Caracterización clínica y epidemiológica de los pacientes con trastorno por uso de opioides atendidos en una institución de cuarto nivel en la ciudad de Medellín, entre 2017 y 2022 / Clinical and epidemiological characterization of patients with opioid use disorder treated at a fourth level institution in the city of Medellín, between 2017 and 2022

Los analgésicos opioides son una opción importante en el manejo del dolor agudo grave, crónico e intratable, sin embargo, sus efectos euforizantes y gratificantes han motivado a que algunos pacientes continúen su uso una vez resuelta la condición médica inicial, haciendo entonces un uso indebido de opioides (UIO) y con el potencial riesgo de desarrollar un trastorno por uso de opioides (TUO). El objetivo del presente trabajo fue caracterizar clínica y epidemiológicamente a los pacientes con trastorno por uso de opioides atendidos en una institución de cuarto nivel de Medellín. Para ello, se realizó un estudio observacional, descriptivo, transversal de fuente secundaria; se incluyeron 309 registros de pacientes adultos, con diagnóstico CIE-10, trastornos causados por opiáceos. TUO e UIO constituyeron las variables de interés, se procesó la información en Jamovi® versión 2.2 y se analizaron los datos de variables cuantitativas con test de Sahpiro Wilk y análisis bivariado exploratorio de las variables clínicas y sociodemográficas. Resultados: El TUO obtuvo una prevalencia del 39.9% frente al 25,6 % del UIO. De los pacientes con TUO el 50% tenían 35 años o menos, el 57.7% fueron mujeres, 58.7% solteros, y predominaron los niveles de educación secundaria y universitaria. En cuanto al UIO, el 50% fueron menores de 37 años el 54% de sexo femenino, en su mayoría solteros (61.5%), y predominó el nivel de educación secundaria (48.7%). En el 71% de los pacientes con TUO hay antecedentes de enfermedad mental predominando los trastornos del afecto: ansiedad y depresión. El opioide más usado fue tramadol (17.04%), seguido de morfina e hidromorfona. Conclusión: Ante el aumento en la prevalencia de UIO y TUO es necesario nuevas políticas salud pública que permitan ejercer un control más estricto en la formulación, comercialización y administración segura de este tipo de medicamentos.(AU)

Opioids analgesics are an important option in the management of severe acute, chronic, and intractable pain; however, their euphoric and rewarding effects have motivated some patients to continue their use once the initial medical condition has resolved, thus misusing them. these (UIO) and with the potential risk of developing an opioid use disorder (OUD).Objectives: to clinically and epidemiologically characterize patients with opioid use disorder treated at a fourth-level institution in Medellín.Methodology: Observational, descriptive, cross-sectional study of secondary source; 309 records of adult patients with ICD-10, diagnosis caused by opioids agents were included. TUO and IOU were the variables of interest, the information was processed in Jamovi® version 2.2 and the data of quantitative variables were analyzed with the Sahpiro Wilk test and exploratory bivariate analysis of the clinical and sociodemographic variables.Results: The TUO obtained a prevalence of 39.9% compared to 25.6% of the UIO. Of the patients with OT, 50% were 35 years of age or younger, 57.7% were women, 58.7% were single, and secondary and university education levels predominated. Regarding the UIO, 50% were under 37 years of age, 54% female, mostly single (61.5%), and the secondary education level predominated (48.7%).In 71% of patients with OLW there is a history of mental illness, predominantly affective disorders: anxiety and depression. The most used opioid was tramadol (17.04%), followed by morphine and hydromorphone. Conclusion: Given the increase in the prevalence of UIO and OTU, new public health policies are necessary to exercise stricter control in the formulation, marketing and safe administration of this type of medication.(AU)

Differential gene expression pattern and plasma sex steroids during testicular development in Genyatremus luteus (Perciforme: Haemulidae) (Bloch, 1790).

The aim of the current study is to evaluate gene expression patterns of LH (lhr) and estrogen (er) receptors and plasma steroid levels during testicular development in Genyatremus luteus. Males were histologically classified as immature (n=7), maturing (n=7) and mature (n=7), based on the cellular structure of their testes. Plasma 11-KT concentration recorded peak at the final maturation stage. The highest plasma 17α-OHP concentrations were observed at the immature stage; they decreased at the maturation and mature stages. On the other hand, 17ß-estradiol (E2) recorded higher concentrations at the maturation stage. Er expression has significantly increased along the maturational development of animals' testes. The mRNA observed for the LH receptor has decreased from immature to maturing stage; it presented expression peak at the mature stage. There was high association between receptor gene expression and plasma steroid levels, mainly E2. The current study was the first to feature different reproductive maturation stages in male G. luteus specimens, based on cellular, endocrine and molecular aspects. In addition, it has shown that the gene expression profile for er and lhr receptors, as well as plasma 11-KT and E2 concentrations, are directly linked to testicular maturation, although they are not necessarily associated with the gonadosomatic index.

Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study.

BACKGROUND: Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence. METHODS: This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis. RESULTS: A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05). CONCLUSION: G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.

Standardization and comparison of nonautomated assays to measure the collagen binding activity of von Willebrand factor.

INTRODUCTION: Diagnosis of von Willebrand disease (VWD) is difficult due to the heterogenic phenotype of patients and to the complex tests that are required for an adequate investigation. The collagen binding assay (VWF:CB) reveals the adhesion capacity of von Willebrand factor (VWF) to collagen and can be useful to reduce the misleading diagnosis of VWD. This study aimed the standardization of 2 nonautomated VWF:CB assays based on ELISA and flow cytometry. METHODS: Plasma samples from 87 patients previously diagnosed with VWD and 22 healthy controls were analyzed. Measurement of the VWF-collagen binding activity was performed using a commercial assay and the 2 tests proposed. VWF:CB/VWF:Ag ratio was calculated for samples and the differentiation between types 1, 2A, and 2M was analyzed. RESULTS: ELISA and flow cytometry tests presented strong correlation with the gold standard test (r2  = .8976 and r2  = .8143, respectively). Tests based on ELISA and flow cytometry presented a bias of +7.2% and -3.6%, respectively. CONCLUSION: The ELISA test demonstrated better performance to detect VWF-collagen binding activity in healthy individuals and VWD patients. This test could differentiate 2A and 2M subtypes using a feasible protocol that can be easily implemented.

Active layer and permafrost thermal regime in a patterned ground soil in Maritime Antarctica, and relationship with climate variability models.

Permafrost and active layer studies are important to understand and predict regional climate changes. The objectives of this work were: i) to characterize the soil thermal regime (active layer thickness and permafrost formation) and its interannual variability and ii) to evaluate the influence of different climate variability modes to the observed soil thermal regime in a patterned ground soil in Maritime Antarctica. The study was carried out at Keller Peninsula, King George Island, Maritime Antarctica. Six soil temperatures probes were installed at different depths (10, 30 and 80cm) in the polygon center (Tc) and border (Tb) of a patterned ground soil. We applied cross-correlation analysis and standardized series were related to the Antarctic Oscillation Index (AAO). The estimated active layer thickness was approximately 0.75cm in the polygon border and 0.64cm in the center, indicating the presence of permafrost (within 80cm). Results indicate that summer and winter temperatures are becoming colder and warmer, respectively. Considering similar active layer thickness, the polygon border presented greater thawing days, resulting in greater vulnerability to warming, cooling faster than the center, due to its lower volumetric heat capacity (Cs). Cross-correlation analysis indicated statistically significant delay of 1day (at 10cm depth) in the polygon center, and 5days (at 80cm depth) for the thermal response between atmosphere and soil. Air temperature showed a delay of 5months with the climate variability models. The influence of southern winds from high latitudes, in the south facing slopes, favored freeze in the upper soil layers, and also contributed to keep permafrost closer to the surface. The observed cooling trend is linked to the regional climate variability modes influenced by atmospheric circulation, although longer monitoring period is required to reach a more precise scenario.

Effect of red blood cell preservation by droplet freezing with non-permeable cryoprotective agents in blood group antigen reactivity.

BACKGROUND: In the last few decades, various red blood cell (RBC) freezing techniques have been developed and improved to enable the preservation of erythrocytes for future use in pre-transfusion tests in reference immunohaematology laboratories. However, not all these techniques have been sufficiently evaluated for the preservation of blood group antigens. OBJECTIVES: In this study, we evaluated the antigenic pattern of RBCs preserved by droplet freezing in liquid nitrogen in a blood bank context. METHODS: Blood samples were evaluated for the reactivity of blood group antigens after droplet freezing using the non-permeable cryoprotective agent polyvinylpyrrolidone (PVP) and sucrose-dextrose (S + D) solutions. RESULTS: No qualitative changes were observed in RBC reactivity after freezing and thawing for the antigens Fyb , Leb , C, E, Cw , Lua , Lub , Kpa , Kpb and Dia . However, cryopreservation using PVP resulted in a significant increase in reactivity of Fyb antigen on comparing fresh and frozen samples (P < 0·001). CONCLUSION: The establishment of detailed protocols for cryopreservation of RBCs, which take into account the maintenance of antigenic characteristics, is necessary to increase security in pre-transfusion testing using frozen RBCs.

Determining the health-related quality of life in individuals with haemophilia in developing economies: results from the Brazilian population.

INTRODUCTION: Several studies show the negative impact of haemophilia in health-related quality of life (HRQOL). This issue is not well explored in developing countries. OBJECTIVES: This cross-sectional study aimed to evaluate the HRQOL and its associated factors in patients with haemophilia A/B in Brazil. Data were collected by questionnaire and in medical records, including a Portuguese version of Haem-A-Qol. RESULTS: Brazilian patients were invited to the study and 175 participants (147 haemophilics A and 28 haemophilics B) were included. The total score of the Haem-A-QoL had a median of 36.96 (range of 0-100), with worse performance in 'sport and leisure' and best on 'relationships' fields. HRQOL was worst among the older participants, the less educated, non-white, non-working, who were hospitalized in the last year, who did not have a single medical consultation and among those with the highest number of affected joints. Moreover, patients with hepatitis B had a significantly worse HRQOL in the domain 'sports and leisure', also observed in married patients. Otherwise, married individuals reported better HRQOL on 'dealing with the disease' domain. Patients with haemophilia B reported worse HRQOL in the domain 'self-perception'. CONCLUSION: The results obtained could be helpful in guidance of haemophilia treatment which is determinant to improve HRQoL of the most vulnerable groups of patients. This work also reinforced the relevance of joint bleeds in all aspects of HRQoL in haemophilic patients. The use of prophylactic factor concentrates and multidisciplinary treatments could contribute to improve the quality of life in haemophilia.

Avaliação da atividade angiogênica da solução aquosa do barbatimão (Stryphnodendron adstringens) / Angiogenic activity of the aqueous solution of Barbatimão (Stryphnodendron adstringens)

RESUMO O Barbatimão (Stryphnodendron adstringens) planta medicinal encontrada no bioma Cerrado apresenta propriedades físico-químicas que lhe garante importantes atividades farmacológicas tais como: anti-inflamatória, analgésica e uma atividade protetora da mucosa gástrica. A casca do tronco é a principal matéria-prima usada para o desenvolvimento de produtos medicinais. Neste estudo, o objetivo foi investigar a influência da solução aquosa da casca do barbatimão no processo de formação de vasos sanguíneos na membrana corioalontoide de ovo embrionado de galinha. Foram utilizadas 30g da casca triturada em um litro de água. Este processo permitiu a obtenção da Solução Aquosa de Barbatimão - SAB em uma concentração de 30mg/mL. A atividade angiogênica da solução aquosa do barbatimão foi avaliada mediante realização de testes laboratoriais “in vivo”, utilizando como modelo experimental a membrana do ovo embrionado de galinha (MCA). Utilizou-se como controle indutor o Regederm®, o qual apresenta atividade angiogênica conhecida. Os resultados demonstraram que a SAB apresentou um percentual de vascularização na MCA de (50.4%) não tendo diferença (p>0,05) aos valores detectados no controle indutor (52,9%). Com os resultados obtidos, percebe-se que o barbatimão apresenta atividade angiogênica no modelo experimental utilizado.

ABSTRACT The Barbatimão (Stryphnodendron adstringens) medicinal plant found in the Cerrado biome has physicochemical properties which guarantee important pharmacological activities such as anti-inflammatic, analgesic and protective activities of gastric mucosa. The bark of the trunk is the main raw material used for the development of medicinal products. In this study, the objective was to investigate the influence of the aqueous solution of barbatimão bark in the formation of blood vessels in the membrane of embryonated chicken egg corioalontoid. 30g of shredded bark was used in one liter of water. This process enabled the obtention of aqueous Barbatimão - BSA at a concentration of 30mg / ml. The angiogenic activity of the aqueous solution of barbatimão was assessed by laboratory testing “in vivo”, using the chorioallantoic membrane of embryonated chicken egg (MCA) as an experimental model. TheRegederm® controlinductor was used, which exhibits known angiogenic activity. The results showed that the percentage of BSA showed a vascularization of the MCA (50.4%) there was no difference (p> 0.05) in the values detected in the control inductor (52.9%). With the obtained results, it is clear that barbatimão shows angiogenic activity under the experimental model used.