Lin-CD117+CD34+FcεRI+ progenitor cells are increased in chronic spontaneous urticaria and predict clinical responsiveness to anti-IgE therapy.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common, debilitating skin disorder characterized by recurring episodes of raised, itchy and sometimes painful wheals lasting longer than 6 weeks. CSU is mediated by mast cells which are absent from peripheral blood. However, lineage-CD34hiCD117int/hiFcεRI+ cells in blood have previously been shown to represent a mast cell precursor. METHODS: We enumerated FcεRI-, FcεRI+ and FcεRIhi lineage-CD34+CD117+ cells using flow cytometry in blood of patients with CSU (n = 55), including 12 patients receiving omalizumab and 43 not receiving omalizumab (n = 43). Twenty-two control samples were studied. Disease control and patient response to omalizumab was evaluated using the urticaria control test. We performed single-cell RNA sequencing (scRNA-Seq) on lineage-CD34hiCD117hi blood cells from a subset of patients with CSU (n = 8) and healthy controls (n = 4). RESULTS: CSU patients had more lineage-CD34+CD117+FcεRI+ blood cells than controls. Lineage-CD34+CD117+FcεRI+ cells were significantly higher in patients with CSU who had an objective clinical response to omalizumab when compared to patients who had poor disease control 90 days after initiation of omalizumab. scRNA-Seq revealed that lineage-CD34+CD117+FcεRI+ cells contained both lymphoid and myeloid progenitor lineages, with omalizumab responsive patients having proportionally more myeloid progenitors. The myeloid progenitor lineage contained small numbers of true mast cell precursors along with more immature FcεRI- and FcεRI+ myeloid progenitors. CONCLUSION: Increased blood CD34+CD117+FcεRI+ cells may reflect enhanced bone marrow egress in the setting of CSU. High expression of these cells strongly predicts better clinical responses to the anti-IgE therapy, omalizumab.

Social cognition interventions for adolescents with autism spectrum disorder. A systematic review.

Early intervention during childhood in patients with Autism Spectrum Disorder (ASD) has been strongly advocated. As adolescence is reached, new, more complex social demands emerge. These demands require a therapeutic approach that has not been widely studied. The aim of this review is to examine and synthesize the existing literature on social cognition interventions in adolescence and lay the groundwork for future interventions.

Circulating mast cell progenitors increase during natural birch pollen exposure in allergic asthma patients.

BACKGROUND: Mast cells (MCs) develop from a rare population of peripheral blood circulating MC progenitors (MCps). Here, we investigated whether the frequency of circulating MCps is altered in asthma patients sensitized to birch pollen during pollen season, compared to out of season. METHODS: Asthma patients were examined during birch pollen season in late April to early June (May), and out of season in November-January. Spirometry measurements, asthma and allergy-related symptoms, asthma control questionnaire (ACQ), and asthma control test (ACT) scores were assessed at both time points. The MCp frequency was determined by flow cytometry in ficoll-separated blood samples from patients with positive birch pollen-specific IgE, and analyzed in relation to basic and disease parameters. RESULTS: The frequency of MCps per liter of blood was higher in May than in November (p = .004), particularly in women (p = .009). Patients that reported moderate to severe asthma symptoms (<.0001), nose or eye symptoms (p = .02; p = .01), or reduced asthma control (higher ACQ, p = .01) had higher MCp frequency in May than those that did not report this. These associations remained significant after adjusting for sex and BMI. The change in asthma control to a lower ACT score in May correlated with an increase in MCp frequency in May (p = .006, rho = 0.46). CONCLUSIONS: The data suggest that the frequency of MCps increases in symptomatic patients with allergic asthma. Our results unravel a link between asthma symptoms and circulating MCps, and bring new insight into the impact of natural allergen exposure on the expansion of MCs.

Intervenciones en cognición social en adolescentes con Trastorno del Espectro Autista. Una revisión sistemática / Social cognition interventions for adolescents with autism spectrum disorder. A systematic review

Introducción. La intervención temprana durante la infancia en pacientes con trastorno del espectro autista (TEA)ha sido fuertemente promovida. Al alcanzar la adolescencia,aparecen nuevas demandas sociales más complejas. Estas demandas precisan nuevamente un abordaje terapéutico, que no ha sido tan ampliamente estudiado. El objetivo de esta revisión es examinar y sintetizar la literatura existente sobre intervenciones en cognición social en adolescencia, y sentar las bases para futuras intervenciones. Método. Se realizaron búsquedas en las bases de datos PubMed, PsycINFO y Web of Science hasta el 20 de abril de 2023. Se incluyeron investigaciones cuantitativa o cualitativa dirigida a examinar la influencia de las intervenciones centradas en cognición social en el tratamiento del TEA en adolescencia, en lengua inglesa o española. Los estudios cuantitativos y cualitativos se evaluaron utilizando una versión modificada de la Escala de Newcastle-Ottawa y la Critical Appraisals Skills Programme checklist, respectivamente. Resultados. Se seleccionaron 19 estudios originales que cumplieron los criterios de inclusión. Los estudios seleccionados incluyeron a un total de 916 pacientes. La duración media de las intervenciones fue de 13,28 semanas. Se categorizaron en intervenciones en habilidades sociales basadas en grupos, intervenciones basadas en la experiencia e intervenciones mediadas por ordenador. Conclusiones. Resulta llamativa la escasez de intervenciones en cognición social diseñadas específicamente para adolescentes con TEA. El intervalo de neuroplasticidad entre la pubertad y la transición a la edad adulta brinda la oportunidad de mejorar la reorganización estructural y funcional dinámica. Por tanto, la adolescencia es una etapa de desarrollo única y susceptible de intervenciones específicas. (AU)

Introduction. Early intervention during childhood in patients with Autism Spectrum Disorder (ASD) has been strongly advocated. As adolescence is reached, new, more complex social demands emerge. These demands require a therapeutic approach that has not been widely studied. The aim of this review is to examine and synthesize the existing literature on social cognition interventions in adolescence and lay the groundwork for future interventions. Methods. Searches were conducted in the PubMed, PsycINFO, and Web of Science databases up until April 20, 2023. Quantitative or qualitative research aimed at examining the influence of social cognition-focused interventions in the treatment of ASD in adolescence, in either English or Spanish language, was included. Quantitative and qualitative studies were evaluated using a modified version of the Newcastle-Ottawa Scale and the Critical Appraisals Skills Programme checklist, respectively. Results. Nineteen original studies that met the inclusion criteria were selected. The selected studies included a total of 916 patients. The average duration of the interventions was 13.28 weeks. They were categorized into group-based social skills interventions, experience-based interventions, and computer-mediated interventions. Conclusions. The scarcity of social cognition interventions specifically designed for adolescents with ASD is striking. The neuroplasticity window between puberty and the transition to adulthood provides an opportunity for structural and dynamic functional reorganization. Therefore, adolescence is a unique developmental stage that is amenable to specific interventions. (AU)

Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review.

OBJECTIVES: To evaluate uterine tamponade devices' effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols. SEARCH STRATEGY: PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021. STUDY SELECTION: Randomised and non-randomised comparative studies. OUTCOMES: Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy. RESULTS: All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom-catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76-7.14) and hysterectomy (RR 4.14, 95% CI 0.48-35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07-15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11-1.03) and hysterectomy (RR 0.49, 95% CI 0.04-5.38) after the inclusion of the Bakri balloon. The second non-randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32-2.81) and hysterectomy (RR 1.84, 95% CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. CONCLUSIONS: The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting. TWEETABLE ABSTRACT: Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.

Comparación de la trombosis venosa profunda de miembro superior e inferior: estudio observacional prospectivo / Comparison between upper and lower extremity deep vein thrombosis: a single-center prospective study

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Funcionamiento familiar, sobrecarga y calidad de vida del cuidador del adulto mayor con dependencia funcional / Family dynamics, overload, and quality of life among caregiver of functionally dependent older adults / Funcionamento familiar, sobrecarga e qualidade de vida no cuidador do idoso com dependência funcional

Resumen Introducción: Ser cuidador de personas con dependencia funcional conlleva el riesgo de presentar deterioro de la calidad de vida, esto puede deberse a que la prolongación del cuidado altera la dinámica familiar y genera sobrecarga en el cuidador. Objetivo: 1) Identificar la relación entre funcionamiento familiar y calidad de vida del cuidador del adulto mayor y 2) Determinar la sobrecarga y calidad de vida del cuidador del adulto mayor. Metodología: Estudio descriptivo y correlacional, muestreo por bola de nieve, la muestra conformada por 86 cuidadores de un centro comunitario. Para las mediciones se utilizó el índice de Barthel, el Test de APGAR Familiar, la prueba de Zarit y la Escala de Calidad de Vida WHOQOL-BREF. Se aplicó la Prueba de Kolmogorov Smirnov y Prueba de Correlación de Spearman. Resultados: El 11.6% de los adultos mayores presentó dependencia total, la percepción de disfuncionalidad familiar grave representó el 3.5%. Los cuidadores con sobrecarga intensa fueron el 32.6%, el 8.1% percibió la calidad de vida deficiente. A mayor funcionamiento familiar mayor calidad de vida del cuidador (p<.05) y a mayor sobrecarga, menor calidad de vida del cuidador (p<.05) en todas las dimensiones. Conclusiones: Se observó que la sobrecarga y funcionalidad familiar están relacionadas con la calidad de vida del cuidador, por lo que se convierten en un escenario disciplinar que plantea la posibilidad de diseñar estrategias de intervención, centradas en la sobrecarga y el funcionamiento de la familia para el mejoramiento de la calidad de vida del cuidador.

Abstract Introduction: The prolonged provision of healthcare to functionally dependent persons can result in the deterioration on the caregiver's quality in terms of family dynamics and overload. Objectives: 1) To identify the relationship between the family dynamics and the quality of life of the caregiver of older adults; and 2) to estimate the quality of life and the overload of the caregiver of older adults. Methodology: This is a descriptive and correlational study with a snowball-derived sample of 86 caregivers in a communitarian center. The corresponding measures were estimated using the Barthel Index, the Family APGAR Test, the Zarit Test, and the WHOQOL-BREF Quality of Life Scale. The Kolmogorov-Smirnov and Spearman Correlation tests were calculated. Results: 11.6% of the older adults being cared showed total dependency. 3.5% of the caregiver's sample perceived having a severe family dysfunction. 32.6% of the sample were found having heavy overloads. 8.1% of the sample perceived having poor quality of life. In all dimensions, the better the family dynamics were, the better the quality of life of the caregivers was (p<.05), and the heavier the overload was, the worse the quality of life of the provider was (p<.05). Conclusions: It was noted that both, overload and family dynamics, are related to the quality of life of the caregivers of older adults; therefore, the design of intervention strategies should be focused on the overload and family dynamics of these professionals in order to improve their quality of life.

Resumo Introdução: Ser cuidador de pessoas com dependência funcional implica o risco de apresentar deterioro da qualidade de vida, isto pode dever-se a que o prolongamento do cuidado altera a dinâmica familiar e gera sobrecarga no cuidador. Objetivo: 1) Identificar a relação entre funcionamento familiar e qualidade de vida do cuidador do idoso e 2) Determinar a sobrecarga e qualidade de vida no cuidador do idoso. Metodologia: Estudo descritivo e correlacional, amostragem por bola de neve, a amostragem conformada por 86 cuidadores de um centro comunitário. Para as medições utilizou-se o índice de Barthel, o Teste de APGAR Familiar, a prova de Zarit e a Escala de Qualidade de Vida WHOQOL-BREF. Aplicou-se a prova de Kolmogorov Smirnov e Prova de Correlação de Spearman. Resultados: O 11.6% dos idosos apresentou dependência total, a percepção de disfuncionalidade familiar grave representou o 3.5%. Os cuidadores com sobrecarga intensa foram o 32.6%, o 8.1% percebeu a qualidade de vida deficiente. Quanto maior funcionamento familiar, maior qualidade de vida do cuidador (p<.05) e quanto maior sobrecarga, menor qualidade de vida do cuidador (p<.05) em todas as dimensões. Conclusões: Observou-se que a sobrecarga e funcionalidade familiar estão relacionadas com a qualidade de vida do cuidador, pelo que se tornam em um cenário disciplinar que envolve a possibilidade de desenhar estratégias de intervenção, centradas na sobrecarga e o funcionamento da família para o melhoramento da qualidade de vida do cuidador.

[Profile of the Family Doctor who gains access to positions with teaching tutorship of Family and Community Medicine by means of relocation examination in Galicia]. / Perfil del médico de familia que accede a plazas con tutoría docente de Medicina Familiar y Comunitaria mediante concurso de traslados en Galicia.

OBJECTIVE: To analyse the profile of Family Doctors who gain access to positions, both to the general quota, as well those reserved for teaching tutors of Family and Community Medicine, by means of a relocation competition. MATERIAL AND METHODS: A descriptive observational study was conducted in which 2 comparison groups were established: A Non-Teaching group that did not include Family Doctors who did not request or gain access to tutor positions, and a Teaching group with those that gained access to positions reserved for tutors. The information was obtained from the marks of the relocation competition carried out in Galicia in 2018. A total of 426 General Practitioners that entered the examination were included, of which 301 were female (70.7%) and 125 (29.3%) males. The variables were the obtaining of a position reserved for tutor, gender, and the merits considered in the competition: professional experience, training, scientific publications, and Galician language. The non-parametric statistics tests of Mann-Whitney and Kruskal-Wallis were used, after checking for non-normal distribution. RESULTS: Statistically significant differences were found in the distribution by gender in favour of males in the Teaching group compared to the Non-Teaching group (P<.01). The Teaching group obtained better results in training and publications. The females obtained statistically significant results in their favour in the training variable, and the males in experience. CONCLUSIONS: For the choice of teaching places in relocation interviews and examinations, publications and training had an important weighting; but, taking the gender perspective into account, a lower percentage of women had gained access to teaching positions due to having lower score in the experience category.

[Correlation between the six-minute walk test and maximal exercise test in patients with type ii diabetes mellitus]. / Correlación entre prueba de marcha de 6 minutos y prueba de esfuerzo máxima en pacientes con diabetes mellitus de tipo ii.

INTRODUCTION: The 6-minute walk test is an exercise test that has been used in diabetic patients to assess the effectiveness of exercise programmes and has been correlated with clinical parameters; however, the correlation with the maximum workload registered during stress testing has not been determined in diabetic patients. OBJECTIVE: To establish the correlation between the 6-minute walk test and the maximum workload registered during a stress test in patients with type ii diabetes mellitus and its association with glycemic control. MATERIALS AND METHODS: We included 42 patients with type ii diabetes mellitus and mean age of 61.1 years, who underwent physical examination, a 6-minute walk test, a treadmill stress test and laboratory studies. RESULTS: The 6-minute walk test had high reproducibility in diabetic patients and showed a moderate-low correlation with maximum workload on the treadmill (r=49, p=0.001). A significant association was found between the 6-minute walk test and glycosylated haemoglobin A1C values (RP 1.57, χ2 <0.05). CONCLUSION: The 6-minute walk test is a highly reproducible test and has a significant correlation with maximum physical workload in the diabetic patients tested. Therefore, it can be used as a test for assessing functional capacity in this population.

[Efficacy of Ozone Infiltrations in the Treatment of Knee Osteoarthritis Vs Other Interventional Treatments: A Systematic Review of Clinical Trials]. / Eficacia de las infiltraciones con ozono en el tratamiento de la osteoartritis de rodilla vs. otros tratamientos intervencionistas: revisión sistemática de ensayos clínicos.

INTRODUCTION: Intra-articular ozone infiltrations have been used as a therapeutic intervention in osteoarthritis of the knee with reports of favourable effects. However, this therapeutic procedure is still controversial due to the lack of scientific evidence to justify its use. OBJECTIVE: To evaluate the safety and efficacy of intra-articular ozone infiltrations in patients with knee osteoarthritis. MATERIAL AND METHODS: A systematic search was performed in electronic databases such as Pubmed, Dialnet, Scielo, Medigraphic and other electronic sources from January 1990 to January 2018. We included controlled clinical trials that used intra-articular ozone infiltrations as a therapeutic intervention in patients with knee osteoarthritis. The variables analysed were the study design, risk of bias, clinical configuration, characteristics of the participants, characteristics of the interventions, results, length of follow-up and adverse events. RESULTS: Ten studies with a total of 400 patients treated with ozone vs 381 controls were included in the systematic review. Most studies had a high risk of bias. Intra-articular ozone infiltrations were more effective than placebo and were as effective as other interventional treatments in short-term follow-up. No adverse effects or serious adverse reactions were reported in the treated patients. CONCLUSION: Intra-articular ozone infiltration appears to be an effective therapeutic intervention in the short term. However studies with better methodological quality are needed to confirm its efficacy and to analyze long-term safety.

Tachykinins modulate nociceptive responsiveness and sensitization: In vivo electrical characterization of primary sensory neurons in tachykinin knockout (Tac1 KO) mice.

Since the failure of specific substance P antagonists to induce analgesia, the role of tachykinins in the development of neuropathic pain states has been discounted. This conclusion was reached without studies on the role of tachykinins in normal patterns of primary afferents response and sensitization or the consequences of their absence on the modulation of primary mechanonociceptive afferents after injury. Nociceptive afferents from animals lacking tachykinins (Tac1 knockout) showed a disrupted pattern of activation to tonic suprathreshold mechanical stimulation. These nociceptors failed to encode the duration and magnitude of natural pronociceptive stimuli or to develop mechanical sensitization as consequence of this stimulation. Moreover, paw edema, hypersensitivity, and weight bearing were also reduced in Tac1 knockout mice 24 h after paw incision surgery. At this time, nociceptive afferents from these animals did not show the normal sensitization to mechanical stimulation or altered membrane electrical hyperexcitability as observed in wild-type animals. These changes occurred despite a similar increase in calcitonin gene-related peptide immunoreactivity in sensory neurons in Tac1 knockout and normal mice. Based on these observations, we conclude that tachykinins are critical modulators of primary nociceptive afferents, with a preeminent role in the electrical control of their excitability with sustained activation or injury.

[Regulatory requirements; What steps must be taken before starting a biomedical research study?] / Requerimientos normativos: ¿Qué pasos tengo que seguir antes de iniciar un estudio de investigación biomédica?

Studies of research with human beings, their biological specimens, or their personal data in the field of biomedicine have been subject to regulation since the middle of the last century. Initially a regulation based on recommendations such as the Nuremberg Code, the Belmont Report or the first versions of the Declaration of Helsinki. All of them documents in which the principles (autonomy, beneficence, non-maleficence, and justice) were conceptualized, and that all researchers had to follow in the development of their research. This first phase is known as a period of self-regulation, because it is considered that the researchers themselves could, by following these recommendations, carry out their investigations without further control. Subsequently, it went through a clearly regulatory period in which the premises of these recommendations were progressively incorporated into the legal system of the different countries, and with this, arose the external control of the investigation by the administrations and other bodies, such as the Research Ethics Committees. The purpose of this article is to serve as a guide to professionals whose main activity is care in the field of Primary Care and who, in turn, are interested in initiating research studies to respond to uncertainties in the context of their daily activity that may arise.

[Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study]. / Factores de riesgo y evolución clínica de las infecciones causadas por Klebsiella pneumoniae productora de carbapenemasas en un hospital universitario de España. Estudio de casos y controles.

OBJECTIVE: Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis. METHODS: We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables. RESULTS: Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95). CONCLUSIONS: Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Prediction of dengue outbreaks in Mexico based on entomological, meteorological and demographic data.

Dengue virus has shown a complex pattern of transmission across Latin America over the last two decades. In an attempt to explain the permanence of the disease in regions subjected to drought seasons lasting over six months, various hypotheses have been proposed. These include transovarial transmission, forest reservoirs and asymptomatic human virus carriers. Dengue virus is endemic in Mexico, a country in which half of the population is seropositive. Seropositivity is a risk factor for Dengue Hemorrhagic Fever upon a second encounter with the dengue virus. Since Dengue Hemorrhagic Fever can cause death, it is important to develop epidemiological mathematical tools that enable policy makers to predict regions potentially at risk for a dengue epidemic. We formulated a mathematical model of dengue transmission, considering both human behavior and environmental conditions pertinent to the transmission of the disease. When data on past human population density, temperature and rainfall were entered into this model, it provided an accurate picture of the actual spread of dengue over recent years in four states (representing two climactic conditions) in Mexico.

Dolor y simulación: reto diagnóstico y terapéutico / Pain and simulation: diagnostic and therapeutic challenges

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Stillbirth rates in 20 countries of Latin America: an ecological study.

OBJECTIVE: To describe country-level stillbirth rates and their change over time in Latin America, and to measure the association of stillbirth rates with socio-economic and health coverage indicators in the region. DESIGN: Ecological study. SETTING: 20 countries of Latin America. POPULATION OR SAMPLE: Aggregated data from pregnant women with countries as units of analysis. METHODS: We used stillbirth estimates, and socio-economic and healthcare coverage indicators reported from 2006 to 2016 from UNICEF, United Nations Development Programme and World Bank datasets. We calculated Spearman's correlation coefficients between stillbirths rates and socioeconomic and health coverage indicators. MAIN OUTCOME MEASURES: National estimates of stillbirth rates in each country. RESULTS: The estimated stillbirth rate for Latin America for 2015 was 8.1 per 1000 births (range 3.1-24.9). Seven Latin America countries had rates higher than 10 stillbirths per 1000 births. The average annual reduction rate for the region was 2% (range 0.1-3.8%), with the majority of Latin America countries ranging between 1.5 and 2.5%. National stillbirth rates were correlated to: women's schooling (rS = -0.7910), gross domestic product per capita (rS = -0.8226), fertility rate (rS = 0.6055), urban population (rS = -0.6316), and deliveries at health facilities (rS = -0.6454). CONCLUSIONS: Country-level estimated stillbirth rates in Latin America varied widely in 2015. The trend and magnitude of reduction in stillbirth rates between 2000 and 2015 was similar to the world average. Socio-economic and health coverage indicators were correlated to stillbirth rates in Latin America. TWEETABLE ABSTRACT: Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.

Cannabis for Chronic Pain: Challenges and Considerations.

The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented.

Relationship between dental occlusion and functional dependence in elderly Caucasians.

OBJECTIVE: To determine whether a relationship exists between the number of functional masticatory units (FMUs) and the level of functional dependence of elderly. SUBJECTS AND METHODS: The study group comprised 502 elderly Caucasians living in nursing homes in north-west Spain and Portugal. The number of FMUs was counted on direct visual inspection. The degree of dependence was assessed using the Barthel index. The results were validated in a group of 156 elderly. Statistical analysis of the results was performed using a generalised linear model (GLM), a logistic GLM, a ROC-GLM curve and a confusion matrix. RESULTS: The number of FMUs significantly affected the Barthel index score (explained deviance = 27.5%). The number of FMUs was significantly associated with a lower probability of dependence, both for women (explained deviance = 31%) and for men (explained deviance = 33%). The model based on FMUs showed a good discriminatory capacity for dependence (AUC = 0.84 in women and 0.82 in men). The predictive capacity of the dependence model based on FMUs was very high (sensitivity = 0.9 in women and 0.8 in men). CONCLUSIONS: In institutionalised elderly Caucasians, the number of FMUs is significantly associated with the Barthel index score and could be a predictive factor for dependence.