravity) may be the most sensitive to pollinator loss. We compared the interaction patterns of plants differing in dependence on pollinators and dispersal ability in a meta-dataset comprising 192 plant species from 13 plant-pollinator networks. In addition, network robustness was compared under different scenarios representing sequences of plant extinctions associated with plant sensitivity to pollinator loss. Species with different dependence on pollinators and dispersal ability showed similar levels of generalization. Although plants with low dispersal ability interacted with more generalized pollinators, low-dispersal plants with strong dependence on pollinators (i.e. the most sensitive to pollinator loss) interacted with more particular sets of pollinators (i.e. shared a low proportion of pollinators with other plants). Only two assemblages showed lower robustness under the scenario considering plant generalization, dependence on pollinators and dispersal ability than under the scenario where extinction sequences only depended on plant generalization (i.e. where higher generalization level was associated with lower probability of extinction). Overall, our results support the idea that species generalization and network topology may be good predictors of assemblage robustness to species loss, independently of plant dispersal ability and breeding system. In contrast, since ecological specialization among partners may increase the probability of disruption of interactions, the fact that the plants most sensitive to pollinator loss interacted with more particular pollinator assemblages suggest that the persistence of these plants and their pollinators might be highly compromised.

[Postoperative analgesia in gyneco-obstetrics]. / Analgesia posoperatoria en ginecoobstetricia.

INTRODUCTION: Frequently, postoperative pain lacks of systematic evaluation and follow-up. OBJECTIVES: 1. To determine the proportion of cases without appropriate pain relief in an Obstetrics and Gynecology hospital service. 2. To describe analgesics' use patterns and medication errors detected in a case series. METHODS: Our study was conducted in a private teaching hospital. To fulfill the first objective, an analogue numeric scale and a color scale were applied to 278 patients, in order to evaluate severity of pain. Measurements equal or higher to 30 mm were considered as inappropriate pain control. For the second objective, a retrospective random sample of 42 cases was selected to analyze analgesic use patterns and to detect medication errors. RESULTS: The 278 cases contributed with 3526 pain registries, average 12.7 +/- 5.46 measurements per patient, 348 data were > or = 30 mm, involving 136/278 patients. For the second objective we included patients with an average age 34.1 +/- 11 years-old, diagnoses were: cesareans n = 15, labor n = 4, myomectomy n = 4, hysterectomy n = 15 y 13 with diverse disease conditions, where an average of 2.47 +/- 1.48 analgesics were prescribed, 8 cases with simultaneous NSAIDs use, 24 cases had medication errors as overdose, therapeutic duplicity, transcription omission, none of them with consequences for patients. CONCLUSIONS: 1. Systematic pain evaluation and its scaled management, according to severity, are essential to improve postoperative health care quality. 2. Studies, as the one presented here, are desirable in any postoperative setting.

Mejorando la asistencia en situaciones dolorosas: comisión de mortalidad perinatal / Improving care in painful situations. Perinatal mortality committee

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