Search

Un síntoma altamente prevalente en las unidades de cuidados intensivos (UCI) es el dolor. Esta es una de las preocupaciones más frecuentes de los médicos debido a su alta incidencia y difícil manejo. Un gran número de pacientes críticos experimentan dolor de moderado a severo durante la UCI. Este padecimiento aumenta la inestabilidad hemodinámica, el riesgo de sufrir alteraciones o trastornos mentales, incrementa el tiempo de estancia en este tipo de unidades, etc; es decir, aumenta la probabilidad de una evolución desfavorable y la mortalidad. Una buena evaluación y tratamiento del dolor en pacientes críticos disminuye la frecuencia de agitación, duración de ventilación mecánica, estancia en UCI y frecuencia de infecciones nosocomiales. En consecuencia, el objetivo de la presente investigación es compendiar el manejo del dolor en paciente crítico, específicamente, el manejo farmacológico y no farmacológico. La investigación se realizó bajo una metodología de tipo documental bibliográfica, bajo la modalidad de revisión. El manejo farmacológico del dolor ha sido el pilar del tratamiento de estos pacientes. Por su potencia analgésica, los opioides intravenosos siguen siendo el analgésico de primera línea para la mayoría de los pacientes internados en la UCI. Asimismo, los coadyuvantes a los opioides, destacan el uso de tratamientos multimodales del dolor como un componente fundamental del abordaje de analgesia primero para minimizar la dosis de opioides y sedantes que se utilizan y optimizar la analgesia y la rehabilitación. Por último, se encuentra la terapia no farmacológica, que busca la reducción de factores de riesgo modificables para el delirium, mejorando la función cognitiva, optimizando el sueño, la movilidad, la visión y la audición del paciente crítico. Entre las principales se encuentran: la musicoterapia, la distracción, el masaje simple, la presencia de familiares cercanos y la crioterapia.

Understanding untreated tumour growth kinetics and its intrinsic behaviour is interesting and intriguing. The aim of this study is to propose an approximate analytical expression that allows us to simulate changes in surface charge density at the cancer-surrounding healthy tissue interface during the untreated solid tumour growth. For this, the Gompertz and Poisson equations are used. Simulations reveal that the unperturbed solid tumour growth is closely related to changes in the surface charge density over time between the tumour and the surrounding healthy tissue. Furthermore, the unperturbed solid tumour growth is governed by temporal changes in this surface charge density. It is concluded that results corroborate the correspondence between the electrical and physiological parameters in the untreated cancer, which may have an essential role in its growth, progression, metastasis and protection against immune system attack and anti-cancer therapies. In addition, the knowledge of surface charge density changes at the cancer-surrounding healthy tissue interface may be relevant when redesigning the molecules in chemotherapy and immunotherapy taking into account their polarities. This can also be true in the design of completely novel therapies.

espanolEl trabajo plantea la relacion entre los ordenamientos juridicos (confesional, espanol y europeo) cuando se trata de recuperar o restituir un bien mueble eclesiastico que ha salido del territorio espanol sin la licencia de exportacion. Despues de exponer el regimen del derecho canonico relativo a la propiedad dominical, se expone el modo de proceder para recuperar un bien que se encuentre en un Estado de la UE, aplicando la Ley 1/2017, de transposicion de la directiva 2014/60/UE, asi como la posibilidad de recuperarlo si se encentra en un Estado no europeo ni miembro de UNIDROIT (p. ej.: Estado Vaticano). EnglishThe papier sets out the relationship between the Canon, Spanish and European legal systems, when it comes to recovering or restoring an ecclesiastical cultural good that has left Spanish territory without an export license. After exposing the canon law regime related to property, the way to proceed to recover a good found in an EU State is exposed, applying 1/2017 act, transposing Directive 2014/60 / EU, as well as the possibility of recovering it if it is located in a non-European State or a member of UNIDROIT (eg: Vatican State).

Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete response (pCR), according to Miller and Payne criteria, in 58.3% of cases. A higher Ki67 value, the absence of Hormonal Receptors expression, and an rCR was significantly related to a pCR finding. This information impacts directly in surgery planning, as it permits adjustment of the breast resection volume.

The role of vitamin D in mammographic density is still unclear. This study examines the association between serum 25-hydroxyvitamin D (25(OH)D) and mammographic density, overall and by specific women characteristics. DDM-Madrid is a cross-sectional study that recruited 1403 premenopausal women in a breast radiodiagnosis unit of Madrid City Council. Information was collected with a questionnaire and plasma 25(OH)D was measured by solid-phase extraction on-line coupled to liquid chromatography–tandem mass spectrometry. Percent mammographic density was assessed using a semi-automated computer tool (DM-Scan). Multivariable linear regression models were used to quantify the associations, categorizing 25(OH)D levels (nmol/L) into 3 groups according to the cut-offs established by the US Endocrine Society. Models were adjusted for age, education, body mass index, age at menarche, parity, previous breast biopsies, family history of breast cancer, physical activity, energy intake, use of corticoids, hypercholesterolemia and day of sample extraction. Mean serum 25(OH)D level was 49.4 + 18.9 nmol/L. Women with sufficient concentrations of 25(OH)D showed a slight decrease in mammographic density (β >75nmol/L=-3.40; p = 0.037). No differences were observed according to women characteristics except for parity, where the protective effect of 25(OH)D was only seen among nulliparous (β >75nmol/L=-13.00; p-heterogeneity = 0.006). In light of the protective effect of vitamin D on mammographic density and the high prevalence of vitamin D insufficiency in our population, improving these levels could be an effective measure for the prevention of health problems related to the lack of this essential vitamin.

The aim of this work is to base an approach to the concept of open access to academic production as part of the formulation of scientific policies in the global South. The methodology covers the comparison between different discursive contexts and the original approach of open access, with the purpose of deducting scientific policies that contribute to overcome the limitations of eurocentrism in the academic production and the approaches of the editorial movements. We interpret open access through the concepts of open science, commons and decoloniality of knowledge, perspectives that complement the original open access approach. As a result, the contrast with these concepts allows us to think about the production of knowledge with vows for the democratization of access, the presence of an associative community and the content of a decolonial program. This allows us to describe Open Access scientific policies as a process of cognitive asset management, from a democratic, associative and decolonial approach.

Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven. • XPN can present different clinical manifestations. • CT is the mainstay of diagnostic imaging in XPN. • Focal type of XPN should be included in the differential diagnosis of children with a renal mass. • There are no clear guidelines on the management of XPN. • Conservative and surgical treatments should be considered for each individual case. • Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.

Este estudio analiza cómo se articula la obligación del obispo diocesano prevista en el c. 386§2 CIC con el debido respeto a la autonomía de los monasterios sui iuris. Los deberes del obispo respecto a la custodia de la fe en su diócesis, la custodia de los carismas contemplativos y la función de especial vigilancia (c. 615) respecto de los monasterios sui iuris permiten la adopción de las medidas que estime prudentes, incluso de carácter penal, en los casos de declaraciones contrarias a la fe por parte de un religioso de un monasterio sui iuris. Deberá respetar el derecho particular del monasterio, si contiene alguna concreción con respecto al derecho común del CIC. Asimismo, debe oír a la persona interesada y comunicarle por escrito su decisión, en la que deben constar los motivos que la fundamentan. De este modo, se garantiza su derecho a recurrir ante instancias superiores.

[EN] Learning practical skills of pathology at the university programs gets huge benefits from the application of digital methodology. It is based on the scanning of microscopic glass slides to obtain high resolution and high quality images that are studied on computer screens with specific visualization software. Students adapt very easily to the digital methodology that allows a closer interaction with the teachers and to incorporate a greater number of cases in each session, as well as facilitate the consultation of them in any location and at any time. The collaborative digital tools allow the simultaneous study of cases by students and teachers and a great capability in the orientation of the study even in remote work. The organization of a practical digital system has an affordable cost and can be implemented by pathology teachers themselves without a high knowledge in informatics., [ES] La docencia práctica universitaria de anatomía patológica se beneficia enormemente de la aplicación de metodología digital. Se basa en el escaneo de las preparaciones microscópicas para obtener imágenes de alta resolución y gran calidad que se estudian en pantallas de ordenador con un software específico de visualización. Los estudiantes se adaptan con gran facilidad a la metodología digital que permite además una interacción más próxima con los profesores e incorporar un número mayor de casos en cada sesión, así como facilitar la consulta de los mismos en cualquier ubicación y en cualquier horario. Las herramientas digitales colaborativas permiten el estudio simultáneo de los casos por alumnos y profesores y una gran facilidad en la orientación del estudio incluso en trabajo remoto. La organización de un sistema práctico digital tiene un coste asequible y puede implementarse por los propios profesores sin un conocimiento informático elevado.

This paper presents the technical means by which each of the criteria has been framed, and to what extent the means employed may be regarded as leading to the achievement of the desired objective (efficiency and cost-free nature of nullity processes, so as to better serve the salvation of souls). Measures that strengthen the responsibility of the bishop in his diocese are clear and effective in achieving this end: both in the processes in which he acts as a judge and in the greater discretion he enjoys in appointing a single judge and lay judges, without sharing such responsibility with the Episcopal Conference. However, greater discretion in the appointment of judges may also be read as a measure that favors episcopal collegiality less than was foreseen prior to the reform. Following the reform, each diocesan Bishop enjoys greater autonomy in his diocese, with no requirement of approval from the Episcopal Conference, which is a structure of government at the service of episcopal collegiality and communion.