Variación de la saturación de oxígeno en la detección de hipertensión pulmonar

16 páginasIntroduction: The analysis of oxygen saturation during the 6-minute walk can represent a useful, accessible and reproducible tool for the assessment of patients with pulmonary arterial hypertension. Objective: To establish the validity of the variation in oxygen saturation in the 6-minute walk for the diagnosis of pulmonary hypertension by transthoracic echocardiography. Methods: Cross-sectional study in patients with suspected pulmonary hypertension who underwent a 6- minute walk and transthoracic echocardiography. The validity and correlation of the variation of the oxygen saturation obtained from the 6-minute walk and the systolic pressure values of the pulmonary artery by echocardiography were calculated. Results: The average age of the subjects was 70.8 years (+/-: 13.3), 52.5% of the people were men. It will be eliminated that the mean initial oxygen saturation in patients with and without probable 2022;51(4):e02202107 http://scielo.sld.cu http://www.revmedmilitar.sld.cu Bajo licencia Creative Commons pulmonary hypertension was similar, with 89.9% (+/-: 4.4) vs 89.4% (+/-: 4.6), respectively. The correlation coefficient between the decrease in oxygen saturation and the systolic pressure of the pulmonary artery was 0.11. Conclusion: The variation in oxygen saturation during the 6-minute walk has an acceptable sensitivity for the detection of probable pulmonary hypertension in transthoracic echocardiography. The drop in oxygen saturation would be an alternative to consider suspecting pulmonary hypertensionIntroducción: El análisis de la saturación de oxígeno durante la caminata de 6 minutos, puede representar una herramienta útil, accesible y reproducible en la valoración de los pacientes con hipertensión arterial pulmonar. Objetivo: Establecer la validez de la variación de la saturación de oxígeno en la caminata de 6 minutos para el diagnóstico de hipertensión pulmonar mediante ecocardiograma transtorácico. Métodos: Estudio de corte transversal en pacientes con sospecha de hipertensión pulmonar que realizaron una caminata de 6 minutos y ecocardiografía transtorácica. Se calculó la validez y correlación de la variación de la saturación de oxígeno obtenido de la caminata de 6 minutos y los valores de presión sistólica de la arteria pulmonar mediante ecocardiografía. Resultados: El promedio de edad de los sujetos fue de 70,8 años (± 13,3), el 52,5 % de las personas eran hombres. Se observó que el promedio de la saturación de oxígeno inicial en los pacientes con y sin hipertensión arterial pulmonar probable fue similar, con 89,9 % (± 4,4) vs. 89,4 % (± 4,6), respectivamente. El coeficiente de correlación entre el descenso de la saturación de oxígeno y la presión sistólica de la arteria pulmonar el cual fue de 0,11. Conclusión: La variación de la saturación de oxígeno durante la caminata de 6 minutos tiene una sensibilidad aceptable para la detección de hipertensión pulmonar probable en ecocardiograma transtorácico, la caída de la saturación de oxígeno sería una alternativa a tener en cuenta para sospechar hipertensión pulmonar

Sob o signo neoliberal: as relações internacionais da América Latina

As relações internacionais da América Latina são vistas sob o ângulo da transição da diplomacia do desenvolvimento para a diplomacia neoliberal. Os estudos de relações internacionais, particularmente no Brasil e na Argentina, fundamentam a interpretação do autor sobre benefícios e malogros do paradigma neoliberal, visto como uma opção ideológica. A noção de Estado logístico é sugerida como alternativa estratégica ao Estado normal.<br>In this article, international relations in Latin America are analysed through the viewpoint of the transition from a diplomacy of development to a neoliberal model. Studies in International Relations as a discipline, especially those carried out in Brazil and Argentina, are the basis for the author's interpretation about benefits and failures of the neoliberal paradigm, understood as an ideological option. The author forwards the notion of Logistic State as a strategic alternative to the Normal State

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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A search for WWγ\gamma and WZγ\gamma production and constraints on anomalous quartic gauge couplings in pp collisions at s\sqrt{s} = 8 TeV

A search for $WV\gamma$ triple vector boson production is presented based on events containing a $W$ boson decaying to a muon or an electron and a neutrino, a second $V$ ($W$ or $Z$) boson, and a photon. The data correspond to an integrated luminosity of $19.3\text{}\text{}{\mathrm{fb}}^{-1}$ collected in 2012 with the CMS detector at the LHC in $pp$ collisions at $\sqrt{s}=8\text{}\text{}\mathrm{TeV}$. An upper limit of 311 fb on the cross section for the $WV\gamma$ production process is obtained at 95% confidence level for photons with a transverse energy above 30 GeV and with an absolute value of pseudorapidity of less than 1.44. This limit is approximately a factor of 3.4 larger than the standard model predictions that are based on next-to-leading order QCD calculations. Since no evidence of anomalous $WW\gamma \gamma$ or $WWZ\gamma$ quartic gauge boson couplings is found, this paper presents the first experimental limits on the dimension-eight parameter ${f}_{T,0}$ and the $CP$-conserving $WWZ\gamma$ parameters ${\kappa }_{0}^{W}$ and ${\kappa }_{C}^{W}$. Limits are also obtained for the $WW\gamma \gamma$ parameters ${a}_{0}^{W}$ and ${a}_{C}^{W}$