Efectividad del programa de mantenimiento con opioides para el tratamiento de su dependencia, en prisión / Effectiveness of opioid maintenance programs for treating drug dependence in prisons

Objetivos: Evaluar la efectividad del programa de mantenimiento con opioides en el tratamiento de su dependencia en prisiones españolas. Material y método: Se realizó una revisión bibliográfica narrativa en las siguientes bases de datos: PubMed, Cochrane, IBECS, LILACS y HealthCare. Se eligieron preferentemente todos aquellos ensayos clínicos, así como artículos de revisión sistemática y algún artículo que se consideró relevante por su contenido. El periodo de tiempo se limitó entre enero de 2011 y noviembre de 2021. El idioma de búsqueda fue: inglés, español y catalán. Se rechazaron los artículos repetidos y los que no tuvieron relación con los objetivos. Los criterios de búsqueda fueron: methadone AND prisons; opiate substitution treatment AND prisons; methadone AND buprenorphine; methadone OR buprenorphine; prisons AND Methadone AND buprenorphine. Resultados: Fueron seleccionados 20 artículos de 647 consultados, tras la aplicación de los filtros correspondientes y tras descartar los artículos duplicados. Discusión: Se evidenció una ligera mayor efectividad de la buprenorfina frente a la metadona. Se destacó una elevada prevalencia del programa, así como variedad de efectos adversos de la metadona. Su utilidad sobre el comportamiento obtiene disparidad de opiniones. Se anuncia la posibilidad de nuevas alternativas de tratamiento con un mejor control farmacológico. (AU)

Objectives: To evaluate the effectiveness of opioid maintenance programs in treating opioid dependence in Spanish prisons. Material and method: A narrative bibliographic review was carried out on the following databases: PubMed; Cochrane; IBECS; LILACS; HealthCare. All clinical trials were chosen as a preference, along with systematic review articles and some articles that were considered relevant for their content. The time period was limited to between January 2011 and November 2021. The languages chosen were English, Spanish and Catalan. Repeated articles and those that were not related to the objectives were rejected. The search criteria were: “methadone AND prisons”; “opiate substitution treatment AND prisons”; “methadone AND buprenorphine”; “methadone OR buprenorphine”; “prisons AND Methadone AND buprenorphine”. Results: 20 articles were selected out of 647 items consulted after applying the corresponding filters and after discarding duplicates. Discussion: There was a slightly greater effectiveness of buprenorphine versus methadone. The high prevalence of the program was highlighted, as well as the variety of adverse effects of methadone. Usefulness with regard to inmates’ behavior showed a range of opinions. The possibility of new treatment alternatives with better pharmacological control is mentioned. (AU)

Intrinsic and environmental basis of aging: A narrative review.

Longevity has been a topic of interest since the beginnings of humanity, yet its aetiology and precise mechanisms remain to be elucidated. Aging is currently viewed as a physiological phenomenon characterized by the gradual degeneration of organic physiology and morphology due to the passage of time where both external and internal stimuli intervene. The influence of intrinsic factors, such as progressive telomere shortening, genome instability due to mutation buildup, the direct or indirect actions of age-related genes, and marked changes in epigenetic, metabolic, and mitochondrial patterns constitute a big part of its underlying endogenous mechanisms. On the other hand, several psychosocial and demographic factors, such as diet, physical activity, smoking, and drinking habits, may have an even more significant impact on shaping the aging process. Consequentially, implementing dietary and exercise patterns has been proposed as the most viable alternative strategy for attenuating the most typical degenerative aging changes, thus increasing the likelihood of prolonging lifespan and achieving successful aging.

Effectiveness of opioid maintenance programs for treating drug dependence in prisons.

OBJECTIVES: To evaluate the effectiveness of opioid maintenance programs in treating opioid dependence in Spanish prisons. MATERIAL AND METHOD: A narrative bibliographic review was carried out on the following databases: PubMed; Cochrane; IBECS; LILACS; HealthCare. All clinical trials were chosen as a preference, along with systematic review articles and some articles that were considered relevant for their content. The time period was limited to between January 2011 and November 2021. The languages chosen were English, Spanish and Catalan. Repeated articles and those that were not related to the objectives were rejected. The search criteria were: "methadone AND prisons"; "opiate substitution treatment AND prisons"; "methadone AND buprenorphine"; "methadone OR buprenorphine"; "prisons AND Methadone AND buprenorphine". RESULTS: 20 articles were selected out of 647 items consulted after applying the corresponding filters and after discarding duplicates. DISCUSSION: There was a slightly greater effectiveness of buprenorphine versus methadone. The high prevalence of the program was highlighted, as well as the variety of adverse effects of methadone. Usefulness with regard to inmates' behavior showed a range of opinions. The possibility of new treatment alternatives with better pharmacological control is mentioned.

Metabolic Reprogramming in Cancer Cells: Emerging Molecular Mechanisms and Novel Therapeutic Approaches.

The constant changes in cancer cell bioenergetics are widely known as metabolic reprogramming. Reprogramming is a process mediated by multiple factors, including oncogenes, growth factors, hypoxia-induced factors, and the loss of suppressor gene function, which support malignant transformation and tumor development in addition to cell heterogeneity. Consequently, this hallmark promotes resistance to conventional anti-tumor therapies by adapting to the drastic changes in the nutrient microenvironment that these therapies entail. Therefore, it represents a revolutionary landscape during cancer progression that could be useful for developing new and improved therapeutic strategies targeting alterations in cancer cell metabolism, such as the deregulated mTOR and PI3K pathways. Understanding the complex interactions of the underlying mechanisms of metabolic reprogramming during cancer initiation and progression is an active study field. Recently, novel approaches are being used to effectively battle and eliminate malignant cells. These include biguanides, mTOR inhibitors, glutaminase inhibition, and ion channels as drug targets. This review aims to provide a general overview of metabolic reprogramming, summarise recent progress in this field, and emphasize its use as an effective therapeutic target against cancer.

Advanced Glycation End Products: New Clinical and Molecular Perspectives.

Diabetes mellitus (DM) is considered one of the most massive epidemics of the twenty-first century due to its high mortality rates caused mainly due to its complications; therefore, the early identification of such complications becomes a race against time to establish a prompt diagnosis. The research of complications of DM over the years has allowed the development of numerous alternatives for diagnosis. Among these emerge the quantification of advanced glycation end products (AGEs) given their increased levels due to chronic hyperglycemia, while also being related to the induction of different stress-associated cellular responses and proinflammatory mechanisms involved in the progression of chronic complications of DM. Additionally, the investigation for more valuable and safe techniques has led to developing a newer, noninvasive, and effective tool, termed skin fluorescence (SAF). Hence, this study aimed to establish an update about the molecular mechanisms induced by AGEs during the evolution of chronic complications of DM and describe the newer measurement techniques available, highlighting SAF as a possible tool to measure the risk of developing DM chronic complications.

The YAP/TAZ Signaling Pathway in the Tumor Microenvironment and Carcinogenesis: Current Knowledge and Therapeutic Promises.

The yes-associated protein (YAP) and the transcriptional coactivator with PDZ-binding motif (TAZ) are transcriptional coactivators, members of the Hippo signaling pathway, which play a critical role in cell growth regulation, embryonic development, regeneration, proliferation, and cancer origin and progression. The mechanism involves the nuclear binding of the un-phosphorylated YAP/TAZ complex to release the transcriptional enhanced associate domain (TEAD) from its repressors. The active ternary complex is responsible for the aforementioned biological effects. Overexpression of YAP/TAZ has been reported in cancer stem cells and tumor resistance. The resistance involves chemotherapy, targeted therapy, and immunotherapy. This review provides an overview of YAP/TAZ pathways' role in carcinogenesis and tumor microenvironment. Potential therapeutic alternatives are also discussed.

Microbiota and Diabetes Mellitus: Role of Lipid Mediators.

Diabetes Mellitus (DM) is an inflammatory clinical entity with different mechanisms involved in its physiopathology. Among these, the dysfunction of the gut microbiota stands out. Currently, it is understood that lipid products derived from the gut microbiota are capable of interacting with cells from the immune system and have an immunomodulatory effect. In the presence of dysbiosis, the concentration of lipopolysaccharides (LPS) increases, favoring damage to the intestinal barrier. Furthermore, a pro-inflammatory environment prevails, and a state of insulin resistance and hyperglycemia is present. Conversely, during eubiosis, the production of short-chain fatty acids (SCFA) is fundamental for the maintenance of the integrity of the intestinal barrier as well as for immunogenic tolerance and appetite/satiety perception, leading to a protective effect. Additionally, it has been demonstrated that alterations or dysregulation of the gut microbiota can be reversed by modifying the eating habits of the patients or with the administration of prebiotics, probiotics, and symbiotics. Similarly, different studies have demonstrated that drugs like Metformin are capable of modifying the composition of the gut microbiota, promoting changes in the biosynthesis of LPS, and the metabolism of SCFA.

From "Coordinated" to "Integrated" Residency Training: Evaluating Changes and the Current State of Plastic Surgery Programs.

BACKGROUND: Since the inception of the integrated model, educational leaders have predicted its ongoing evolution, as the optimal plastic surgery curriculum remains a source of debate. With the now complete elimination of the "coordinated" pathway, the total number of integrated programs has arguably reached a plateau. Accordingly, this study examines the current state of training in integrated residencies and reevaluates the variability in the first 3 years of training observed previously. METHODS: Program information was obtained for all 68 integrated plastic surgery programs, and rotation schedules were available for 59. Plastic, general, and subspecialty surgery exposures were quantified and compared. Inclusion of rotations "strongly suggested" by the Residency Review Committee was also examined. RESULTS: Plastic surgery exposure ranged from 3.5 to 25 months (mean, 13.9 ± 5.4 months). General surgery ranged from 5 to 22.5 months (mean, 12.8 ± 4.7 months). Subspecialty rotations ranged from 0 to 8 months (mean, 3.6 ± 1.8 months). There was no difference in mean plastic surgery exposure between programs based within departments versus divisions (15.4 months versus 13.3 months; p = 0.184). There remained significant variability in the inclusion of 18 non-plastic surgery rotations, including the "strongly suggested" rotations. CONCLUSIONS: Plastic surgery exposure remains highly variable with a greater than 7-fold difference between programs. This suggests that programs are still sorting out the ideal curriculum. However, there is an overall trend toward earlier and increased plastic surgery exposure, which now exceeds the average time spent on general surgery rotations.

Resultados de la encuesta nacional sobre cuidados perioperatorios en cirugía resectiva gástrica / Results of a national survey about perioperative care in gastric resection surgery

INTRODUCCIÓN: Las medidas de rehabilitación multimodal en cirugía abdominal se están instaurando progresivamente. El objetivo del estudio es evaluar la aplicación de diferentes cuidados perioperatorios en la cirugía gástrica por parte de los cirujanos españoles. MÉTODOS: Estudio descriptivo de 162 encuestas contestadas desde septiembre a diciembre de 2017 acerca del manejo y cuidados perioperatorios en cirugía de resección gástrica no bariátrica. RESULTADOS: Las profilaxis antibiótica y antitrombótica son empleadas siempre por el 96,9 y 99,4%, respectivamente. El tiempo de ayuno para líquidos es mayor de 6 horas para el 62,7%, empleando solo bebidas con sobrecarga de hidratos de carbono prequirúrgicamente el 3%. Tan solo el 32,4 y el 13,3% de las gastrectomías subtotales y totales son realizadas laparoscópicamente. El 56,8% emplea analgesia epidural y los drenajes son colocados siempre por un 53,8% en la gastrectomía total. La sonda nasogástrica es empleada selectivamente por el 34,6% y siempre por el 11,3%. La retirada del catéter vesical es realizada durante las primeras 48 horas por el 77,2%. En las primeras 24 horas postoperatorias, menos del 20% indica la ingesta oral y un 15,4% moviliza a sus pacientes, comenzando la deambulación a partir de las 24 horas el 49,3%. El 30,4% emplea una vía clínica para el cuidado de estos pacientes y solo un 15,2% utiliza un protocolo de recuperación intensificada. CONCLUSIONES: La aplicación de medidas de rehabilitación multimodal en la cirugía de resección gástrica no bariátrica se encuentra poco extendida en nuestro país

INTRODUCTION: Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. METHODS: A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. RESULTS: Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6 hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48 hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24 hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. CONCLUSIONS: The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country

Results of a national survey about perioperative care in gastric resection surgery. / Resultados de la encuesta nacional sobre cuidados perioperatorios en cirugía resectiva gástrica.

INTRODUCTION: Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. METHODS: A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. RESULTS: Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. CONCLUSIONS: The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country.

Cigarette smoking and metabolic syndrome components: a cross-sectional study from Maracaibo City, Venezuela.

Background: A growing body of evidence suggests that cigarette smoking can cause the onset of metabolic syndrome prior to cardiovascular diseases. Therefore, the objective of this study was to evaluate the relationship between smoking habit and metabolic syndrome components in an adult population from Maracaibo city, Venezuela. Methods: The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multi-stage sampling. In this sub-study, 2212 adults from both genders were selected. On the basis of their medical background, they were classified as smokers, non-smokers and former smokers. Metabolic syndrome was defined according to Harmonizing 2009 criteria, using population-specific abdominal circumference cut-off points. The association between risk factors was evaluated using a logistic regression model. Results: In the studied population, 14.8% were smokers, 15.4% were former smokers. In the multivariate analysis, the presence of metabolic syndrome (smokers: OR, 1.54; 95% CI, 1.11-2.14; p=0.010) and its components were related to cigarette smoking, with the exception of hyperglycemia. High blood pressure was inversely associated with current smoking status (smokers: OR, 0.70 (0.51-0.95); p=0.025). Conclusion: Cigarette smoking represents a related factor with metabolic syndrome, being associated with low high-density lipoprotein-cholesterol, increased abdominal circumference and elevated triacylglyceride levels. Former smokers did not present a greater risk for developing this metabolic disease when compared to non-smokers. The effect of avoiding this habit should be evaluated in future studies in our population.

Optimal cutoff for the evaluation of insulin resistance through triglyceride-glucose index: A cross-sectional study in a Venezuelan population.

Background: Insulin resistance (IR) evaluation is a fundamental goal in clinical and epidemiological research. However, the most widely used methods are difficult to apply to populations with low incomes. The triglyceride-glucose index (TGI) emerges as an alternative to use in daily clinical practice. Therefore the objective of this study was to determine an optimal cutoff point for the TGI in an adult population from Maracaibo, Venezuela. Methods: This is a sub-study of Maracaibo City Metabolic Syndrome Prevalence Study, a descriptive, cross-sectional study with random and multi-stage sampling. For this analysis, 2004 individuals of both genders ≥18 years old with basal insulin determination and triglycerides < 500 mg/dl were evaluated.. A reference population was selected according to clinical and metabolic criteria to plot ROC Curves specific for gender and age groups to determine the optimal cutoff point according to sensitivity and specificity.The TGI was calculated according to the equation: ln [Fasting triglyceride (mg / dl) x Fasting glucose (mg / dl)] / 2. Results: The TGI in the general population was 4.6±0.3 (male: 4.66±0.34 vs. female: 4.56±0.33, p=8.93x10 -10). The optimal cutoff point was 4.49, with a sensitivity of 82.6% and specificity of 82.1% (AUC=0.889, 95% CI: 0.854-0.924). There were no significant differences in the predictive capacity of the index when evaluated according to gender and age groups. Those individuals with TGI≥4.5 had higher HOMA2-IR averages than those with TGI <4.5 (2.48 vs 1.74, respectively, p<0.001). Conclusions: The TGI is a measure of interest to identify IR in the general population. We propose a single cutoff point of 4.5 to classify individuals with IR. Future studies should evaluate the predictive capacity of this index to determine atypical metabolic phenotypes, type 2 diabetes mellitus and even cardiovascular risk in our population.

Prevalencia de hipertensión arterial en alumnos de 4° básico a 1° medio en un colegio de Santiago (Chile) / Prevalence of hypertension in students of 4th grade to 9th grade in a school in Santiago (Chile)

Objetivo: Determinar el comportamiento de la presión arterial en niños de 9 a 16 años y comprobar si existe asociación entre la presencia de HTA con diversos factores considerados como posibles riesgos por la literatura. Material y método: Estudio de tipo no experimental, exploratorio, descriptivo y transversal. La muestra estuvo constituida por 109 alumnos de ambos sexos. La variable "presión arterial" se obtuvo mediante la técnica estandarizada de medición de presión arterial del Ministerio de Salud de Chile en dos ocasiones. Resultados: Se observaron alteraciones de la presión arterial en el 19,6 % del total con una cantidad de cuatro niños hipertensos, equivalente al 3,6 %. Discusión y conclusiones: No se encontró asociación entre los factores de riesgo estudiados y la HTA; lo anterior podría atribuirse a que probablemente estos factores actúan a largo plazo. Los datos sobre colesterol fueron obtenidos mediante una ficha encuesta, no por medio de exámenes de laboratorio, ya que la muestra obtenida fue pequeña. La presencia y riesgo de HTA en niños revela una debilidad en la pesquisa de esta y sugiere la necesidad de implementar normas para la obligatoriedad de la medición de presión arterial en el control de niño sano.

Objective: High Blood Pressure (BP) is one of the principal cardiovascular risks. Nevertheless, it is not included in the physical examination of people younger than 15 years old, which does not allow high BP early detection. The aim of the study is to determine the presence of elevated arterial blood pressure in children's from 9 to 16 years old, and to verify if there exists an association with risk factors considered by literature. Materials and methods: Non-experimental, exploratory, descriptive and transversal study. The sample consisted of 109 children of both sexes. The arterial pressure was obtained through the standardized measurement of arterial blood pressure of the Chilean ministry of health in two occasions. Results: Alterations of the arterial blood pressure were detected in 19,6% of the children, with 4 children's presenting high BP, equivalent to 3,6%. Discussion and conclusions: There was no association between the studied risk factors and the high BP. This might be attributed to the fact that the studied factors operate in the long term, cholesterol data were obtained through a survey, not through laboratory tests and the obtained sample was small. The presence and risk of high BP in children reveal a weakness in its screening and suggest including measurement of arterial blood pressure as an obligation in children's health controls.

Convivendo com HIV/AIDS: percepções de idosos de um ambulatório público na região sul do Brasil / Living with HIV / AIDS: perceptions of elderly people in a public clinic in southern Brazil

Esta dissertação apresenta o projeto de pesquisa que visa compreender como os idosos vivenciam sua soropositividade e qual o significado do HIV/aids no cotidiano desses. Busca investigar o impacto do diagnóstico do HIV/aids na vida dos idosos; conhecer as mudanças ocorridas em suas vidas após o conhecimento de sua enfermidade e identificar possíveis dificuldades no relacionamento familiar e social a partir do diagnóstico da sua soropositividade(AU)

Convivendo com HIV/AIDS: percepções de idosos de um ambulatório público na região sul do Brasil

Esta dissertação apresenta o projeto de pesquisa que visa compreender como os idosos vivenciam sua soropositividade e qual o significado do HIV/aids no cotidiano desses. Busca investigar o impacto do diagnóstico do HIV/aids na vida dos idosos; conhecer as mudanças ocorridas em suas vidas após o conhecimento de sua enfermidade e identificar possíveis dificuldades no relacionamento familiar e social a partir do diagnóstico da sua soropositividade.

Physico-chemical characterization of steel slag. Study of its behavior under simulated environmental conditions.

The chemical and mineralogical composition of steel slag produced in two ArcelorMittal steel plants located in the North of Spain, as well as the study of the influence of simulated environmental conditions on the properties of the slag stored in disposal areas, was carried out by elemental chemical analysis, XRF, X-ray diffraction, thermal analysis, and scanning electron microscopy with EDS analyzer. Spectroscopic characterization of the slag was also performed by using FTIR spectroscopy. Due to the potential uses of the slag as low cost adsorbent for water treatment and pollutants removal, its detailed textural characterization was carried out by nitrogen adsorption-desorption at 77 K and mercury intrusion porosimetry. The results show that the slag is a crystalline heterogeneous material whose main components are iron oxides, calcium (magnesium) compounds (hydroxide, oxide, silicates, and carbonate), elemental iron, and quartz. The slags are porous materials with specific surface area of 11 m(2)g(-1), containing both mesopores and macropores. Slag exposure to simulated environmental conditions lead to the formation of carbonate phases. Carbonation reduces the leaching of alkaline earth elements as well as the release of the harmful trace elements Cr (VI) and V. Steel slags with high contents of portlandite and calcium silicates are potential raw materials for CO(2) long-term storage.

Humanização do cuidador de enfermagem na Unidade de Cuidados Intermediários Adulta do Hospital Fêmina

O presente projeto de pesquisa foi elaborado com o objetivo de atender a uma solicitação do Curso de Especialização em Informação Científica e Tecnológica em Saúde, do Grupo Hospitalar Conceição em parceria com a Fundação Oswaldo Cruz (FIOCRUZ). Durante a minha experiência profissional, tive a oportunidade de trabalhar em uma unidade de cuidados intermediários (UCI) e ao decorrer do tempo fui observando as características desse setor e a realidade vivida pelos profissionais da enfermagem.Através dessa vivência, pude conhecer os trabalhadores de enfermagem e observar que estes acabavam, em determinados momentos, enfrentando dificuldades em relação ao estresse gerado pelo ambiente de trabalho.Ao presenciar essas experiências senti a necessidade de entender como humanizar o profissional para poder ajudá-lo a lidar com suas angústias e anseios frente ao estresse de trabalho e, também, poder proporcionar um ambiente mais adequado para as relações interpessoais e assim, facilitar o desenvolvimento de suas atividades e como conseqüência gerar um atendimento de melhor qualidade para o paciente. Desta maneira, a instituição de saúde poderá ser beneficiada com profissionais satisfeitos e desempenhando suas funções de acordo com os princípios do Sistema Único de Saúde (SUS). Com o intuito de identificar fatores que geram estresse no ambiente de trabalho do cuidador de UCI e desta forma poder colaborar para obtermos uma humanização desse profissional, decidi realizar meu projeto de pesquisa com trabalhadores de enfermagem que prestam cuidados intermediários e intensivos na UCI .