Analgesia post parto con morfina epidural: efectividad analgésica de dos dosis diferentes comparadas con placebo

La anestesia gineco obstétrica ha centrado su atención en la analgesia y manejo del trabajo de parto dejando olvidada a la analgesia del postparto, siendo manejada usualmente con analgésicos orales (que tienen efecto techo), olvidando una via tan importante como la via epidural ya instaurada en las pacientes como parte del manejo de la analgesia del trabajo de parto1. Muchos estudios han demostrado la incidencia del dolor postparto, en especial el dolor perineal, que esta condicionado por muchos determinantes: primigestantes, desgarros vaginales, instrumentación, etc.; se han encontrado tasas hasta del 75% de dolor perineal en el postparto vaginal cuyo factor desencadenante ha sido el trabajo de parto2. La administración epidural de morfina en el puerperio es un procedimiento sencillo, económico y mas cuando se cuenta con el catéter para manejo analgésico del dolor en el trabajo de parto, ya que el cateter es colocado durante el trabajo de parto y es retirado una vez que se obtiene el fruto de la concepción. El manejo del dolor es de vital importancia en los pacientes y diferentes estudios han demostrado que el dolor post parto vaginal interfiere en la realización de actividades diarias como la de ambulación, la sed estación limitando a la madre al reposo en cama, y adicionando riesgos de trombosis venosa y tromboembolismo pulmonar. La determinación de la efectividad analgésica postparto de dos dosis diferentes de morfina posterior al parto han sido objeto de un trabajo previamente publicado2, donde se demuestra la efectividad analgésica de la morfina; sin embargo es importante establecer una dosis efectiva con mínimos efectos adversos y valorar la efectividad de este manejo en nuestra población, ya que no existen estudios que valoren la presencia de dolor postparto. Una limitante para el uso de morfina epidural son sus efectos adversos, sin embargo basados en evidencia previa, dosis bajas de morfina en pacientes obstétricas conllevan mínimos efectos adversos.Otr

The influence of sorbitol doping on aggregation and electronic properties of PEDOT:PSS: a theoretical study

Many organic electronics applications such as organic solar cells or thermoelectric generators rely on PEDOT:PSS as a conductive polymer that is printable and transparent. It was found that doping PEDOT:PSS with sorbitol enhances the conductivity through morphological changes. However, the microscopic mechanism is not well understood. In this work, we combine computational tools with machine learning to investigate changes in morphological and electronic properties of PEDOT:PSS when doped with sorbitol. We find that sorbitol improves the alignment of PEDOT oligomers, leading to a reduction of energy disorder and an increase in electronic couplings between PEDOT chains. The high accuracy (r2 > 0.9) and speed up of energy level predictions of neural networks compared to density functional theory enables us to analyze HOMO energies of PEDOT oligomers as a function of time. We find a surprisingly low degree of static energy disorder compared to other organic semiconductors. This finding might help to better understand the microscopic origin of the high charge carrier mobility of PEDOT:PSS in general and potentially help to design new conductive polymers

Interface Molecular engineering for laminated monolithic perovskite/silicon tandem solar cells with 80.4% fill factor

A multipurpose interconnection layer based on poly(3,4‐ethylenedioxythiophene) doped with poly(styrene sulfonate) (PEDOT:PSS), and d‐sorbitol for monolithic perovskite/silicon tandem solar cells is introduced. The interconnection of independently processed silicon and perovskite subcells is a simple add‐on lamination step, alleviating common fabrication complexities of tandem devices. It is demonstrated experimentally and theoretically that PEDOT:PSS is an ideal building block for manipulating the mechanical and electrical functionality of the charge recombination layer by controlling the microstructure on the nano‐ and mesoscale. It is elucidated that the optimal functionality of the recombination layer relies on a gradient in the d‐sorbitol dopant distribution that modulates the orientation of PEDOT across the PEDOT:PSS film. Using this modified PEDOT:PSS composite, a monolithic two‐terminal perovskite/silicon tandem solar cell with a steady‐state efficiency of 21.0%, a fill factor of 80.4%, and negligible open circuit voltage losses compared to single‐junction devices is shown. The versatility of this approach is further validated by presenting a laminated two‐terminal monolithic perovskite/organic tandem solar cell with 11.7% power conversion efficiency. It is envisioned that this lamination concept can be applied for the pairing of multiple photovoltaic and other thin film technologies, creating a universal platform that facilitates mass production of tandem devices with high efficiency

The Role of Mobile Health Technologies in Allergy Care:an EAACI Position Paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed

Guía Mexicana para el Diagnóstico y el Tratamiento de la Urticaria

La urticaria es una enfermedad que padece una quinta parte de la población en algún momento de su vida. Las guías inter- nacionales recientes han propuesto unos cambios de fondo en su diagnóstico y tratamiento, por lo que había la necesidad de crear una guía nacional y multidisciplinaria, con base amplia en los gremios de especialistas y médicos de primer contacto en México. ABSTRACT Urticaria is a disease that a fifth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico

Impacto de la pandemia por Covid 19 en el desarrollo del módulo de manejo de vía aérea en tres facultades de Medicina de la ciudad de Bogotá

El manejo de la vía aérea es uno de los elementos fundamentales en el cuidado de los pacientes. No solamente los especialistas deben conocerlo, hace parte de los conocimientos base, con los que deben contar con un médico general. Desde el 2020, que fue declarada la pandemia por COVID 19, las instituciones educativas en medicina, se vieron enfrentadas a usar métodos académicos no convencionales para continuar la educación y práctica clínica. Por lo tanto realizamos un estudio cualitativo descriptivo, con una perspectiva fenomenológica, con la intención de identificar las estrategias usadas por tres instituciones en educación superior de la ciudad de Bogotá, durante la pandemia por COVID 19, para el desarrollo del módulo de vía aérea y lograr el aprendizaje teórico-práctico; se realizará una entrevista con encuestas, como técnica de recolección de información a los estudiantes de VII semestre, que evaluaran así las estrategias metodológicas y herramientas TIC, usadas durante el periodo de no presencialidad universitaria y hospitalaria.Airway management is one of the fundamental elements in patient care. Not only specialists should know it, it is part of the basic knowledge, with which they should have a general practitioner. Since 2020, when the COVID 19 pandemic was declared, medical educational institutions have been faced with using unconventional academic methods to continue education and clinical practice. Therefore, we carried out a qualitative descriptive study, with a phenomenological perspective, with the intention of identifying the strategies used by three institutions in higher education in Bogotá city, during COVID-19 pandemic, for the development of the airway module and achieve theoretical-practical learning; An interview with surveys will be carried out, as an information collection technique, to the students of the VII semester, which will thus evaluate the methodological strategies and ICT tools used during this period of non-attendance at the university and hospital

Beyond Ternary OPV: High‐Throughput Experimentation and Self‐Driving Laboratories Optimize Multicomponent Systems

Fundamental advances to increase the efficiency as well as stability of organic photovoltaics (OPVs) are achieved by designing ternary blends, which represents a clear trend toward multicomponent active layer blends. The development of high‐throughput and autonomous experimentation methods is reported for the effective optimization of multicomponent polymer blends for OPVs. A method for automated film formation enabling the fabrication of up to 6048 films per day is introduced. Equipping this automated experimentation platform with a Bayesian optimization, a self‐driving laboratory is constructed that autonomously evaluates measurements to design and execute the next experiments. To demonstrate the potential of these methods, a 4D parameter space of quaternary OPV blends is mapped and optimized for photostability. While with conventional approaches, roughly 100 mg of material would be necessary, the robot‐based platform can screen 2000 combinations with less than 10 mg, and machine‐learning‐enabled autonomous experimentation identifies stable compositions with less than 1 mg

Mexican Guidelines on the Diagnosis and Treatment of Urticaria

Background: Urticaria is a disease that a fth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico. Material and method: Internationally recognized tools for guideline- development were used. An interdisciplinary group of clinical experts (some of them knowledgeable in methodology of guideline develop- ment) determined the objectives and scope of the Evidence Based Clinical Practice Guideline with SCOPE. It was decided to adapt and transculturize international guidelines on the diagnosis and treatment of urticaria. With AGREE-II three high-quality guidelines (Zuberbier 2014, Sánchez-Borges 2012, Powell 2007) were selected to function as basic guidelines (BG). A set of Clinical Questions was formulated that lead to recommendations/suggestions, based on these BG, taking into account the cultural and economic background of Mexico, according to GRADE recommendation development. Results: By a formal process of discussion and voting during several working-sessions, experts and rst level healthcare physicians deter- mined the wording of the nal guideline, taking particularly care of developing a document, adjusted to the reality, values and preferences of the Mexican patients. The use of oral second generation, non-sedating antihistamines as rst line treatment is emphasized. Conclusion: This document is an Evidence Based Clinical Practice Guideline for the diagnosis and treatment of acute and chronic urticaria, based on three, high quality, international guidelines. It was developed by a multidisciplinary group. Tables and algorithms make the guideline user-friendly for both, rst line health care physicians and specialist

The role of mobile health technologies in allergy care: An EAACI position paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the “Be He@lthy, Be Mobile” WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the “General Data Protection Regulation” and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed

Chocó bio-innovador y sustentable

La formulación del Plan Estratégico Regional en Ciencia, Tecnología e Innovación del departamento del Chocó (PERCTI) tiene como propósito central señalar el camino para fortalecer el desarrollo propio e intercambio de mejores prácticas en sectores claves; reconocer la formación de expertos en áreas temáticas priorizadas; fortalecer la capacitación del talento humano mediante el aprovechamiento de capacidades instaladas en el territorio; coadyuvar a la transferencia de tecnologías necesarias para impulsar el desarrollo endógeno sustentable y, por supuesto, incentivar la incorporación de conocimiento científico y tecnológico en la cotidianidad de las personas para mejorar su calidad de vida