Título del artículo:

Hiroshima, mon amour: An inner pilgrimage to catharsis

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Pilgrimages and Spiritual Quests in Japan

Título del artículo:

A global view of population health in Columbia: Role of social macro-determinants

Introduction. The social environment is an important determinant of population and individual health. However, its impact is often not considered in national health policies and generally its attributes are considered as constants. For this reason, contemporary health policies place greater emphasis on individual risk factors. Objective. Colombia\'s position in the world ranking is described with respect to several social macro-determinants of health, previously characterized as components of class/welfare regime model. Materials and methods. The exploratory study included all countries with comparable data including the following: (1) economic development [gross domestic product per capita adjusted for purchasing power parity], (2) income inequality [Gini coefficient], (3) social capital [corruption perceptions index and generalized trust], and (4) political regime [index of freedom]. First, correlations between these macro-determinants were estimated, and second, the relationship between them and life expectancy at birth was explored. Finally, the position of Colombia in global context was determined. Results. Important correlations occurred among the macro-determinants. Colombia tended to have intermediate to low positions in the global context in all macro-determinants, with the exception of gross domestic product per capita adjusted for purchasing power parity. Conclusion. The macro-determinant of population health with the highest potential of effecting improvement in health conditions is to modify income inequality.

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Biomedica

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Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia

OBJECTIVE: Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. METHODS: A case-control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure ≥140/90 mmHg and proteinuria ≥0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. RESULTS: The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n = 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P = 0.01). A similar tendency was observed in controls with periodontal disease (n = 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P = 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P = 0.01). CONCLUSION: These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia. © 2007 Lippincott Williams & Wilkins, Inc.

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Journal of Hypertension

Título del artículo:

Socioeconomic pathology as a cause of regional differences in the prevalence of metabolic syndrome and pregnancy-induced hypertension

The epidemic of cardiovascular desease being experienced by developing countries has resulted in a debate about the possible existence of regional differences in etiology and pathophysiology that could be associated with socioeconomic factors. Clear demonstration of these differences is important because there may be a need for different approaches to prevention, diagnosis and treatment. There is some evidence that there are differences between populations in developed and developing countries in the pathophysiologic mechanisms underlying pregnancy-induced hypertension and metabolic syndrome, just as there are in the relative weightings of risk factors that predict the appearance of these conditions. Observations in our country suggest that increasing exposure to changes in lifestyle brought about by the consumer society (e.g., a lack of exercise, and a high-fat, high-calorie diet) results in a natural biological response (e.g., obesity, metabolic syndrome, and diabetes) that increases the risk of cardiovascular disease. We propose that the term socioeconomic pathology should be used to describe these changes associated with modern society so that they can be differentiated and considered in isolation from socioeconomic factors and other risk factors. We regard the interaction between these various factors as the most important cause of the rapidly increasing incidence of cardiovascular disease observed in developing countries in recent years.

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Revista Espanola de Cardiologia

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A randomized, double blind, cross-over, placebo-controlled clinical trial to assess the effects of Candesartan on the insulin sensitivity on non diabetic, non hypertense subjects with dysglyce mia and abdominal obesity. \"ARAMIA\"

Background: The raising prevalence of type-2 diabetes mellitus and obesity has been recognized as a major problem for public health, affecting both developed and developing countries. Impaired fasting plasma glucose has been previously associated with endothelial dysfunction, higher levels of inflammatory markers and increased risk of developing insulin resistance and cardiovascular events. Besides life-style changes, the blockade of the renin-angiotensin system has been proposed as a useful alternative intervention to improve insulin resistance and decrease the number of new type-2 diabetes cases. The aim of this clinical trial is to study the effect of the treatment with Candesartan, an angiotensin II receptor antagonist, on the insulin resistance, the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in a group of non diabetic, non hypertensive, dysglycemic and obese subjects. Methods and design: A randomized, double blind, cross-over, placebo-controlled, clinical trial was designed to assess the effects of Candesartan (up to 32 mg/day during 6 months) on the Homeostasis Model Assessment (HOMA) index, lipid profile, protrombotic state, oxidative stress and plasma levels of inflammatory markers. The participants will be recruited in the \"Fundación Cardiovascular de Colombia\". Subjects who fullfil selection criteria will receive permanent educational, nutritional and exercise support during their participation in the study. After a 15 days-run-in period with placebo and life-style recommendations, the patients who have a treatment compliance equal or greater than 80% will be randomily assigned to one of the treatment groups. Group A will receive Candesartan during 6 months and placebo during 6 months. Group B will receive placebo during the first 6 months, and then, Candesartan during the last 6 months. Control visits will be programed monthly and all parameters of interest will be evaluated every 6 months. Hypothesis: Treatment with Candesartan, could improve the HOMA index, the response to the oral glucose tolerance test and reduce the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in non diabetic, non hypertense subjects with dysglycemia and abdominal obesity, recruited from a population at high risk of developing insulin resistance. These effects are independent of the changes in arterial blood pressure. Trial registration: NCT00319202. © 2006 López-Jaramillo et al; licensee BioMed Central Ltd.

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Trials

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Double blind, randomized controlled trial, to evaluate the effectiveness of a controlled nitric oxide releasing patch versus meglumine antimoniate in the treatment of cutaneous leishmaniasis [NCT00317629]

Background: Cutaneous Leishmaniasis is a worldwide disease, endemic in 88 countries, that has shown an increasing incidence over the last two decades. So far, pentavalent antimony compounds have been considered the treatment of choice, with a percentage of cure of about 85%. However, the high efficacy of these drugs is counteracted by their many disadvantages and adverse events. Previous studies have shown nitric oxide to be a potential alternative treatment when administered topically with no serious adverse events. However, due to the unstable nitric oxide release, the topical donors needed to be applied frequently, making the adherence to the treatment difficult. The electrospinning technique has allowed the production of a multilayer transdermal patch that produces a continuous and stable nitric oxide release. The main objective of this study is to evaluate this novel nitric oxide topical donor for the treatment of cutaneous leishmaniasis. Methods and design: A double-blind, randomized, double-masked, placebo- controlled clinical trial, including 620 patients from endemic areas for Leishmaniasis in Colombia was designed to investigate whether this patch is as effective as meglumine antimoniate for the treatment of cutaneous leishmaniasis but with less adverse events. Subjects with ulcers characteristic of cutaneous leishmaniasis will be medically evaluated and laboratory tests and parasitological confirmation performed. After checking the inclusion/exclusion criteria, the patients will be randomly assigned to one of two groups. During 20 days Group I will receive simultaneously meglumine antimoniate and placebo of nitric oxide patches while Group 2 will receive placebo of meglumine antimoniate and active nitric oxide patches. During the treatment visits, the medications will be daily administered and the presence of adverse events assessed. During the follow-up, the research group will visit the patients at days 21, 45, 90 and 180. The healing process of the ulcer, the health of the participants, recidivisms and/or reinfection will also be assessed. The evolution of the ulcers will be photographically registered. In case that the effectiveness of the patches is demonstrated, a novel and safe therapeutic alternative for one of the most important public health problems in many countries will be available to patients. © 2006 Silva et al; licensee BioMed Central Ltd.

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Trials

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Laser in situ keratomileusis to correct post-keratoplasty astigmatism: 1-Step versus 2-step procedure

Purpose: To investigate the correction of post-penetrating keratoplasty (PKP) astigmatism using laser in situ keratomileusis (LASIK). Visual and refractive outcomes were evaluated after LASIK was performed in 1 step (lamellar cut and ablation in 1 procedure) or 2 steps (lamellar cut then ablation in 2 successive procedures). Setting: Department of Cornea and Refractive Surgery, Vissum-Instituto Oftalmológico de Alicante, University of Miguel Hernández, Alicante, Spain. Methods: In this prospective observational study, 22 consecutive eyes were divided into 2 groups depending on the LASIK procedure performed to correct post-PKP astigmatism. Group 1 (1-step LASIK) included 11 eyes and Group 2 (2-step LASIK), 11 eyes. The patients were followed for 6 months. Results: A statistically significant improvement was obtained in Group 2 with a mean vector analysis result of the cylinder of -4.37 diopters (D) ± 1.79 (SD) (P = .018). In Group 1, the mean astigmatism correction was 2.38 ± 1.71 D. The number of reoperations and residual refractive defects were significantly better in Group 2. Conclusion: The 2-step technique improved the accuracy of excimer laser correction of post-PKP astigmatism. © 2004 ASCRS and ESCRS.

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Journal of Cataract and Refractive Surgery

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Strategies for the electric supply restoration in Colombian transmission substations

The new regulatory frameworks have converted the reliability issue and its increase, in a critical issue. This document presents the evaluation of reliability indexes and the development of restoration strategies for ten transmission substations of the Colombian transmission company (ISA). An example is also presented emphasizing the reduction of ENS (Energy non Supplied). Case Based Reasoning is proposed as the methodology to be used for Fault diagnosis and action proposing. © 2003 IEEE.

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2003 IEEE Bologna PowerTech - Conference Proceedings

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Space-variant optical correlator based on the fractional Fourier transform: Implementation by the use of a photorefractive Bi12GeO12 (BGO) holographic filter

A space-variant optical correlator is proposed on the basis of the fractional Fourier transform. The optical device uses as a recording medium for the holographic filter a photorefractive Bi12GeO12 (BGO) crystal. The experimental results confirm the shift-variance properties. Some limitations that arise from the volume diffraction are also considered. © 1996 Optical Society of America.

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Applied Optics

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Recent progress in invariant pattern recognition

We present some recent results in invariant pattern recognition, including methods that are invariant under two or more distortions of position, orientation and scale. There are now a few methods that yield good results under changes of both rotation and scale. Some new methods are introduced. These include locally adaptive nonlinear matched filters, scale-adapted wavelet transforms and invariant filters for disjoint noise. Methods using neural networks will also be discussed, including an optical method that allows simultaneous classification of multiple targets. ©2005 Copyright SPIE - The International Society for Optical Engineering.

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Proceedings of SPIE - The International Society for Optical Engineering

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Optical neural networks for classification into arbitrary classes

Some important concepts of neural networks are similarity, generalization, invariance and training. Some neural networks are supposed to be able to classify objects according to hidden similarities. All of those concepts are put into question by the consideration first put forward by Watenabe that from a purely logical point of view, similarity is a purely arbitrary concept. It can be shown that this implies that the notion of invariance is also arbitrary , that so-called hidden similarities and generalization cannot exist without some external criteria. Such criteria are either implicit in the training algorithms or must be imposed explicitly. This imposes severe limitations on what neural networks can accomplish. However there are some positive implications; neural networks can be designed to classify objects into arbitrary classes. Applications to optical neural networks and examples will be presented.

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Proceedings of SPIE - The International Society for Optical Engineering

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Cyclacillin in the treatment of acute sinus infections and exacerbations of chronic infections

Cyclacillin was used to treat 40 patients with bacterial sinus infections, either acute or exacerbations of chronic infections. The drug was administered orally in a dosage of 500 mg every six hours for ten days, although three patients required extended treatment. More than 70% of the patients had remission of symptoms in six days, and all but the aforementioned three had remission in ten days or less. More than 90% of the patients had a moderate to good response. The only side effects were gastrointestinal disorders, which disappeared with administration of antacids. No side effects were noted in 72.5% of patients. Cyclacillin proved to be an effective and well-tolerated antibiotic for infections of the paranasal cavities.

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Clinical Therapeutics

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Application of the calculus of variations to the vertical cut off in cohesive frictionless soil

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Geotechnique

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Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study

Background: There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries. Methods: In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants’ metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35–70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586. Findings: In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5–12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9–5·2] per 1000 person-years) and 4911 in men (8·2 [8·0–8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01–1·21) in women and 1·28 (1·19–1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98–1·21) in women and 1·42 (1·25–1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08–1·26]) than in men (1·07 [0·99–1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5–2·1] in women vs 10·7% [8·8–12·6] in men). Interpretation: Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women. Funding: Funding sources are listed at the end of the Article.

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The Lancet

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Epidemiology of trauma in Bucaramanga, Colombia: Analysis of the institutional trauma registry at the Hospital Universitario of Santander

Introduction. Trauma is one of the main causes of mortality worldwide and represents a public health problem. In Latin America, and particularly in Colombia, few trauma registries have been successfully developed. The objective of this study is to describe the epidemiology of trauma at the Hospital Universitario of Santander in the first year of implementation of the institutional trauma registry. Methods. The Department of General Surgery of the Universidad Industrial of Santander, together with the Hospital Universitario of Santander, began the design of the trauma registry in 2020. All patients admitted to the hospital or who died in the emergency department were included. The implementation of the registry began on August 1, 2020, after carrying out a pilot test. Reports were automatically collected and exported to an unidentified electronic database. Results. 3114 patients were evaluated (M: 31 years; men: 78.1%). The median pre-hospital time was three hours and the most frequent means of transport was self-admission (51.16%). The most frequent mechanism of trauma was penetrating trauma (41.81%), with the majority being injuries caused by a sharp weapon (24.92%). Blunt trauma occurred in 41.71% of the patients evaluated and 14.4% of the population was under the influence of psychoactive substances. The general surgery service was the most consulted (26.97%), followed by the plastic surgery service (21.8%). The median hospital stay was two days (Q1:0; Q3:4) and 75 patients (2.41%) died during their hospital stay. Conclusion. The trauma registry of our institution is presented as a favorable platform for the analysis of prehospital and institutional trauma care, and the development of improvement plans in this context. This registry constitutes a solid tool for the execution of new research projects in this area.

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Revista Colombiana de Cirugia

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Covid-19 en la Región de las Américas

No disponible.

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Salud publica de Mexico

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Tuberculosis & Heart

Tuberculosis (TB) is a communicable disease caused by the bacilli Mycobacterium tuberculosis. It is the leading cause of mortality from an infectious disease and is among the top 10 leading causes of death worldwide, particularly in low and middle-income countries (LMIC) where it generates a significant burden of disease (World Heart Organization, 2019). Although TB has been considered a global public health emergency for the last 25 years, it remains poorly controlled. For this reason, in September 2018, the United Nations held its first-ever high-level meeting on TB to assess the state of the epidemic and seek to combat it from a global perspective. As a result, the target 3.3 strategy, which will try to end the TB epidemic by 2030, was established. The goal will be a reduction by 90% of TB mortality and 80% of TB incidence rate compared to 2015 (Harding, 2020).

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The NET-Heart Book: Neglected Tropical Diseases and other Infectious Diseases affecting the Heart

Título del artículo:

Rabies & Heart

Rabies is a neglected tropical disease caused by the Rabies Virus, a single-stranded RNA virus belonging to the Lyssavirus genus. Due to its predilection for the nervous system, the main clinical manifestation of rabies infection is severe encephalitis; however, involvement of other organs have been reported (Jackson, 2016; World Health Organization, 2018). Limited reports have demonstrated that the virus may have a tropism for the heart conduction system, leading to a range of cardiovascular manifestations. While it is important to understand the cardiac manifestations of rabies, it is mostly of academic interest, as once clinically apparent disease is established the fatality rate is virtually 100%. This chapter will review the epidemiology, pathophysiology, diagnosis, treatment and reports of cardiac involvement of rabies.

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The NET-Heart Book: Neglected Tropical Diseases and other Infectious Diseases affecting the Heart

Título del artículo:

Risk factors for prevalent childhood diseases in comprehensive care homes

Introduction: The World Health Organization states that prevalent childhood diseases in 2016 caused a mortality of 5 million in children under 5 years old, due to pneumonia and acute diarrheal disease. Objective: Examine modifiable risk factors for prevalent childhood diseases in traditional community welfare homes in Cucuta, Colombia. Methods: An observational, descriptive, cross-sectional study was conducted in 2018 in 23 households of the Colombian Institute of Family Welfare in Cúcuta; the information was collected from the instrument to identify risk factors for prevalent childhood diseases after initial testing. Results: 276 children were attended, 56.8% of them were boys. Modifiable risk factors were identified in homes; in 22,0% of these, children should improve hand washing; with a similar percentage, it was shown that the cleaning of teaching materials, toys, fans and curtains should be insisted upon; in 17.3% regular infrastructure conditions were observed. In addition, 20,0% of the children shared food, there were children with ongoing diseases and absence of care protocols to follow in such cases, among others. Conclusions: The risk factors can be intervened through the strategy of integrated care for prevalent childhood diseases from its clinical, community and local organization components for its prevention, with the interest and understanding of the shared responsibility for the care of this health problem.

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Revista Cubana de Pediatria

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The Empowerment of Indigenous Women as a Factor in the Socio-Productive Development of a Rural Community

This article discusses the point of view of women\'s empowerment and its impact on public policy. Also mentions the importance of the role of indigenous women in rural and captures the scenario in the municipality of Pueblo Bello, Cesar, where the indigenous community Jewrwa. For the above, research is developed from the application of the emerging paradigm, for which a dialectical synthesis is assumed through the use of qualitative and quantitative methods in a complementary way. It is developed in three phases: the first consists of field visits to interview 5 groups of indigenous women located in the rural area of \"Pueblo Bello\" - Colombia. In addition, 5 indigenous women from the same region, successful in their professional lives, are interviewed. The second phase consists of the search and systematization of documents from multiple sources of information consulted in the year 2020 in search engines such as: Scielo, Dialnet and Google Scholar, and the third phase is a comparative analysis of the sources of information mentioned above. Data analysis was carried out by structuring thematic categories related to the empowerment of rural indigenous women. Empowerment from the intuitive perspective to drive positive changes in the situations they live, and even the political organization to transform those relationships. Hence, in order to promote processes of empowerment, it is necessary to work on the construction of the autonomy of rural indigenous women. Traditionally, indigenous women are in charge of the care work, learned by inheritance and pre-established social constructs, leaving themselves in the last place, at the service of others.

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Proceedings of the LACCEI international Multi-conference for Engineering, Education and Technology

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Genetic Algorithm for the Optimization of the Unequal-Area Facility Layout Problem

The facility layout problem is one of the most important and complex problems in operations management. When the area requirements of departments are different, the problem is known as the unequal-area facility layout problem (UAFLP) and consists of locating a given number of departments within a facility plan, to minimize the total material handling cost, which is the most addressed criteria for the facility layout problems. In this chapter, a genetic algorithm (GA) is presented for solving the UAFLP for the case of a sportswear company. The genetic algorithm uses a two-part chromosome and the flexible bay structure (FBS) to obtain feasible solution alternatives for the facility layout. A set of data instances and parameters are used to validate and tune the genetic algorithm, respectively. The GA is applied to a garment production company showing that the genetic algorithm generates feasible and efficient layout alternatives for the case study.

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Intelligent Systems Reference Library

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Dorsal Vascular Complex Nonligation Method and Preservation of Puboprostatic Ligaments and Endopelvic Fascia During Laparoscopic Radical Prostatectomy: Effect on Continence

Objective: To evaluate the impact on continence rate during 1-year follow-up of a preservation technique that included nonligation of the dorsal vascular complex and sparing of the puboprostatic ligaments and the endopelvic fascia during laparoscopic radical prostatectomy. Material and methods: Information from 30 patients who underwent the preservation technique was pro-spectively collected and compared with data from 60 patients who underwent the nonpreservation traditional technique. A single surgeon performed all procedures. Results: Demographic and preoperative characteristics were similar. The mean patient age was 59 years in both groups. All patients were stage cT1c or cT2. Operative time was significantly lower in the preservation technique group (229.6 vs. 262.7 minutes, P < .001). There were no significant differences in intraopera-tive bleeding, discharge hemoglobin level, blood transfusion rate, length of hospitalization, and drop in the hemoglobin level. The probability of continence recovery was significantly higher in the preservation technique group than in the traditional technique group (hazard ratio = 0.50, 95% CI = 0.31-0.81). The continence rate (0 pads/day) for the preservation technique group versus the traditional technique group at 1, 3, 6, and 12 months was, respectively, 53.3% versus 30% (P = .031), 90% versus 45% (P < .001), 90% versus 63.3% (P = .008), and 96.6% versus 78.3% (P = .024). There were no significant differences between the groups regarding potency and oncologic outcomes. Conclusion: Nonligation of the dorsal vascular complex and preservation of the puboprostatic ligaments and the endopelvic fascia improved urinary continence compared with the traditional nonpreservation technique, with no impact in terms of bleeding and oncologic outcomes.

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Turkish Journal of Urology

Título del artículo:

Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia

Purpose: The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft. Patients and Methods: This was an analytical retrospective case–control study. Cases were defined as subjects requiring prolonged mechanical ventilation (>48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery. Results: A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06–3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: −3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73–7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation <60% (OR 2.00; 95% CI: 1.18–3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06–84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77–4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02–6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91–6.25, p = 0.00). Conclusion: This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.

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Vascular Health and Risk Management

Título del artículo:

Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?

Cardiovascular diseases remain the leading cause of death globally, with acute myocardial infarction being one of the most frequent. One of the complications that can occur after a myocardial infarction is cardiogenic shock. At present, the evidence on the use of inotropic agents for the management of this complication is scarce, and only a few trials have evaluated the efficacy-adverse effects relationship of some agents. Milrinone and Dobutamine are some of the most frequently mentioned drugs that have been studied recently. However, there are still no data that affirm with certainty the supremacy of one over the other. The aim of this review is to synthesize evidence on basic and practical aspects of these agents, allowing us to conclude which might be more useful in current clinical practice, based on the emerging literature.

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Annals of Medicine and Surgery

Título del artículo:

Burnout Syndrome in Emergency Physicians in Venezuela Early in the COVID-19 Pandemic

Background: Burnout syndrome is a clinical entity that can negatively affect healthcare workers, especially frontline medical staff. Objective: Determine the prevalence of burnout in emergency physicians at the start of the COVID-19 pandemic. Methods: The Maslach Burnout Inventory was administered to 150 emergency physicians in 2020 during the first months of the pandemic in a Venezuelan hospital. There are two limitations, the size of sample is small and the study physicians have poor social conditions that do not allow generalizing the results. Results: Over three quarters of the physicians surveyed (76.7%) experienced burnout and 55.3% had health problems due to stress. The higher the number of years working in the hospital and/or the lower the job satisfaction, the higher the burnout rate (p <0.05). Conclusion: A large number of physicians in Venezuela experienced burnout during the first months of the pandemic, but half of them believed they did not need psychological help. Prevalence of burnout was high among physicians with more years of service and among those with lower job satisfaction.

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Current Psychiatry Research and Reviews