Ayahuasca: farmacología, efectos agudos, potencial terapéutico y rituales

La ayahuasca es una preparación botánica alucinógena compuesta de Banisteriopsis caapi y Psychotria viridis que, tradicionalmente, ha sido consumida por grupos indígenas de la Amazonia. Este brebaje contiene el agonista serotoninérgico N,N-dimetiltriptamina (DMT) y alcaloides inhibidores de la monoaminooxidasa (IMAO) (harmina, harmalina y tetrahidroharmina). La literatura científica hasta el momento sugiere que la administración o ingesta aguda de la ayahuasca no es mal tolerada, incluso en aquellos casos en los que se ha registrado un uso crónico de la misma, no habiéndose informado sobre toxicidad en ningún estudio en humanos. No obstante, teniendo en cuenta la limitación del uso de una muestra sana y joven en la mayoría de los ensayos llevados a cabo, y los datos escasos referentes a patologías previas de tipo cardíaco y hepático, así como el uso combinado con otras sustancias, se sugiere una contraindicación importante al consumo de ayahuasca. El objetivo de este trabajo es realizar una revisión abarcando desde la composición y mecanismos de acción de la propia ayahuasca y sus efectos, tanto deseados como adversos de su ingesta, hasta el uso de dicha sustancia como terapia farmacológica en el marco de las drogodependencias, alcoholismo y trastornos afectivos, además de una breve descripción de las connotaciones de su uso en rituales organizados.Ayahuasca is a botanical hallucinogenic preparation which is made up of Banisteriopsis caapi and Psychotria viridis, consumed by indigenous groups of the Amazonia region. This beverage contains the serotoninergic agonist N,N-dimethyltryptamine (DMT) and monoamine oxidase-inhibiting alkaloids (harmine, harmaline and tetrahydroharmine). Scientific literature has until now suggested that the administration or acute consumption of ayahuasca is not badly tolerated, even in situations where consumers have endured chronic use of the substance, no study having detected any effect of toxicological nature in humans. However, taking into account the limitations of performing most studies on a young and healthy sample, and the scant data on preexisting hepatic and cardiac pathologies, as well as the combined use of ayahuasca with other substances, a warning about the contraindication of ayahuasca use is suggested. The aim of this work is to put forward an overview through the composition and action mechanisms of ayahuasca and the desired and adverse effects of its administration. The use of this preparation as a new pharmacological therapy on substance abuse and affective disorders is explained, as well as a brief description regarding the connotations of ayahuasca use in organized rituals

Drogas emergentes: catinonas sintéticas ('sales de baño')

Las catinonas sintéticas son una nueva clase de drogas de diseño de tipo psicoestimulante y alucinógeno y con efectos similares a la cocaína, la metilendioximetanfetamina (MDMA) u otras anfetaminas. El abuso de catinonas sintéticas, con frecuencia incluidas en los productos vendidos como 'sales de baño', se puso de moda a principios de 2009, lo que llevó a la clasificación legislativa en toda Europa en 2010 y a la lista I de clasificación de drogas dentro de los Estados Unidos en 2011. Los estudios clínicos recientes indican que el mecanismo de acción de la catinona sintética afecta a los sistemas centrales de monoaminas. En esta revisión abordaremos la historia de estas drogas, su mecanismo de acción, la toxicología y los aspectos legales.Synthetic cathinones are a new class of designer drug of the hallucinogenic stimulant type with effects similar to cocaine, methylenedioxymethamphetamine (MDMA) and other amphetamines. The abuse of synthetic cathinones often included in products sold as 'bath salts' became fashionable in early 2009, which led to legislative classification across Europe in 2010 and Schedule I drug classification in the USA in 2011. Recent clinical studies indicate that the action mechanism of synthetic cathinone affects the central monoamine systems. In this paper we will review the history of these drugs, their action mechanism, toxicology and legal aspects

Drogas legales emergentes: marihuana sintética, kratom, salvia divinorum, metoxetamina y los derivados de la piperazina

A pesar de su amplia oferta y disponibilidad a través de internet, muchas de las drogas de abuso emergentes siguen siendo desconocidas para un gran número de médicos y profesionales sanitarios. Las alternativas herbales a la marihuana (también conocidas como marihuana sintética), tales como el K2 o el spice, son un grupo de hierbas que contienen una mezcla de materia vegetal además de cannabinoides de origen sintético. El Kratom, es un producto vegetal derivado de Mitragyna speciosa Korth que tiene efectos similares a los de los opioides, y que se emplea para el tratamiento del dolor crónico y el alivio de los síntomas de retirada de los opiáceos. La Salvia divinorum es un alucinógeno con una farmacología muy singular que tiene cierto potencial terapéutico, pero que ha sido prohibido en muchos estados debido a las preocupaciones con respecto a sus efectos adversos de tipo psiquiátrico. La Metoxetamina se ha convertido recientemente en la 'ketamina legal' disponible a través de internet. Además, los derivados de la piperazina, una clase de compuestos similares a la anfetamina que incluyen la BZP y TMFPP, han aparecido como una versión legal del 'éxtasis'. Todos estos compuestos psicoactivos son percibidos como drogas seguras por los usuarios y están disponibles en internet a un golpe de ratón. Desafortunadamente, estas drogas tienen efectos indeseables dependiendo de la dosis y de la mezcla de drogas y oscilan de efectos mínimos a efectos serios sobre la salud. Este artículo revisa la farmacología, los efectos clínicos, la toxicidad y el manejo de su intoxicación para que los profesionales de la salud conozcan todas estas drogas emergentes de origen sintéticoDespite its wide range and availability over the Internet, many emerging abuse drugs remain unknown to many doctors and health professionals. Herbal marijuana alternatives (also known as synthetic marijuana), such as K2 or 'spice', are a group of herbal mixtures containing vegetable matter in addition to synthetic cannabinoids. Kratom is a plant product derived from Mitragyna speciosa Korth that has similar effects to opioids, and is used for the treatment of chronic pain and alleviating the symptoms of opioid withdrawal. Salvia divinorum is a hallucinogenic drug with a therapeutic potential, but has been banned in many states due to concerns about its psychiatric effects. Methoxetamine has recently become the 'legal ketamine' available over the Internet. In addition, piperazine derivatives, a class similar to amphetamine including BZP and TMFPP compounds have emerged as a legal version of 'ecstasy' All these psychoactive compounds are perceived as safe drugs for people and are available online. Unfortunately, these drugs have side effects depending on the dose and the mixture of drugs with health effects ranging from slight to serious. This article reviews the pharmacology, clinical effects, toxicity and managing of these drugs

Fostering English-taught higher education programs in a Spanish university: the "TechEnglish" innovative project

In recent years, coinciding with adjustments to the Bologna process, many European universities have attempted to improve their international profile by increasing course offerings in English. According to the Institute of International Education (IIE), Spain has notably increased its English-taught higher education programs, ranking fifth in the list of European countries by number of English-taught Master's programs in 2013. This article presents the goals and preliminary results of an on-going innovative education project (TechEnglish) that aims to promote course offerings in English at the Technical University of Madrid (Universidad Politécnica de Madrid, UPM). The UPM is the oldest and largest of all Technical Universities in Spain. It offers graduate and postgraduate programs that cover all the engineering disciplines as well as architecture. Currently, the UPM has no specific bilingual/multilingual program to promote teaching in English, although there is an Educational Model Whitepaper (with a focus on undergraduate degrees) that promotes the development of activities like an International Semester or a unique shared curriculum. The TechEnglish project is an attempt to foster courses taught in English at 7 UPM Technical Schools, including students and 80 faculty members. Four tasks were identified: (1) to design a university wide framework to increase course offerings, (2) to identify administrative difficulties, (3) to increase visibility of courses offered, and (4) to disseminate the results of the project. First, to design a program we analyzed existing programs at other Spanish universities, and other projects and efforts already under way at the UPM. A total of 13 plans were analyzed and classified according to their relation with students (learning), professors (teaching), administration, course offerings, other actors/institutions within the university (e.g., language departments), funds and projects, dissemination activities, mobility plans and quality control. Second, to begin to identify administrative and organizational difficulties in the implementation of teaching in English, we first estimated the current and potential course offerings at the undergraduate level at the UPM using a survey (student, teacher and administrative demand, level of English and willingness to work in English). Third, to make the course offerings more attractive for both Spanish and international students we examined the way the most prestigious universities in Spain and in Europe try to improve the visibility of their academic offerings in English. Finally, to disseminate the results of the project we created a web page and a workspace on the Moodle education platform and prepared conferences and workshops within the UPM. Preliminary results show that increasing course offerings in English is an important step to promote the internationalization of the University. The main difficulties identified at the UPM were related to how to acknowledge/certify the departments, teachers or students involved in English courses, how students should register for the courses, how departments should split and schedule the courses (Spanish and English), and the lack of qualified personnel. A concerted effort could be made to increase the visibility of English-taught programs offered on-line

Next Generation Flow for highly sensitive and standardized detection of minimal residual disease in multiple myeloma

Flow cytometry has become a highly valuable method to monitor minimal residual disease (MRD) and evaluate the depth of complete response (CR) in bone marrow (BM) of multiple myeloma (MM) after therapy. However, current flow-MRD has lower sensitivity than molecular methods and lacks standardization. Here we report on a novel next generation flow (NGF) approach for highly sensitive and standardized MRD detection in MM. An optimized 2-tube 8-color antibody panel was constructed in five cycles of design-evaluation-redesign. In addition, a bulk-lysis procedure was established for acquisition of

Alcance y limitaciones de la justicia internacional

El presente libro hace parte de los trabajos del grupo de justicia internacional de la Red Multidisciplinar de Investigación “Perspectiva Epistemológica Ibero-Americana sobre la Justicia” Volumen 4, coordinada desde el Instituto Ibero-Americano de la Haya para la Paz, los Derechos Humanos y la Justicia Internacional. Así mismo, se inscribe dentro de los siguientes proyectos de investigación: (i) “Principios de armonización entre la función y alcance de la Justicia Internacional y las demandas surgidas en los procesos políticos de transición”, financiado por el Fondo de Investigación de la Universidad del Rosario, Bogotá, Colombia —FIUR—; y (ii) “La función de los órganos judiciales y arbitrales internacionales en la ejecución de un eventual acuerdo de paz en Colombia fruto de la renegociación resultante del Referéndum del 2 de octubre de 2016”, financiado por la Facultad de Jurisprudencia de la Universidad del Rosario. Ambos proyectos se encuentran adscritos a la línea de investigación “Crítica al Derecho Internacional desde Fundamentos Filosóficos”, del Grupo de Investigación de Derecho Internacional de la Facultad de Jurisprudencia de la Universidad del Rosario, Bogotá, Colombia

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)