Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.

Famotidina en el tratamiento de pacientes hospitalizados con COVID-19. Revisión sistemática y metaanálisis / Famotidine in the treatment of hospitalized patients with COVID-19. Systematic review and meta-analysis

Introducción: El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), de alta morbimortalidad, carece a la fecha de preparar esta revisión, de una terapia específica altamente eficaz. Famotidina se ha postulado como una opción terapéutica viable, basado en trabajos de cohorte retrospectiva y modelos computacionales guiados por inteligencia artificial. Objetivo: Recopilar la mejor evidencia científica disponible para determinar la efectividad y eficacia de famotidina en el tratamiento de pacientes hospitalizados con COVID-19, para reducir el riesgo de progresión de la enfermedad, intubación, muerte y tiempo de estancia hospitalaria. Material y Métodos: Se realizó una búsqueda en PubMed, EBSCO, Scopus, Web of Science y Cochrane Central, de artículos originales que reporten las variables de interés asociadas al uso de famotidina en pacientes hospitalizados con COVID- 19. Los investigadores independientemente evaluaron y seleccionaron los estudios, se extrajeron los datos expuestos para las asociaciones de interés y se procesaron con el software Revman 5.3. Resultados: En la búsqueda se obtuvo un total de 126 artículos potenciales para la revisión, de los cuales 14 fueron seleccionados para el análisis. En el metaanálisis se incluyeron un total de 47.044 pacientes, de los cuales 6.647 fueron los usuarios de famotidina. El riesgo de intubación se vio reducido en el grupo no expuesto a famotidina, aunque sin significancia estadística, (RR 1,43 IC95% 0,42-4,83), en cuanto a la mortalidad no se evidenció reducción significativa en el grupo de famotidina (RR 0,95 IC 95% 0,70-1,29). Se observó reducción en el tiempo de estancia hospitalaria (DM -1,60 -2,89, -0,31) y finalmente se mostró que no hay presencia de asociación entre el uso de famotidina y el desenlace compuesto de reducción del riesgo de ingreso a UCI, intubación y muerte (RR 1,03 IC 95% 0,46-2,34). Conclusión: Famotidina no presenta efectividad ni eficacia en la reducción de riesgo de intubación o ingreso a UCI ni de mortalidad en pacientes hospitalizados por COVID-19. La eficacia en la reducción de la estancia hospitalaria no es consistente y se necesitan más ensayos clínicos con buena calidad metodológica para definirla.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with high morbidity and mortality, lacks, at the time of preparing this review, a highly effective specific therapy. Famotidine has been postulated as a viable therapeutic option, based on retrospective cohort investigations and computational models guided by artificial intelligence. Aim: The objective of this study was to compile the best scientific evidence available to determine the effectiveness and efficacy of famotidine in the treatment of hospitalized patients with COVID-19, to reduce the risk of disease progression, intubation, death, and time to hospital stay. Methods: A search was carried out in PubMed, EBSCO, Scopus, Web of Science, and Central Cochrane, for original articles that report the variables of interest associated with the use of famotidine in hospitalized patients with COVID-19. The investigators independently evaluated and selected the studies, the exposed data for the associations of interest were extracted and processed with Revman 5.3 software. Results: The search yielded a total of 126 potential articles for the review, of which 14 were selected for analysis. A total of 47,044 patients were included in the meta-analysis of which 6,647 were famotidine users. The risk of intubation was reduced in the group not exposed to famotidine, although without statistical significance (RR 1.43 IC95% 0.42 - 4.83), regarding mortality there was no significant reduction in the famotidine group (RR 0.95 IC 95 % 0.70-1.29). A reduction in the length of hospital stay was observed (MD -1.60 -2.89, -0.31) and finally it was shown that there is no association between the use of famotidine and the composite outcome of reduced risk of ICU admission, intubation and death. (RR 1.03 95% CI 0.46-2.34). Conclusion: Famotidine does not show effectiveness or efficacy in reducing the risk of intubation or ICU admission or mortality in patients hospitalized for COVID-19. The efficacy in reducing hospital stay is not consistent and more clinical trials with good methodological quality are needed to define it.

A systematic review and meta-analysis on abnormal posturing among brain injury patients / Uma revisão sistemática e metanálise sobre postura anormal entre pacientes com lesão cerebral

Abstract Background Abnormal motor posturing (AMP), exhibiting as decorticate, decerebrate, or opisthotonos, is regularly noticed among children and adults. Objective This systematic review and meta-analysis examined the risk factors and outcome of posturing among severe head and brain injury subjects. Methods Based on the inclusion and exclusion criteria and using MeSH terms: "decerebrate posturing", "opisthotonic posturing", "brain injury", and/or "cerebral injury" articles were searched on Scopus, PubMed, Science Direct, and google scholar databases. Observational studies, case series, and case reports were included. Results A total of 1953 studies were retrieved initially, and based on the selection criteria, 20 studies were finally selected for review and were analyzed for meta-analysis based on the mortality between the hematomas. The functional outcomes of this study are the risk factors, mortality rate and Glasgow Outcome Scale. Decerebrative patients were higher among the studies related to head injury surgeries. Males were mainly treated for decerebrate postures compared with the female subjects. Extradural hematoma and acute subdural hematoma with cerebral contusion were quite common in the surgical mass lesions. Conclusion The findings reported that the lesion types, the operative procedures, and the age of the decerebrating patients with brain injuries are the significant prognostic factors determining the survival outcomes.

Resumo Antecedentes Postura motora anormal (AMP), exibindo-se como decorticada, descerebrada ou opistótono, é regularmente observada entre crianças e adultos. Objetivo Esta revisão sistemática e metanálise examinou os fatores de risco e os resultados da postura entre indivíduos com lesões graves na cabeça e no cérebro. Métodos Com base nos critérios de inclusão e exclusão e usando termos MeSH: artigos sobre "postura descerebrada", "postura opistótona", "lesão cerebral" e/ou "lesão cerebral" foram pesquisados nas bases de dados Scopus, PubMed, Science Direct e Google Scholar. Foram incluídos estudos observacionais, séries de casos e relatos de casos. Resultados Um total de 1.953 estudos foram recuperados inicialmente e, com base nos critérios de seleção, 20 estudos foram finalmente selecionados para revisão e analisados para metanálise com base na mortalidade entre os hematomas. Os resultados funcionais deste estudo são os fatores de risco, taxa de mortalidade e Escala de Resultados de Glasgow. Os pacientes descerebrados foram maiores entre os estudos relacionados a cirurgias de traumatismo cranioencefálico. Os homens foram tratados principalmente para posturas descerebradas em comparação com as mulheres. Hematoma extradural e hematoma subdural agudo com contusão cerebral foram bastante comuns nas lesões de massa cirúrgica. Conclusão Os achados relataram que os tipos de lesões, os procedimentos operatórios e a idade dos pacientes descerebrados com lesões cerebrais são os fatores prognósticos significativos que determinam os resultados de sobrevivência.

Prevention of Diabetic Nephropathy Through RAAS Blockade in a Resource Poor Setting – A review of Evidence

Background@#In Fiji, 1 in every 3 Fijian is being diagnosed with diabetes. The contribution of chronic kidney disease (CKD) to mortality in Fiji has increased to become the fourth leading cause of death in the country. Fiji Ministry of Health and Medical Services data show that admissions to hospitals for CKD are increasing and treatment of end‐stage kidney disease (ESKD) is a growing burden. Since renal replacement therapy is not readily available or affordable in Fiji, it is advisable to prevent or slow the progression of renal disease to ESKD. Early deduction of renal impairment in diabetic patient is paramount and foremost is to identify proteinuria in the earliest stage. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) offer reno-protection. These agents reduce proteinuria, a risk marker for renal disease progression.@*Aim@#To evaluate and provide evidence for use ACE-I and ARB in prevention of diabetic nephropathy in our clinical setting.@*Method@#An online search using MESH terms that best answered our research question was conducted on the Medline database. Four seminal papers were identified after shifting through abstracts of 210 studies. These papers were evaluated and conclusions discussed.@*Results@#ACE-I and ARBs are equally reno-protective agents when used individually; it slows the progression of diabetic renal impairment to ESKD and reduces proteinuria to almost normal levels. ARBs are likely to be used as first line agent in patients who have already developed significant diabetic proteinuria since additional blood pressure lowering capabilities of this class of drug may have accentuated benefits. Additionally, ARB’s should be used in patients who cannot tolerate ACE-I induced side effects. For prevention and conversion of diabetic nephropathy to normo-proteinuria; moderate to maximum doses of ACE-I or ARB should be used in clinical practice. Combination of ACE-I plus ARB in management is not recommended. ACE-I still remains the most cost-effective drug for a low resourced clinical setting such as ours.

Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Nursing Sensitive Outcomes evaluation in the Emergency Department: An Umbrella Review / Evaluación de resultados sensibles de Enfermería en el Servicio de urgencias. Revisión de alcance / Avaliação de resultados de enfermagem sensíveis no pronto-socorro. Revisão do escopo

Objective. The aim of this review was to identify reported nursing-sensitive outcomes in the Emergency Department to date. Methods. An Umbrella review was conducted. Four databases, CINAHL, Pubmed, Web of Science and Scopus, were searched from inception until October 2022. MeSH terms were: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Two reviewers independently screened studies against the inclusion criteria for eligibility, extracted data and assessed study quality with the SIGN tool. Results of the included studies were summarized and described in themes for narrative analysis. The study was enrolled in the PROSPERO registry (CRD42022376941) and PRISMA guidelines were followed. Results. The search strategy yielded 2289 records. After duplicate removal, title, abstract and full-text eligibility screening, nine systematicInvest Educ Enferm. 2023; 41(3): e03Nursing Sensitive Outcomes evaluation in the Emergency Department:An Umbrella Reviewreviews were included in the review. A total of 35 nursing-sensitive outcomes were reported. The most described outcomes were waiting times, patient satisfaction and time to treatment. The less measured were mortality, left without being seen and physical function. Synthesizing nursing-sensitive outcomes in themes for reporting, the most measured outcomes were within the safety domain (n=20), followed by the clinical (n=9), perceptual (n=5) and the least explored functional domain (n=1). Conclusion. Nursing sensitive outcomes research in emergency nursing practice is a conceptual challenge still in its early stage. Several nursing-sensitive outcomes were identified in this review that can evaluate the contribution of emergency department nursing care to patient outcomes. Further research is required to explore patient outcomes sensitive to emergency nursing care.

Objetivo. Identificar los resultados sensibles de enfermería reportados en los Servicios de Urgencias. Métodos. Se realizó una revisión general. Se hicieron búsquedas en cuatro bases de datos, CINAHL, Pubmed, Web of Science y Scopus, desde su inicio hasta octubre de 2022. Los términos MeSH empleados fueron: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Dos revisores examinaron de forma independiente los estudios en función de los criterios de inclusión para determinar su elegibilidad, extrajeron los datos y evaluaron la calidad de los estudios con la herramienta SIGN. Los resultados de los estudios incluidos se resumieron y describieron en temas para el análisis narrativo. El estudio se inscribió en el registro PROSPERO (CRD42022376941) y se siguieron las directrices PRISMA. Resultados. La estrategia de búsqueda produjo 2289 registros. Tras la eliminación de duplicados y el cribado de elegibilidad de título, resumen y texto completo, se incluyeron en la revisión nueve revisiones sistemáticas. Se informó de un total de 35 resultados sensibles a la enfermería. Los resultados más descritos fueron los: tiempos de espera, la satisfacción del paciente y el tiempo hasta el tratamiento. Los menos medidos fueron la mortalidad, el tiempo sin ser evaluado y la función física. Sintetizando los resultados sensibles a la enfermería en temas para la notificación, los resultados más medidos estaban dentro del dominio de la seguridad (n=20), seguidos por el clínico (n=9), el perceptivo (n=5) y el dominio funcional menos explorado (n=1). Conclusión. En esta revisión se identificaron varios resultados sensibles a la enfermería que pueden evaluar la contribución de los cuidados de enfermería en los servicios de urgencias a los resultados de los pacientes. La investigación de resultados sensibles a la enfermería en la práctica de la enfermería de urgencias es un reto conceptual que aún se encuentra en su fase inicial.

Objetivo. Identificar resultados de enfermagem sensíveis notificados em Serviços de Emergência. Métodos. Foi realizada uma revisão geral. Foram pesquisadas quatro bases de dados: CINAHL, Pubmed, Web of Science e Scopus, desde a sua criação até outubro de 2022. Os termos MeSH utilizados foram: "enfermagem", "sensibilidade e especificidade", "serviço de emergência, hospital", "cuidados de enfermagem". Dois revisores selecionaram independentemente os estudos em relação aos critérios de inclusão para determinar a elegibilidade, extraíram os dados e avaliaram a qualidade do estudo com a ferramenta SIGN. Os resultados dos estudos incluídos foram resumidos e descritos em temas para análise narrativa. O estudo foi registrado no registro PROSPERO (CRD42022376941) e as diretrizes PRISMA foram seguidas. Resultados. A estratégia de busca produziu 2.289 registros. Após remoção das duplicatas e triagem do título, resumo e texto completo para elegibilidade, nove revisões sistemáticas foram incluídas neste estudo. Foram relatados 35 resultados de enfermagem sensíveis, sendo os mais descritos: tempo de espera, satisfação do paciente e tempo para tratamento. Os menos frequentes foram: mortalidade, tempo sem avaliação e função física. Sintetizando os resultados sensíveis à enfermagem por meio de tópicos de relato, os mais mensurados foram dentro do domínio segurança (n=20), seguido do domínio clínico (n=9), do perceptual (n=5) e do funcional. menos explorados (n=1). Conclusão. Esta revisão identificou vários resultados sensíveis à enfermagem que podem avaliar a contribuição dos cuidados de enfermagem nos serviços de urgências para os resultados dos pacientes. A investigação de resultados sensíveis na prática de enfermagem em emergências é um desafio conceitual que ainda está em fase inicial.

Mortalidad de pacientes hospitalizados por Covid-19 en México, revisión sistemática / Mortality of patients hospitalized by Covid-19 in Mexico, systematic review

RESUMEN Introducción: Desde el inicio de la pandemia, México fue de los países que presentó tasas de mortalidad más altas por COVID 19. Objetivo: Determinar si la diabetes mellitus tipo 2, la hipertensión arterial y la obesidad incrementan la tasa de mortalidad en pacientes con diagnóstico de COVID-19 que requirieron hospitalización en México. Métodos: Revisión sistemática en Pubmed MeSH, Web of Science, Lilas, Scielo y Google Scholar con los términos MeSH "COVID-19", "SARS-COV2", "Coronavirus", y "México" durante los años 2020 y 2021, incluyendo artículos en inglés y español. Para el proceso de selección de artículos, dos revisores seleccionaron los estudios mientras que otros dos revisores adicionales participaron en el análisis de dichos estudios. Resultados: Se incluyeron 73 estudios realizados en México del 2020 al 2021 con información obtenida a través de las bases de datos del Sistema Nacional de Vigilancia Epidemiológica de México. Se incluyeron pacientes con un promedio de edad de 52,9 años ±13,27, el 64% de los pacientes incluidos fueron mujeres, se reportó una tasa de mortalidad de 6.76% (Min-Max 0.77-73.73%). El 71% de los estudios (52), no reportaron la mortalidad específica relacionada con las comorbilidades. La patología más prevalente fue la obesidad con un 24.23% (Min-Max 11.50-71.00%), seguida de la hipertensión arterial con un 22.23% (Min-Max 2.0-53.96%) y finalmente la diabetes mellitus tipo 2 con un 18.10% (Min-Max 1.83-40.00%). Conclusión: La comorbilidad más común entre los pacientes hospitalizados por COVID 19 en México fue la obesidad, seguida de la diabetes mellitus tipo 2 y por último la hipertensión.

ABSTRACT Introduction: Since the start of the pandemic, Mexico was one of the countries with the highest mortality rates from COVID 19. Objective: To determine if type 2 diabetes mellitus, arterial hypertension, and obesity increase mortality in patients diagnosed with COVID-19 who required hospitalization in Mexico. Methods: Systematic review in Pubmed MeSH, Web of Science, Lilas, Scielo, and Google Scholar with the terms MeSH COVID-19, SARS-COV2, Coronavirus, and Mexico for the years 2020 and 2021, in English or Spanish. Two reviewers selected the studies, two additional reviewers participated in the analysis of the studies. Results: Seventy three studies carried out in Mexico from 2020 to 2021 were included with information obtained from the databases of the National Epidemiological Surveillance System of Mexico. With an average age of 52.9 ± 13.27 years, 64% of the included patients were women, in general, a mortality rate of 16.76% (Min-Max 0.77-73.73%) was reported. 71% of the studies (52) did not report specific mortality related to comorbidities the most prevalent pathology was obesity with 24.23% (Min-Max 11.50-71.00%), followed by arterial hypertension 22.23% (Min-Max 2.0-53.96%) and finally Diabetes mellitus with 18.10% (Min-Max 1.83-40.00%). Conclusion: The most common comorbidity among patients hospitalized for COVID in Mexico was obesity, followed by type 2 diabetes mellitus and hypertension.

Hernia inguinoescrotal gigante: un caso infrecuente

Introducción: Las hernias de la pared abdominal afectan entre el 10% al 15% de la población mundial, siendo hasta el 60% de estas hernias inguinales. Las hernias inguinales gigantes son poco comunes, pero con una gran carga de enfermedad para el paciente. Caso Clínico: Se presenta el caso de un paciente de 51 años, con antecedente de diabetes mellitus tipo II, proveniente de zona rural aislada, por cuatro días de evolución consistente en quemadura escrotal por metal caliente, relacionada a una hernia inguinoescrotal derecha gigante. Es llevado a intervención quirúrgica por cirugía general y urología. Por adecuada evolución clínica se da de alta al 5° día posoperatorio. Discusión: Las hernias inguinales gigantes son raras y frecuentemente se presentan en pacientes de bajo estrato socioeconómico, procedencia rural y cierto grado de negligencia. El reto del equipo quirúrgico consiste en lidiar con los posibles efectos adversos de la reducción del contenido herniario en un abdomen con diversos grados de pérdida del dominio. Se puede requerir resección o debulking del contenido abdominal o la expansión de la cavidad abdominal mediante frenectomía, neumoperitoneo progresivo perioperatorio o la creación de hernias ventrales mediante maniobras avanzadas. La reparación con malla libre de tensión disminuye el riesgo de recurrencia. Conclusión: La hernia inguinal gigante es una patología rara. El cirujano general está llamado a conocer el abanico de opciones que existen en caso de enfrentarse a estos pacientes, lo cual ayuda a reducir la elevada morbimortalidad y altas tasas de recurrencia.

Introduction: Abdominal wall hernias affect between 10% to 15% of the world population and up to 60% of these are inguinal hernias. Giant inguinal hernias are rare, but have high burden of disease for the patients. Clinical Case: We present the case of a 51-year-old patient, with a history of type II diabetes mellitus, from an isolated rural area, with four days of a scrotal burn by hot metal, related to a giant right inguinoscrotal hernia. He is taken to surgical intervention by general surgery and urology. Due to adequate clinical evolution, he was discharged on the 5th postoperative day. Discussion: Giant inguinal hernias are rare and frequently occur in patients of low socioeconomic status, rural origin and a certain degree of neglect. The challenge for the surgical team consist in dealing with the potential adverse effects of reducing hernia contents in an abdomen with varying degrees of loss of normal capacity. Resection or debulking of the abdominal contents or expansion of the abdominal cavity by frenectomy, perioperative progressive pneumoperitoneum, or the creation of ventral hernias by advanced maneuvers may be required. Tension-free mesh repair decreases the risk of recurrence. Conclusion: Giant inguinal hernia is a rare pathology. The general surgeon is called to know the range of options that exist in the event of facing these patients, which helps to reduce the high morbidity and mortality and high rates of recurrence.

Terapia de estrógenos vaginales y riesgo de recurrencia en mujeres con antecedente de cáncer de mama

El cáncer de mama sigue siendo la neoplasia maligna más frecuente y una de las mortales en mujeres, considerándose un importante objetivo de la salud global y prioridad en salud pública. Con el uso de terapias innovadoras, ha mejorado la supervivencia, apareciendo condiciones asociadas, como el síndrome genitourinario menopaúsico. La terapia hormonal, se utiliza para el manejo de esta condición, mejorando sustancialmente la sintomatología, e incluso, siendo en algunos casos la única solución. La más utilizada, es la terapia de estrógenos vaginales. Sin embargo, se ha descrito un posible riesgo de recurrencia de cáncer de mama con su uso. En habla hispana, no existe evidencia que haya discutido este tópico. Se llevó a cabo una búsqueda en las bases PubMed, ScienceDirect y MEDLINE, utilizando los términos "Terapia de estrógenos vaginales", "Recurrencia" y "Cáncer de mama". Se encontró, que, de forma global, la terapia de estrógenos vaginales es una opción terapéutica eficaz y segura en el manejo del síndrome genitourinario menopaúsico en mujeres con antecedente de cáncer de mama, sin incrementar el riesgo de recurrencia, a excepción de aquellas tratadas con inhibidores de la aromatasa, en quienes se recomienda el uso de otras terapias para evitar acarrear este riesgo.

Breast cancer remains the most common malignant neoplasm and one of the leading causes of mortality in women, making it a significant target for global health efforts and a public health priority. Through the use of innovative therapies, survival rates have improved, leading to the emergence of associated conditions such as genitourinary menopausal syndrome. Hormonal therapy is employed for managing this condition, significantly alleviating its symptoms and, in some cases, serving as the sole solution. The most commonly utilized approach is vaginal estrogen therapy. Nevertheless, there have been reports of a potential risk of breast cancer recurrence associated with its use. In the Spanish-speaking context, there is limited evidence discussing this topic. A search was conducted across PubMed, ScienceDirect, and MEDLINE databases, using the terms "Vaginal Estrogen Therapy", "Recurrence" and "Breast Cancer." It was determined that, on a global scale, vaginal estrogen therapy is an effective and safe therapeutic option for managing genitourinary menopausal syndrome in women with a history of breast cancer. This therapy does not appear to increase the risk of recurrence, with the exception of those undergoing treatment with aromatase inhibitors. For these individuals, alternative therapies are recommended to mitigate this potential risk.

Experiencia del tratamiento de la hernia incisional en un hospital de tercer nivel en Colombia / Experience of the treatment of incisional hernia in a third level hospital in Colombia

Introducción. El manejo de las hernias se ha instaurado como un problema quirúrgico común, estimándose su aumento en los próximos años. El objetivo del presente trabajo fue describir el curso clínico, los aspectos del tratamiento quirúrgico y factores asociados a la presencia de complicaciones en pacientes intervenidos por hernia incisional. Métodos. Estudio descriptivo en el que se analizaron las características de una cohorte de pacientes llevados a corrección quirúrgica de hernia incisional en el Hospital Universitario Hernando Moncaleano Perdomo, un centro de alta complejidad en Neiva, Colombia, entre 2012 y 2019. Los datos fueron recolectados en programa Microsoft Excel® y analizados en SPSSTM, versión 21. Resultados. Se realizaron 133 correcciones de hernias incisionales, 69,9 % en mujeres y la mayoría ubicadas en la línea media (84,2 %). La edad media de los pacientes al momento de la intervención fue de 52 años ±14,6. Las comorbilidades más frecuentes fueron obesidad, hipertensión y diabetes. La causa más frecuente de la hernia fue traumática (61,7 %). La frecuencia de complicaciones fue superior al 50 %, en su mayoría menores; se encontró asociación con obesidad para la presencia de seroma. La mortalidad fue del 2,3 %. Conclusión.La hernia incisional es un problema de salud pública. Consideramos que la obesidad y el uso de malla pueden ser factores de riesgo asociados con la presentación de complicaciones postoperatorias, así como el aumento de los gastos relacionados con días de hospitalización

Introduction. Hernias management has become a common surgical problem, with an estimated increase in the coming years. The objective of this study was to describe the clinical course, aspects of surgical treatment and factors associated with the presence of complications in patients operated on for incisional hernia. Methods. Descriptive study, in which the characteristics of a cohort of patients taken to surgical correction of incisional hernia at the Hospital Universitario Hernando Moncaleano Perdomo, a high complexity medical center located in Neiva, Colombia, between 2012 and 2019 were analyzed, whose data were collected in Microsoft Excel® software and analyzed in SPSSTM, version 21. Results. One-hundred-thirty-three incisional hernia corrections were performed. The mean age at the intervention was 52 years ±14.6. The most frequent comorbidities were weight disorders, hypertension and diabetes. Only one laparoscopy was performed, the first etiology of the hernia was traumatic (61.7%) and midline (84.2%). The frequency of complications was greater than 50%, mostly minors. An association with obesity was found for the presence of seroma. Mortality was 2.3%. Conclusion. Incisional hernia is a public health problem. We consider that obesity and the use of mesh are a risk factor associated with the presentation of postoperative complications as well as the increase in costs related to days of hospitalization

Asociación entre el riesgo nutricional, estancia hospitalaria y diagnóstico médico en pacientes de un hospital del seguro social peruano

Objetivo: Determinar la asociación que existe entre el riesgo nutricional, la estancia hospitalaria y el diagnóstico médico en pacientes hospitalizados en el Centro Especializado de Rehabilitación Profesional (CERP) del Hospital Nacional Guillermo Almenara Irigoyen. Materiales y métodos: Se realizó un estudio observacional de cohorte longitudinal, retrospectivo, que incluyó a las personas hospitalizadas durante el periodo comprendido entre el 1 de julio del 2021 y el 27 de febrero del 2022. Hubo un seguimiento de los pacientes hasta su alta del centro hospitalario (egreso). Se excluyeron los individuos menores de 18 años, gestantes o puérperas, y cuya permanencia fue menor a 24 horas. Los datos de interés fueron recogidos a partir de la revisión de las historias clínicas y kárdex de nutrición. La variable principal fue el riesgo nutricional, el cual fue detectado mediante el Nutritional Risk Screening (NRS) 2002; las variables secundarias fueron los grupos etarios, el sexo, la estancia hospitalaria, el diagnóstico médico principal, la condición de egreso y el estado nutricional. En el análisis de los datos, para la comparación de variables cualitativas o categóricas se utilizó la prueba chi-cuadrado y para variables cuantitativas, la prueba t de Student y ANOVA. Se consideró significancia estadística al valor de p < 0,05. Resultados: Se incluyó un total de 1 929 pacientes. La prevalencia del riesgo nutricional fue 33,13 %. Los pacientes con esta condición presentaron tasas de mortalidad más altas (57,51 %). Se observó que la prevalencia del riesgo nutricional está relacionada con una mayor estancia hospitalaria (4,6 días más) (p < 0,001), con el diagnóstico nutricional de delgadez (48,67 %) (p < 0,001) y con el diagnóstico médico, donde la enfermedad oncológica es la más asociada (50,93 %). Conclusiones: El riesgo nutricional se asocia a una evolución negativa de la enfermedad, lo que origina un aumento de la estancia hospitalaria, la tasa de mortalidad y, por ende, los costos intrahospitalarios. Es importante realizar su detección temprana para poder brindar intervenciones nutricionales adecuadas.

Objective: To determine the association between nutritional risk, hospital stay and medical diagnosis among patients admitted at Centro Especializado de Rehabilitación Profesional (CERP) of Hospital Nacional Guillermo Almenara Irigoyen. Materials and methods: An observational retrospective longitudinal cohort study was conducted with inpatients between July 1, 2021 and February 27, 2022. The patients were followed up until they left the hospital (discharge). Individuals under 18 years of age, pregnant or puerperal women, and those whose stay was less than 24 hours were excluded. The data of interest was collected from the patients' medical records and diet cards. The main variable was the nutritional risk, which was detected using the Nutritional Risk Screening (NRS) 2002. The secondary variables were age group, sex, hospital stay, main medical diagnosis, discharge condition and nutritional status. Data analysis was performed using the chi-square test to compare the qualitative or categorical variables, and the Student's t-test and ANOVA for the quantitative variables. A value of p < 0.05 was considered as statistically significant. Results: A total of 1,929 patients were included in the study. Nutritional risk prevalence accounted for 33.13 %. Patients with this condition showed the highest mortality rates (57.51 %). It was found that nutritional risk prevalence was related to a longer hospital stay (4.6 more days) (p < 0.001), a diagnosis of constitutional thinness (48.67 %) (p < 0.001) and the medical diagnosis, being oncology disorders the most associated ones (50.93 %). Conclusions: Nutritional risk is associated with disease progression, resulting in an increased hospital stay, mortality rate and therefore hospital costs. Early detection is important to provide adequate dietary interventions.

Características y frecuencia de tuberculosis antes y durante la pandemia por COVID-19 en adultos atendidos en un centro de atención primaria, Lima-Perú, 2019-2020

Objetivo: Determinar las características y la frecuencia de pacientes con tuberculosis (TBC), mayores de 18 años, en prepandemia (2019) y durante la pandemia por COVID-19 (2020), en un centro de salud (CS) de Lima-Perú. Materiales y métodos: Estudio descriptivo, retrospectivo, que incluyó historias clínicas de 100 pacientes >18 años adscritos al programa de TBC en el CS Los Libertadores (SMP-Lima, Perú), durante el período 2019-2020. Se analizaron variables sociodemográficas (sexo, lugar de procedencia, edad), clínicas (condición de ingreso/egreso, índice de masa corporal, comorbilidades, localización de tuberculosis, tipo de resistencia, esquema de tratamiento) y laboratoriales (baciloscopia, cultivo, métodos de prueba de sensibilidad). Se excluyó a pacientes que no contaban con todas las variables. Se elaboró una base de datos en Excel y se realizó un análisis estadístico descriptivo en SPSS de las variables cualitativas, expresadas en frecuencias, y de las variables cuantitativas, en medidas de tendencia central (media) y desviación estándar. Se determinó la prevalencia de TBC por año, de acuerdo con la población adscrita al centro de salud; dicha información fue obtenida por medio del Sistema de Información Gerencial de Tuberculosis (SIGTB). Resultados: En 2019, la prevalencia de tuberculosis fue de 0,0015 % (49 pacientes); en el 2020, 0,075 % (51 pacientes). En ambos años, predominó el sexo masculino y el grupo etario de 18 a 29 años; la localización predominante fue pulmonar. El 2020 se observó un aumento de la comorbilidad asociada a VIH y de la tasa de mortalidad (0,074), así como más casos positivos en la baciloscopia. Conclusiones: La prevalencia de TBC fue mayor en el 2020, primer año de la pandemia del COVID-19, debido a un menor abordaje de los programas de TBC por la situación que impuso la pandemia. Además del aumento de las tasas de mortalidad de TBC en ese mismo año, probablemente, por la tasa de abandono del tratamiento o una mayor comorbilidad con VIH y la diabetes.

Objective: To determine the characteristics and frequency of patients aged over 18 years with tuberculosis (TB) before (2019) and during (2020) the COVID-19 pandemic in a healthcare center (CS) in Lima, Peru. Materials and methods: A descriptive retrospective study that included medical records of 100 patients aged > 18 years enrolled in the TB program at CS Los Libertadores (SMP-Lima, Peru) from 2019 to 2020. Sociodemographic (sex, origin, age), clinical (admission/discharge status, body mass index, comorbidities, TB infection site, type of resistance, treatment regimen) and laboratory (smear microscopy, culture, drug susceptibility testing) variables were analyzed. Patients who did not have all the variables were excluded. An Excel database was prepared and a descriptive statistical analysis of the qualitative variables, expressed in frequencies, and quantitative variables, expressed in measures of central tendency (mean) and standard deviation, was performed using IBM SPSS Statistics. TB prevalence per year was determined, according to the population assigned to the healthcare center. Said information was obtained through the Tuberculosis Management Information System (SIGTB). Results: TB prevalence was 0.0015 % (49 patients) in 2019 and 0.075 % (51 patients) in 2020. In both years, the male sex and the age group between 18 and 29 years prevailed, and the most common site of infection were the lungs. In 2020, an increase in HIV comorbidity and mortality rate (0.074) was observed, as well as more positive smear microscopy cases. Conclusions: TB prevalence was higher in 2020, the first year of the COVID-19 pandemic, due to a reduced approach to TB programs as a result of the situation imposed by the pandemic. In addition, TB mortality rates raised in the same year, probably due to an increase in treatment dropouts or HIV and diabetes comorbidity rates.

Pacientes con enfermedad injerto contra huésped e infecciones asociadas al rechazo de trasplante / Patients with graft-versus-host disease and infections associated with transplant rejection

Introducción: durante muchos años las células madre hematopoyéticas han sido el tratamiento para muchos trastornos hematológicos, pero su eficacia está limitada por la enfermedad injerto contra huésped (EICH); una de las principales complicaciones del trasplante alogénico se encuentra asociado con morbilidad y mortalidad, por lo tanto, la prevención es importante para el éxito del trasplante alogénico. Objetivo: realizar una revisión acerca del reconocimiento clínico de una EICH para brindar el tratamiento correcto y evitar ciertas complicaciones, como infecciones que llevan al rechazo del injerto y ponen en riesgo la calidad de vida del paciente. En la mayoría de los casos las pruebas de laboratorio como biomarcadores y biopsias, son buenos predictores para procesos biológicos o patológicos que confirmen el diagnóstico y establezcan el estadio de la enfermedad. Metodología: se realizó una revisión bibliográfica en bases de datos, tales como Pubmed y ClinicalKey, con base en los siguientes términos MeSH: cirugía, mortalidad, patología, complicaciones, virología. Conclusión: la prevención y tratamiento de esta enfermedad predispone a infecciones y diferentes complicaciones que ponen en riesgo la vida del paciente.

Introduction: For many years hematopoietic stem cells have been the treatment for many hematological disorders, but their efficacy is limited by graft-versus-host disease (GVHD), one of the main complications of allogeneic transplantation associated with morbidity and mortality; therefore, prevention is important for the success of allogeneic transplantation. Objective: To review the clinical recognition of GVHD in order to provide the correct treatment and avoid certain complications, such as infections that lead to graft rejection and jeopardize the patient's quality of life. In most cases laboratory tests such as biomarkers and biopsies are good predictors of biological or pathological processes that confirm the diagnosis and establish the stage of the disease. Methodology: A bibliographic review was carried out in databases such as Pubmed and ClinicalKey based on the following MeSH terms: surgery, mortality, pathology, complications, virology. Conclusion: The prevention and treatment of this disease predisposes to infections and different complications that put the patient's life at risk.

Clasificación de la hiperglucemia en el embarazo. Revisión narrativa / Classification of hyperglycemia in pregnancy. Narrative review

Resumen ANTECEDENTES: La coexistencia de hiperglucemia y embarazo se asocia con morbilidad, mortalidad y riesgo cardiometabólico para la madre y su hijo. En el año 2010, la International Association of the Diabetes and Pregnancy Study Groups (IADPSG) estableció una clasificación, aceptada por la Organización Mundial de la Salud (OMS) y la International Federation of Gynecologt and Obstetrics (FIGO) en el 2013, en la que se consideran las semanas de gestación al diagnóstico de hiperglucemia y las concentraciones séricas de glucosa en diferentes escenarios. OBJETIVO: Actualizar los escenarios de clasificación de la hiperglucemia en la embarazada y documentar, de acuerdo con lo soportado en la evidencia, su repercusión clínica. METODOLOGÍA: Búsqueda bibliográfica en las bases de datos PubMed, Google Académico y Clinicalkey de artículos publicados entre los años 2008 a 2022, que contuvieran las palabras clave (MESH): "gestational diabetes" e "hyperglycemia in pregnancy" que posteriormente se filtraron conforme a su contenido específico definido en los criterios de inclusión (estudios epidemiológicos, de diagnóstico y clasificación de la hiperglucemia en el embarazo y de desenlaces maternos y perinatales en coexistencia con hiperglucemia en el embarazo). RESULTADOS: Se identificaron 25,886 artículos, de los que solo 24 cumplieron con los criterios de inclusión (8 observacionales descriptivos, 2 de revisión sistemática y metanálisis, 13 revisiones de la bibliografía y consensos globales, y 1 ensayo clínico aleatorizado). CONCLUSIÓN: Clasificar a la hiperglucemia en diferentes escenarios clínicos es importante para su debido diagnóstico, orientación clínica, estudios adicionales y tratamiento temprano.

Abstract BACKGROUND: Hyperglycemia in pregnancy is associated with perinatal maternal morbidity and mortality and cardiometabolic risk for the mother and her offspring. In 2010, the International Diabetes and Pregnancy Study Group (IADPSG) established a classification, accepted by the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) in 2013, considering gestational age. diagnosis and serum glucose levels to be classified in different scenarios. OBJECTIVE: To update the classification scenarios of hyperglycemia in pregnant women and to document, in accordance with what is supported by the evidence, its clinical impact. MATERIALS AND METHODS: The PubMed, Google Scholar, and Clinicalkey databases were searched with the MESH terms ("gestational diabetes," "hyperglycemia in pregnancy"), subsequently filtered according to specific content, defined in the inclusion criteria (studies on epidemiology, diagnosis and classification of hyperglycemia in pregnancy and studies on maternal and perinatal outcomes in hyperglycemia in pregnancy) all articles published between 2008 and 2022. RESULTS: 25,886 articles were identified, 24 of these met the inclusion criteria; eight were descriptive observational, two systematic reviews and meta-analyses, thirteen reviews of the literature and global consensus, and one randomized clinical trial. CONCLUSION: Classifying hyperglycemia within the different clinical scenarios is important for its approach, clinical orientation, additional studies if required, and early management interventions.

Tumores malignos em região de cabeça e pescoço no público infanto-juvenil: revisão narrativa da literatura / Head and neck malignant tumors in childhood: narrative literature review

Objetivo: Verificar as características clínico-histopatológicas dos tumores malignos infanto-juvenis de maior ocorrência em região de cabeça e pescoço, bem como seus respectivos tratamentos e prognóstico. Métodos:Tratou-se de uma revisão narrativa da literatura. Foram utilizadas as plataformas Literatura Latino Americana e do Caribe em Ciências (LILACS), Scientific Eletronic Libray Online (SCIELO) e PubMed, mediante cruzamento de descritores DeCS/MeSH com os operadores booleanos, além de busca livre secundária. Após todas as etapas de refinamento, um total de 34 artigos foram incluídos. Resultados: Apesar do câncer ser relativamente raro no público infanto-juvenil, no Brasil, representa elevada mortalidade na infância. Os tipos de neoplasias mais comuns em cabeça e pescoço são: carcinoma mucoepidermóide, de células escamosas (CEC) e osteossarcoma, além do rabdomiossarcoma e carcinoma de células acinares. A glândula parótida é a mais acometida por tumores glandulares na infância. O rabdomiossarcoma é o câncer de células musculares mais frequente em crianças e adolescentes, e o CEC é uma neoplasia menos comum neste público, porém pode apresentar caráter agressivo e prognóstico desfavorável, assim como o osteossarcoma. O tratamento é multimodal devido às diferenças comportamentais dessas neoplasias. Conclusão: Apesar do câncer de cabeça e pescoço apresentar baixa prevalência no público infanto-juvenil, o conhecimento acerca das características clínicas e histopatológicas pode favorecer o diagnóstico imediato e o tratamento precoce.

Aim: To verify the clinicohistopathological characteristics of the most common malignant tumors in the head and neck region in children and adolescents, as well as their respective treatments and prognosis. Methods: This was a narrative literature review. The platforms Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (SCIELO), and PubMed were used, through the cross-referencing of DeCS/MeSH descriptors with Boolean operators, in addition to secondary free search. After all refinement steps, a total of 34 articles were included. Results: Despite malignant tumors being relatively rare in the pediatric population, they represent a high mortality rate in childhood in Brazil. The most common types of cancer in the head and neck are: mucoepidermoid carcinoma, acinar cell carcinoma and squamous cell carcinoma (SCC) and osteosarcoma, as well rhabdomyosarcoma and acinar cell carcinoma. The parotid gland is the most affected by gland tumors in childhood. Rhabdomyosarcoma is the most common cancer of muscle cells in children and adolescents, and SCC is less common neoplasm in this population, which can be aggressive and have an unfavorable prognosis, as well as osteosarcoma. The treatment is multimodal due to the behavioral differences of these neoplasms.Conclusion: Despite head and neck cancer being a rare condition in the pediatric population, knowledge about the clinical and histopathological characteristics can facilitate immediate diagnosis and early treatment.

Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática / Long-term use of albumin in the cirrhotic patient. Systematic review

Introducción. La cirrosis constituye la etapa final de la enfermedad hepática crónica, con una alta mortalidad, y puede deberse a diferentes etiologías. La albúmina tiene tres indicaciones bien establecidas: la prevención de la disfunción circulatoria inducida por paracentesis, la peritonitis bacteriana espontánea y el síndrome hepatorrenal, sin embargo, su uso a largo plazo es controvertido. El objetivo de esta revisión fue identificar si el uso prolongado de la albúmina tiene efectos beneficiosos en el tratamiento de pacientes cirróticos. Metodología. Se realizaron búsquedas en la base de datos de PubMed, empleando los siguientes términos: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Se excluyeron los artículos que no cumplieron con la temática y aquellos que tenían más de 5 años de antigüedad, a excepción de aquellos relevantes para la revisión. Resultados. Se ha demos-trado en varios estudios realizados en los últimos 4 años, que la administración prolongada de albúmina reduce la mortalidad en el paciente cirrótico. Además, resulta en una disminución en ingresos hospitalarios por complicaciones de la cirrosis, disminución de la necesidad de para-centesis y menor uso de albúmina para otras indicaciones ya establecidas, lo que contrarresta los costos derivados de la terapia. Conclusión. Se concluye con base en la evidencia presenta-da, que el uso de albúmina a largo plazo podría resultar beneficioso en pacientes con cirrosis hepática descompensada. No obstante, es necesario abordar otros aspectos de la terapia en estudios posteriores

Introduction. Cirrhosis is the final stage of chronic liver disease, has a high mortality and can be due to different etiologies. Albumin has three well-established indications: prevention of circulatorydysfunction induced by paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndrome, however, its long-term use is controversial. The objective of this review was to identify if the prolonged use of albumin has beneficial effects in the treatment of cirrhotic patients. Methodology. PubMed database was searched using the following terms: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Articles that did not meet the topic and those that were more than 5 years old were excluded, except for those relevant to the review. Results.It has been shown in several studies within the previous 4 years, that prolonged administration of albumin reduces mortality in cirrhotic patients. In addition, it results in a decrease in hospital ad-missions due to complications of cirrhosis, a decrease in the need for paracentesis and less use of albumin for other established indications, which offsets the costs derived from therapy. Conclusion. It is concluded based on the evidence presented, that the long-term use of albumin could be beneficial in patients with decompensated liver cirrhosis. However, other aspects of the therapy need to be addressed in further studies

Reanimación cardiopulmonar y cerebral durante el embarazo. Revisión narrativa / Cardiopulmonary and brain resuscitation during pregnancy. Narrative review

Resumen ANTECEDENTES: La reanimación cardiopulmonar representa el 1 a 2% de los ingresos a las unidades de cuidados intensivos. En 2018, 17.4 por cada 1000 pacientes embarazadas de Estados Unidos requirieron reanimación cardiopulmonar e ingreso a unidades de cuidados intensivos, con mortalidad del 52% posterior al primer día de puerperio. OBJETIVO: Aportar conceptos indispensables de reanimación cardiopulmonar, causas de paro cardiaco materno y difundir algoritmos de atención y respuesta luego de la activación de un código para probable cesárea de urgencia en los cuatro minutos posteriores al paro cardiorrespiratorio, en casos sin retorno a la circulación espontánea. Esto con la finalidad de aumentar la calidad de atención de salud y disminuir los índices de mortalidad materna. METODOLOGÍA: Primera etapa: búsqueda en PubMed de artículos con antigüedad no mayor a cinco años, publicados en inglés o español, Guías de Práctica Clínica de Perinatología Clínica, revisiones sistemáticas y metanálisis. Segunda etapa: algoritmo de búsqueda ("cardiopulmonary resuscitation "[MeSH-Terms] AND "pregnancy" [MeSH-Terms]) AND ((y_5[Filter]) AND (systemati creview[Filter]) AND (english [Filter]) OR spanish [Filter])). RESULTADOS: Se reunieron 35 artículos o páginas web de los que se seleccionaron 19, incluidos 3 libros de texto relacionados con el tema y 3 páginas web gubernamentales. Además, se analizaron otros artículos para complementar el conocimiento del tema. CONCLUSIONES: El reconocimiento del colapso materno y la oportuna respuesta del personal de salud permitirán una reanimación cardiopulmonar de alta calidad; por esto debe fomentarse la capacitación al personal de salud.

Abstract BACKGROUND: Cardiopulmonary resuscitation accounts for 1% to 2% of intensive care unit admissions. In 2018, 17.4 per 1000 US pregnant patients requiring cardiopulmonary resuscitation were admitted to intensive care units, with mortality of 52% after the first postpartum day. OBJECTIVE: To provide essential concepts of cardiopulmonary resuscitation, causes of maternal cardiac arrest and to disseminate algorithms of care and response after activation of a code for probable emergency cesarean section within four minutes after cardiorespiratory arrest, in case of failure to return to spontaneous circulation. The aim is to increase the quality of health care and reduce maternal mortality rates. METHODOLOGY: First stage: search in PubMed of articles not older than five years, published in English or Spanish, Clinical Practice Guidelines of Clinical Perinatology, systematic reviews, and meta-analyses. Second stage: search algorithm ("cardiopulmonary resuscitation "[MeSH-Terms] AND "pregnancy" [MeSH-Terms]) AND ((y_5[Filter]) AND (systematic creview[Filter]) AND (english [Filter]) OR spanish [Filter])). RESULTS: Thirty-five articles or web pages were collected from which 19 were selected, including 3 textbooks related to the topic and 3 governmental web pages. In addition, other articles were analyzed to complement knowledge of the topic. CONCLUSIONS: Recognition of maternal collapse and timely response by health care personnel will enable high-quality cardiopulmonary resuscitation; therefore, training of health care personnel should be encouraged.

Early outcomes of the bird-cage chest wall reconstruction in the Philippine General Hospital

Objective@#To describe the treatment outcomes of patients with chest wall tumors undergoing resection and Birdcage chest wall reconstruction in the local setting. @*Methods@#Data were obtained from 13 patients who underwent chest wall resection and Bird-cage (methylmethacrylate neo-rib, mesh, soft tissue, and skin) reconstruction in the Philippine General Hospital from January 2008 to September 2019. Demographics, operative procedures, 30-day operative morbidity, and mortality were evaluated using means and frequencies.@*Results@#We included 13 (77% female) patients with a mean age of 44.5 years. The most common indication for chest wall resection was recurrent neoplasm (5/13, 38.46%). The most extensive chest wall defect was 600 cm2. The average length of ICU stay was 5.15 days, and two patients had prolonged intubation (>3 days). The graft infection rate was 38%, pneumonia 23%, and the operative mortality rate was zero.@*Conclusion@#Bird-cage reconstruction is a safe, reliable, and cheap method of providing rigid chest wall reconstruction for chest wall tumor resection.

Management of congenital diaphragmatic hernia in preterm and low birth weight infants / 中华围产医学杂志

Objective:To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia (CDH) and to share the experience.Methods:This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital, Capital Institute of Pediatrics from May 1, 2011, to March 31, 2022. Based on gestational age and birth weight, the infants were divided into the preterm and/or low birth weight group (gestational age < 37 weeks and/or birth weight less than 2 500 g, n=41) and the control group (gestational age ≥ 37 weeks and birth weight ≥ 2 500 g, n=76). Furthermore, the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup ( n=31) and the open surgery subgroup ( n=10) according to the surgical approach. Statistical analysis of the data was performed using two independent sample t-tests, rank sum tests, Chi-square test, or Fisher's exact probability test. Results:Preoperative data showed that the Apgar scores at 1 min [7.0 (6.0-8.0) vs 9.0 (8.0-9.8), Z=－4.03] and 5 min [9.0 (8.0-10.0) vs 9.0 (9.0-10.0), Z=－2.13] of the preterm and/or low birth weight infants were both lower than those in the control group (both P<0.05), while the proportion of infants with moderate to severe pulmonary hypertension was higher [68.3% (28/41) vs 38.2% (29/76), χ 2=9.68, P<0.05]. There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery, operation time, right diaphragmatic hernia, presence of hernia sac, grading of the defect, presence of liver herniation, and application of mesh (all P>0.05). Regarding the postoperative outcomes, the death rate in the preterm and/or low birth weiht group was higher compared to the control group [36.6% (15/41) vs 13.2% (10/76), χ 2=8.70, P<0.05]. Additionally, the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group [25 d (18-29 d) vs 16 d (10-25 d), Z=2.31, P<0.05]. The thoracoscopic subgroup had a lower mortality compared to the open surgery subgroup [25.8% (8/31) vs 7/10, P<0.05]. The thoracoscopic surgery subgroup had a higher Apgar score at 1 min after birth [(7.4±1.6) vs (6.0±2.2), t=2.20, P<0.05], later age at operation (hours after birth) [31.0 h (23.0-48.0 h) vs 17.0 h (4.7-24.5 h), Z=2.57, P<0.05], a lower proportion of infants operated within 24 hours after birth [32.3% (10/31) vs 8/10, P<0.05], and longer duration of operation [170.0 min (122.0-200.0 min) vs 110.0 min (87.3-120.0 min), Z=3.65, P<0.05]. Conclusions:In this study, a higher mortality in the preterm and/or low birth weight group compared to the control group was observed, which may be attributed to the higher proportion of neonates with moderate-severe pulmonary hypertension. The thoracoscopic diaphragmatic repair can be attempted for preterm and low birth weight infants who have relatively stable respiratory and circulatory functions.

Experiencias de cuidadores frente a un programa integral en salud para niños con cardiopatías congénitas

Las enfermedades congénitas complejas son un grave problema de salud pública que afecta a millones de niños y sus cuidadores en el mundo, razón por la cual es necesario generar programas de apoyo formal para favorecer el seguimiento en casa de estos menores y así, incrementar la adherencia al tratamiento y reducir la mortalidad interestadio. El presente estudio tuvo como objetivo describir la percepción de los cuidadores frente a un programa integral en salud, planeado sobre la educación y el uso extenso de las herramientas de telecomunicación para el seguimiento en casa de niños con cardiopatías congénitas complejas, en el marco del proyecto Promesa de la Fundación Cardiovascular de Colombia, a partir de un enfoque cualitativo de diseño fenomenológico. La muestra seleccionada estuvo compuesta por 12 cuidadores con quienes se realizó entrevista a profundidad y grupo focal. Los datos fueron analizados a través del software para el análisis de estudios cualitativos Atlas.ti, estableciendo las siguientes categorías: Valoración del proyecto y del programa integral, Experiencias con el uso de dispositivos médicos, tecnologías de la información y de la comunicación, Comunicación y relación con profesionales, Apoyo institucional y Redes de cuidadores. Se concluye que implementar las Tic en el tratamiento de cardiopatías congénitas complejas es una estrategia novedosa y aceptada por los cuidadores, que se ajusta a las condiciones del sistema de salud colombiano y a las necesidades de los usuarios.

Congenital heart disease are a serious public health problem that affects millions of children and their caregivers around the world, which is why it is necessary to generate formal support programs to promote follow-up at home for these minors and thus increase adherence to treatment and reduce interstage mortality. The objective of this study was to describe the perception of caregivers regarding a comprehensive health program, planned on education and the extensive use of telecommunication tools for home monitoring of children with complex congenital heart disease, within the framework of the project Promise of the Cardiovascular Foundation of Colombia, based on a qualitative approach of phenomenological design. The selected sample consisted of 12 caregivers with whom an in-depth interview and focus group were conducted. The data was analyzed through the software for the analysis of qualitative studies Atlas.ti, establishing the following categories: Assessment of the project and the comprehensive program, Experiences with the use of medical devices, information and communication technologies, Communication and relationship with professionals, institutional support and networks of caregivers. It is concluded that implementing ICTs in the treatment of complex congenital heart diseases is a novel strategy accepted by caregivers, which is adjusted to the conditions of the Colombian health system and the needs of users.