Abordaje inicial del paciente y criterios para remitirlo a la clínica del dolor

31 páginasTabla de contenido : Escalera analgésica de la OMS -- Escalas unidimensionales para valorar la intensidad del dolor -- Escalas multidimensionales para valoración del dolor -- Un nuevo enfoque del tratamiento del dolor basado en la evidencia científica: analgesia multimodal en dolor posquirúrgico -- Recomendaciones basadas en protocolos para la recuperación optimizada después de la cirugía (eras) -- Recomendaciones para el manejo del dolor quirúrgico en cirugía de tórax basadas en la evidencia -- Usos de gabapentinoides en el control y prevención del dolor -- Conductas y acciones que se deben evitar -- Conductas y acciones que se deben fomentar ¿cuándo solicitar interconsulta a clínica del dolor? -- Criterios para remitir un paciente desde primer nivel de atención a la clínica del dolor -- Posibles escenarios -- Titulación con morfina para dolor moderado a severo (eva > 4-10) en paciente adulto no oncológico -- Titulación con morfina en paciente oncológico -- Ratios de conversión de opioides -- Mecanismo de acción, indicaciones y contraindicaciones de los principales medicamentos usados en el tratamiento del dolor

recommendations from the CVBD World Forum

The human-animal bond has been a fundamental feature of mankind's history for millennia. The first, and strongest of these, man's relationship with the dog, is believed to pre-date even agriculture, going back as far as 30,000 years. It remains at least as powerful today. Fed by the changing nature of the interactions between people and their dogs worldwide and the increasing tendency towards close domesticity, the health of dogs has never played a more important role in family life. Thanks to developments in scientific understanding and diagnostic techniques, as well as changing priorities of pet owners, veterinarians are now able, and indeed expected, to play a fundamental role in the prevention and treatment of canine disease, including canine vector-borne diseases (CVBDs).The CVBDs represent a varied and complex group of diseases, including anaplasmosis, babesiosis, bartonellosis, borreliosis, dirofilariosis, ehrlichiosis, leishmaniosis, rickettsiosis and thelaziosis, with new syndromes being uncovered every year. Many of these diseases can cause serious, even life-threatening clinical conditions in dogs, with a number having zoonotic potential, affecting the human population.Today, CVBDs pose a growing global threat as they continue their spread far from their traditional geographical and temporal restraints as a result of changes in both climatic conditions and pet dog travel patterns, exposing new populations to previously unknown infectious agents and posing unprecedented challenges to veterinarians.In response to this growing threat, the CVBD World Forum, a multidisciplinary group of experts in CVBDs from around the world which meets on an annual basis, gathered in Nice (France) in 2011 to share the latest research on CVBDs and discuss the best approaches to managing these diseases around the world.As a result of these discussions, we, the members of the CVBD Forum have developed the following recommendations to veterinarians for the management of CVBDs

Vector-Borne Diseases - constant challenge for practicing veterinarians: recommendations from the CVBD World Forum

The human-animal bond has been a fundamental feature of mankind's history for millennia. The first, and strongest of these, man's relationship with the dog, is believed to pre-date even agriculture, going back as far as 30,000 years. It remains at least as powerful today. Fed by the changing nature of the interactions between people and their dogs worldwide and the increasing tendency towards close domesticity, the health of dogs has never played a more important role in family life. Thanks to developments in scientific understanding and diagnostic techniques, as well as changing priorities of pet owners, veterinarians are now able, and indeed expected, to play a fundamental role in the prevention and treatment of canine disease, including canine vector-borne diseases (CVBDs)

Subjetividades diversas : análisis de la situación política, social y económica de las juventudes peruanas

El foro nacional «Análisis de la Situación Política, Social y Económica de los Jóvenes en el Perú», realizado los días 14 y 15 de marzo de 2013 en Lima, permitió comprobar que se están desplegando estudios e investigaciones de gran relevancia en este campo, y su socialización, entre los propios responsables de tales estudios, en su mayoría investigadores/as jóvenes que se están especializando en este importante campo. Asimismo, permitió corroborar que, además de intereses en común, existen visiones y expectativas compartidas, respecto a la posibilidad de contar a futuro con más respaldos y con más visibilidad en lo que atañe al resultado de sus trabajos, justificando plenamente la iniciativa de SENAJU.Investigaciones y estudios sobre juventud en el Perú: Camino recorrido, esfuerzos recientes y desafíos a encarar / Rodríguez, Ernesto, Corcuera, Julio -- Análisis de la situación política, social y económica de los jóvenes en el Perú / Golte, Jürgen -- Historicidad y juventud en el Perú Contemporáneo / Torres, Ronald -- Jóvenes, política y revocatoria de autoridades municipales en Lima / Montoya, Luis -- Juventud y política en la universidad peruana: avances de investigación / Ramírez, Ivan -- Juventud y violencia en el Perú / Nureña, César R. -- Transiciones clandestinas y violencia juvenil: un estudio de pandillas en la Comunidad Autogestionaria de Huaycán / Loayza, Jerjes -- Una aproximación al mundo de las pandillas juveniles en Lima / Loayza, Jerjes -- Auto-identificación étnica, valores y su relación con el voto en las elecciones presidenciales peruanas del 2011 en una muestra de jóvenes universitarios / Solano, Dante, Díaz, Cynthia, Peña, Paulo -- Quién accede a la educación superior en el Perú?: Juventud y pobreza en estudiantes de educación universitaria y tecnológica superior / Salazar, Diego, Manco, Kervin -- Radicalismo político y etnicización de los estudiantes: el peso de la memoria y la generación en el caso de la Universidad de Huamanga / Gamarra, Jefrey -- Sexualidad adolescente y cultura mediática en Lima / León, Doris -- Violencia, desigualdades de género y vulnerabilidad frente al VIH: una aproximación desde las Ciencias Sociales / Caparachin, Cecilia -- Trabajo, migración y vulnerabilidad frente a las ITS en jóvenes de la amazonia peruana / Nureña, César R. -- Beca 18 : Programa Nacional de Becas / Baldeón, Edson -- Cuota Joven y Cuota de Género / Baldeón, Edso

Staging Parkinson’s Disease According to the MNCD (Motor/Non-motor/Cognition/Dependency) Classification Correlates with Disease Severity and Quality of Life

Background: Recently, a novel simple classification called MNCD, based on 4 axes (Motor; Non-motor; Cognition; Dependency) and 5 stages, has been proposed to classify Parkinson's disease (PD). Objective: Our aim was to apply the MNCD classification in a cohort of PD patients for the first time and also to analyze the correlation with quality of life (QoL) and disease severity. Methods: Data from the baseline visit of PD patients recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD classification. Three instruments were used to assess QoL: 1) the 39-item Parkinson's disease Questionnaire [PDQ-39]); PQ-10; the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Results: Four hundred and thirty-nine PD patients (62.05 +/- 7.84 years old; 59% males) were included. MNCD stage was: stage 1, 8.4% (N = 37); stage 2, 62% (N = 272); stage 3, 28.2% (N = 124); stage 4-5, 1.4% (N = 6). A more advanced MNCD stage was associated with a higher score on the PDQ39SI (p < 0.0001) and a lower score on the PQ-10 (p < 0.0001) and EUROHIS-QOL8 (p < 0.0001). In many other aspects of the disease, such as disease duration, levodopa equivalent daily dose, motor symptoms, non-motor symptoms, and autonomy for activities of daily living, an association between the stage and severity was observed, with data indicating a progressive worsening related to disease progression throughout the proposed stages. Conclusion: Staging PD according to the MNCD classification correlated with QoL and disease severity. The MNCD could be a proper tool to monitor the progression of PD

¡Atención Poli, con la vista en el riesgo! cuentos para seguritos

El contar historias o el storytelling, aparece como una herramienta para autores que no solo buscan el conectar de forma más auténtica con sus lectores; sino que buscan ir más allá al comprender cómo el cerebro procesa esta poderosa forma de comunicación. (Suzuki, W., Feliú-Mójer, M., Hasson, U., Yehuda, R., &amp; Zarate, J. 2018). Esta nueva forma de contar algo, es presentada aquí, en la primera compilación de cuentos como resultado de trabajos de módulos que tratan sobre el cuerpo humano, donde el estudio y la comprensión de la forma cómo funciona nuestro organismo, es uno de los principales objetivos. Además, surge como estrategia pedagógica, que precisamente busca incentivar el desarrollo de la creatividad de los estudiantes dentro de módulos que contienen un importante abordaje de temas y conceptos como base para su desarrollo, módulos que, al incluir un alto contenido teórico, se presentan como retos para que sus temas sean interiorizados por los estudiantes. De este modo, cuando se acude a el uso de la creatividad a través del storytelling, donde se expresan ideas relacionadas con el cuerpo humano, los cuentos realizados por estudiantes aquí presentes logran mostrar cómo emplean dichos conocimientos adquiridos, organizan ideas y crean cuentos que permiten al lector recrease, conociendo diferentes aspectos sobre nuestro cuerpo y a su vez dejándose llevar por la imaginación de los autores

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks