Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica / Mexican clinical practice guideline for the diagnosis and treatment of dyslipidemias and atherosclerotic cardiovascular disease

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Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Farmacogenómica de los anticoagulantes orales: la importancia de establecer algoritmos de dosificación en población chilena

There is an important interindividual variability in dose requirement for coumarinic anticoagulants, which could be explained by genetic and non-genetic factors. Among hereditary factors, there are gene polymorphisms that code the therapeutic target and the main enzyme responsible for their metabolism. However, there are other candidate genes that could modulate dose requirements. The is a paucity of pharmacogenomic platforms to determine dose requirements of coumarinics in the Chilean population. Therefore, algorithms considering different variables to adjust individual dosages are required. Herein, we analyze the available evidence about factors that can modify the effects of vitamin K antagonists and that should be incorporated to dosing algorithms.

Musicoterapia grupal activa y depresión en pacientes del Hospital de Psiquiatría - CNS

La depresión se constituye en uno de los mayores problemas de salud mental a nivel mundial y nuestro país no está exento de dicha problemática, esto significa un enorme reto para los profesionales del área y una búsqueda de tratamientos accesibles, innovadores, sostenibles y efectivos, por lo que la musicoterapia podría, de alguna manera, dar respuestas a estas demandas, ya que como lo señalaría Bruscia K. en 1988, entre sus objetivos terapéuticos estarían la restauración, el mantenimiento y el acrecentamiento de la salud tanto física como mental. Es con este propósito que la presente investigación a través de un diseño Cuasiexperimental, pretende demostrar que la denominada Musicoterapia grupal activa disminuye los niveles de depresión. Para alcanzar dicho objetivo, se ha estructurado un programa de intervención basado por un lado en los principios propuestos por Gastón T, y Poch S., y en el principio de Iso (Identidad sonoro musical) de Altshuler I. y Benenzon R.; y por otro, en la metodología grupal activa, (Poch S. Alvin J. y Satinosky S.) que ha sido implementado en el Hospital de Psiquiatría de la CNS de la ciudad de La Paz en un grupo de pacientes con depresión, en un tiempo estimado de cuatro meses, a la vez de haberse realizado un análisis comparativo con un grupo de control, obteniendo resultados estadísticos significativos que confirman la hipótesis de investigación y que permiten avizorar la incursión de este novedoso recurso terapéutico en el tratamiento de la depresión en nuestro contexto sociocultural.

Depression is one of the biggest mental health problems worldwide and our country is not exempt from this problem, this means a huge challenge for professionals in the area and a search for accessible, innovative, sustainable and effective treatments, for what music therapy could, in some way, provide answers to these demands, since as Bruscia K. indicated in 1988, among its therapeutic objectives would be the restoration, maintenance and enhancement of both physical and mental health. It is with this purpose that the present investigation through a quasi-experimental design, aims to demonstrate that the named active group music therapy reduces the levels of depression. To achieve this goal, a music therapy intervention program has been structured based on the principles presented by Gaston T. and Poch S. and on the principle of Iso (Sound musical identity) principle from Altshuler I. and Benenzon R.; and on the other hand, in the active group methodology (Poch S., Alvin J. and Satinosky S.) that has been implemented in the Psychiatry Hospital of the CNS in a group of patients with depression, in an estimated time of four months, as well as a comparative analysis with a control group, obtaining significant statistical results that confirm the research hypothesis and that allow foreseeing the incursion of this novel therapeutic resource in the treatment of depression in our sociocultural context.

A depressão é um dos maiores problemas de saúde mental a nível mundial e nosso país não está isento desse problema, o que significa um grande desafio para os profissionais da área e uma busca por tratamentos acessíveis, inovadores, sustentáveis ​​e eficazes, para que a musicoterapia poderia, de alguma forma, responder a essas demandas, pois, como aponta Bruscia K. em 1988, entre seus objetivos terapêuticos estão a restauração, a manutenção e o aprimoramento da saúde física como mental. É com este propósito que a presente investigação através de um desenho Quase-experimental, demonstram que a chamada musicoterapia grupal ativa diminui os níveis de depressão. Para atingir esse objetivo, foi estruturado um programa de intervenção em musicoterapia baseado por um lado nos princípios proposta por Gastón T., e Poch S., e no princípio de Iso (Identidade som musical) de Altshuler I. e Benenzón R.; e por outro, na metodologia grupal ativa, (Poch S., Alvin J. e Satinosky S.) que foi implementado no Hospital Psiquiátrico CNS da cidadi de La Paz a um grupo de pacientes com depressão, em tempo estimado de quatro meses, a tempo de ter feito uma análise comparativa com um grupo de controle, obtendo resultados estatísticos significativos que confirmam a hipótese da pesquisa e que permitem assistir a incursão de um novo recurso terapêutico no tratamento da depressão em nosso contexto sociocultural.

Traqueostomía percutánea versus convencional / Percutaneous tracheostomy versus conventional

Introducción. La traqueostomía es un pedido frecuente al cirujano en la UTI para los pacientes en ARM prolongados. La misma puede realizarse en UTI o quirófano. La traqueostomía percutánea (TP) es un procedimiento que minimiza los gestos quirúrgicos.Objetivo. Mostrar las ventajas y desventajas de la TP en comparación con la traqueostomía convencional (TC).Diseño. Retrospectivo, descriptivo y comparativo.Material y Métodos. Se incluyeron 15 pacientes ingresados a la UTI en ARM prolongados a quienes se les indicó traqueostomía. Se valoró edad, sexo de los pacientes; causa de la indicación, vía de abordaje, tiempo del procedimiento, costo de los materiales, morbilidad y mortalidad.Resultados. La edad media fue de 60 años. Seis ACV, 3 neumonías, 2 insuficiencias respiratorias y 4 por trauma grave. Estuvieron internados en promedio 12 días en ARM. El tiempo operatorio fue de 9 minutos para la TP y de 30 minutos para la TQ.Conclusiones. El menor tiempo operatorio, la mayor facilidad técnica, poder realizarla en la propia UTI nos hacen pensar en lo ideal de la indicación de la TP. En nuestra breve experiencia notamos las claras ventajas técnicas y médicas de la TP sobre la TC.