Fentanyl and other New Psychoactive Synthetic Opioids. Challenges to Prevention and Treatment

ABSTRACT Synthetic opioids have played a significant role in the current opioid crisis in the United States (U.S.) and Canada and are a matter of concern worldwide. New psychoactive opioids (NPOs) are classified in the internationally recognized new psychoactive substances (NPSs) category. This group comprises compounds that may have been synthesized decades ago but appeared only recently in the illicit drug market. Such is the case of fentanyl, fentanyl analogs, and non-fentanyl opioids. Most NPOs have effects similar to morphine, including euphoria and analgesia, and can produce fatal respiratory depression. Here, we present an overview of the systemic and molecular effects of main NPOs, their classification, and their pharmacological properties. We first review the fentanyl group of NPOs, including the four compounds of clinical use (fentanyl, alfentanil, sufentanil, and remifentanil) and the veterinary drug carfentanil. We also provide essential information on non-medical fentanyl analogs and other synthetic opioids such as brorphine, etonitazene, and MT-45, used as adulterants in commonly misused drugs. This paper also summarizes the scarce literature on the use of NPOs in Mexico. It concludes with a brief review of the challenges to prevention and treatment posed by NPOs and some recommendations to face them.

Algoritmo para el diagnóstico de pacientes con trastornos del neurodesarrollo y sospecha de un síndrome genético / Algorithm for the diagnosis of patients with neurodevelopmental disorders and suspicion of a genetic syndrome

El amplio espectro de aberraciones cromosómicas observable en los trastornos del neurodesarrollo no siempre puede ser caracterizado por análisis cromosómico. El objetivo del trabajo fue determinar la etiología genética de estos trastornos en pacientes con afecciones neurológicas congénitas y sospecha clínica de un síndrome genético, aplicando un algoritmo de estudio clínico-molecular. En 71 de 111 niños analizados, se hallaron aberraciones submicroscópicas asociadas a síndromes de microdeleción-microduplicación: DiGeorge (22 casos), Prader-Willi (26 casos), Angelman (2 casos), Williams-Beuren (17 casos), Smith-Magenis (1 caso), Miller-Dieker (1 caso) y síndrome cri du chat (1 caso). Adicionalmente, se detectó una inserción desbalanceada de novo de la región 17p12p11.2, en el punto 5p13.1, en un niño de tres años. La utilización del método clínico unido a técnicas moleculares, como hibridación fluorescente in situ, ha permitido, en la mayoría de los casos, el diagnóstico certero de pacientes y/o familias con trastornos del neurodesarrollo.

The wide range of chromosome aberrations seen in neurodevelopmental disorders may not always be characterized by means of a chromosome analysis. The objective of this study was to determine the genetic etiology of these disorders in patients with congenital neurological conditions and clinical suspicion of a genetic disorder using a clinical and molecular testing algorithm. Among 111 studied children, 71 showed submicroscopic chromosome aberrations associated with microdeletion/microduplication syndromes: DiGeorge (22 cases), Prader-Willi (26 cases), Angelman (2 cases), Williams-Beuren (17 cases), Smith-Magenis (1 case), Miller-Dieker (1 case), and cri du chat syndrome (1 case). Additionally, a de novo trisomy 17p12p11.2 due to an unbalanced insertion into 5p13.1 was identified in a 3-year-old child. In most cases, the use of a clinical method together with molecular techniques, such as fluorescence in situ hybridization, has allowed to make an accurate diagnosis in patients and/or families with neurodevelopmental disorders.

Asociación entre calidad de vida relacionada con salud y factores sociodemográficos y antropométricos en una institución de salud de Medellín, Colombia / Association between quality of life related to health and sociodemographical and anthropometric factors in a colombian health institution / Associação entre qualidade de vida relacionada à saúde e fatores sociodemográficos e antropométricos em uma instituição de saúde colombiana

Introducción. La calidad de vida relacionada con la salud se define como la percepción subjetiva e influenciada por el estado de salud actual sobre la capacidad para realizar aquellas actividades importantes para un individuo, la cual puede verse afectada en el adulto mayor por procesos de envejecimiento. Objetivo. Caracterizar la calidad de vida relacionada con la salud y las posibles asociaciones con factores antropométricos y sociodemográficos de la población adulta mayor. Materiales y métodos. Se realizó un estudio descriptivo con intención analítica y de corte transversal en el que se evaluó la calidad de vida relacionada con la salud en adultos mayores. La población de estudio estuvo constituida por 145 personas con edades entre los 70 y 92 años que participaron voluntariamente en el estudio y a quienes se les aplicó el cuestionario SF-36 con preguntas sociales y demográficas, además se realizó toma de medidas de talla y peso. Con la información recolectada se procedió a realizar un análisis univariado. Resultados. El 60,7 % de los participantes presentó una buena calidad de vida relacionada con salud. Dentro de las características sociodemográficas se encontró que el 63,4 % eran mujeres, el 67,6 % pertenecían a estrato medio-alto, el 67,6 % tenía escolaridad básica-media, el 81,4 % pertenecía al régimen contributivo y el 48,3 % tenía sobrepeso. Conclusiones. Es necesario implementar programas de protección y cubrimiento en seguridad social al adulto mayor que beneficien especialmente al género femenino, a adultos mayores de edades avanzadas y a los pertenecientes al régimen subsidiado de seguridad social.

Introduction: Quality of life is related to health, thus defined as the subjective perception of an individual ́s current capacity to carry out meaningful activities. Such perception is influenced by the current state of health which is turn affected by aging processes. Objective: To characterize the quality of life related to health and its possible associations with the anthropometric and sociodemographic characteristics. Methodology: A cross-sectional study was carried out to assess health-related quality of life in the elderly. The study counted 145 participants, ranging from the ages between sixty and ni- nety-two, who voluntarily participated in the study; A health- related quality of life questionnaire (SF-36) with social and demographic questions was administered. Height and weight measurements were also taken. With this information, a univariate analysis was carried out. Results: For the total result of the SF-36 questionnaire, it was found that 60.7% of the participants presented a good quality of life related to health.63.4% of the participants in this study were women and, 67.6% of the overall sample were placed as having upper-middle income. Also, most of the participants were found to have basic schooling (67.6). Regarding social security, 81.4% of the sample belonged to social security health plans and (48.3%) was found to have overweight. Conclusions: As a result of the analysis carried out, recommendations such as the implementation of social security protection and coverage programs for the elderly, specifically benefitting the females, older adults and those belonging to the subsidized social security system, can be provided.

Introdução. A qualidade de vida relacionada à saúde é definida como a percepção subjetiva e influenciada pelo estado atual de saúde sobre a capacidade de realizar as atividades importantes de uma pessoa, frequentemente afetadas pelo processo de envelhecimento. Objetivo. Caracterizar a qualidade de vida relacionada à saúde e possíveis associações com fatores antropométricos e sociodemográficos na população idosa. Materiais e métodos. Foi realizado um estudo descritivo com intenção analítica e um estudo transversal, avaliando a qualidade de vida relacionada à saúde em idosos. A população do estudo foi composta por 145 pessoas com idades entre 70 e 92 anos, que participaram voluntariamente do estudo e para quem foi aplicado o questionário SF-36 com questões sociais e demográficas, além de medidas de altura e peso. Com as informações coletadas, foi realizada uma análise univariada. Resultados. 60,7% dos participantes apresentaram boa qualidade de vida relacionada à saúde. Entre as características sociodemográficas, verificou-se que 63,4% eram mulheres, 67,6% pertenciam à classe média alta, 67,7% possuíam ensino médio-médio (67,6), 81,4% pertenciam ao sistema contributivo e 48,3% estavam acima do peso. Conclusões. É necessário implementar programas de proteção e cobertura da previdência social para idosos que beneficiem especialmente o sexo feminino, idosos de idade avançada e pertencentes ao sistema subsidiado.

El concepto zona de desarrollo próximo y su manifestación en la educación médica superior cubana / The concept near development zone and its manifestation in the Cuban higher medical education

La zona de desarrollo próximo es un concepto creado por Vigotsky que se refiere a la distancia que existe entre el desarrollo psíquico actual del sujeto y su desarrollo potencial. Por esta razón es un concepto de suma importancia para la educación en todos los niveles de enseñanza. El objetivo del presente artículo es describir cómo el concepto zona de desarrollo próximo se manifiesta en la educación superior médica cubana. Se explica la importancia de este concepto en los principios didácticos y se especifica cómo se utiliza en la formación de valores y mediante el uso de las tecnologías de la información y las comunicaciones. Se exponen las razones por las cuales la gestión del profesor ha de sustentarse en la ampliación de la zona de desarrollo próximo de sus estudiantes.

The concept near development zone was created by Vigotsky and refers to the distance between the present psychical development of the individual and his potential development. It is a concept of vital importance for education at all levels. The objective of the article is to describe how this concept behaves in the higher medical education in Cuba. The importance of this concept in the didactic principles were explained, as well as how it is used in the formation of values through the information and communication technologies. The reasons why the work of the professor has to be supported on the widening of the near development zone of their students were also stated.