Differential Experience of Interdose Withdrawal During Long-Term Opioid Therapy and its Association With Patient and Treatment Characteristics: A Latent Class Analysis in Chronic Pain Population.

Opioid withdrawal is characterized by a set of physical and psychological symptoms that depend on both opioid and patient specific characteristics. The present study aims to identify different latent classes of chronic pain patients according to the type of opioid withdrawal symptoms experienced, and to analyze the relationships between the classes and demographic, opioid therapy, psychological and substance use variables. This cross-sectional descriptive study included 391 chronic pain patients on long-term opioid therapy. A Latent Class Analysis (LCA) identified 3 classes (BIC = 7051.89, entropy = .87, LRTs P < .01). The mild withdrawal class showed low probabilities of presenting physical and psychological symptoms, the moderate withdrawal class was characterized by experiencing psychological symptoms, and the severe withdrawal class stood out for high probabilities of presenting both types of symptoms. The classes differed from each other, with higher rates of moderate-severe POUD, opioid misuse, anxiety, depression, and greater pain intensity and interference in more severe withdrawal classes (P < .05). The multinomial logistic regression showed that moderate-severe POUD and anxiety were the strongest variables related to moderate (ORPOUD = 3.34, ORAnxiety = 2.58) and severe withdrawal classes (ORPOUD = 4.26, ORAnxiety = 5.15). Considering that POUD and anxiety were strongly related to a more severe withdrawal syndrome, the inclusion of psychological interventions in pain management seems critical in this population. PERSPECTIVE: Although interdose opioid withdrawal is common in chronic pain patients, this study shows 3 different patterns in its experience (mild, moderate, and severe withdrawal). A more severe withdrawal may result in reduced effectiveness of opioids in relieving pain and increased negative consequences, such as higher risk of POUD. Findings that could help improve chronic pain management.

PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19.

Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.

Influence of Structure and Composition of Woven Fabrics on the Conductivity of Flexography Printed Electronics.

The work is framed within Printed Electronics, an emerging technology for the manufacture of electronic products. Among the different printing methods, the roll-to-roll flexography technique is used because it allows continuous manufacturing and high productivity at low cost. Nevertheless, the incorporation of the flexography printing technique in the textile field is still very recent due to technical barriers such as the porosity of the surface, the durability and the ability to withstand washing. By using the flexography printing technique and conductive inks, different printings were performed onto woven fabrics. Specifically, the study is focused on investigating the influence of the structure of the woven fabric with different weave construction, interlacing coefficient, yarn number and fabric density on the conductivity of the printing. In the same way, the influence of the weft composition was studied by a comparison of different materials (cotton, polyester, and wool). Optical, SEM, color fastness to wash, color measurement using reflection spectrophotometer and multi-meter analyses concluded that woven fabrics have a lower conductivity due to the ink expansion through the inner part of the textile. Regarding weft composition, cotton performs worse due to the moisture absorption capacity of cellulosic fiber. A solution for improving conductivity on printed electronic textiles would be pre-treatment of the surface substrates by applying different chemical compounds that increase the adhesion of the ink, avoiding its absorption.

Clinical and psychological factors associated with interdose opioid withdrawal in chronic pain population.

BACKGROUND: The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). METHODS: This cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference. RESULTS: Forty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05). CONCLUSION: Psychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions.

Flexible Hybrid Electrodes for Continuous Measurement of the Local Temperature in Long-Term Wounds.

Long-term wounds need a continuous assessment of different biophysical parameters for their treatment, and there is a lack of affordable biocompatible devices capable of obtaining that uninterrupted flow of data. A portable prototype that allows caregivers to know the local temperature behavior of a long-term wound over time and compare it with different reference zones has been developed. Alternative flexible substrates, screen-printing techniques, polymeric inks, and an embedded system have been tested to achieve potential indicators of the status and evolution of chronic wounds. The final system is formed by temperature sensors attached to a flexible and stretchable medical-grade substrate, where silver conductive tracks have been printed as interconnections with the data-acquisition unit. In addition, a specific datalogger has been developed for this system. The whole set will enable health personnel to acquire the temperature of the wound and its surroundings in order to make decisions regarding the state and evolution of the wound.

Trombosis y Covid-19: atención primaria clave en el abordaje interdisciplinar / Thrombosis and Covid-19: key primary care in the interdisciplinary approach

No disponible

Reduction of ventilatory time using the multidisciplinary disconnection protocol. Pilot study.

OBJECTIVE: compare ventilatory time between patients with the application of a disconnection protocol, managed in a coordinated way between doctor and nurse, with patients managed exclusively by the doctor. METHOD: experimental pilot study before and after. Twenty-five patients requiring invasive mechanical ventilation for 24 hours or more were included, and the protocol-guided group was compared with the protocol-free group managed according to usual practice. RESULTS: by means of the multidisciplinary protocol, the time of invasive mechanical ventilation was reduced (141.94 ± 114.50 vs 113.18 ± 55.14; overall decrease of almost 29 hours), the time spent on weaning (24 hours vs 7.40 hours) and the numbers of reintubation (13% vs 0%) in comparison with the group in which the nurse did not participate. The time to weaning was shorter in the retrospective cohort (2 days vs. 5 days), as was the hospital stay (7 days vs. 9 days). CONCLUSION: the use of a multidisciplinary protocol reduces the duration of weaning, the total time of invasive mechanical ventilation and reintubations. The more active role of the nurse is a fundamental tool to obtain better results.

Withdrawal symptoms predict prescription opioid dependence in chronic pain patients.

BACKGROUND: The last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification. METHODS: Data were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements. RESULTS: 26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p < .01). Anxiolytics (p < .01) and antidepressants use (p < .05) and percentage of smokers (p < .05) were significantly higher in patients with severe withdrawal. Logistic regression analyses suggested moderate [odds ratio (OR) = 3.25] and severe (OR = 10.52) withdrawal as the strongest predictor of POUD. Age, anxiolytics use, and smoking were also associated with POUD, but multilevel analysis showed that these variables do not moderate the association between withdrawal intensity and POUD. CONCLUSION: Escalation of withdrawal intensity during opioid treatment can be used to identify patients with POUD. Further studies are needed to assess the clinical implications of these findings during long-term opioid therapy for chronic pain.

Pollutants and parasites in bycatch teleosts from south eastern Spanish Mediterranean's fisheries: Concerns relating the foodstuff harnessing.

This research provides an evaluation of the quality and health status of some locally abundant fish species, usually otter-trawl bycatch species. The study was conducted in the southern and eastern Spanish Mediterranean coast. Mean concentration of heavy metals in muscle and parasitisation indices showed moderate levels. Higher lead concentration was found in fish from the western Alboran and arsenic, cadmium and mercury were more present on fishes from the eastern Alboran area, although most species analysed contain moderate levels of heavy metals in muscle. Concerning parasitisation, F. Anisakidae nematodes were present in all the species, except sardine. Only mercury showed a positive relationship with parasitisation. We also considered three feeding guilds. Metal mean concentrations were higher in benthivores and more littoral fishes. Pelagic planktivores species are the healthiest and the more suitable for consumers from the sanitary point of view.

A model for the functional assessment of elderly with myeloid neoplasms

Objective: Myeloid neoplasms are heterogeneous diseases that are more incident in the elderly. The goals of this study were to aggregate a geriatric approach to the patient assessment, to show the impact of gender, age, hemoglobin concentration and comorbidities on the functionality of elderly with myeloid neoplasms and to better understand how the instruments of functional assessment work according to the aggressiveness of the disease. Methods: Elderly patients (≥60 years old) with myeloid neoplasms were assessed using the Karnofsky scale, Eastern Cooperative Oncologic Group scale, and basic and instru- mental activities of daily living scales. The hematopoietic cell transplantation-comorbidity index assessed the comorbidities. A mixed logistical regression model was fitted to estimate the impact of gender, age, hemoglobin concentration and the hematopoietic cell transplantation-comorbidity index on patients' functionality. Results: Eighty-two patients with a mean age of 72.8 years (range: 60-92 years) were evaluated. Eighty percent had good Karnofsky and Eastern Cooperative Oncologic Group scales and 39% were independent according to the daily living activity scales. All of the patients with poor Karnofsky and Eastern Cooperative Oncologic Group scales were classified as dependent by the daily living activity scales. The mixed logistic regression models showed that age, gender, hemoglobin concentration and the comorbidity index impacted on the daily living activity scales. Karnofsky and Eastern Cooperative Oncologic Group scales were affected by hemoglobin and the comorbidity index. The model hypothesized the hemoglobin concentration at which there was a higher risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales. This hemoglobin concentration depended on comorbidities and on the aggressiveness of the myeloid neoplasm. Conclusion: The geriatric approach improved the sensitivity and specificity ...

A model for the functional assessment of elderly with myeloid neoplasms.

OBJECTIVE: Myeloid neoplasms are heterogeneous diseases that are more incident in the elderly. The goals of this study were to aggregate a geriatric approach to the patient assessment, to show the impact of gender, age, hemoglobin concentration and comorbidities on the functionality of elderly with myeloid neoplasms and to better understand how the instruments of functional assessment work according to the aggressiveness of the disease. METHODS: Elderly patients (≥60 years old) with myeloid neoplasms were assessed using the Karnofsky scale, Eastern Cooperative Oncologic Group scale, and basic and instrumental activities of daily living scales. The hematopoietic cell transplantation-comorbidity index assessed the comorbidities. A mixed logistical regression model was fitted to estimate the impact of gender, age, hemoglobin concentration and the hematopoietic cell transplantation-comorbidity index on patients' functionality. RESULTS: Eighty-two patients with a mean age of 72.8 years (range: 60-92 years) were evaluated. Eighty percent had good Karnofsky and Eastern Cooperative Oncologic Group scales and 39% were independent according to the daily living activity scales. All of the patients with poor Karnofsky and Eastern Cooperative Oncologic Group scales were classified as dependent by the daily living activity scales. The mixed logistic regression models showed that age, gender, hemoglobin concentration and the comorbidity index impacted on the daily living activity scales. Karnofsky and Eastern Cooperative Oncologic Group scales were affected by hemoglobin and the comorbidity index. The model hypothesized the hemoglobin concentration at which there was a higher risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales. This hemoglobin concentration depended on comorbidities and on the aggressiveness of the myeloid neoplasm. CONCLUSION: The geriatric approach improved the sensitivity and specificity of the patients' assessment. Hemoglobin concentration associated to the risk of poor Karnofsky and Eastern Cooperative Oncologic Group scales depended on the comorbidity score and on the disease aggressiveness. The Karnofsky and Eastern Cooperative Oncologic Group scales had higher sensitivity in patients with more aggressive diseases.

Síndrome dolor disfunción temporomandibular en pacientes que han abandonado el tratamiento de ortodoncia / Temporomandibular dysfunction pain syndrome in patients who have abandoned the orthodontic treatment

FUNDAMENTACIÓN: actualmente el abandono del tratamiento se ha convertido en algo común en Ortodoncia y una parte importante de estos que se ausentan lo hacen con extracciones terapéuticas realizadas, lo cual combinado con otros factores psicogenéticos puede dar lugar a la aparición del síndrome dolor disfunción temporomandibular. OBJETIVO: determinar la prevalencia del síndrome dolor disfunción temporomandibular en pacientes que han abandonado el tratamiento de Ortodoncia. MÉTODO: se realizó un estudio analítico transversal en la Clínica Estomatológica Docente La Vigía de la ciudad de Camagüey, desde marzo de 2012 a marzo de 2013. El universo estuvo constituido por los 160 pacientes que ingresaron al servicio de Ortodoncia durante el año 2009, la muestra quedó conformada por 45 pacientes de los que abandonaron el tratamiento y que además reunieron los criterios de inclusión previamente establecidos; a estos se les realizó el test de Helkimo. RESULTADOS: el 40 % de los pacientes examinados presentó síndrome dolor disfunción temporomandibular, de ellos el 72,2% tenía extracciones terapéuticas realizadas y el 50 % había tenido instalado anteriormente aparatología ortodóncica fija. CONCLUSIONES: un número considerable de los pacientes que abandonaron el tratamiento ortodóncico presentaron síndrome dolor disfunción temporomandibular, a pesar de estar aparentemente asintomáticos.

BACKGROUND: nowadays quitting a treatment has become very common in Orthodontics; a great part of the patients who quit had undergone therapeutic extractions, which combined with other psychogenetic factors can give place to the appearance of temporomandibular dysfunction pain syndrome. OBJECTIVE: to determine the prevalence of temporomandibular dysfunction pain syndrome in patients who have abandoned the orthodontic treatment. METHOD: a cross-sectional, analytical study was conducted in La Vigia Teaching Stomatological Clinic, Camagüey, from March 2012 to March 2013. The universe was composed of 160 patients that came to the orthodontic service during the year 2009; the sample was composed of 45 patients who had quit the treatment and matched the previously established inclusion criteria. The Helkimo test was made to these patients. RESULTS: the 40 % of the examined patients presented temporomandibular dysfunction pain syndrome; the 72, 2 % of them had undergone therapeutic extractions and the 50 % had previously had an orthodontic fixed appliance. CONCLUSIONS: a considerable number of patients that quit the orthodontic treatment presented temporomandibular dysfunction pain syndrome in spite of being apparently asymptomatic.

Síndrome dolor disfunción temporomandibular en pacientes que han abandonado el tratamiento de Ortodoncia / Temporomandibular dysfunction pain syndrome in patients who have abandoned the orthodontic treatment

Fundamentación: actualmente el abandono del tratamiento se ha convertido en algo común en Ortodoncia y una parte importante de estos que se ausentan lo hacen con extracciones terapéuticas realizadas, lo cual combinado con otros factores psicogenéticos puede dar lugar a la aparición del síndrome dolor disfunción temporomandibular.Objetivo: determinar la prevalencia del síndrome dolor disfunción temporomandibular en pacientes que han abandonado el tratamiento de Ortodoncia.Método: se realizó un estudio analítico transversal en la Clínica Estomatológica Docente La Vigía de la ciudad de Camagüey, desde marzo de 2012 a marzo de 2013. El universo estuvo constituido por los 160 pacientes que ingresaron al servicio de Ortodoncia durante el año 2009, la muestra quedó conformada por 45 pacientes de los que abandonaron el tratamiento y que además reunieron los criterios de inclusión previamente establecidos; a estos se les realizó el test de Helkimo.Resultados: el 40 por ciento de los pacientes examinados presentó síndrome dolor disfunción temporomandibular, de ellos el 72,2 por ciento tenía extracciones terapéuticas realizadas y el 50 por ciento había tenido instalado anteriormente aparatología ortodóncica fija.Conclusiones: un número considerable de los pacientes que abandonaron el tratamiento ortodóncico presentaron síndrome dolor disfunción temporomandibular, a pesar de estar aparentemente asintomáticos(AU)

Background: nowadays quitting a treatment has become very common in Orthodontics; a great part of the patients who quit had undergone therapeutic extractions, which combined with other psychogenetic factors can give place to the appearance of temporomandibular dysfunction pain syndrome.Objective: to determine the prevalence of temporomandibular dysfunction pain syndrome in patients who have abandoned the orthodontic treatment.Method: a cross-sectional, analytical study was conducted in La Vigia Teaching Stomatological Clinic, Camagüey, from March 2012 to March 2013. The universe was composed of 160 patients that came to the orthodontic service during the year 2009; the sample was composed of 45 patients who had quit the treatment and matched the previously established inclusion criteria. The Helkimo test was made to these patients.Results: the 40 percent of the examined patients presented temporomandibular dysfunction pain syndrome; the 72, 2 percent of them had undergone therapeutic extractions and the 50 percent had previously had an orthodontic fixed appliance.Conclusions: a considerable number of patients that quit the orthodontic treatment presented temporomandibular dysfunction pain syndrome in spite of being apparently asymptomatic(AU)

Desarrollo de la Ortodoncia en Camagüey / Development of the Orthodontics in Camagüey

Objetivo: Realizar un estudio retrospectivo, descriptivo e histórico sobre la Ortodoncia en Camagüey. Método: Se revisaron las bases de datos Scielo, Cumed y documentos impresos disponibles en bibliotecas, sobre evolución de la Ortodoncia a nivel mundial, nacional y provincial. Resultados: Se analizaron los resultados según diferentes momentos: desarrollo mundial de la Ortodoncia durante el siglo XIX; práctica de la Ortodoncia en Cuba desde el siglo XIX hasta después del triunfo de la Revolución; y el desarrollo de la Ortodoncia en Camagüey. Conclusiones: El triunfo revolucionario provocó profundas transformaciones en la Estomatología. Los profesores que asumieron la enseñanza contribuyeron al desarrollo del país y la formación de profesionales competentes. También fue útil la comprensión y apoyo brindado por las direcciones provincial y nacional del Ministerio de Salud Pública.

Objective: To carry out a retrospective, descriptive and historical study on the beginning and development of this specialization in the county of Camagüey. Method: Documents were revised it has more than enough history and evolution of the world Orthodontics, in the country and databases Scielo, Cumed and printed documents in books and magazines in libraries. Results: Their results were analyzed according to different moments: the develop of the Orthodontics during the XIX century; practice of the Orthodontics in Cuba during the XX century before and after the victory of the Cuban revolution; year 1962 and dentistry changes in the county of Camagüey and development of the Orthodontics in the territory. Conclusions: The revolutionary victory in Cuba caused deep transformations in the dentistry. The professors that assumed the teaching in Cuba contributed to the development of the country and the formation of competent professionals with positive values. The understanding and support toasted by the provincial and national addresses of the Ministry of Public health also useful.

Desarrollo de la Ortodoncia en Camagüey / Development of the Orthodontics in Camagüey

Objetivo: Realizar un estudio retrospectivo, descriptivo e histórico sobre la Ortodoncia en Camagüey.Método: Se revisaron las bases de datos Scielo, Cumed y documentos impresos disponibles en bibliotecas, sobre evolución de la Ortodoncia a nivel mundial, nacional y provincial.Resultados: Se analizaron los resultados según diferentes momentos: desarrollo mundial de la Ortodoncia durante el siglo XIX; práctica de la Ortodoncia en Cuba desde el siglo XIX hasta después del triunfo de la Revolución; y el desarrollo de la Ortodoncia en Camagüey.Conclusiones: El triunfo revolucionario provocó profundas transformaciones en la Estomatología. Los profesores que asumieron la enseñanza contribuyeron al desarrollo del país y la formación de profesionales competentes. También fue útil la comprensión y apoyo brindado por las direcciones provincial y nacional del Ministerio de Salud Pública(AU)

Objective: To carry out a retrospective, descriptive and historical study on the beginning and development of this specialization in the county of Camagüey.Method: Documents were revised it has more than enough history and evolution of the world Orthodontics, in the country and databases Scielo, Cumed and printed documents in books and magazines in libraries.Results: Their results were analyzed according to different moments: the develop of the Orthodontics during the XIX century; practice of the Orthodontics in Cuba during the XX century before and after the victory of the Cuban revolution; year 1962 and dentistry changes in the county of Camagüey and development of the Orthodontics in the territory.Conclusions: The revolutionary victory in Cuba caused deep transformations in the dentistry. The professors that assumed the teaching in Cuba contributed to the development of the country and the formation of competent professionals with positive values. The understanding and support toasted by the provincial and national addresses of the Ministry of Public health also useful(AU)

Experiencias de ortodoncistas sobre colaboración docente en la Universidad de Saná, República de Yemen / Orthodontists Experiences on the teachers collaboration in Saná University, Republic of Yemen

Se mencionan hechos importantes y transformaciones ocurridas en el Ministerio de Salud Pública, la Educación Superior desde el siglo XX, y la Colaboración Internacional de Cuba después del triunfo de la Revolución. Se relata la experiencia docente durante 7 años de profesoras especialistas en Ortodoncia, quienes representaron la Facultad de Estomatología de la Universidad de Ciencias Médicas "Carlos J. Finlay" de Camagüey, en la Universidad de Saná en la República de Yemen. El reconocimiento por parte de estudiantes, profesores y evaluadores externos de otras universidades del mundo árabe, sobre la calidad de programas de la especialidad, introducción de formas de organización docentes y la metodología en las evaluaciones frecuentes es una muestra de la utilidad de la colaboración docente cubana en países hermanos (AU)

Important events and changes that occurred within the Public Health Ministry, the Higher Education from the 20th century, and the International Collaboration of Cuba after the Triumph of the Revolution are mentioned. The objective of the work is to expose the teaching experiences during the teaching of the undergraduate degree in Stomatology and contribution provided by two medical teachers from the Medical University "Carlos J. Finlay" of Camagüey in Sana'a University, Republic of Yemen during the international collaboration for 7 years. Recognition by students, faculty and external evaluators of other universities in the Arab world on the equality of programs of specialty, introduction of Teaching Organization Forms and the methodology in the frequent evaluations is an example of the usefulness of the Cuban educational collaboration in neighboring countries (AU)

Experiencias de ortodoncistas sobre colaboración docente en la Universidad de Saná, República de Yemen / Orthodontists Experiences on the teachers collaboration in Saná University, Republic of Yemen

Se mencionan hechos importantes y transformaciones ocurridas en el Ministerio de Salud Pública, la Educación Superior desde el siglo XX, y la Colaboración Internacional de Cuba después del triunfo de la Revolución. Se relata la experiencia docente durante 7 años de profesoras especialistas en Ortodoncia, quienes representaron la Facultad de Estomatología de la Universidad de Ciencias Médicas "Carlos J. Finlay" de Camagüey, en la Universidad de Saná en la República de Yemen. El reconocimiento por parte de estudiantes, profesores y evaluadores externos de otras universidades del mundo árabe, sobre la calidad de programas de la especialidad, introducción de formas de organización docentes y la metodología en las evaluaciones frecuentes es una muestra de la utilidad de la colaboración docente cubana en países hermanos.

Important events and changes that occurred within the Public Health Ministry, the Higher Education from the 20th century, and the International Collaboration of Cuba after the Triumph of the Revolution are mentioned. The objective of the work is to expose the teaching experiences during the teaching of the undergraduate degree in Stomatology and contribution provided by two medical teachers from the Medical University "Carlos J. Finlay" of Camagüey in Sana'a University, Republic of Yemen during the international collaboration for 7 years. Recognition by students, faculty and external evaluators of other universities in the Arab world on the equality of programs of specialty, introduction of Teaching Organization Forms and the methodology in the frequent evaluations is an example of the usefulness of the Cuban educational collaboration in neighboring countries.

Uso del sugammadex para la reversión del bloqueo neuromuscular de larga duración con rocuronio: bolos vs infusión continua / Use of sugammadex for reversal of neuromuscular blockade of long duration with rocuronium: bolus vs continuous infusion

Introducción: El bloqueo neuromuscular residual es causa de complicaciones postoperatorias. Objetivo: Identificar la eficacia del sugammadex para revertir el bloqueo neuromuscular con rocuronio, en procederes de larga duración, cuando éste se administra en forma de bolos versus infusión continua. Método: Se realizó un estudio descriptivo exploratorio en una serie de 10 pacientes para tratamiento quirúrgico de más de dos horas, de forma electiva con anestesia general en el Hospital General Universitario de Alicante, España, entre los meses de noviembre y diciembre del 2010. La inducción y el mantenimiento del bloqueo neuromuscular se realizaron mediante bolos (B) o infusión continua (IC), quedando los pacientes divididos en dos grupos. Se compararon los grupos según el tiempo de recuperación mediante la prueba de U-Mann Whitney. Resultados: Existió homogeneidad entre los grupos en cuanto a edad, peso corporal y estado físico según la ASA II – III. La mediana del tiempo quirúrgico para el grupo B fue de 3:55 horas versus 4:20 horas en el grupo de infusión continua. Para alcanzar el cociente T4/T1 > 90%, la mediana del tiempo de recuperación fue de 75.0 minutos para el grupo IC, mientras en el grupo que se utilizaron bolos se observó un tiempo de 140.0 minutos; las diferencias entre ambos grupos resultaron ser estadísticamente significativas (p = 0,008). Conclusiones: La reversión del bloqueo neuromuscular de larga duración inducido por rocuronio fue más rápida cuando el sugammadex se administró en infusión continua en nuestro grupo de pacientes.