Proposta de um protocolo de reabilitação pulmonar em pacientes sobreviventes da COVID-19

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus is a new disease characterized by generating lung damage and compromising multiple tissues and organs throughout the body. Some of the patients with the infection should need intrahospital management with O2 support and additional measures that may include prolonged ICU immobilization. Patients who have moderate or severe conditions and survive the disease, could experience long-term impairment and dysfunction, including pulmonary fibrosis, cardiomyopathy, renal, hepatic and peripheral nerve injury, and all complications arising from hospitalizations in the ICU. It is considered that intervention in pulmonary rehabilitation is particularly important, especially at the recovery stage, and should be performed mainly with the objectives of improving: dyspnea, severe muscle weakness and fatigue, in order to promote functional independence and increase quality of life, so that anxiety and depression are diminished.La enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 es una nueva enfermedad caracterizada por generar daño pulmonar y compromiso de múltiples tejidos y órganos de todo el cuerpo. Algunos de los pacientes que presentan la infección ameritan manejo intrahospitalario con soporte de O2 y medidas adicionales que pueden incluir inmovilización prolongada en UCI. Los pacientes que presentan cuadros moderados o severos y sobreviven a la enfermedad pueden presentar deterioro y disfunciones a largo plazo, incluyendo fibrosis pulmonar, miocardiopatía, lesión renal, hepática, de nervio periférico y todas las complicaciones derivadas de hospitalizaciones en UCI. Se considera que la intervención en rehabilitación pulmonar reviste gran importancia, especialmente en la etapa de recuperación, y debe realizarse, principalmente, con los objetivos de mejorar la disnea, la debilidad muscular severa y la fatiga, a fin de promover la independencia funcional y aumentar la calidad de vida, de manera que se disminuye así la ansiedad y la depresión.Doença por coronavírus (COVID-19), causada pelo vírus SARS-CoV-2, é uma nova doença caracterizada por gerar dano pulmonar e comprometimento de múltiplos tecidos e órgãos de todo o corpo. Alguns dos pacientes que apresentam a infecção merecem atendimento intra-hospitalar com suporte de O2 e medidas extraordinárias que podem incluir imobilização prolongada na UTI. Os pacientes que apresentam quadros moderados ou graves e sobrevivem à doença podem apresentar deterioração e disfunções em longo prazo, incluindo fibrose pulmonar, miocardiopatia, lesão renal, hepática, de nervo periférico e todas as complicações derivadas de internações em UTI. Considera-se que a intervenção em reabilitação pulmonar ganha grande importância, especialmente na etapa de recuperação, e deve realizar-se principalmente com o objetivo de melhorar a dispneia, a debilidade muscular grave e a fatiga, a fim de promover a independência funcional e aumentar a qualidade de vida, para que assim a ansiedade e a depressão diminuam

Circunstancias en las que se desestima la acción de repetición como herramienta del ordenamiento jurídico colombiano

En esta investigación se abordarán las actuaciones del consejo de estado en referencia al desarrollo de los procesos de repetición, determinando las circunstancias que propician la inefectividad del proceso en referencia a la responsabilidad de los funcionarios y empleados públicos causantes del hecho dañoso, el cual tuvo que reparar el estado a través indemnización económica, generando un daño patrimonial al erario público, el cual desde la norma se pretende reparar el daño económico generado a cargo del empleado o funcionario público. El legislador para tal fin desarrolla la ley 678 de 2001 por medio de la cual se regula el proceso de repetición y el llamamiento en garantía con el propósito de reducir el impacto del daño sufrido al erario público, pero las grandes condenas que ha pagado el estado sin lograr reparar el daño por este mecanismo evidencia una falencia del mismo, donde los responsables del hecho antijurídicos están evadiendo la responsabilidad, siendo fundamental determinar las circunstancias donde realmente el funcionario o servidor público puede evitar su responsabilidad en el proceso de reparación.This investigation will address the actions of the state council in reference to the development of repetition processes, determining the circumstances that lead to the ineffectiveness of the process in reference to the responsibility of public officials and employees responsible for the harmful event, which had to repair the state through economic compensation, generating a patrimonial damage to the public treasury, which from the norm is intended to repair the economic damage generated by the employee or public official. The legislator for this purpose develops the law 678 of 2001 by means of which regulates the process of repetition and the call in guarantee with the purpose of reducing the impact of the damage suffered to the public treasury, but the great sentences that the state has paid without being able to repair the damage by this mechanism, it shows a flaw in it, where those responsible for the unlawful act are evading responsibility, being fundamental to determine the circumstances where the official or public servant can actually avoid his responsibility in the reparation process

Ley de justicia y paz como garantía del derecho a la justicia, la verdad y la reparación de las víctimas

Esta investigación se ha centrado en un análisis crítico a la Ley 975 de 2005, denominada “Justicia y Paz”, y el cumplimiento de la misma en cuanto a los derechos a la verdad, la justicia y la reparación de las víctimas. Para hablar de la ley de “Justicia y Paz”, hay que hablar un poco del fenómeno del paramilitarismo. Por eso este trabajo comenzará su primer capítulo haciendo referencia al contexto del conflicto armado en Colombia y el surgimiento del paramilitarismo en nuestro país, así como el proceso de paz con este grupo. Posteriormente, se abordan en el segundo capítulo algunos contextos y experiencias latinoamericanas de procesos similares en cuanto a la verdad, la justicia y la reparación en el marco de la reconciliación nacional de países como Argentina, Chile, El Salvador, Guatemala y Perú. En el tercer capítulo se analiza el contenido de la Ley de Justicia y Paz, se tratan algunos de sus aspectos fundamentales, así como que se puede hacer para evitar que sean esclarecidos los hechos, se conozca toda la verdad, se repare a las víctimas y se haga justicia. Seguidamente, en el cuarto capítulo se desarrollan los derechos de las víctimas a la verdad, la justicia y la reparación integral de las víctimas. Pero para todo esto, es necesario conocer las instituciones encargadas de la ejecución de la Ley 975 de 2005 y sus funciones, lo cual se hace en el siguiente capítul

Proposta de um protocolo de reabilitação pulmonar em pacientes sobreviventes da COVID-19

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus is a new disease characterized by generating lung damage and compromising multiple tissues and organs throughout the body. Some of the patients with the infection should need intrahospital management with O2 support and additional measures that may include prolonged ICU immobilization. Patients who have moderate or severe conditions and survive the disease, could experience long-term impairment and dysfunction, including pulmonary fibrosis, cardiomyopathy, renal, hepatic and peripheral nerve injury, and all complications arising from hospitalizations in the ICU. It is considered that intervention in pulmonary rehabilitation is particularly important, especially at the recovery stage, and should be performed mainly with the objectives of improving: dyspnea, severe muscle weakness and fatigue, in order to promote functional independence and increase quality of life, so that anxiety and depression are diminished.La enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 es una nueva enfermedad caracterizada por generar daño pulmonar y compromiso de múltiples tejidos y órganos de todo el cuerpo. Algunos de los pacientes que presentan la infección ameritan manejo intrahospitalario con soporte de O2 y medidas adicionales que pueden incluir inmovilización prolongada en UCI. Los pacientes que presentan cuadros moderados o severos y sobreviven a la enfermedad pueden presentar deterioro y disfunciones a largo plazo, incluyendo fibrosis pulmonar, miocardiopatía, lesión renal, hepática, de nervio periférico y todas las complicaciones derivadas de hospitalizaciones en UCI. Se considera que la intervención en rehabilitación pulmonar reviste gran importancia, especialmente en la etapa de recuperación, y debe realizarse, principalmente, con los objetivos de mejorar la disnea, la debilidad muscular severa y la fatiga, a fin de promover la independencia funcional y aumentar la calidad de vida, de manera que se disminuye así la ansiedad y la depresión.Doença por coronavírus (COVID-19), causada pelo vírus SARS-CoV-2, é uma nova doença caracterizada por gerar dano pulmonar e comprometimento de múltiplos tecidos e órgãos de todo o corpo. Alguns dos pacientes que apresentam a infecção merecem atendimento intra-hospitalar com suporte de O2 e medidas extraordinárias que podem incluir imobilização prolongada na UTI. Os pacientes que apresentam quadros moderados ou graves e sobrevivem à doença podem apresentar deterioração e disfunções em longo prazo, incluindo fibrose pulmonar, miocardiopatia, lesão renal, hepática, de nervo periférico e todas as complicações derivadas de internações em UTI. Considera-se que a intervenção em reabilitação pulmonar ganha grande importância, especialmente na etapa de recuperação, e deve realizar-se principalmente com o objetivo de melhorar a dispneia, a debilidade muscular grave e a fatiga, a fim de promover a independência funcional e aumentar a qualidade de vida, para que assim a ansiedade e a depressão diminuam

Predictores de necesidad de marcapasos permanente y alteraciones de la conducción con el implante transcatéter de una nueva válvula aórtica autoexpandible

Introduction and objectives: The incidence of permanent pacemaker implantation (PPI) and new conduction abnormalities (CA) with the ACURATE neo (Symetis S.A., Eclubens, Switzerland) has not been studied in detail. We aimed to analyze their predictors, evaluating patient- and device-related factors, including implantation depth and device-to-annulus ratio (DAR). Methods: Two analyses of a multicenter population were performed: new PPI in pacemaker-naive patients (n = 283), and PPI/new-CA in patients without prior CA or pacemaker (n = 232). Results: A new PPI was required in 9.9% of patients, who had a higher body mass index, higher rate of right bundle branch block and bradycardia. Neither implantation depth nor DAR differed in patients with PPI compared with those without. In the multivariable analysis neither DAR (OR, 1.010; 95%CI, 0.967-1.055; P = .7) nor implantation depth (OR, 0.972; 95%CI, 0.743-1.272; P = .8) predicted PPI. Only high body mass index, bradycardia and right bundle branch block persisted as independent predictors. PPI/ new-onset CA occurred in 22.8% of patients and was associated with a higher logistic EuroSCORE. Neither implantation depth nor DAR differed in patients with PPI/new-CA vs those without (7.3 +/- 1.9 vs 7.1 +/- 1.5 mm; P = .6 and 41.0 +/- 7.9 vs 42.2 +/- 10.1%; P = .4). The only predictor of PPI/new-CA was a higher logistic EuroSCORE (OR, 1.039; 95%CI, [1.008-1.071]; P = .013). Conclusions: New PPI and new-onset CA rates were low with the ACURATE neo. These were mainly influenced by patient characteristics and not by device-depending factors. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved

Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI

Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in > 50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p median were higher at 1 week (14 vs. 4 %, p = .007) and in SS > median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.y This work was supported by the "Instituto de Salud Carlos III" (PI1102323 grant). O. Husser was supported by the "Regensburger Forschungsforderung in der Medizin (ReForM)".Husser, O.; Monmeneu Menadas, JV.; Bonanad, C.; Gomez, C.; Chaustre, F.; Nuñez, J.; López Lereu, MP.... (2013). Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI. International Journal of Cardiovascular Imaging. 29(7):1499-1509. https://doi.org/10.1007/s10554-013-0239-1S14991509297Perazzolo Marra M, Lima JA, Iliceto S (2011) MRI in acute myocardial infarction. 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Metabolomic Profile of Human Myocardial Ischemia by Nuclear Magnetic Resonance Spectroscopy of Peripheral Blood Serum A Translational Study Based on Transient Coronary Occlusion Models

Objectives The aim of this study was to investigate the metabolomic profile of acute myocardial ischemia (MIS) using nuclear magnetic resonance spectroscopy of peripheral blood serum of swine and patients undergoing angioplasty balloon-induced transient coronary occlusion. Background Biochemical detection of MIS is a major challenge. The validation of novel biosignatures is of utmost importance. Methods High-resolution nuclear magnetic resonance spectroscopy was used to profile 32 blood serum metabolites obtained (before and after controlled ischemia) from swine (n = 9) and patients (n = 20) undergoing transitory MIS in the setting of planned coronary angioplasty. Additionally, blood serum of control patients (n = 10) was sequentially profiled. Preliminary clinical validation of the developed metabolomic biosignature was undertaken in patients with spontaneous acute chest pain (n = 30). Results Striking differences were detected in the blood profiles of swine and patients immediately after MIS. MIS induced early increases (10 min) of circulating glucose, lactate, glutamine, glycine, glycerol, phenylalanine, tyrosine, and phosphoethanolamine; decreases in choline-containing compounds and triacylglycerols; and a change in the pattern of total, esterified, and nonesterified fatty acids. Creatine increased 2 h after ischemia. Using multivariate analyses, a biosignature was developed that accurately detected patients with MIS both in the setting of angioplasty-related MIS (area under the curve 0.94) and in patients with acute chest pain (negative predictive value 95%). Conclusions This study reports, to the authors' knowledge, the first metabolic biosignature of acute MIS developed under highly controlled coronary flow restriction. Metabolic profiling of blood plasma appears to be a promising approach for the early detection of MIS in patients. (J Am Coll Cardiol 2012;59:1629-41) (c) 2012 by the American College of Cardiology FoundationFrom the *Cardiology Department, Hospital Clinico Universitario-INCLIVA, Universidad de Valencia, Valencia, Spain; dagger Unidad Central de Investigacion en Medicina, Universidad de Valencia, Valencia, Spain; double dagger Centro de Biomateriales e Ingenier a Tisular, Universidad Politecnica de Valencia, Valencia, Spain; Department of Clinical Analyses, Hospital Clinico Universitario-INCLIVA, Valencia, Spain; parallel to Cardiology Department, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain; Department of Biochemistry and Molecular Biology, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; and the #Fundacion Investigacion, Hospital Clinico Universitario-INCLIVA, Valencia, Spain. The present study was supported by Instituto de Salud Carlos III (PI 11/02323 and Heracles grants to Dr. Bodi), Fundacion Gent per Gent (to Drs. Bodi and Monleon), the Ministry of Science and Innovation of Spain (grant SAF2008- 00270 to Dr. Monleon), and Generalitat Valenciana (grant GVASAN AP014/2009 to Dr. Monleon and grant PROMETEO2010-075 to Dr. Vina). Dr. Monleon gratefully acknowledges a 2006 Ramon y Cajal contract from the Ministry of Education of Spain. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.Bodi, V.; Sanchis, J.; Morales, JM.; Marrachelli, VG.; Nunez, J.; Forteza, MJ.; Chaustre Mendoza, LF.... (2012). Metabolomic Profile of Human Myocardial Ischemia by Nuclear Magnetic Resonance Spectroscopy of Peripheral Blood Serum A Translational Study Based on Transient Coronary Occlusion Models. Journal of the American College of Cardiology. 59(18):1629-1641. https://doi.org/10.1016/j.jacc.2011.09.083S16291641591