Impacto de la pandemia por COVID-19 sobre el trasplante hepático en la argentina. Otro daño colateral / Impact of COVID-19 pandemic in liver transplantation in Argentina. Other collateral damage

Resumen La pandemia COVID-19 declarada en marzo del 2020, ha generado preocupación mundial por su efecto en la salud de la población y el potencial colapso sanitario. La estrategia de "aplanar la curva" mediante el distanciamiento social permitió adaptar los recursos del sistema de salud a pacientes con COVID-19, pero no se pudo prever su repercusión en otras áreas de la salud. El objetivo de este trabajo fue analizar las consecuencias de la pandemia sobre el trasplante hepático en general y por hepatocarcinoma (HCC). Fueron realizados los siguientes estudios: a) un análisis retrospectivo utilizando datos del CRESI/INCUCAI para comparar ingreso en lista de espera, mortalidad en lista, donación y trasplante hepático desde 20/03 a 15/08, 2019 e igual periodo de 2020, y b) una encuesta a los centros de trasplante de mayor actividad trasplantológica para valorar el efecto de las medidas tomadas en diferentes situaciones institucionales y regionales. El primer análisis evidenció una disminución del 55% de los trasplantes hepáticos, con una reducción similar en la donación y en el ingreso a lista de espera hepática; mientras que el trasplante por HCC ascendió de 10% en 2019 a 22% en 2020. El segundo análisis, mostró que la tasa de ocupación de camas por pacientes COVID-19/semana fue variable: de 0.4% al 42.0%. El número de cirugías, hepato-bilio-pancreática, resección de HCC y trasplante hepático, se redujeron en 47%, 49%, 31% y 36% respectivamente. La reducción de la actividad trasplantológica afectó mayormente los centros con alta ocupación por COVID-19. El impacto final a largo plazo deberá evaluarse.

Abstract The COVID-19 pandemic declared in March 2020, has generated worldwide concern due to its effect on the health of the population and the potential health collapse. The strategy of "flattening the curve" through social distancing made it possible to adapt the resources of the health system to patients with COVID-19, but results in other areas of health could not be predicted. The objective of this work was to analyze the consequences of the pandemic on liver transplantation in general and for hepatocarcinoma (HCC). The following studies were carried out: a) a retrospective analysis using data from the CRESI / INCUCAI to compare admission to the waiting list, mortality on the list, donation and liver transplantation from 03/20 to 08/15, 2019 and the same period in 2020, and b) a survey of the transplant centers with the highest transplant activity to assess the effect of the measures taken in different institutional and regional situations. The first analysis showed a 55% decrease in liver transplants, with a similar reduction in donation and admission to the liver waiting list; while HCC transplantation rose from 10% in 2019 to 22% in 2020. The second analysis showed that the occupancy rate of beds by COVID-19 patients / week was variable: from 0.4% to 42.0%. The number of surgeries, hepato-bilio-pancreatic, resection of HCC and liver transplantation, were reduced by 47%, 49%, 31% and 36% respectively. The reduction in transplant activity mainly affected centers with high occupancy due to COVID-19. The final long-term outcome will need to be assessed.

El daño colateral de la atención de la pandemia de COVID-19.

Throughout history, pandemics have had a major impact on humanity. The measures used to combat them cause collateral damage. During the COVID-19 pandemic, the actions taken to reduce the exposure, the number of infections, and the case fatality rate focus on reducing mortality, however, the collapse of the health system can cause an even greater number of deaths. At the same time, both medical personnel and patients are affected by the economic slowdown and the "effect of negativity". In this review article the different tools available for pandemic control, their development in a historical context, and how they may impact risk stratification for vulnerable patients (elderly, patients with chronic degenerative and oncological diseases) were analyzed.

A lo largo de la historia, las pandemias han tenido un gran impacto para la humanidad. Las medidas utilizadas para combatirlas causan daño colateral. En la pandemia por COVID-19, las acciones generadas para disminuir la exposición, el número de contagios y la tasa de letalidad conllevan un enfoque en la reducción de la mortalidad, sin embargo el colapso del sistema de salud puede provocar un número aún mayor de muertos. A su vez, tanto el personal médico como los pacientes se ven afectados por la desaceleración económica y el "efecto de la negatividad". En este artículo de revisión se analizaron las diferentes herramientas para el control de la pandemia, su desarrollo en un contexto histórico y como impactan en la estratificación del riesgo para pacientes vulnerables (ancianos, pacientes con enfermedades crónico degenerativas y oncológicos).

Daño a niños y sus familias por el consumo de alcohol: resultados de una encuesta poblacional / Alcohol's impact on children and families: A population survey

Introducción Entre los adultos jóvenes el uso de alcohol es frecuente. Este consumo puede afectar negativamente a los menores que conviven con ellos, lo que constituye el objetivo de este estudio, que forma parte de un estudio colaborativo internacional financiado por Thai Health y la OMS. Sujetos y método Se describen los efectos negativos en niños, mediante un muestreo multietápico, aplicando una entrevista adaptada por los coinvestigadores a 1.500 chilenos de más de 18 años. Resultados Un total de 408 encuestados (27,2%) convivían con niños en el hogar. De ese total, el 10,5% estimó que el uso de alcohol de algún miembro de la familia había afectado negativamente a un niño. Los efectos más comunes fueron la violencia verbal (29,7%), presenciar violencia en el hogar (23,1%), ausencia de supervisión (18,7%), falta de dinero para proveer necesidades básicas (14,3%) y violencia física (7,7%). Casi en la mitad de los casos (46,3%) el bebedor era el padre o la madre, el padrastro/madrastra, o la pareja de la madre/padre, luego venían otros parientes (24,4%), un hermano/a del niño (4,9%) o un tutor del niño (2,4%). Conclusión Estos datos corroboran la observación clínica de que el consumo de alcohol es frecuente en los hogares. El consumo excesivo daña la salud física y mental no solo del bebedor sino también de quienes lo rodean. La violencia verbal y ser testigo de violencia grave en el hogar son frecuentes, así como los problemas económicos al no poder proveer sus necesidades básicas.

Introduction Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. Subjects and method This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18 years of age. Results A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). Conclusion These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs.

[Alcohol's impact on children and families. A population survey]. / Daño a niños y sus familias por el consumo de alcohol: resultados de una encuesta poblacional.

INTRODUCTION: Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. SUBJECTS AND METHOD: This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18years of age. RESULTS: A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). CONCLUSION: These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs.