A systematic review on cannabinoids for neuropathic pain administered by routes other than oral or inhalation

12 páginasThe use of cannabis and cannabinoid products for the treatment of neuropathic pain is a growing area of research. This type of pain has a high prevalence, limited response to available therapies and high social and economic costs. Systemic cannabinoid-based therapies have shown some unwanted side effects. Alternative routes of administration in the treatment of neuropathic pain may provide better acceptance for the treatment of multiple pathologies associated with neuropathic pain. To examine the efficacy, tolerability, and safety of cannabinoids (individualized formulations, phytocannabinoids, and synthetics) administered by routes other than oral or inhalation compared to placebo and/or conventional medications in the management of neuropathic pain. This systematic review of the literature reveals a lack of clinical research investigating cannabis by routes other than oral and inhalation as a potential treatment for neuropathic pain and highlights the need for further investigation with well-designed clinical trials. There is a significant lack of evidence indicating that cannabinoids administered by routes other than oral or inhaled may be an effective alternative, with better tolerance and safety in the treatment of neuropathic pain. Higher quality, long-term, randomized controlled trials are needed to examine whether cannabinoids administered by routes other than inhalation and oral routes may have a role in the treatment of neuropathic pain.Especialización en Farmacología ClínicaEspecialista en Farmacología Clínic

Escalas de calidad de vida y valoración de los síntomas en disfagia

La disfagia es un síntoma que tiene repercusiones en la calidad de vida de cualquier individuo que la padezca. Asimismo puede asociarse a varias complicaciones respiratorias y nutricionales que van a impactar en los diferentes ámbitos psicosociales. Por esta razón se han establecido parámetros para evaluar la calidad de vida de los pacientes con este diagnóstico. Por otro lado es importante reconocer los síntomas que caracterizan la disfagia para que ésta sea detectada de manera oportuna por el personal de salud. Es por ello que también se han desarrollado escalas para este fin. Las escalas de calidad de vida y de evaluación de síntomas son instrumentos de evaluación importantes porque proporcionan información valiosa al médico tratante acerca de la percepción del estado de salud actual del paciente, los síntomas clave y los efectos de la intervención terapéutica. En este trabajo se describen las características y propiedades psicométricas de los instrumentos existentes para la evaluación de la calidad de vida y la valoración de los síntomas de los pacientes con disfagia

Frecuencia de visitas al departamento de emergencias y hospitalizaciones debido a exacerbaciones de la enfermedad pulmonar obstructiva crónica en pacientes incluidos en dos modelos de atención

Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) have a huge impact on lung function, quality of life and mortality of patients. Emergency Department visits and hospitalizations due to exacerbations cause a significant economic burden on the health system.Objective: To describe the differences in the number of emergency visits and hospitalizations due to exacerbations of COPD among patients included in two models of care of the same institution.Materials and methods: A historical cohort study in which COPD patients who are users of two models of care were included: COPD integrated care program (CICP) and general consultation of pulmonology (GCP). The first model, unlike the second one, offers additional educational activities, 24/7 telephone service, and priority consultations. The number of emergency visits and hospitalizations due to COPD exacerbations in patients who had completed at least one year of follow-up was evaluated. The multivariable Poisson regression model was used for calculating the incidence rate (IR) and the incidence rate ratio (IRR) with an adjustment for confounding factors.Results: We included 316 COPD patients (166 from the CICP and 150 from the GCP). During the year of follow-up, the CICP patients had 50% fewer emergency visits and hospitalizations than patients from the GCP (IRR=0.50, 95%CI: 0.29-0.87, p=0.014). Conclusions: COPD patients in the CICP had fewer emergency visits and hospitalizations due to exacerbations. Prospective clinical studies are required to confirm the results and to evaluate the factors that contribute to the differences.Introducción. Las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) tienen un gran impacto en la función pulmonar, la calidad de vida y la mortalidad de los pacientes. Las visitas al Departamento de Emergencias y las hospitalizaciones debido a las exacerbaciones, causan una carga económica importante para el sistema de salud.Objetivo. Describir las diferencias en el número de visitas de emergencia y hospitalizaciones debidas a exacerbaciones de la EPOC, entre los pacientes incluidos en dos modelos de atención de la misma institución. Materiales y métodos. Se trata de un estudio de cohorte histórica en el que se incluyeron pacientes que son usuarios de dos modelos de atención: el programa de atención integrada de la EPOC (CICP) y la consulta general de neumología (PCG). El primer modelo, a diferencia del segundo, ofrece actividades educativas adicionales, servicio telefónico las 24 horas del día y consultas prioritarias. Se evaluó el número de visitas de emergencia y hospitalizaciones debido a exacerbaciones de la EPOC en pacientes que habían completado, al menos, un año de seguimiento. Se utilizó el modelo de regresión multivariable de Poisson para calcular la tasa de incidencia (IR) y la razón de tasas de incidencia (IRR), con un ajuste para factores de confusión. Resultados. Se incluyeron 316 pacientes con EPOC, 166 del CICP y 150 de la PCG. Durante el año de seguimiento, los pacientes en el CICP tuvieron 50 % menos visitas de emergencia y hospitalizaciones que los pacientes en la PCG (IRR=0,50; IC95% 0,29-0,87; p=0,014). Conclusiones. Los pacientes con EPOC en el CICP, tuvieron menos visitas de emergencia y hospitalizaciones debido a las exacerbaciones. Se requieren estudios clínicos prospectivos para confirmar los resultados y evaluar los factores que contribuyen a las diferencias

Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies: a multicenter study in 21 Spanish pulmonology services

Background: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist’s perception of its quality has not been evaluated. Methods: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of cen‑ tral tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. Results: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfed in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores>70/100 from the frst procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score

Bronchoscopist's perception of the quality of the single-use bronchoscope (Ambu aScope4™) in selected bronchoscopies : a multicenter study in 21 Spanish pulmonology services

Background: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. Methods: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. Results: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. Conclusions: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images

Morte, eutánasia e cuidados paliativos

The human person has, whether in act or potency, has intelligence to perform abstract operations; a will which can love, and freedom to determinate what to do or not to (or not to do at all). These characteristics, inherent to human person’s being, are derived of the substantial unity of spiritual soul and body, and they bestow human beings with a special dignity, which must be reflected in the way each one assumes his or her own existence, and how he/she is treated and respected by others.Indeed, the human person’s dignity confers personal rights and duties, among which is found, in a preeminent place, the unconditioned respect to every innocent human life (one’s one as well as others’). Therefore, the human being’s death and its surrounding period demand profound respect and to be treated according to such dignity, which allows every one to face this step with a maximum of decorum and integrity.While euthanasia represents a manner of facing death which disclaims human life’s inviolability and, hence, attempts against the human person’s dignity, on the other hand, palliative care counts nowadays with very efficacious tools to alleviate suffering and to attend human beings in this crucial step of life in consonance with the dignity of which they are endowed.La persona humana posee, en potencia o en acto, una inteligencia capaz de realizar operaciones abstractas; una voluntad capaz de amar el bien, y una libertad que le permite determinar su manera de obrar (o de no obrar). Estas características, inherentes al ser de la persona humana, se derivan de la unidad sustancial que existe entre el alma espiritual y el cuerpo, y la dotan de una dignidad especial que debe reflejarse en la forma como afronta toda su existencia, y como es tratada y respetada por los demás.En efecto, la dignidad de la persona humana le confiere unos derechos y deberes entre los cuales se encuentra, de manera primordial, el respeto incondicionado a la vida humana inocente (tanto propia como ajena). Por este motivo, la muerte del ser humano y el periodo próximo a la misma requieren de un profundo respeto y de un tratamiento acorde con esa dignidad, que le permitan afrontar esta etapa con el máximo decoro e integridad.Mientras que la eutanasia representa una manera de afrontar la muerte que desconoce la inviolabilidad de la vida humana y, por tanto, atenta contra la dignidad de la persona, los cuidados paliativos hoy día cuentan con herramientas muy eficaces para aliviar el sufrimiento y acompañar al ser humano en esta crucial etapa de la vida en consonancia con la dignidad de la que está revestido.A pessoa humana tem, em pessoa ou em ato, uma inteligência capaz de realizar operações abstratas, uma vontade capaz de amar o bem e uma liberdade que lhe permite definir seu modo de atuar (ou de não atuar). Estas características, inerentes ao ser da pessoa humana, derivam-se da unidade substancial entre a alma espiritual e o corpo, e lhe conferem uma dignidade especial que deve refletirse em como afronta sua existência e como é tratada e respeitada pelos demais. De fato, a dignidade da pessoa humana lhe confere direitos e deveres como o respeito incondicionado da vida humana inocente (própria e alheia). Portanto, a morte do ser humano e o período cercão a esta exigem um grande respeito e um tratamento acorde com essa dignidade, que lhe permitam enfrentar esta etapa com grande decoro e integridade.Enquanto a eutanásia representa um modo de enfrentar a morte, o que desconhece a inviolabilidade da vida humana, e, portanto atenta contra a dignidade da pessoa, os cuidados paliativos atuais contam com ferramentas muito eficazes para aliviar o sofrimento e acompanhar o ser humano nesta crucial etapa da vida em consonância com a dignidade da que é revestido

Cheyne-Stokes respiration and severe bruxism documented by polysommography that improves with administration of oxygen at 1L/min

5 páginasSe presenta el caso de una mujer de 59 años con diagnóstico de encefalopatía anoxicoisquémica, quien se encuentra en estado vegetativo persistente y epilepsia secundaria de difícil control, quien en el transcurso de su evolución clínica desarrolla apnea central del sueño con índice de apnea hipopnea (IAH) de 87.86/h con patrón de respiración de Cheyne-Stokes (RCS) y bruxismo severo documentado mediante polisomnografía, alteraciones que mejoraron tras la administración de oxígeno por cánula nasal a 1 L/min

Antecedentes de la ecosofía

Abstract It describes the processes through which two types of rationality in the Social Sciences, a pre-environmental rationality that conceives society, in the words of Augusto Ángel Maya as "an entelechy without roots in the environment"; and an environmental rationality that makes it possible to find the background of an ethical position called ecosophy, from an "environmental dimension" that opens a different historical perspective, based on the relationship between forms of social organization and the transformation of ecosystems. This is possible through the realization of a historical journey as a fundamental element to find anchoring points that enable environmental analysis, using as tool the hermeneutical method. Reference is made to the background that has constituted the new discipline of ecosophy in the second half of the 20th century, starting from a new way of relating to the environment, a new philosophy of life, in response to the break in the planetary order with respect to an anthropocentric position, due to the environmental crisis caused by the human being. This new philosophy of life is shared by many authors such as Augusto Ángel Maya, Arne Naess, Aldo Leopold, Sheila Collins, Edgar Morín, among others who have understood that the relationship between man and nature must be more harmonious and they have been busy reflecting on the respect, proposing new forms of more integral relationship, as a mechanism to overcome the global environmental crisis.Resumo Ele descreve os processos através dos quais dois tipos de racionalidade nas Ciências Sociais, uma racionalidade pré-ambiental que concebe a sociedade, nas palavras de Augusto Ángel Maya como "uma entelequia sem raízes no meio ambiente"; e uma racionalidade ambiental que permite encontrar o contexto de uma posição ética chamada ecosofia, de uma "dimensão ambiental" que abre uma perspectiva histórica diferente, baseada na relação entre as formas de organização social e a transformação dos ecossistemas. Isto é possível através da realização de uma jornada histórica como elemento fundamental para encontrar pontos de ancoragem que permitem a análise ambiental, utilizando como o método hermenêutico. Refere-se ao fundo que constituiu a nova disciplina da ecosofia na segunda metade do século XX, a partir de uma nova maneira de se relacionar com o meio ambiente, uma nova filosofia de vida, em resposta à quebra da ordem planetária em relação a uma posição antropocêntrica, devido à crise ambiental causada pelo ser humano. Esta nova filosofia de vida é compartilhada por muitos autores, como Augusto Ángel Maya, Arne Naess, Aldo Leopold, Sheila Collins, Edgar Morín, entre outros que entenderam que a relação entre homem e natureza deve ser mais harmoniosa e tem estado ocupada refletindo sobre a respeito, propondo novas formas de relacionamento mais integral, como mecanismo para superar a crise ambiental global.Resumen Se describen los procesos a través de los cuales transcurren dos tipos de racionalidad en las ciencias sociales: una racionalidad pre-ambiental que concibe la sociedad, en palabras de Augusto Ángel Maya, como “una entelequia sin raíces en el entorno”, y una racionalidad ambiental que posibilita encontrar los antecedentes de una posición ética llamada ecosofía, a partir de la “dimensión ambiental” que abre una perspectiva histórica diferente, con base en la relación entre las formas de organización social y la transformación de los ecosistemas. Esto es posible a través de un recorrido histórico fundamental para encontrar puntos de anclaje que permitan el análisis ambiental, utilizando como herramienta el método hermenéutico. Se hace referencia a los antecedentes que han constituido la nueva disciplina de la ecosofía en la segunda mitad del siglo XX, partiendo de una nueva forma de relacionarse con el medio, una nueva filosofía de vida, en respuesta al quiebre en el orden planetario respecto a una postura antropocéntrica, debido a la crisis ambiental provocada por el ser humano. Esta nueva filosofía de vida es compartida por muchos autores como el mismo Augusto Ángel Maya, Arne Naess, Aldo Leopold, Sheila Collins, Edgar Morín, entre otros quienes han comprendido que la relación hombre-naturaleza debe ser más armónica, y se han ocupado de reflexionar al respecto, planteando nuevas formas de relación más integrales, como mecanismo para superar la crisis ambiental mundial

Bronquiolitis respiratoria y neumonía descamativa asociada a fungemia por trichosporon asahii en inmunocompetente

Trichosporon asahii es un hongo patógeno emergente reportado en la literatura médica principalmente en pacientes inmunocomprometidos. No obstante, el presente caso es inusual debido a que se trata de un paciente adulto joven inmunocompetente que presentó fungemia por T. asahii y al mismo tiempo desarrolló insuficiencia respiratoria aguda por bronquiolitis respiratoria y neumonía descamativa, la cual resolvió posterior al tratamiento antimicótico instaurado, soporte ventilatorio y vigilancia en Unidad de Cuidado Intesivo (UCI