Revisiones_bibliográficas TyO_Web: 11/2/18

Wiley Interdiscip Rev Cogn Sci. 2014 Mar;5(2):151-171. doi: 10.1002/wcs.1273. Epub 2014 Jan 14.

Abstract

This review is an introduction to addiction, the reward circuitry, and laboratory addiction models. Addiction is a chronic disease hallmarked by a state of compulsive drug seeking that persists despite negative consequences. Most of the advances in addiction research have centered on the canonical and contemporary drugs of abuse; however, addictions to other activities and stimuli also exist. Substances of abuse have the potential to induce long-lasting changes in the brain at the behavioral, circuit, and synaptic levels. Addiction-related behavioral changes involve initiation, escalation, and obsession to drug seeking and much of the current research is focused on mapping these manifestations to specific neural pathways. Drug abuse is well known to recruit components of the mesolimbic dopamine system, including the nucleus accumbens and ventral tegmental area. In addition, altered function of a wide variety of brain regions is tightly associated with specific manifestations of drug abuse. These regions peripheral to the mesolimbic pathway likely play a role in specific observed comorbidities and endophenotypes that can facilitate, or be caused by, substance abuse. Alterations in synaptic structure, function, and connectivity, as well as epigenetic and genetic mechanisms are thought to underlie the pathologies of addiction. In preclinical models, these persistent changes are studied at the levels of molecular pharmacology and biochemistry, ex vivo and in vivo electrophysiology, radiography, and behavior. Coordinating research efforts across these disciplines and examining cell type- and circuit-specific phenomena are crucial components for translating preclinical findings to viable medical interventions that effectively treat addiction and related disorders. WIREs Cogn Sci 2014, 5:151-171. doi: 10.1002/wcs.1273 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

Dependencia química y el médico.

Chemical dependency and the physician.

Berge KH1, Seppala MD, Schipper AM.

Mayo Clin Proc. 2009 Jul;84(7):625-31. doi: 10.1016/S0025-6196(11)60751-9.

Abstract

Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician.

Abuso de Drogas, Adicción y Dependencia

Drug Abuse, Addiction and Dependence

Alewu Benjamin1 and Nosiri Chidi

Pharmacology and Therapeutics

Edited by Sivakumar Joghi Thatha Gowder, ISBN 978-953-51-1620-2, 356 pages, Publisher: InTech, Chapters published July 02, 2014 under CC BY 3.0 license

Introduction

Before the dawn of civilization, they are natural substances that were discovered e.g euphoria's, narcotics, hallucinogens, excitants. Some of these were used by farmers. In fact, there were dope addict long before they were farmers. There are certain drives that persuade or compel somebody to resort to drug to obtain vacation from intolerable selfhood. One of the principal appetite of the soul is the urge to escape if for a few seconds the painful aspect of life, acquisition of wealth which may not be forthcoming. The distinguishing facts between legitimate use of drug for social purpose and their abuse are not certain if not indistinct. It is not a matter of which drug but the amount taken and if directed anti-socially or not. For instance normal people use alcohol for their occasional purpose without harm but, here there is appropriate degree of mental abnormality to the individual and the society as well. These people may then depend on it physically or emotionally.

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

World Congress on Regional Anesthesia & Pain Medicine

April 19-21, 2018, New York City, USA

Anestesiología y Medicina del Dolor

52 664 6848905

www.mihombroycodo.com.mx/academia/descompresion-subacromial-artroscopica-para-el-dolor-subacromial-de-hombro-csaw-un-ensayo-quirurgico-aleatorizado-multicentrico-pragmatico-de-grupos-paralelos-controlado-con-placebo-de-tres-gru/

miércoles, 14 de febrero de 2018

Descompresión subacromial artroscópica para el dolor subacromial de hombro

Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.

La #acromioplastia, la operación más frecuente de #hombro que se realiza en nuestro medio, puede no estar indicada, según este estudio https://www.ncbi.nlm.nih.gov/pubmed/29169668 publicado en Lancet que seguro cambiará la práctica clínica.

Fuente

Este artículo es originalmente oublicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29169668

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803129/

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext

De:

Beard DJ¹, Rees JL², Cook JA³, Rombach I³, Cooper C³, Merritt N³, Shirkey BA², Donovan JL⁴, Gwilym S², Savulescu J⁵, Moser J², Gray A⁶, Jepson M⁴, Tracey I⁷, Judge A², Wartolowska K², Carr AJ⁸; CSAW Study Group.

Lancet. 2018 Jan 27;391(10118):329-338. doi: 10.1016/S0140-6736(17)32457-1. Epub 2017 Nov 20.

Author information ► Copyright and License information ▼

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract

BACKGROUND:

Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression.

INTERPRETATION:

Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process.

FUNDING:

Arthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England).

Resumen

ANTECEDENTES:

La descompresión subacromial artroscópica (descompresión del espacio subacromial mediante la eliminación de espolones óseos y tejidos blandos artroscópicamente) es una cirugía común para el dolor subacromial del hombro, pero su eficacia es incierta. Hicimos un estudio para evaluar su efectividad e investigar el mecanismo para la descompresión quirúrgica. INTERPRETACIÓN: Los grupos quirúrgicos tuvieron mejores resultados para el dolor y la función del hombro en comparación con ningún tratamiento, pero esta diferencia no fue clínicamente importante. Además, la descompresión quirúrgica pareció no ofrecer ningún beneficio adicional sobre la artroscopia solamente. La diferencia entre los grupos quirúrgicos y ningún tratamiento podría ser el resultado de, por ejemplo, un efecto placebo o fisioterapia posoperatoria. Los hallazgos cuestionan el valor de esta operación para estas indicaciones, y esto debe ser comunicado a los pacientes durante el proceso de toma de decisiones de tratamiento compartido.

FONDOS:

Arthritis Research UK, el Instituto Nacional de Investigación en Salud, el Centro de Investigación Biomédica, y el Royal College of Surgeons (Inglaterra).

PMID: 29169668 PMCID: PMC5803129 DOI: 10.1016/S0140-6736(17)32457-1

Free PMC Article

La #acromioplastia, la operación más frecuente de #hombro que se realiza en nuestro medio, puede no estar indicada, según este estudio https://t.co/iL72RGK8Lq publicado en Lancet que seguro cambiará la práctica clínica pic.twitter.com/et02KTMXas
— Santiago Arauz (@arauz_santiago) 6 de febrero de 2018

El anestesiólogo y las drogadicciones / Addiction and substance abuse in anesthesiology

Febrero 14, 2018. No. 2994

Abuso a drogas en anestesiólogos. Realidad preocupante

Dr. Gustavo Calabrese

Rev Mex Anestesiol Vol. 33. Supl. 1, Abril-Junio 2010 pp S206-S208

Adicción y anestesiología

Dra. Dania Elena Escamilla-Ríos

Rev Mex Anestesiol Vol. 35. Supl. 1 Abril-Junio 2012 pp S226-S229

Abuso de Fármacos Anestésicos por parte de los Anestesiólogos

Flavia Serebrenic Jungerman, Hamer Nastasy Palhares Alves, Maria José Carvalho Carmona, TSA, Nancy Brisola Conti, André Malbergier

Rev Bras Anestesiol 2012; 62: 3: 375-386

Adicción y abuso de sustancias en anestesiología.

Addiction and substance abuse in anesthesiology.

Bryson EO1, Silverstein JH.

Anesthesiology. 2008 Nov;109(5):905-17. doi: 10.1097/ALN.0b013e3181895bc1.

Abstract

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact anesthesiologists at rates similar to those in other professions, as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid. There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions. Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the anesthesiologist wishes to attempt reentry into clinical practice.

Safe Anaesthesia Worldwide

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World Congress on Regional Anesthesia & Pain Medicine

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martes, 13 de febrero de 2018

Cannabis

Enero 31, 2018. No. 2980

¿Los cannabinoides confieren neuroprotección contra la epilepsia? Una descripción general.

Do Cannabinoids Confer Neuroprotection Against Epilepsy? An Overview.

Capasso A1.

Open Neurol J. 2017 Dec 18;11:61-73. doi: 10.2174/1874205X01711010061. eCollection 2017.

Abstract

OBJECTIVE: Cannabinoid-based medications provide not only relief for specific symptoms, but also arrest or delay of disease progression in patients with pain, multiple sclerosis, and other conditions. Although they also seem to hold potential as anticonvulsant agents, evidence of their efficacy in epilepsy is supported by several evidences. METHOD: The data reviewed herein lend support to the notion that the endocannabinoid signalling system plays a key modulation role in the activities subserved by the hippocampus, which is directly or indirectly affected in epilepsy patients. CONCLUSION: The notion is supported by a variety of anatomical, electrophysiological, biochemical and pharmacological findings. These data suggest the need for developing novel treatments using compounds that selectively target individual elements of the endocannabinoid signalling system.

KEYWORDS: Antiepileptic; Cannabinoids; Cannabis sativa; Epilepsy; Neuroprotection

Safe Anaesthesia Worldwide

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Opioides postoperatorios en pacientes vírgenes a narcóticos / Postsurgical opioids prescriptions for opioid naive patients

Prescripciones posquirúrgicas para pacientes vírgenes a los opioides y asociación

con sobredosis y uso indebido: estudio de cohorte retrospectivo.

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse:

retrospective cohort study.

Brat GA1,2, Agniel D3, Beam A3, Yorkgitis B4, Bicket M5, Homer M3, Fox KP6, Knecht DB6, McMahill-Walraven CN6, Palmer N3, Kohane I3.

BMJ. 2018 Jan 17;360:j5790. doi: 10.1136/bmj.j5790.

Uso persistente de opiáceos después del parto por cesárea: patrones y predictores entre mujeres que no habían recibido opiáceos.

Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women.

Bateman BT1, Franklin JM2, Bykov K2, Avorn J2, Shrank WH3, Brennan TA3, Landon JE2, Rathmell JP4, Huybrechts KF2, Fischer MA2, Choudhry NK2.

Am J Obstet Gynecol. 2016 Sep;215(3):353.e1-353.e18. doi: 10.1016/j.ajog.2016.03.016. Epub 2016 Mar 17.

Abstract

BACKGROUND: The incidence of opioid-related death in women has increased 5-fold over the past decade. For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the United States is by cesarean, and opioids are commonly prescribed for postsurgical pain management. OBJECTIVE: The objective of this study was to determine the risk that opioid-naïve women prescribed opioids after cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery and to identify predictors for this behavior. STUDY DESIGN: We identified women in a database of commercial insurance beneficiaries who underwent cesarean delivery and who were opioid naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which group together patients with similar patterns of medication filling during follow-up, based on patterns of opioid dispensing in the year following cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group. RESULTS: A total of 285 of 80,127 (0.36%, 95% confidence interval, 0.32-0.40), opioid-naïve women became persistent opioid users (identified using trajectory models based on monthly patterns of opioid dispensing) following cesarean delivery. Demographics and baseline comorbidity predicted such use with moderate discrimination (c statistic = 0.73). Significant predictors included a history of cocaine abuse (risk, 7.41%; adjusted odds ratio, 6.11, 95% confidence interval, 1.03-36.31) and other illicit substance abuse (2.36%; adjusted odds ratio, 2.78, 95% confidence interval, 1.12-6.91), tobacco use (1.45%; adjusted odds ratio, 3.04, 95% confidence interval, 2.03-4.55), back pain (0.69%; adjusted odds ratio, 1.74, 95% confidence interval, 1.33-2.29), migraines (0.91%; adjusted odds ratio, 2.14, 95% confidence interval, 1.58-2.90), antidepressant use (1.34%; adjusted odds ratio, 3.19, 95% confidence interval, 2.41-4.23), and benzodiazepine use (1.99%; adjusted odds ratio, 3.72, 95% confidence interval, 2.64-5.26) in the year prior to the cesarean delivery. CONCLUSION: A very small proportion of opioid-naïve women (approximately 1 in 300) become persistent prescription opioid users following cesarean delivery. Preexisting psychiatric comorbidity, certain pain conditions, and substance use/abuse conditions identifiable at the time of initial opioid prescribing were predictors of persistent use.

KEYWORDS: cesarean delivery; cohort; opioids; pain; pregnancy studies

Incidencia y factores de riesgo para el uso crónico de opiáceos en pacientes vírgenes a opioides en el período postoperatorio.

Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period.

Sun EC1, Darnall BD1, Baker LC2, Mackey S1.

JAMA Intern Med. 2016 Sep 1;176(9):1286-93. doi: 10.1001/jamainternmed.2016.3298.

Abstract

IMPORTANCE: Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery. .....

CONCLUSIONS AND RELEVANCE: In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

World Congress on Regional Anesthesia & Pain Medicine

April 19-21, 2018, New York City, USA

Anestesiología y Medicina del Dolor

52 664 6848905