Serviço infantojuvenil para usuários de drogas: clientela e atendimento / Child and youth service for drug users: clientele and service

O estudo intenta conhecer o perfil de crianças e adolescentes atendidos em serviço comunitário para usuários de drogas e analisar as características do atendimento oferecido. Estudo quantitativo, descritivo-exploratório, com análise descritiva dos dados de 115 prontuários de um CAPSi especializado em drogas. Foi utilizada frequência válida, devido aos dados não informados. A maioria era de homens (78,2%) com idade média de 14,7 anos (dp = 1,98). Mais da metade não frequentava a escola (54,2%) e 33,7% residia com a mãe. Em 81,9% dos prontuários algum familiar fazia uso abusivo de drogas, sendo 52,9% o pai. A maconha apresentou maior prevalência e início mais precoce. O serviço dispunha de atividades que buscavam abranger diferentes necessidades, entre elas, questões escolares e familiares da clientela, justificando a proposta de um serviço comunitário especializado no cuidado a crianças e adolescentes usuários de drogas. Entretanto, observou-se como maior desafio a continuidade do atendimento no serviço.

Mecanismo de los AINES y antiinflamatorios derivados para el control del dolor y la inflamación. Uso de antiinflamatorios en odontología / Mechanism of NSAIDs and derived drugs for pain and inflammation control. Use of anti-inflammatories in odontology

Las urgencias odontológicas son, quizá, las razones principales de atención en el consultorio, muchas veces el significado de dolor se encuentra acompañado por inflamación; el uso de antiinflamatorios no esteroideos (AINES) es común en el ejercicio de la odontología por la excelente respuesta analgésica y antiinflamatoria que tiene, por lo que es importante conocer la fisiopatología de la inflamación y el dolor y cómo actúan los AINES, ya que algunos de estos fármacos tienen respuestas adversas y sitios de acción importantes. Los factores de riesgo por inflamación y dolor nos obligan a conocer la variedad de fármacos que no entran en la clasificación de AINES y que tenemos a disposición, hay más opciones para la elección ante la presencia de inflamación por un factor en particular, cada uno de éstos tienen indicaciones y contraindicaciones que conoceremos, lo cual nos ampliará el conocimiento para dar una prescripción ante la presencia de eventos inflamatorios. Se realizó un estudio detallado de artículos bibliográficos de cada tema, los fármacos más usados en odontología son los AINES, hay poco uso y conocimiento de antiinflamatorios que podemos usar en urgencias, el porcentaje de uso de los AINES derivados del ácido propiónico es alto por la excelente respuesta en pacientes y otras veces por el desconocimiento de más opciones (AU)

Dental emergencies are perhaps the main reasons for care in the office, many times the meaning of pain is accompanied by inflammation, the use of non-steroidal anti-inflammatory drugs is common in the practice of dentistry due to the excellent analgesic and anti-inflammatory response it has, important is knowing the pathophysiology of inflammation and pain, how NSAIDs act, some of these drugs have adverse responses and important sites of action, risk factors for inflammation and pain require us to know the variety of drugs that do not enter the classification of NSAIDs and we have at our disposal, there are more options for choosing in the presence of inflammation due to a particular factor, each of these have indications and contraindications that we will know, it expands our knowledge to give a prescription in the presence of inflammatory events. A detailed study of bibliographic articles on each topic was carried out, the drugs most used in dentistry are NSAIDs, there is little use and knowledge of anti-inflammatories that we can use in the emergency room, the percentage of use of NSAIDs derived from propionic acid is high, due to the excellent response in patients and others due to lack of knowledge of more options (AU)

Realidades de las mujeres reclusas en Colombia / The Realities of Female Inmates in Colombia / Realidades de mulheres presas na Colômbia

Resumen Este artículo de revisión documental tiene como objetivo visibilizar la realidad de las mujeres reclusas en Colombia mediante el análisis de la bibliografía existente tanto en español como en inglés de los últimos diez años, usando mujeres reclusas y prisioneras como categorías de búsqueda. Se consultaron las bases de datos especializadas, los repositorios de universidades de Latinoamérica, España y páginas web de distintas entidades. De esta exploración se seleccionaron 201 documentos entre informes, diagnósticos, estudios de casos, normativas nacionales e internacionales, tesis de pregrado, maestría y doctorado, además de otros artículos de revisión documental. Estos se inscriben en las Ciencias Sociales y Humanas desde sus diferentes perspectivas teóricas y diseños metodológicos. De los resultados del análisis emergen dos categorías: (1) Características sociodemográficas y (2) Problemáticas y necesidades. Se llega a la conclusión que las mujeres reclusas en Colombia tienen un amplio rango de edad, la mayoría son solteras, madres, y el delito prevalente es el tráfico de estupefacientes. Sus problemáticas están asociadas con la infraestructura de los centros penitenciarios, los derechos humanos y las repercusiones de la estancia carcelaria en la salud integral y las relaciones familiares.

Abstract This documentary review article's objective is to raise visibility regarding the reality of female inmates in Colombia by analyzing the existing literature in Spanish and English from the last ten years, using mujeres reclusas y prisioneras ("female inmates and prisoners") as search categories. Specialized databases, university repositories in Latin America and Spain, and various institutions' websites were consulted. Two hundred and one documents were selected based on this query, among which were reports, diagnoses, case studies, national and international regulations and undergraduate, master's and doctorate degree projects, as well as other documentary review articles. These are registered under Social and Human Sciences based on their different theoretical perspectives and methodological designs. Two categories emerge from the analysis' results: (1) Sociodemographic characteristics, and (2) Issues and needs. The conclusion was that female inmates in Colombia comprise a wide range of ages. Most are single mothers, and the prevalent crime is drug trafficking. Their issues are associated with the infrastructure of prisons, human rights, and negative impacts on their comprehensive health and family relationships due to imprisonment.

Resumo Este artigo de revisão documental tem como objetivo tornar visível a realidade das mulheres presas na Colômbia por meio da análise da bibliografia existente tanto em espanhol quanto em inglês nos últimos dez anos, usando mulheres presas e prisioneiras como categorias de busca. Foram consultadas as bases de dados especializadas, os repositórios de universidades da América Latina, Espanha e sites de diferentes entidades. A partir dessa exploração, foram selecionados 201 documentos como relatórios, diagnósticos, estudos de caso, regulamentações nacionais e internacionais, trabalhos de conclusão de curso de graduação, teses de mestrado e doutorado, assim como outros artigos de revisão documental. Estes estão inscritos nas Ciências Sociais e Humanas a partir de suas diferentes perspectivas teóricas e desenhos metodológicos. Dos resultados da análise emergem duas categorias: (1) Características sociodemográficas e (2) Problemas e necessidades. Conclui-se que as mulheres presas na Colômbia têm uma ampla faixa etária, a maioria são solteiras e mães, e que o delito prevalente é o tráfico de drogas. Seus problemas estão associados à infraestrutura das prisões, aos direitos humanos e às repercussões da permanência na prisão na saúde integral e nas relações familiares.

Detecção de esteroides anabólicos androgênicos e seus produtos de biotransformação em dried urine spots por ionização por paper spray acoplada à espectrometria de massas (PS-MS) / Detection of anabolic androgenic steroids and its biotransformation products in dried urine spots by paper spray-mass spectrometry ionization (PS-MS)

Os esteroides anabólicos androgênicos (EAA) são utilizados clinicamente para tratar diferentes doenças, porém propagou-se o uso não terapêutico por atletas de elite e fisiculturistas, com o intuito de aumentar a massa muscular e melhorar o desempenho físico. O uso de substâncias ergogênicas, como fármacos estimulantes e narcóticos analgésicos no esporte, foi proibido em 1967 pelo International Olympic Committee (COI), mas somente em 1976 os EAA entraram para a lista de substâncias proibidas. O uso de EAA está associado a diversos efeitos adversos, principalmente cardiovasculares, neuroendócrinos e distúrbios psiquiátricos, além de dislipidemia, elevação dos marcadores inflamatórios e disfunção endotelial. As análises toxicológicas constam como a maneira mais eficaz de minimizar o doping no esporte. O material é fornecido pelo atleta durante as competições ou treinamentos e previne que os competidores alcancem vantagem competitiva devido ao uso de EAA. A utilização de métodos para amostragem alternativos tem ganhado força, devido à necessidade de técnicas mais práticas que utilizam pouco volume de amostra e possuem facilidade de armazenamento. O dried urine spots é um método no qual pequenas amostras de urina são aplicadas em papéis de filtro para análises qualitativas ou quantitativas. Ele se caracteriza por ser uma técnica rápida, fácil, simples e barata para a coleta, armazenamento e distribuição, além de minimizar os riscos de infecção, podendo ser utilizado na rotina. A técnica de paper spray (PS-MS) foi desenvolvida a partir da relevância de métodos como o dried blood spots por proporcionar análises mais rápidas, apresenta alta especificidade, capacidade de analisar diferentes analitos simultaneamente, baixo limite de detecção e dispensa a necessidade de reagentes específicos. Sendo assim, neste trabalho foi desenvolvido e validado o método de screening de EAAs em dried urine spots por ionização por paper spray acoplada à espectrometria de massas. O método apresentou limites de detecção entre 2-15ng/mL e presença de três interferentes endógenos. Os dez analitos de interesse deste estudo são estáveis por 150 dias em temperatura ambiente. Dessa forma, a análise de EAAs em dried urine spots por PS-MS demonstra grande potencial para se tornar um método alternativo no monitoramento rápido de drogas de abuso

Anabolic androgenic steroids (AAS) are used clinically to treat different diseases, but non-therapeutic use has spread among elite athletes and bodybuilders, with the aim of increase muscle mass and improve physical performance. The International Olympic Committee (IOC) banned the use of ergogenic substances, such as stimulating drugs and analgesic narcotics in sports, in 1967, but only in 1976, AAS were included on the list of prohibited substances. The use of AAS is associated with several adverse effects, mainly cardiovascular, neuroendocrine and psychiatric disorders, in addition to dyslipidemia, elevated inflammatory markers and endothelial dysfunction. Toxicological analyzes are the most effective approach to minimize doping in sport. The material is provided by the athlete during competitions or training and prevents competitors from achieving a competitive advantage due to the use of AAs. The use of alternative sampling methods has gained strength, due to the need for more practical techniques that use low sample volume and can be easily storage. Dried urine spots are a method, which a small amount of urine samples is applied to filter papers for qualitative or quantitative analysis. It is characterized by being a fast, easy, simple and inexpensive technique for collection, storage and distribution, in addition to minimizing the risks of infection, and can be used in the routine. The paper spray technique (PS-MS) was developed based on the relevance of methods such as dried blood spots for providing faster analysis, high specificity, ability to analyze different analytes simultaneously, low detection limit and for eliminating the need for specific reagents. Therefore, this work developed and validated a screening method for AAS in dried urine spots by paper spray-mass spectrometry ionization. The method provided detection limits between 2-15ng/mL and the presence of three endogenous interferents. The ten analytes of interest in this study are stable for 150 days at room temperature. Thus, the analysis of AAS in dried urine spots by PS-MS demonstrates great potential to become an alternative method for the rapid monitoring of drugs of abuse

Drogas e alienação: para além da droga-mercadoria e do capital / Drugs and alienation: beyond the drug-merchandise and capital / Drogas y alienación: más allá de la droga-mercancía y del capital

O presente trabalho tem como escopo compreender, a partir da tradição marxista, a "questão" das drogas como um complexo mediador entre indivíduo e sociedade, centrando-se em sua relação com processos de alienação no âmbito da sociedade capitalista. Isto é, em como a relação indivíduo-drogas no momento histórico atual contribui para aprofundar a alienação humana, advinda da alienação primária posta pelo trabalho. No seu decorrer, são apontados subsídios teórico-metodológicos, através da dialética singular-particular-universal, a serem analiticamente incorporados para uma compreensão aprofundada sobre a temática. Por fim, busca-se estabelecer uma visão contra hegemônica nessa área, rompendo com moralismos e traçando horizontes emancipatórios que abarcam novas formas de nos relacionarmos com as drogas, com os outros e com nós mesmos, algo inseparável da tarefa histórica de edificação de uma nova sociedade.

This paper aims to understand, from the marxist tradition, the "issue" of drugs as a complex mediator between individual and society, focusing on their relation with processes of alienation within the capitalist society. In other words, on how the individual-drug relation in the current historical moment contributes to deepen human alienation, arising from the primary alienation posed by work. In its elapse, theoretical and methodological subsidies are pointed out, through the singular-particular-universal dialectic, to be analytically incorporated for an in-depth understanding of the thematic. Finally, we seek to establish a counter-hegemonic vision in this area breaking with moralisms and drawing emancipatory horizons that embrace new ways of relationg to drugs, others and ourselves, something inseparable from the historical task of building a new society.

El presente trabajo tiene cómo objetivo compreender, desde la tradición marxista, el "problema" de las drogas cómo un complejo mediador entre el individuo y la sociedad, centrándose en su relación con los processos de alienación dentro de la sociedad capitalista. Es decir, cómo la relación individuo-droga en el momento histórico actual contribuye a profundizar la alienación humana, que surge de la alienación primaria planteada por el trabajo. En su curso, se señalan subsídios teóricos y metodológicos, a través de la dialéctica singular-particular-universal, para ser incorporados analíticamente para una comprensión más profunda sobre el tema. Finalmente, buscamos estabelecer una visión contrahegemónica en esta área, rompiendo con los moralismos y trazando horizontes emancipatórios que abarquen nuevas formas de relacionarnos con las drogas, con los otros y con nosotros mismos, algo inseparable de la tarea histórica de construir una nueva sociedad.

Factores de riesgo familiar en el consumo de drogas y su relación con la conducta antisocial en adolescentes. Distrito de salud 09D08. 2019 / Family risk factors in drug use and its relationship with adolescent's antisocial behavior. health district 09d08. 2019

El consumo de drogas y las conductas antisociales en adolescentes son un problema social y de salud pública que afecta gravemente a la mayoría de los países y Ecuador no es la excepción, ya que, requiere de acciones preventivas inmediatas y de promoción de la salud. Objetivo: Determinar los factores de riesgo familiar en el consumo de drogas y su relación con las conductas antisociales en adolescentes del distrito 09D08. SALUD. 2018 ­ 2019. Materiales y métodos: Esta investigación se realizó bajo el paradigma positivista con enfoque cuantitativo. La modalidad de investigación es de campo de tipo descriptivo, no experimental, y de corte transversal. La población estuvo constituida por 234 adolescentes y la muestra por 177. La técnica empleada fue la encuesta y su instrumento el cuestionario constituido por 59 items. Resultados: el 74% de adolescentes presenta economía familiar baja el 57% de los adolescentes indican manifestaciones de abuso, descuido y abandono dentro de su entorno familiar. El 53% de los adolescentes consumieron alcohol cada mes, mientras el 28% lo hizo cada semana y el 20% a diario y el 69% de los adolescentes admite robar, cosas o dinero. Conclusiones: se encontró que los principales factores influyentes son los ambientes familiares abusivos, violentos y permisivos. Los adolescentes durante la sesión del grupo focal, manifestaron la situación familiar influyó en sus conductas antisociales y consumo de drogas(AU)

Drug use and adolescents' antisocial behaviors are a social and public health problem that seriously affects most countries and Ecuador is no exception, since it requires immediate preventive actions and health promotion. Objective: To determine the family risk factors in drug use and their relationship with adolescents' antisocial behaviors in in the 09D08 district. HEALTH. 2018 - 2019. Materials and methods: This research was carried out under the positivist paradigm with a quantitative approach. The research modality is descriptive, non-experimental, and cross-sectional. The population consisted of 234 adolescents and the sample 177. The technique used was the survey and its instrument the questionnaire, consisting of 59 items. Results: 74% of adolescents present a low family economy, 57% of adolescents indicate manifestations of abuse, neglect and abandonment within their family environment. The 53% of adolescents consumed alcohol each month, while 28% did so each week and 20% daily and 69% of adolescents admit to stealing, things or money. Conclusions: it was found that the main influencing factors are abusive, violent and permissive family environments. Adolescents during the focus group session, manifested the family situation influenced their antisocial behaviors and drug use(AU)

Prevención de la adicción a narcóticos dirigido a los usuarios que asisten a la consulta de traumatología de un Centro Médico / Prevention of narcotic addiction aimed at users who attend the trauma consultation of the Medical Center / Prevenção da dependência aos narcóticos destinada aos usuários que comparecem à consulta de trauma de um Centro Médico

INTRODUCCIÓN: enfermería mediante el cumplimiento de su función docente promueve actitudes reflexivas en los pacientes para prevenir adicción a los narcóticos. OBJETIVO: información para la prevención de la adicción a narcóticos que tienen los pacientes que asisten a la unidad clínica de traumatología del Centro Médico. MATERIALES Y MÉTODOS: estudio descriptivo, de campo, cuya población estuvo conformada por 50 usuarios, se trabajó con la totalidad, se aplicó estadística descriptiva. Los datos se recogieron mediante cuestionario con 13 ítems con escala de Likert, la validez bajo el juicio de expertos y la confiabilidad por la prueba Alfa de Crombach. RESULTADOS: los resultados señalan que los pacientes ingieren analgésicos distintos a los de la prescripción médica en un 80%, aumentan la dosis diaria prescrita de analgésicos narcóticos siempre en un 50% de la población. Así como también 80% manifestaron la importancia de que los profesionales de enfermería aporten a los usuarios de traumatología información sobre la prevención de la adicción a analgésicos narcóticos. CONCLUSIÓN: los pacientes cumplen más de la dosis de analgésicos indicada por los médicos, además de combinarlos con otros no prescritos y no lo reconocen como una adicción por lo que es importante la información que los profesionales de enfermería puedan aportar al respecto.

INTRODUCTION: nursing by fulfilling its teaching role promotes reflexive attitudes in patients to prevent addiction to narcotics. OBJECTIVE: information for the prevention of narcotic addiction that have the patients who attend the trauma unit of the Medical Center. MATERIALS AND METHODS: descriptive, field study, whose population was made up of 50 users, we worked with all, descriptive statistics were applied. The data were collected by means of a questionnaire with 13 items with a Likert scale, validity under the judgment of experts and reliability by the Alpha test of Cronbach. RESULTS: the results indicate that patients ingest pain relievers other than those prescribed by a doctor by 80%, increase the prescribed daily dose of narcotic pain relievers always by 50% of the population. As well as 80% stated the importance that nursing professionals provide trauma users with information on the prevention of addiction to narcotic pain relievers. CONCLUSIONS: the patients fulfill more than the dose of analgesics indicated by the doctors, in addition to combining them with other non-prescribed ones and do not recognize it as an addiction, so it is important the information that nursing professionals can provide in this regard.

INTRODUÇÃO: a enfermagem, cumprindo seu papel educacional, promove atitudes reflexivas nos pacientes para evitar o vício em narcóticos. OBJETIVOS: facilitar informações objetivas para a prevenção de dependência de narcóticos realizadas por pacientes atendidos no centro de trauma do Centro Médico. MATERIAIS E MÉTODOS: estudo de campo descritivo, cuja população era composta por 50 pacientes, trabalhamos com todos, aplicamos estatística descritiva. Os dados foram coletados por meio de um questionário com 13 itens, tipo escala Likert, previamente avaliado por especialistas da área e com confiabilidade pelo teste Alpha de Crombach. RESULTADOS: os resultados indicam que os pacientes ingerem analgésicos diferentes dos prescritos por médicos em 80%, aumentam a dose diária prescrita de analgésicos narcóticos sempre em 50% da população. Da mesma forma, 80% afirmaram a importância de que os profissionais de enfermagem fornecerem aos pacientes de trauma, informações sobre a prevenção do vício em analgésicos narcóticos. CONCLUSÃO: os pacientes cumprem mais do que a dose de analgésicos indicada pelos médicos, além de combiná-los com outros não prescritos e não o reconhecem como um vício, por isso é importante a informação que os profissionais de enfermagem possam fornecer a esse respeito.

Nuevos avances en el conocimiento de la historia natural de la displasia fibrosa / News advances in the knowledge of natural history of the fibrous dysplasia

La displasia fibrosa (DF) es una enfermedad infrecuente del hueso, no hereditaria, producida por una mutación activadora del gen GNAS, responsable de codificar la unidad a-estimuladora de la proteína G (Gsa). La presentación clínica de la enfermedad es muy variada, pues adopta desde formas asintomáticas hasta otras marcadamente sintomáticas. En los últimos años, el análisis exhaustivo de bases de datos de pacientes con DF ha permitido conocer más sobre su historia natural. En este artículo se revisa la información actualmente disponible sobre algunos aspectos que ayudarán al mejor enfoque clínico del paciente, como son: la utilidad clínica de los marcadores óseos, los factores pronósticos para el desarrollo de fracturas, la DF como condición predisponente para el desarrollo de tumores específicos, nuevas perspectivas sobre la fisiopatología del dolor óseo y nuevas estrategias terapéuticas. Un mayor conocimiento sobre la historia natural de esta enfermedad finalmente redundará en la mejor calidad de vida de los pacientes con DF. (AU)

Fibrous dysplasia (FD) is an infrequent, non-hereditary bone disease caused by a somatic mutation of the GNAS gene, responsible for encoding the a-subunit of the G-protein (Gsa). The clinical presentation of the disease varies greatly, with some patients being asymptomatic and others markedly symptomatic. The exhaustive analysis of the database from patients with FD has allowed to learn more about the natural history of this disease. This article reviews the current information available on the clinical utility of bone markers, the prognostic factors for the occurrence of fractures, the evidence supporting as a predisposing condition for the development of specific tumors, new perspectives on the pathophysiology of bone pain, and emerging therapeutic strategies. A greater understanding of the natural history of this disease will allow to make better medical decisions, which will ultimately contribute to improve FD patients' quality of life. (AU)

Marihuana en México, ¿droga recreativa o medicina? / Marijuana in Mexico, recreational drug or medicine?

El tema que discutimos tiene una relevancia que alcanza todos los ámbitos de la sociedad actual, debido a que incluye factores sociales, políticos, económicos y de salud; sin embargo, es de mencionar la situación risible que ocurre en relación con el consumo de marihuana en México, dado que los artículos 477 y 479 de la Ley General de Salud determinan su posible portación y consumo personal a la cantidad de 5 g del estupefaciente. Dicho en otras palabras, el uso con fines médicos se encuentra aún penalizado e inclusive mal visto dentro de la práctica, mientras que la finalidad recreativa sobre la posesión y el uso tanto de la marihuana como de algún derivado del tetrahidrocannabinol (THC) son contemplados dentro de la ley explícitamente. Esto ha quedado ejemplificado claramente el pasado 24 de noviembre de 2015, fecha en la cual, a pesar de la ley ya existente, el Pleno de la Suprema Corte de Justicia de la Nación concedió a cuatro personas el derecho a la «... producción, uso y autoconsumo del estupefaciente cannabis y el psicotrópico "THC" para fines "lúdicos"¼; al compararlo con los casos actuales que han obtenido la autorización pertinente del gobierno para el uso médico, son muchos menos. Si bien el 19 de junio de 2017 se aprobó el uso medicinal de la marihuana en productos con un contenido neto de THC < 1%, la Cofepris (Comisión Federal para la Protección contra Riesgos Sanitarios) dio a conocer los reglamentos en materia de control sanitario del cannabis y sus derivados hasta finales de 2018; tal hecho, dejó a merced de la obtención de un permiso para la importación de medicamentos a base del psicoactivo provenientes del extranjero acorde a lo escrito en el artículo 290. Asimismo destaca que los permisos solo pueden ser otorgados tras la ordenanza de un juez, situación que hasta la fecha continúa como «difícil¼, ya que tras recibir aproximadamente 534 solicitudes, solo 9 se habían autorizado a 5 de septiembre de 2018, esto según el portal del propio gobierno de México.

The issue we are discussing is relevant to all areas of today's society, as it includes social, political, economic and health factors; however, it is worth mentioning the laughable situation that occurs in relation to the consumption of marijuana in Mexico, given that articles 477 and 479 of the General Health Law determine its possible possession and personal consumption to the amount of 5 g of the drug. In other words, use for medical purposes is still criminalised and even frowned upon in practice, while the recreational purpose of possession and use of both marijuana and a derivative of tetrahydrocannabinol (THC) is explicitly contemplated in the law.This was clearly exemplified on 24 November 2015, when, despite the existing law, the Plenary of the Supreme Court of Justice of the Nation granted four people the right to "... production, use and self-consumption of the narcotic drug cannabis and the psychotropic "THC" for "recreational" purposes"; when compared to the current cases that have obtained the relevant government authorisation for medical use, there are far fewer. Although the medical use of marijuana in products with a net THC content < 1% was approved on 19 June 2017, the Cofepris (Comisión Federal para la Protección contra Riesgos Sanitarios) released the regulations on the sanitary control of cannabis and its derivatives until the end of 2018; this fact left the importation of medicines based on the psychoactive drug from abroad subject to obtaining a permit in accordance with the provisions of article 290. It also points out that permits can only be granted following a judge's order, a situation that to date continues to be "difficult", as after receiving approximately 534 applications, only 9 had been authorised as of 5 September 2018, according to the Mexican government's own website.

Uso de testosterona en mujeres: un comentario sobre el consenso global sobre el uso de la terapia de testosterona para mujeres / Global consensus position statement on the use of testosterone therapy for women

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)

There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)

Triggers and Outcomes of Falls in Hematology Patients: Analysis of Electronic Health Records / 기본간호학회지

PURPOSE: The goal was to use electronic health records to identify factors and outcomes associated with falls among patients admitted to hematology units. METHODS: This retrospective case-control study included data from a tertiary university hospital. Analysis was done of records from 117 patients with a history of falls and 201 patients with no history of falls who were admitted to the hematology unit from January 1, 2013 to December 31, 2014. Risk factors were analyzed using hierarchical logistic regression; patient outcomes were analyzed using multiple logistic regression, Cox proportional hazards regression, and multiple linear regression. RESULTS: Clinical factors such as self-care nursing (OR=4.47, CI=1.64~12.11), leukopenia (OR=6.03; CI=2.51~14.50), and hypoalbuminemia (OR=2.79, CI=1.31~5.96); treatment factors such as use of narcotics (OR=2.06, CI=1.01~4.19), antipsychotics (OR=3.05, CI=1.20~7.75), and steroids (OR=4.51, CI=1.92~10.58); and patient factors such as low education (OR=3.16, CI=1.44~6.94) were significant risk factors. Falls were also associated with increased length of hospital stay to 21.58 days (p < .001), and healthcare costs of 17,052,784 Won (p < .001). CONCLUSION: These findings can be a resource for fall prevention education and to help develop fall risk assessment tools for adults admitted to hematology units.

Impact of Environmental Stressors on the Risk for Posttraumatic Stress Disorder and Quality of Life in Intensive Care Unit Survivors / 중환자간호학회지

PURPOSE: This study was to determine the levels of environmental stressor, posttraumatic stress disorder, and quality of life in intensive care units (ICU) survivors after intensive care, and to explore the factors affecting posttraumatic stress disorder and quality of life.METHODS: With a longitudinal survey design, data were collected from 116 patients who were discharged from the ICU of a university hospital. The environmental stressor, posttraumatic stress disorder, and quality of life were measured immediately following and 1 month after the ICU discharge.RESULTS: Of all the subjects, 16.4% experienced posttraumatic stress disorder after discharge. Multiple regression analysis revealed that ICU environmental stressors, experience of ICU readmission, using psychotropic drugs and narcotic analgesics, and ICU admission after surgery or cardiac intervention accounted for 22.2% of posttraumatic stress disorder. Posttraumatic stress disorder and sedation status when entering ICU accounted for 28.3% of the quality of life 1 month after ICU discharge.CONCLUSION: Nursing interventions focused on ICU environmental stressors would not only reduce environmental stress but also contribute to the reduction of posttraumatic stress disorder and later improvement of quality of life.

Consumo de drogas médicas, medicamentos de venta libre y alcohol en adultos mayores / Consumption of medical drugs, over-the-counter medications and alcohol in elderlys / Consumo de drogas médicas, medicamentos de venda livre e álcool em idosos

Objetivo: realizar una revisión sistemática de la literatura para identificar los estudios que reportan la frecuencia del consumo drogas médicas, medicamentos de venta libre y alcohol, así como el consumo combinado de estas sustancias en los adultos mayores. Método: se utilizó como guía la Preferred Reporting Items for Systematic Reviews and Meta-Analyses, se identificaron 4,881 artículos a través de las bases de datos y tres artículos en el buscador google scholar, se eligieron doce estudios ya que cumplieron con los criterios de elegibilidad y por su calidad metodológica. Resultados: la revisión de la literatura permitió identificar que las drogas médicas más utilizadas fueron los benzodiacepinas, los sedantes, los antidepresivos y los psicotrópicos, los medicamentos de venta libre más usados fueron los analgésicos, laxantes, antiácidos y antihistamínicos; la combinación con el alcohol son prácticas observadas entre los adultos mayores. Conclusión: las drogas médicas y medicamentos de venta libre son consumidas para tratar los trastornos del sueño, depresión, ansiedad y estrés; con relación al alcohol entre el 20.3% y el 57.1% de los adultos mayores lo consumen; la combinación de alcohol y drogas médicas se observó entre el 9.3% y el 18.1%.(AU)

Objective: to perform a systematic review of the literature to identify the studies that report the frequency of consumption of medical drugs, over-the-counter medications and alcohol, as well as the combined use of these substances in the elderly. Method: the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes were used as a guide, 4,881 items through the databases and three items in the search google scholar were identified, twelve studies were chosen as they met the eligibility criteria and their methodological quality. Results: the literature review allowed us to identify that the most used medical drugs were benzodiazepines, sedatives, antidepressants and psychotropic drugs, the most used over-the-counter medications were analgesics, laxatives, antacids and antihistamines; the combination with alcohol are practices observed among the elderly. Conclusion: medical drugs and over-the-counter medications are consumed to treat sleep disorders, depression, anxiety and stress; in relation to alcohol between 20.3% and 57.1% of the elderly consume it; the combination of alcohol and medical drugs was observed between 9.3% and 18.1%.(AU)

Objetivo: realizar uma revisão sistemática da literatura para identificar os estudos que revelam a frequência do consumo de drogas médicas, medicamentos de venda livre e álcool, assim como o consumo combinado dessas substâncias em idosos. Método: foi utilizada como guia a Preferred Reporting Items for Systematic Reviews and MetaAnalyses, foram identificados 4,881 artigos através das bases de dados e três artigos no Navegador Google Scholar, foram selecionados doze exames já que cumpriram com os critérios de elegibilidade e pela sua qualidade metodológica. Resultados: a revisão da literatura permitiu identificar que as drogas médicas mais utilizadas foram as benzodiazepínicas, sedativos, antidepressivos e os psicotrópicos. Os medicamentos de venda livre mais usados foram os analgésicos, laxantes, antiácidos e anti-histamínicos. A combinação com o álcool é um comportamento observado nos idosos. Conclusão: as drogas médicas e medicamentos de venda livre são consumidos para o tratamento dos distúrbios do sono, depressão, ansiedade e estresse. Com relação ao álcool, entre 20.3% e 57.1% das pessoas idosas o consomem. A combinação de álcool e drogas médicas foi observada entre 9.3% e 18.1%.(AU)

A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering / Estudo prospectivo randômico, duplo-cego e controlado comparando tramadol, clonidina e dexmedetomidina para tremores pós-raquianestesia

Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg-1, Group C getting clonidine 1 mcg.kg-1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg-1. The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo-cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 mg.kg-1 de tramadol (Grupo T), 1 mcg.kg-1 de clonidina (Grupo C) e 0,5 mcg.kg-1 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis.

Effects of warmed carrier fluid on nefopam injection-induced pain

BACKGROUND: Nefopam is a non-opioid, non-steroidal analgesic drug with fewer adverse effects than narcotic analgesics and nonsteroidal anti-inflammatory drugs, and is widely used for postoperative pain control. Because nefopam sometimes causes side effects such as nausea, vomiting, somnolence, hyperhidrosis and injection-related pain, manufacturers are advised to infuse it slowly, over a duration of 15 minutes. Nevertheless, pain at the injection site is very common. Therefore, we investigated the effect of warmed carrier fluid on nefopam injection-induced pain. METHODS: A total of 48 patients were randomly selected and allocated to either a control or a warming group. Warming was performed by diluting 40 mg of nefopam in 100 ml of normal saline heated to 31–32℃ using two fluid warmers. The control group was administered 40 mg of nefopam dissolved in 100 ml of normal saline stored at room temperature (21–22℃) through the fluid warmers, but the fluid warmers were not activated. RESULTS: The pain intensity was lower in the warming group than in the control group (P < 0.001). The pain severity and tolerance measurements also showed statistically significant differences between groups (P < 0.001). In the analysis of vital signs before and after the injection, the mean blood pressure after the injection differed significantly between the groups (P = 0.005), but the heart rate did not. The incidence of hypertension also showed a significant difference between groups (P = 0.017). CONCLUSIONS: Use of warmed carrier fluid for nefopam injection decreased injection-induced pain compared to mildly cool carrier fluid.

Pain medication and long QT syndrome

Long QT syndrome is a cardiac repolarization disorder and is associated with an increased risk of torsades de pointes. The acquired form is most often attributable to administration of specific medications and/or electrolyte imbalance. This review provides insights into the risk for QT prolongation associated with drugs frequently used in the treatment of chronic pain. In the field of pain medicine all the major drug classes (i.e. NSAIDs, opioids, anticonvulsive and antidepressant drugs, cannabinoids, muscle relaxants) contain agents that increase the risk of QT prolongation. Other substances, not used in the treatment of pain, such as proton pump inhibitors, antiemetics, and diuretics are also associated with long QT syndrome. When the possible benefits of therapy outweigh the associated risks, slow dose titration and electrocardiography monitoring are recommended.

Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naïve Adult Patients / 中华医学杂志(英文版)

Background@#Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED) and the 95% effective dose (ED) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone.@*Methods@#Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain EDdata for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the EDand EDto blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection.@*Results@#Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED and EDof oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220-0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297-2.563 mg/kg), respectively. In men, the ED and EDwere 0.324 mg/kg (95% CI, 0.274-0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384-2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%).@*Conclusions@#Oxycodone can be used for induction to prevent intubation reactions. Gender affected the EDand EDof oxycodone for blunting the tracheal intubation reaction.

Narcotics Monitoring with Narcotics Information Management System / 대한내과학회지

No abstract available.

An overview of the management of back pain

Back pain affects people across any socio-economic category and is a leading cause of absenteeism and decreased productivity in the workplace. This symptomatic condition is caused by multiple factors, making it difficult to manage. With a small proportion of people experiencing back pain due to pathological reasons, in the larger majority, back pain is due to a mechanical cause. Taking a complete history that includes identifying risk factors such as depression, poor posture, lack of exercise, older age and a physically demanding job is crucial to the effective management of the condition. Behavioural, psychological and social factors of the patient should form the backbone for treatment of back pain. Non-pharmacological management such as exercise, spinal manipulation and acupuncture should be the first-line treatment; however, if this provides poor results then pharmacological measures such as the use of non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or muscle relaxants such as cyclobenzaprine should be considered

Pediatric Nurses' Knowledge and Attitude on Iatrogenic Narcotic Analgesic Withdrawal Symptoms Management / 중환자간호학회지

PURPOSE: This study investigates pediatric nurses' knowledge and attitudes regarding iatrogenic narcotic analgesic withdrawal symptoms management (INAWSM).METHOD: In this cross-sectional study, 253 pediatric nurses working at a tertiary hospital in Seoul participated. Instruments were the inventory consisting questionnaires on 35 items knowledge and 12 items attitude for INAWSM. Further, descriptive statistics, t-test, and analysis of variance were used to evaluate the nurses' knowledge and attitudes.RESULTS: The correct answers rate of knowledge toward INAWSM was 44.9%. With respect to the pediatric nurses' attitudes, the participants scored an average value of 2.83±0.25 out of 4 points. The factor related to the knowledge and attitude level was age, pediatric nursing experience, educational experience, and educational needs.CONCLUSION: Results revealed that pediatric nurses had inadequate knowledge and attitude on INAWSM despite a compulsory education. Therefore, it is necessary to develop an efficient INAWSM educational program.