Prevalencia de fragilidad en cirugía electiva para personas mayores usuarios del Hospital de Clínicas. Análisis de la población quirúrgica de personas mayores del Hospital de Clínicas "Dr. Manuel Quintela" (marzo 2019-marzo 2020) / Prevalence of frailty in elective surgery for older adults at Clínicas Hospital. Analysis of the surgical population of older adults at "Dr. Manuel Quintela" University Hospital from March, 2029 to March, 2020 / Prevalência de fragilidade em cirurgia eletiva em idosos usuários do Hospital de Clínicas. Análise da população cirúrgica de idosos do Hospital de Clínicas "Dr. Manuel Quintela" (março 2019-março 2020)

La fragilidad determina una incapacidad para enfrentar estresores debido a la disminución de las reservas fisiológicas multisistémicas. El acto anestésico quirúrgico constituye un evento estresante y la presencia de fragilidad es un factor de riesgo independiente de morbimortalidad perioperatoria. Identificarla permitiría abordar los factores reversibles que la determinan con la intención de disminuir los riesgos inherentes a dicho acto. Su detección en la valoración perioperatoria aporta información relevante que no se obtiene con una evaluación tradicional. Este enfoque se ha convertido en un estándar en la valoración perioperatoria de personas mayores. El objetivo del estudio es valorar la prevalencia de fragilidad en la cirugía electiva de personas mayores en el Hospital de Clínicas. Es un estudio prospectivo y descriptivo. Fue aprobado por el Comité de Ética institucional. Se reclutaron 206 pacientes de 65 años y más, coordinados para cirugía electiva, entre marzo del 2019 y marzo del 2020. Se aplicó la Escala de Fragilidad de Edmonton Reportada (REFS) para la detección de la fragilidad. La prevalencia de fragilidad fue del 22,8% con un IC 16-29,6, por lo que decimos que es alta en esta población y similar al de otros contextos quirúrgicos y no quirúrgicos. Se encontraron un número significativamente mayor de hipertensión arterial, arritmias, diabetes, hipotiroidismo y tabaquismo entre los pacientes frágiles. Su prevalencia e impacto en la morbimortalidad operatoria constituyen razones de peso para su inclusión en la valoración perioperatoria en nuestro sistema de salud así como la capacitación de los anestesiólogos en la detección de la fragilidad a través del uso de herramientas prácticas, válidas y confiables.

Frailty determines an inability to cope with stressors due to decreased multisystem physiologic reserves. The surgical anesthetic act is a stressful event and the presence of frailty is an independent risk factor for perioperative morbidity and mortality Detection of frailty would allow for addressing reversible factors causing it, with the intention of reducing the risks that are inherent to anesthetic acts. Detection in the perioperative assessment provides relevant information that is not obtained in a traditional evaluation. This approach has become the standard in perioperative assessment of geriatric surgical patients. The study aims to assess the prevalence of frailty in elective surgery for the elderly at Clínicas Hospital. Method: prospective, descriptive study approved by the institutional Ethics Committee. 206 patients aged 65 years old and over who had been coordinated for elective surgery were recruited for the study between March, 2019 and March, 2020. The Reported Edmonton Frailty Scale (REFS) was applied to detect frailty. Prevalence of frailty was 22.8% with a CI of 16-29 in this population, rather high and similar to the frail patients percentages in other surgical and non-surgical settings. Significantly higher numbers of arterial hypertension, arrhythmias, diabetes and hypothyroidism cases and tobacco users were found among frail patients. Prevalence and impact of frailty on operative morbidity and mortality are compelling reasons for its inclusion in the perioperative assessment of our health system, as well as the training of anesthesiologists in the detection of frailty through the use of practical, valid and reliable tools.

A fragilidade determina uma incapacidade de lidar com estressores devido à diminuição das reservas fisiológicas multissistêmicas. O ato anestésico cirúrgico é um evento estressante e a presença de fragilidade é um fator de risco independente para morbimortalidade perioperatória. Identificá-lo permitiria abordar os fatores reversíveis que o determinam com o intuito de reduzir os riscos inerentes ao referido ato. Sua detecção na avaliação perioperatória fornece informações relevantes que não são obtidas com uma avaliação tradicional. Essa abordagem tornou-se padrão na avaliação perioperatória de idosos. O objetivo do estudo é avaliar a prevalência de fragilidade em cirurgias eletivas para idosos no Hospital de Clínicas. Realizou-se um estudo prospectivo e descritivo, aprovado pelo Comitê de Ética institucional. 206 pacientes com 65 anos ou mais, coordenados para cirurgia eletiva, foram recrutados entre março de 2019 e março de 2020. A Reported Edmonton Frailty Scale (REFS) foi aplicada para detectar fragilidade. A prevalência de fragilidade foi de 22,8% com um IC de 16-29,6, pelo que podemos dizer que é elevada nesta população e semelhante à de outros contextos cirúrgicos e não cirúrgicos. Números significativamente maiores de hipertensão arterial, arritmias, diabetes, hipotireoidismo e tabagismo foram encontrados entre os pacientes frágeis. A prevalência e impacto da fragilidade na morbimortalidade operatória são razões convincentes para sua inclusão na avaliação perioperatória em nosso sistema de saúde, bem como para o treinamento de anestesistas na detecção de fragilidade por meio do uso de ferramentas práticas, válidas e confiáveis.

The impact of the COVID-19 pandemic on mortality: life expectancy reduction and geographical disparities in Argentina / O impacto da pandemia de COVID-19 na mortalidade: redução da expectativa de vida e disparidades geográficas na Argentina

ABSTRACT: Objective: To assess the impact of the COVID-19 pandemic on mortality in Argentina, considering temporal trends in life expectancy at birth and premature mortality rate during 2010-2020. Methods: Based on demographic projections, this ecological time-series study compares a "normal" versus a "COVID-19" mortality scenario for 2020 over a set of 11 Argentine provinces. Annual life expectancy at birth and age-standardized rates of premature mortality were estimated from 2010 to 2020. Joinpoint regression and multilevel models were used. Results: A potential reduction in life expectancy at birth (a gap between scenarios >1 year) was observed. A significant (negative) point of inflection in temporal trends was identified for the country and most of the provinces, under the COVID-19 mortality scenario. However, our findings reveal disparities between provinces in the estimated life expectancy reduction toward 2020 (values range from -0.63 to -1.85 year in females and up to -2.55 years in males). While men showed more accentuated declines in life expectancy at birth in 2020 (a national gap between scenarios of -1.47 year in men vs. -1.35 year in women), women experienced more unfavorable temporal trends of premature mortality. In the absence of COVID-19, an improvement in both indicators was estimated toward 2020 in both sexes, while a return to levels reported in the past was observed under the COVID-19 scenario. Conclusion: The COVID-19 pandemic might seriously affect the trends of mortality and exacerbate health disadvantages in Argentina. A temporal and contextual perspective of health inequities merits special attention in the COVID-19 research.

RESUMO: Objetivo: Avaliar o impacto da pandemia de COVID-19 sobre a mortalidade na Argentina, considerando as tendências temporais da expectativa de vida ao nascer e a taxa de mortalidade prematura 2010-2020. Métodos: Com base em projeções demográficas, este estudo ecológico de séries temporais compara um cenário de mortalidade "normal" versus "COVID-19" para 2020 em 11 províncias argentinas. Foram calculadas a expectativa de vida ao nascer anual e taxas de mortalidade prematura padronizadas por idade (2010-2020). Utilizaram-se modelos de regressão joinpoint e multiníveis. Resultados: Observou-se redução da expectativa de vida ao nascer (lacuna entre cenários >1 ano). Foi identificado um ponto de inflexão significativo (negativo) nas tendências temporais para o país e a maioria das províncias no cenário COVID-19. Nossos resultados revelam disparidades entre as províncias na redução da expectativa de vida 2020 (valores de -0,63 a -1,85 ano nas mulheres e até -2,55 nos homens). Enquanto os homens mostraram declínios mais acentuados na expectativa de vida ao nascer em 2020 (lacuna nacional entre os cenários de -1,47 vs. -1,35 ano nas mulheres), as mulheres experimentaram tendências temporais mais desfavoráveis de mortalidade prematura. Na ausência do COVID-19, estimou-se melhoria de ambos os indicadores até 2020 em ambos os sexos, enquanto se observou retorno aos níveis reportados no passado no cenário COVID-19. Conclusão: A pandemia de COVID-19 pode afetar seriamente as tendências de mortalidade e agravar as desvantagens para a saúde na Argentina. Uma perspectiva temporal e contextual das iniquidades em saúde merece atenção especial na pesquisa em COVID-19.

Salud y Pobreza en Chile de Post-Transición: ¿Qué nos dicen los indicadores de pobreza sobre la salud de la población? / Degree of association between healthcare indicators and poverty measures in Chile over the period 1992-2017

Background: More than half of the worlds's population is deprived of essential healthcare services. In consideration of this, the World Health Organization introduced the concept of Social Determinants of Health to improve the awareness of this problem. Aim: To investigate and compare the pertinence of monetary and multidimensional measures of poverty as indirect measures of health status. Material and Methods: Three indices were used: the Historic Multidimensional Poverty Index (HMPI), calculated using Alkire-Foster method; health deprivations associated with the HMPI; and households in conditions of monetary poverty. The poverty identification outcomes for the three indices mentioned were all estimated using data from the Chilean national socioeconomic survey CASEN for the period 1992-2017. Results: First, independently of how poverty is measured (monetarily or multidimensionally), the degree to which households living in poverty conditions are simultaneously suffering health deprivations steadily decreased during the period 1992-2017. Second, the association between multidimensional poverty and health deprivations is stronger than the association between health deprivations and monetary poverty. Conclusions: Poverty calculated on the basis of income alone is an inadequate predictor of health deprivations; multidimensional poverty performs better. However, poverty and health indicators have become progressively less associated. Therefore, it becomes necessary either to adapt the health indicators included in Multidimensional Poverty Index to the current health challenges or to implement a Multidimensional Health Deprivation Index, with a view to improving the integration of health within the current social policy framework.

Evolución del nivel de mortalidad vial en Argentina en el periodo 1998-2017 / Evolution of the level of road mortality in Argentina in the period 1998-2017

Resumen Objetivo: Determinar el impacto que tuvieron las muertes por atropellos de peatones y colisiones entre vehículos sobre la esperanza de vida en Argentina durante el periodo 1998-2017. Material y métodos: Se obtuvieron las bases de datos sobre las causas de muerte, sexo, edad y jurisdicción de residencia de los fallecidos de la Dirección de Estadísticas e Investigación en Salud de Argentina. Se calcularon las tasas de mortalidad y el indicador de los años de esperanza de vida perdidos (AEVP) para determinar el impacto de la mortalidad vial. Resultados: Argentina redujo en un 13 % los fallecimientos por atropellos de peatones y choques entre vehículos durante los últimos 20 años. La tasa de mortalidad vial pasó de 12.0 a 10.6 defunciones cada 100 000 habitantes entre los trienios 1998-2000 y 2015-2017 respectivamente. Los decesos en el tránsito tuvieron mayor impacto entre los hombres de edades de 15 a 49 años. Al mismo tiempo, hubo un fuerte contraste del nivel de mortalidad vial registrado en cada una de las jurisdicciones del interior del país, donde las tasas de mortalidad oscilaron entre 1.2 y 24.1 decesos cada 100 000 habitantes. Conclusiones: Si bien hubo una disminución del nivel de mortalidad vial, las políticas públicas implementadas en Argentina no han logrado el objetivo de reducir a la mitad la cantidad de defunciones. Este flagelo sigue generando la destrucción y desarticulación de las familias del país. Es necesario la implementación de nuevos programas que apunten a reducir las conductas violatorias de las normas de tránsito.

Abstract Objective: To determine the impact that the deaths caused by pedestrian abuses and vehicle collisions had on life expectancy in Argentina during the period 1998-2017. Material and methods: The databases on the causes of death, sex, age and jurisdiction of residence of the deceased of the Directorate of Health Statistics and Research of Argentina were obtained. Mortality rates and the indicator of years of life expectancy lost (YLEL) were calculated to determine the impact of road mortality. Results: Argentina reduced by 13% the number of deaths due to pedestrian accidents and collisions between vehicles during the last 20 years. The road mortality rate went from 12.0 to 10.6 deaths per 100.000 inhabitants between the triennia 1998-2000 and 2015-2017, respectively. Deaths in transit had a greater impact among men aged 15 to 49 years. At the same time, there was a strong contrast in the level of road mortality recorded in each of the jurisdictions in the interior of the country, where mortality rates ranged from 1.2 to 24.1 deaths per 100,000 inhabitants. Conclusions: Although there was a decrease in the level of road mortality, public policies implemented in Argentina have not achieved the objective of halving the number of deaths. This scourge continues to cause destruction and disarticulation of families residing in the country. It is necessary to implement new programs that aim to reduce the behaviors that violate traffic regulations.

Estudio comparativo de la bioactividad de dos materiales biocerámicos / Comparative Study of the Bioactivity of Two Bioceramic Materials

RESUMEN Los materiales a base de silicato de calcio han demostrado ser bioactivos debido a su capacidad para producir apatita carbonatada biológicamente compatible. El objetivo de este estudio fue analizar la bioactividad de Biodentine™ y MTA Repair HP® en contacto con discos de dentina humana, que se obturaron y dividieron aleatoriamente para formar cuatro grupos: grupo 1 Biodentine™, grupo 2 MTA Repair HP®, grupo control positivo MTA Angelus® y grupo control negativo IRM®, los cuales se incubaron en solución PBS durante 10 días, para posterior análisis por medio de MEB-EDS y Espectroscopía Raman. Los tres materiales a base de silicato de calcio analizados en este estudio demostraron ser bioactivos pues al entrar en contacto con una solución a base de fosfato desencadenaron la precipitación inicial de fosfato de calcio amorfo, que actúa como precursor durante la formación de apatita carbonatada.

ABSTRACT Calcium silicate-based materials have been shown to be bioactive due to their ability to produce biologically compatible carbonated apatite. The objective of this study was to analyze the bioactivity of Biodentine ™ and MTA Repair HP® in contact with human dentine discs, which were sealed and divided randomly to form four groups: group 1 Biodentine™, group 2 MTA Repair HP®, positive control group MTA Angelus® and negative control group IRM®, which were incubated in PBS solution for 10 days, for a subsequent analysis by means of MEB-EDS and Raman spectroscopy. The three calcium-based materials analyzed in this study proved to be bioactive because upon contact with a phosphate-based solution they were triggered at the onset of amorphous calcium phosphate, as the precursor during the formation of carbonated apatite.

Estudio de agregación plaquetaria con diferentes agonistas. Valores de referencia / Platelet aggregation study using different agonists. Reference values

Introducción: los estudios de agregación plaquetaria permiten identificar pacientes con trastornos de función y el monitoreo de terapias antiplaquetarias, estableciéndose patrones clásicos. Debido a que no está establecido un acuerdo acerca del establecimiento de los rangos de referencia, existen numerosos esfuerzos actualmente para mejorar la estandarización de esta prueba. Objetivos: establecer los valores de referencia para los estudios de agregación plaquetaria con diferentes agonistas en el Hospital Hermanos Ameijeiras comparándolos con los preestablecidos en la literatura. Identificar la influencia de las variables: sexo, hábito de fumar y consumo de alcohol. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal, de agregación plaquetaria utilizando diferentes agonistas, en el laboratorio clínico del Hospital Hermanos Ameijeiras entre septiembre de 2009 y septiembre de 2015. La población de estudio estuvo integrada por 192 donantes del banco de sangre, utilizados como control. Los rangos de referencia de la agregación plaquetaria con los diferentes agonistas se obtuvieron utilizando los percentiles 2.5 (P2.5) y 97.5 (P97.5) y para comparar la media poblacional de este estudio con la media muestral prestablecida en la literatura se empleó la prueba de t para una muestra. Resultados: la media del porcentaje de agregación que se obtuvo en nuestro estudio con cada agonista fue: ADP: 62,4 por ciento, epinefrina: 66,4 por ciento, colágeno: 69,9 por ciento y ristocetina: 69,7 por ciento.Los intervalos de referencia en la investigación con cada agonista fueron los siguientes: ADP: 44,1-86,7 por ciento, epinefrina: 50,8-80,0 por ciento, colágeno: 60,0-85,5 por ciento y ristocetina: 52,9-91,7 por ciento. Conclusiones: Las variables sexo, hábito de fumar y consumo de alcohol no influyeron en los resultados del estudio de agregación plaquetaria. Los resultados de la población para el estudio de agregación plaquetaria presentaron diferencias estadísticamente significativas al compararlos con los valores de agregación preestablecidos en la literatura(AU)

Introduction: Platelet aggregation studies allow the identification of patients with functional disorders and the monitoring of antiplatelet therapies, establishing classic patterns. Because there is no agreement on the establishment of reference ranges, numerous efforts are currently being made to improve the standardization of this test. Objectives: To establish reference values for platelet aggregation studies with different agonists by comparing them with those preset in the literature, at Hermanos Ameijeiras Hospital. To identify the influence of the variables sex, smoking habits and alcohol consumption. Methods: An observational, descriptive, cross-sectional study of platelet aggregation using different agonists was performed in the clinical laboratory of Hermanos Ameijeiras Hospital, between September 2009 and September 2015. The study population consisted of 192 donors from the blood bank, used as control group. The reference ranges of platelet aggregation with the different agonists were obtained using the 2.5 (P2.5) and 97.5 (P97.5) percentiles. In order to compare this study's population mean with the sample mean preset in the literature, we used the T-test for one sample. Results: The mean of aggregation percentage obtained in our study with each agonist was ADP (62.4 percent), epinephrine (66.4 percent), collagen (69.9 percent), and ristocetin (69.7 percent). The reference ranges in the research with each agonist were the following: ADP (44.1-86.7 percent), epinephrine (50.8-80.0 percent), collagen (60.0-85.5 percent), and ristocetin (52.9-91.7 percent). Conclusions: The variables gender, smoking and alcohol consumption did not influence the results of the platelet aggregation study. The results of the population for the platelet aggregation study presented statistically significant differences when compared with the values of aggregation preset in the literature(AU)

Perioperatorio de trasplante renopancreático / Perioperative of renopancreatic transplantation

El trasplante renopancreático es el tratamiento de elección para el paciente diabético con insuficiencia renal crónica. En el Hospital Universitario, desde junio de 2002 a mayo de 2010 se han realizado 35 trasplantes renopancreáticos. Los receptores presentaban una larga evolución de su diabetes y del tratamiento dialítico, con alta incidencia de patología médica asociada. En todos los pacientes se realizó anestesia general y a la monitorización estándar se agregó: monitorización invasiva de la presión arterial y de la presión venosa central, así como monitorización paraclínica seriada. Se administró insulina en infusión continua para control de la glicemia. La duración promedio del procedimiento fue de 407,9 ± 76,4 min. La reposición intraoperatoria se realizó en base a cristaloides y coloides (4.665 ± 2.127 ml y 1.015 ± 492 ml respectivamente). En 21 pacientes (60%) se administraron glóbulos rojos (858 ± 502 ml). El balance promedio fue positivo: 1.430 ± 832 ml. Para mantener la estabilidad hemodinámica se utilizaron fármacos vasoactivos y aporte de volumen. Ocho pacientes (22,8%) presentaron hipotensión severa transitoria; 14 (40%) presentaron acidosis metabólica, ocho pacientes (22,8%) hipokaliemia leve y tres (8,5%) hipoglicemia. Veintitrés pacientes (65%) requirieron al menos una reintervención en la internación inicial. La mortalidad global fue de 11,4% (cuatro pacientes): 2,8% (un paciente) en las primeras 48 horas. Ocho pacientes (22,8%) presentaron insuficiencia renal desde el inicio del postoperatorio. Se perdieron 15 páncreas (42,8%); cinco de ellos (14,2%) en las primeras 48 horas. Actualmente sobreviven 31 pacientes (88%), 25 preservan la función renal (80,6%) y 20 la función pancreática (64,5%). Se reveló una alta incidencia de complicaciones anestésico-quirúrgicas precoces, las cuales tienen gran importancia sobre los resultados a corto y largo plazo.