Secuelas médicas de la COVID-19 / Medical sequels of COVID-19

La pandemia de COVID-19 ha impactado gravemente en la población mundial, con una gran tasa de morbilidad y mortalidad. Si bien la evidencia hasta la fecha ha intentado definir la clínica de la enfermedad aguda, informes recientes también han comenzado a describir síntomas persistentes que se extienden más allá del período inicial de la enfermedad. Se ha encontrado que los resultados adversos, además de respiratorios, se presentan a diferentes niveles: cardiovascular, neurológico o inmunológico, manifestaciones cutáneas, gastrointestinales o renales. También se ha descrito el efecto perjudicial sobre la salud mental, no solo en pacientes con COVID-19. Es probable que la carga de enfermedad secundaria a esta pandemia sea enorme y no se limite únicamente a la enfermedad aguda, por lo que se necesitan estudios epidemiológicos que investiguen más a fondo el impacto a largo plazo de esta patología. Esta revisión resume la evidencia actual sobre los efectos a corto plazo y describe las posibles secuelas a largo plazo de la COVID-19. (AU)

COVID-19 pandemic has impacted the world population, with a high rate of morbidity and mortality. While the evidence to date has attempted to describe clinical feature of acute illness, recent reports have also begun to describe persistent symptoms that extend beyond the initial period of illness. Adverse outcomes, in addition to respiratory, have been found to occur at different levels: cardiovascular, neurological, or immunological; skin, gastrointestinal or renal manifestations. The detrimental effect on mental health has also been described, not only in COVID-19 patients. The burden of disease secondary to this pandemic is likely to be enormous and not limited to acute disease alone, thus epidemiological studies are needed to further investigate the long-term impact of this disease. This review summarizes the current evidence on short-term effects and describes the possible long-term sequelae of COVID-19. (AU)

Medical sequels of COVID-19. / Secuelas médicas de la COVID-19.

COVID-19 pandemic has impacted the world population, with a high rate of morbidity and mortality. While the evidence to date has attempted to describe clinical feature of acute illness, recent reports have also begun to describe persistent symptoms that extend beyond the initial period of illness. Adverse outcomes, in addition to respiratory, have been found to occur at different levels: cardiovascular, neurological, or immunological; skin, gastrointestinal or renal manifestations. The detrimental effect on mental health has also been described, not only in COVID-19 patients. The burden of disease secondary to this pandemic is likely to be enormous and not limited to acute disease alone, thus epidemiological studies are needed to further investigate the long-term impact of this disease. This review summarizes the current evidence on short-term effects and describes the possible long-term sequelae of COVID-19.

Processo de formação de contas em um hospital de ensino especializado em cardiologia e pneumonia / The billing process at a teaching hospital specialized in cardiology and pulmonology / Proceso de formación de cuentas en un hospital de enseñanza especializado en cardiología y neumología

Esta pesquisa exploratória objetivou descrever e mapear o processo de formação de contas em um hospital público universitário, de nível terciário, especializado em cardiologia e pneumologia. No período de maio a junho de 2012, procedeu-se à identificação e documentação das etapas do processo que foram validadas junto aos profissionais envolvidos na auditoria de contas hospitalares. Evidenciou-se que, no momento da pré-análise das contas, os auditores realizam correções para fundamentar a cobrança dos procedimentos e evitar glosas e perdas de faturamento. O mapeamento do processo permitiu a proposição de estratégias visando minimizar o tempo de apresentação de contas às fontes pagadoras. Ao conferir visibilidade à dinâmica deste processo, fundamental para o equilíbrio econômico-financeiro do hospital estudado, torna-se esse conhecimento de domínio público e acessível a outras organizações de saúde que queiram incrementar o seu faturamento e reduzir as divergências entre o prontuário clínico e a conta hospitalar do paciente.

The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences be tween patient charts and the patient's hospital bill

Se objetivó describir y mapear el proceso de formación de cuentas en un hospital público universitario terciario especializado en cardiología y neumología. Entre mayo y junio de 2012 se procedió a identificar la documentación de las etapas del proceso, validadas con los profesionales involucrados en la auditoría de cuentas hospitalarias. Se evidenció que antes del análisis de cuentas, los auditores realizan correcciones para fundamentar la cobranza de los procedimientos y evitar divergencias y pérdidas de facturación. El mapeo del proceso permitió la propuesta de estrategias orientadas a disminuir el tiempo de presentación de cuentas a las fuentes de pago. Al otorgársele visibilidad a la dinámica del proceso, fundamental para el equilibrio económico-financiero del hospital estudiado, ese conocimiento se vuelve de dominio público y es accesible para otras organizaciones de salud que quieran incrementar su facturación y reducir las divergencias entre las historias clínicas y la cuenta hospitalaria del paciente.

Evaluación del nivel de conocimientos en áreas básicas en un posgrado de Cardiología / Evaluation of the Level of Knowledge in Basic Areas in Postgraduate Cardiology Education

Background In our country, training in cardiology is achieved by participating in residency programs, attending a hospital cardiology unit or taking university courses. On the basis of comments from teachers giving classes in the SAC Biennial Course about certain kind of deficit in basic areas of the specialty among cardiology residents attending the course, we decided to investigate their knowledge in cardiovascular anatomy, physiology, physical diagnosis, pharmacology and clinical cardiology after 1 or 2 years of training in Internal Medicine or Cardiology residency programs, respectively. Objective To evaluate the knowledge in basic areas in cardiology among residents attending the UBA Biennial Cardiology Course given by the Argentine Society of Cardiology. Material and Methods We conducted an observational, cross-sectional study. A questionnaire was designed with 50 multiple choice questions, divided in three subjects: Subject A, 17 questions about cardiovascular anatomy, physiology, pathophysiology and pharmacology; Subject B, 15 questions about clinical cardiology, physical diagnosis and electrocardiography; and Subject C, 17 questions regarding medical practice and cardiological clinical syndromes. The questionnaire was answered by residents either initiating the course (Group 1) or who were attending the second year (Group 2). Results In the general exam, Group 1 (n=63) had a median of 29/50 right answers (58%) and Group 2 (n=57) 30/50 (60%). There were no significant differences between both groups (p=0.21). The performance in Subject A was significantly lower compared to Subjects B and C in both groups. Conclusion The level of knowledge in basic areas of cardiology among residents is considered insufficient, with greatest deficits in cardiovascular anatomy, physiology, pathophysiology and pharmacology. It is necessary to revise the program of the Biennial Course and to analyze the opportunities of learning and reflection offered by the residency program.

Desarrollo y modelos de relación de fundaciones y sociedades de cardiología / Development and relationship models between foundations and societies of cardiology

La cardiología es una de las especializaciones de la medicina que se encuentra más organizada en relación con su estructura científica y su alcance poblacional. El movimiento societario cardiológico tiene sus orígenes en 1994 con la creación de la Sociedad Interamericana de Cardiología, en México mientras que las fundaciones tienen su origen en 1915, con la creación de la primera asociación para la prevención y alivio de las enfermedades cardiovasculares en Nueva York. Con el correr de los años estas estructuras se han organizado a nivel mundial en la Federación Mundial del Corazón, que es la que dicta las políticas en esta área. La presencia de estas organizaciones de cardiología, sociedades y fundaciones, ha llevado a revisar sus modelos de relacionamiento y líneas de acción, como están estructuralmente organizadas y cuales son sus ámbitos de acción.

Cardiology is one of the most organized medical specialties in terms of scientific structure and population coverage. The movement of establishing cardiology societies originated in 1994 when the Inter-American Society of Cardiology was created in Mexico. On the other hand, foundations date from 1915 when the first association for the preventión and relief of cardiovascular diseases was created in New York. Since then, these strutures have become organized worldwide as the World Heart Federation, which is responsible for dictating policies in this area. The existence of said cardiology organizations, societies and foundations, has lead to review the ways they relate to each other and their action lines, as well as their organizational structures and their fields of action.

El largo camino hacia la cardiología mexicana de hoy / The Long Way Toward Mexican Cardiology

Se bosqueja la evolución del pensamiento médico desde una fase precientífica, en el Renacimiento, hacia una fase posrenacentista de ciencia incipiente, en el siglo XVII, dominada por el magno evento del descubrimiento de la circulación sanguínea. La irradiación de la doctrina circulatoria fue paralela al de la teoría copernicana. Harvey, iniciador del método experimental en medicina, se graduó en la universidad de Padua, en donde ya había estudiado Copérnico. Ahí recibió las enseñanzas de Galileo, de quien adoptó el enfoque cuantitativo en sus investigaciones fisiológicas. Sabemos que su monografía Exercitatio anatómica de motu cordis... se hallaba en México, aunque no podemos establecer cuándo llegó. En el tratado de fisiología del doctor Marcos Joseph Salgado (1727), se describe la circulación sanguínea de acuerdo con la doctrina del sabio inglés. Estudios e intervenciones de interés cardiovascular se iniciaron aquí en la época aciaga de la ocupación francesa, paralelamente al despegue de nuestra Academia de Medicina. las observaciones iniciales, de carácter quirúrgico, se realizaron sobre los vasos sanguíneos. Durante el periodo 1870-1900, se presentaron en la Escuela de Medicina unas 30 tesis relacionadas con el sistema cardiovascular y se publicaron varios libros sobre el tema. A fines del siglo pasado y a principios del nuestro, se efectuaron en el Instituto Médico Nacional algunas investigaciones de farmacología cardiovascular bajo la guía del Dr. Fernando Altamirano. Pero sólo hacia mediados del siglo XX se ha logrado la sistematización de la especialidad cardiológica, gracias a la visión del maestro Ignacio Chávez. la cardiología de hoy constituye una disciplina madre, fragmentada en un gran número de subespecialidades, cada una con características, metodología y enfoque propios.

The evolution of medical thought from the precientific phase during Renaissance toward the beginning of scientific phase in the XVII Century, is reviewed. This phase was dominated by the great event of the discovery of blood circulation. The irradiation of this doctrine was parallel to that of Copernican theory. Harvey, the starter of experimental method in medicine, graduated at the University of Padua, where previously studied Copernicus. There he was influenced by Galileo's teaching, from whom adopted the quantitative focussing for his physiological research. His monograph Exercitatio anatómica de motu cordis... was present in México, although it is not possible to establish when it arrived here. Only in the physiological treatise of doctor Marcos Joseph Salgado (1727) the blood circulation is described following Harvey's doctrine. Studies in the cardiovascular field began here during French intervention , at the same time of the development of our Academy of Medicine. The first observations, concerning the blood vessels, were of surgical interest. Between 1870 and 1900, around 30 thesis related to cardiovascular system were presented at Mexican Medical School and various books related to this field were published. At the end of XIX century and in the beginning of the XX, some cardiovascular pharmacological investigations were done at the National Medical Institute under the direction of Dr. Fernando Altamirano. However only toward the middle of XX century it was possible to create and sistematize a cardiological specialty, thanks to the foresight of Dr. Ignacio Chávez. Cardiology today constitutes a mother discipline fragmented in a great number of subspecialities, each one having own characteristics, methodology and focussing.