Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

 Introducción: La asociación entre obesidad e incremento del riesgo cardiovascular en prevención primaria está bien establecida; después que se diagnostica insuficiencia cardiaca, paradójicamente, la obesidad parece conferir una ventaja en la supervivencia y existen resultados controversiales respecto a la paradoja en subgrupos de poblaciones seleccionadas, como la diabética. Objetivo: Evaluar la influencia del índice de masa corporal en la mortalidad de pacientes diabéticos tipo 2 con insuficiencia cardiaca crónica. Método: estudio observacional de cohorte prospectivo en el periodo comprendido entre enero del año 2006 y diciembre de 2018, la muestra quedó conformada por 153 pacientes diabéticos tipo 2 con insuficiencia cardiaca crónica. Se evaluó la supervivencia, mediante el método de Kaplan-Meier. Se utilizó el modelo de regresión de Cox para estimar el efecto del índice de masa corporal sobre el pronóstico en relación a la mortalidad. Resultados: observamos que las categorías sobrepeso y obesidad tuvieron mejor supervivencia que los que presentaron bajo peso (al año 0,41, a los tres y cinco años 0,33), la curva de éstos se distanció del resto significativamente, Log Rank p= 0,000. En el modelo de regresión de Cox la variable bajo peso presentó una relación significativa en relación al tiempo en que ocurre el evento de muerte, con OR= 4,33 (intervalo de confianza de 1,69-11,09). Conclusión: En los pacientes diabéticos tipo 2 con insuficiencia cardiaca crónica se observó el fenómeno de obesidad paradójica. 

Las enfermedades cardiovasculares (ECV) constituyen actualmente la primera causa de muerte a nivel mundial. Pero si bien en la última década ha disminuido su prevalencia en países de elevados ingresos, en los países de bajos y medianos ingresos es lo contrario. En nuestro país, al comparar ambos sexos, si bien los hombres mueren más de enfermedades oncológicas, en el caso de las mujeres las ECV constituyen la primera causa. Las diferencias en los factores de riesgo tradicionales y emergentes, en la fisiopatología de la enfermedad cardíaca isquémica (ECI), las atipicidades del cuadro clínico y, principalmente, la insuficiente concientización del problema por parte tanto de los médicos de asistencia como de las propias mujeres, hacen que la ECI en la mujer sea muchas veces subdiagnosticada y no reciba un adecuado tratamiento. Se presentan las semejanzas y diferencias entre mujeres y hombres en relación con los factores de riesgo cardiovascular tradicionales y se hace hincapié en los factores de riesgo emergentes, específicos de la mujer, de forma de contribuir a una detección más precoz de la enfermedad y a un adecuado tratamiento que permita mejorar el pronóstico.

Este manual ha sido concebido para ayudarlo en el manejo de los pacientes hipertensos. Se trata de la tercera edición revisada en el 2018.

COVID-19. Punto de vista del cardiólogo.

The COVID-19 pandemic has dramatically exposed the lack of investment and management in the health system and the structural weaknesses of the social protection. The analysis of the dilemmas that arise as a sequence of decision-making to deal with the effects of the pandemic can leave aside the protection and promotion of the well-being of the person as the center of the organization of society, and focus only on the collective and institutional well-being. Ontological personalism as a bioethical theory allows a deep analysis of these dilemmas, since its philosophical base is centralized in the defense and promotion of the person, and in the search for the common good. This article analyzes the foundations of this bioethical current and the responses it can provide to the moral dilemmas exposed untimely by the COVID-19 pandemic.

The dignity of the terminally ill patient must be appreciated, for the condition of being human, showing the corresponding dignity for the fact of "being", of the existence. It is known that terminal situations change the conditions in which the patient finds himself, but it is not lawful to claim that circumstances affect his intrinsic dignity, in the same way that it cannot be claimed that because he is in a terminal situation he does not have the right to lifetime. Adverse circumstances may be present in the life of the human being, but it will always be an end and never a means, within which the dignity of the terminally ill patient must be respected, and the necessary conditions must be ensured of how the corresponding care will be provided until the end. of your life, but not direct actions aimed at when to end your life.

In El Salvador, access to palliative care is limited. In July 2013, he started a private support and symptom control unit in palliative care. They care for cancer and non-cancer patients at three levels: outpatient consultation, hospitalization in private centers and home care. The objective of this study is to describe the demographic and clinical characteristics of the population attended from January 2014 to December 2016 as the first experience of private palliative care in San Salvador.It is an observational, retrospective and descriptive study, using the population census and clinical records. Where sociodemographic and clinical variables of the patients were collected in an initial assessment by the palliative doctor.The total of patients was 125. Being 56.8% women with an average age of 72 years. 68% of patients live in San Salvador. 14.4% have private health insurance. 68% received a home consultation. 86.4% of the patients attended suffered from oncological diseases. The most frequent symptoms: weakness 90.4%, lack of appetite 88.8% and pain 76%. The most widely used opioid was morphine 28.8% followed by tramadol 17.6%, oxycodone 8% and fentanyl 8%. 12.8% required palliative sedation. The patients were referred by doctors in 52.8% and by relatives 47.2%.We present the characteristics of the patients cared for in the private unit and whose results show that when palliative care cares for its principles and basic elements of work, the results are similar to other units in the rest of the world.

Professionals working in a sanitary environment are often exposed to high emotional experiences that rise from the contact with vulnerability, loss, and suffering of patients and relatives, leading to a high exposition to stress.Advances in neurobiology and a higher knowledge of therapeutic relationships allow a better understanding of how we can look after ourselves better and provides resources to transform the experience of sufferers and companions.Understanding the role of self-awareness, presence and self-care and their neurobiological fundamentals allow the development of proposals to prevent the risk of burnout and other prevalent mental health problems among professionals.This work reviews the basis of help relationship, the risks and chances of our work, the relationship between empathy, self-awareness and compassion, as well as the emotional balance needed to work in this environment and self-awareness as a platform of presence and emotional regulation.Some useful practices for selfcare are presented, including teamwork as a protection factor. Finally, a commitment of professionals with their self-care is proposed.

The technological and scientific development has allowed a great development of conscientious objections in the bioethical and bio-legal field, one of them conscientious objection to euthanasia. The current debate around conscientious objection lies in deciding whether the protection of the dictates of conscience, manifested in respect for intimate moral convictions, should be included, or not, in that ethical minimum that the law must protect. In such a way that the recourse to conscientious objection presupposes the existence of a conflict between two clearly legal requirements, since what is debated is whether the imposition or prohibition of a certain conduct should or should not be included in the ethical minimum that any legal order Legal of a Rule of Law must guarantee. The conclusion reached in this article is that conscientious objection is a figure that seeks to preserve the conscience of a minority, of those doctors or health personnel who want to be faithful to their conscience, refusing to carry out the euthanic act. This action has not only a moral but also a legal connotation, which is why conscientious objection is an authentic right that must be protected in every state of law.

Death accompanies life from the very moment of conception. This finite character of the human being has led people to wonder about whether death has value or not, and what are the implications of this question for their existence. From time immemorial, philosophy has reflected on the meaning of death; Bioethics has done the same over time. However, now the reflection on the meaning of death can be accomplished in light of a relatively new discipline, called Thanato-Ethics. Hence, this article explores, through this new discipline, the question of what the meaning of death is. Since death is a very complex reality, we had to take into consideration theoretic fields of knowledge -philosophy and the ethics of death- and practical knowledge -such as an analysis of the dimensions that surround the concrete act of dying. Later, we analyze the implication of euthanasia and assisted suicide. Finally, we conclude recognizing the importance and relevance of this discipline today.