Combinar fàrmacs antiemètics amb analgèsics no sempre és favorable

Un equip de recerca de l'Hospital del Mar recomana no coadministrar alguns fàrmacs antiemètics, l'ondasetron i droperidol, que preveuen les nàusees i els vòmits postoperatoris, amb tramadol, donat que interfereixen en l'efectivitat analgèsica d'aquest últim. Per evitar aquesta interacció farmacològica negativa es recomana l'administració d'un altre antiemètic, la dexametasona, que sí ha donat bons resultats en pacients en període postoperatori, a més de potenciar el tractament analgèsic del dolor. Aquest estudi ha sorgit com a resposta a un recent editorial de la Societat Americana d'Anestèsia Ambulatòria (SAMBA), que proposa realitzar profilaxi antiemètica a tots els pacients sotmesos a anestèsia general, argumentant que són fàrmacs inofensius i que el seu preu és actualment raonable

Digital co-construction of relational values : understanding the role of social media for sustainability

Unidad de excelencia María de Maeztu MdM-2015-0552There is a deeply relational aspect to the systems people employ for sorting through and prioritizing plural values assigned to social-ecological interactions. Spurred by interpersonal relationships and adhesion to societal core values, such as justice and reciprocity, relational values go beyond instrumental and intrinsic approaches to understanding human behaviour vis-à-vis the environment. Currently, this relational dimension of values is entering the spotlight of the cultural ecosystem services (CES) literature focusing on non-material benefits and values people derive from ecosystems, such as aesthetics and sense of place. Relational values foster reflections on appropriateness and morality of preferences and respective behaviours in contributing to collective flourishment across space and time, holding implications for social-ecological justice and sustainability. Recently, several studies explored the potential of using social media data for assessing values ascribed to CES, but did not look at how this emerging approach could contribute to an enhanced understanding of relational values. In order to take up this goal, we conducted a systematic review, screening 140 publications and selecting 29 as relevant for exploring the extent to which relational CES values are inferable through social media. Our results show that social media data can reveal CES values' plural and relational dimension. Social media platforms, thus, can be understood as new arenas for the co-construction of values, where relational values stemming from social-ecological interactions are negotiated and defined. Yet, work on their implications for social-ecological justice and sustainability needs to be extended

Novetats en el diagnòstic de lesions tumorals al pulmó

S'ha publicat un estudi sobre l'ús d'una nova tecnologia mínimament invasiva en el diagnòstic de lesions tumorals al pulmó, l'ultrasonografia endobronquial (USEB), que consisteix en una minisonda ecogràfica que s'introdueix pel canal de treball del broncofibroscopi i pot accedir a les ramificacions bronquials per localitzar una lesió tumoral. Els resultats mostren que el rendiment diagnòstic d'utilitzar conjuntament aquest procediment i la fluoroscòpia (radiologia) és més elevat que l'ús de la fluoroscòpia únicament.Se ha publicado un estudio sobre el uso de una nueva tecnología mínimamente invasiva en el diagnóstico de lesiones tumorales en el pulmón, la ultrasonografía endobronquial (USEB), que consiste en una minisonda ecográfica que se introduce por el canal de trabajo del fibrobroncoscopio y puede acceder a las ramificaciones bronquiales para localizar una lesión tumoral. Los resultados muestran que el rendimiento diagnóstico de utilizar conjuntamente este procedimiento y la fluoroscopia (radiología) es más elevado que el uso de la fluoroscopia únicamente

Salivary Secretory Disorders, Inducing Drugs, and Clinical Management

Background: Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. Aim: To review the salivary secretory disorders, inducing drugs and their clinical management. Methods: In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. Results: Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. Conclusion: At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions

Psychometric properties of the Spanish version of the Psychopathy Checklist: Youth Version

Acord transformatiu CRUE-CSICThe current study examined the psychometric properties (factor structure, reliability and validity) of the Psychopathy Checklist: Youth Version (PCL:YV; Forth et al., 2003) in Spanish samples of male justice-involved youths between 15 and 22-years old. The PCL:YV was administered to two groups of youths who were incarcerated (n = 62; n = 95) and a sample of youth on probation (n = 122). Confirmatory factor analyses showed acceptable-to-good fit for three- and four-factor models. The four-factor hierarchical model with a second-order higher factor representing the whole psychopathy construct was considered for further analyses. PCL:YV scores showed high internal consistency and inter-rater reliability. Low-to-moderate convergence with other measures of psychopathic traits evinced an adequate convergent validity. Convergent and discriminant validity of the PCL:YV total scores were also confirmed considering several measures of psychopathology and personality traits. Importantly, the differential external correlates of the PCL:YV factors provide support for a multidimensional conceptualization of the psychopathy construct. Altogether, these results reveal adequate psychometric properties of the PCL:YV in Spanish population of justice-involved youths and justifies its use to assess psychopathic traits in this kind of populations

The Roses Ocean and Human Health Chair: A New Way to Engage the Public in Oceans and Human Health Challenges

Involving and engaging stakeholders is crucial for studying and managing the complex interactions between marine ecosystems and human health and wellbeing. The Oceans and Human Health Chair was founded in the town of Roses (Catalonia, Spain, NW Mediterranean) in 2018, the fruit of a regional partnership between various stakeholders, and for the purpose of leading the way to better health and wellbeing through ocean research and conservation. The Chair is located in an area of the Mediterranean with a notable fishing, tourist, and seafaring tradition and is close to a marine reserve, providing the opportunity to observe diverse environmental conditions and coastal and maritime activities. The Chair is a case study demonstrating that local, collaborative, transdisciplinary, trans-sector, and bottom-up approaches offer tremendous opportunities for engaging coastal communities to help support long-lasting solutions that benefit everyone, and especially those living by the sea or making their living from the goods and services provided by the sea. Furthermore, the Chair has successfully integrated most of its experts in oceans and human health from the most prestigious institutions in Catalonia. The Chair focuses on three main topics identified by local stakeholders: Fish and Health; Leisure, Health, and Wellbeing; and Medicines from the Sea. Led by stakeholder engagement, the Chair can serve as a novel approach within the oceans and human health field of study to tackle a variety of environmental and public health challenges related to both communicable and non-communicable diseases, within the context of sociocultural issues. Drawing on the example provided by the Chair, four principles are established to encourage improved participatory processes in the oceans and human health field: bottom-up, "think local", transdisciplinary and trans-sectorial, and "balance the many voices"

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Neurogenetics of Dynamic Connectivity Patterns Associated With Obsessive-Compulsive Symptoms in Healthy Children

Obsessive-compulsive symptoms (OCSs) during childhood predispose to obsessive-compulsive disorder and have been associated with changes in brain circuits altered in obsessive-compulsive disorder samples. OCSs may arise from disturbed glutamatergic neurotransmission, impairing cognitive oscillations and promoting overstable functional states. A total of 227 healthy children completed the Obsessive Compulsive Inventory-Child Version and underwent a resting-state functional magnetic resonance imaging examination. Genome-wide data were obtained from 149 of them. We used a graph theory-based approach and characterized associations between OCSs and dynamic functional connectivity (dFC). dFC evaluates fluctuations over time in FC between brain regions, which allows characterizing regions with stable connectivity patterns (attractors). We then compared the spatial similarity between OCS-dFC correlation maps and mappings of genetic expression across brain regions to identify genes potentially associated with connectivity changes. In post hoc analyses, we investigated which specific single nucleotide polymorphisms of these genes moderated the association between OCSs and patterns of dFC. OCSs correlated with decreased attractor properties in the left ventral putamen and increased attractor properties in (pre)motor areas and the left hippocampus. At the specific symptom level, increased attractor properties in the right superior parietal cortex correlated with ordering symptoms. In the hippocampus, we identified two single nucleotide polymorphisms in glutamatergic neurotransmission genes (GRM7, GNAQ) that moderated the association between OCSs and attractor features. We provide evidence that in healthy children, the association between dFC changes and OCSs may be mapped onto brain circuits predicted by prevailing neurobiological models of obsessive-compulsive disorder. Moreover, our findings support the involvement of glutamatergic neurotransmission in such brain network changes

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research