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Historically, the poppy plant has had multiple uses including as a food product and with medical uses in pain relief; today it is most commonly known as the plant from which heroin is derived. The United Nations international drug control regime currently only allows legal poppy production for medical use in 19 countries. Although Mexico is the third largest illegal poppy producer in the world, no Latin American country is currently allowed to legally produce poppies. Meanwhile, the United States and Canada are experiencing an overdose crisis due in large part to the adulteration and substitution of heroin with fentanyl and its analogues, while the price of opium gum has dropped 80% in the last two years in poppy producing areas of Mexico. The prohibition of opium has wide ranging health and development impacts that bring up a moral imperative regarding the safe supply of diverse opium-based products -including opium gum and heroin- that urgently need to be explored and addressed. Opium gum can be used orally or smoked, reducing riskier modes of administration and possible fatal overdoses. This article discusses the political and legal possibilities of safely supplying opium gum and manually extracted heroin from Mexico to Canada as a public health, harm reduction and development policy.

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OBJECTIVES: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. METHODS: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. RESULTS: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. CONCLUSION: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

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Abstract Objectives: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.

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Introducción: la escoliosis, entidad frecuente en Cuba, es fuente de preocupación e investigación por su repercusión estética y afecciones funcionales que produce. Su tratamiento definitivo es quirúrgico y el dolor es una molestia significativa para estos pacientes en el postoperatorio. Objetivos: caracterizar el desempeño de la morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis. Métodos: análisis del dolor postoperatorio de 24 pacientes portadores de escoliosis idiopática con curvaturas mayores o iguales a 40 grados divididos en un grupo «Estudio¼ receptor de morfina intratecal y un grupo «Control¼ con tratamiento convencional. Análisis estadístico con la prueba t, ANOVA, Chi-cuadrado, Odds Ratio y Correlación Lineal de Spearman con un nivel de significación de 5 por ciento. Resultados: ambos grupos no exhibieron diferencias estadísticamente significativas respecto a edad, sexo, peso corporal, estado físico ASA, grado de escoliosis y tiempo quirúrgico pero difirieron significativamente en la analgesia de rescate requerida en la totalidad de los controles y en menos de la mitad del grupo Estudio. Solo un paciente del grupo Estudio no presentó efectos adversos atribuibles a la morfina. Los dos grupos revelaron diferencias estadísticamente significativas en relación al dolor postoperatorio a las 3, 6, 12 y 48 horas, no así a las 24 horas. Conclusiones la morfina intratecal fue altamente efectiva para disminuir el dolor postoperatorio con desempeño superior al tratamiento convencional. La incidencia y severidad de los efectos colaterales fueron aceptables y fácilmente controlables, no se presentó ninguna complicación(AU)

Introduction: scoliosis, a frequent entity in Cuba, is a source of concern and research due to the esthetic repercussion and functional affections that produces. Surgery is the definite treatment and the pain is a significant bother for patients in postoperative. Objective: to characterize the behavior of intratecal morphine as a postoperative analgesic in the surgical correction of scoliosis. Methods: analysis of postoperative pain in 24 patients who suffer from idiopathic scoliosis with main curvatures or equal to 40 degrees divided into a study group as a receptor of intratecal morphine and a control group with a conventional treatment. Statistical analysis with the T test , ANOVA, Chi-squared, Odds Ratio and Linear Correlation of Spearman with a level of significance of 5 percent. Results: both groups did not show significant statistical differences as to age, sex. body weight, ASA physical conditions, degree of scoliosis and surgical time but they differed significantly in the rescue analgesia in all controls and in less than the half of the study group. Only one patient of the group study did not show side effects attributed to morphine. Both groups revealed statistical differences in relation to postoperative pain at 3, 6, 12 y 48 hours, but not at 24 hours. Conclusions: intratecal morphine was effective to reduce postoperative pain with a higher behavior to conventional treatment. Incidence and severity of side effects were acceptable and easily controllable, there was no complication(AU)

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Introducción: la escoliosis, entidad frecuente en Cuba, es fuente de preocupación e investigación por su repercusión estética y afecciones funcionales que produce. Su tratamiento definitivo es quirúrgico y el dolor es una molestia significativa para estos pacientes en el postoperatorio. Objetivos: caracterizar el desempeño de la morfina intratecal como analgésico postoperatorio en la corrección quirúrgica de escoliosis. Métodos: análisis del dolor postoperatorio de 24 pacientes portadores de escoliosis idiopática con curvaturas mayores o iguales a 40 grados divididos en un grupo «Estudio¼ receptor de morfina intratecal y un grupo «Control¼ con tratamiento convencional. Análisis estadístico con la prueba t, ANOVA, Chi-cuadrado, Odds Ratio y Correlación Lineal de Spearman con un nivel de significación de 5 %. Resultados: ambos grupos no exhibieron diferencias estadísticamente significativas respecto a edad, sexo, peso corporal, estado físico ASA, grado de escoliosis y tiempo quirúrgico pero difirieron significativamente en la analgesia de rescate requerida en la totalidad de los controles y en menos de la mitad del grupo Estudio. Solo un paciente del grupo Estudio no presentó efectos adversos atribuibles a la morfina. Los dos grupos revelaron diferencias estadísticamente significativas en relación al dolor postoperatorio a las 3, 6, 12 y 48 horas, no así a las 24 horas. Conclusiones la morfina intratecal fue altamente efectiva para disminuir el dolor postoperatorio con desempeño superior al tratamiento convencional. La incidencia y severidad de los efectos colaterales fueron aceptables y fácilmente controlables, no se presentó ninguna complicación.

Introduction: scoliosis, a frequent entity in Cuba, is a source of concern and research due to the esthetic repercussion and functional affections that produces. Surgery is the definite treatment and the pain is a significant bother for patients in postoperative. Objective: to characterize the behavior of intratecal morphine as a postoperative analgesic in the surgical correction of scoliosis. . Methods: analysis of postoperative pain in 24 patients who suffer from idiopathic scoliosis with main curvatures or equal to 40 degrees divided into a study group as a receptor of intratecal morphine and a control group with a conventional treatment. Statistical analysis with the T test , ANOVA, Chi-squared, Odds Ratio and Linear Correlation of Spearman with a level of significance of 5 %. . Results: both groups did not show significant statistical differences as to age, sex. body weight, ASA physical conditions, degree of scoliosis and surgical time but they differed significantly in the rescue analgesia in all controls and in less than the half of the study group. Only one patient of the group study did not show side effects attributed to morphine. Both groups revealed statistical differences in relation to postoperative pain at 3, 6, 12 y 48 hours, but not at 24 hours. Conclusions: intratecal morphine was effective to reduce postoperative pain with a higher behavior to conventional treatment. Incidence and severity of side effects were acceptable and easily controllable, there was no complication.

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JUSTIFICATIVA E OBJETIVOS: Devido à finalidade do ambulatório e os fármacos utilizados rotineiramente, o objetivo deste estudo foi rever e atualizar os conhecimentos sobre os receptores opioides e como complemento de estudo após palestra apresentada aos integrantes da equipe. CONTEÚDO: Foram revisados desde os aspectos históricos até os conhecimentos mais recentes sobre receptores opioides, descritos seus subtipos e mecanismos de ação. Para tal, foram consultadas referências indexadas pelo Pubmed. CONCLUSÃO: Com os dados presentes na literatura atual, concluiu-se que ainda existe muito a ser pesquisado sobre o tópico, visando medicações mais seguras e novas técnicas biomoleculares ainda são necessárias.

BACKGROUND AND OBJECTIVES: Due to the objective of the outpatient setting and to routinely used drugs, this study aimed at reviewing and updating the knowledge about opioid receptors and worked as a study complement after a lecture presented to team members. CONTENTS: We have reviewed from historical aspects to most recent developments about opioid receptors, in addition to describing subtypes and action mechanisms. For such, Pubmed-indexed references were queried. CONCLUSION: After reviewing current literature data, we have concluded that there is still a lot to be researched about the topic, aiming at safer drugs, and new biomolecular techniques are still needed.

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William Wilkie Collins (WWC) is a well-known prolific and innovator English writer of the Victorian age. After 150 years he is still being extensively read and all his main works are translated into Spanish. Furthermore, WWC has been acclaimed by famous writers such as JL Borges and TS Eliot as one of the best story-tellers of all times, and a master of the complexities of the plot of stories. WWC mentioned on his works many innovator aspects of medicine, demonstrating an uncanny power of observation and real interest in science. Notoriously, WWC described posttraumatic epilepsy, the clinical effects of opium, the introduction of people with sensorial deficits, such as blindness and deafness, as main figures in his novels. WWC also showed an interest in the management of mental disorders and the use of music as a potential therapy. In this review, we comment these interesting aspects of the creative work of this genius of the fiction literature.

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