Actitudes ante la muerte en profesionales de enfermería latinoamericanos: una revisión integrativa

Introducción: La muerte es parte de los tabúes sociales existentes y puede fomentar actitudes que distan de su abordaje explícito en relación con los cuidados. Objetivo: Analizar las actitudes ante la muerte en profesionales de enfermería de acuerdo con las publicaciones científicas en el contexto latinoamericano en el período 2018 a 2022. Metodología: Se realizó una revisión de literatura integrativa de las publicaciones científicas latinoamericanas respecto de las actitudes ante la muerte en el contexto de la enfermería, empleando los siguientes términos estandarizados: actitud, muerte, enfermería y cuidados de enfermería. Se incluyeron 8 artículos publicados en el período definido, en idioma español y portugués, en los que se abordó explícitamente la temática de la revisión. La información de los artículos fue analizada tomando como referencia los conceptos de la teoría de las transiciones. Resultados: Se encontraron diseños tanto cuantitativos (50 %) como cualitativos (50 %), elaborados en su totalidad en el ámbito hospitalario. Los principales resultados dan cuenta del predominio de la indiferencia ante la muerte en el contexto de los cuidados. En relación con la teoría de las transiciones, la mayoría de los artículos abordan las condiciones en que estas se dan, además de los conceptos de terapéutica de enfermería y patrones de respuesta. Conclusiones: La producción de investigaciones sobre la actitud ante la muerte en profesionales de enfermería es escasa en Latinoamérica. Las experiencias de pérdidas cercanas, la capacitación y el soporte institucional son la base para contribuir a una mejor actitud hacia la muerte

Introdução: A morte faz parte dos tabus sociais existentes e pode fomentar atitudes que se distanciam de sua abordagem explícita em relação aos cuidados. Objetivo: analisar as atitudes diante da morte em profissionais de enfermagem de acordo com as publicações científicas no contexto latino-americano no período de 2018 a 2022. Metodologia: Foi realizada uma revisão de literatura integrativa de publicações científicas latino-americanas sobre atitudes diante da morte no contexto da enfermagem, utilizando os seguintes termos padronizados: atitude, morte, enfermagem e cuidados de enfermagem. Foram incluídos 8 artigos publicados no período definido, em espanhol e português, nos quais o tema da revisão foi abordado explicitamente. As informações dos artigos foram analisadas tendo como referência os conceitos da teoria das transições. Resultados: Foram identificados desenhos quantitativos (50 %) e qualitativos (50 %), elaborados totalmente no âmbito hospitalar. Os principais resultados mostram a predominância da indiferença diante da morte no contexto do cuidado. Em relação à teoria das transições, a maioria dos artigos aborda as condições em que as transições ocorrem, além dos conceitos de terapêutica de enfermagem e padrões de resposta. Conclusões: A produção de pesquisas sobre atitudes diante da morte em profissionais de enfermagem é escassa na América Latina. As experiências de perdas próximas, a capacitação e o apoio institucional são a base para contribuir para uma melhor atitude em relação à morte

Introduction: Death is part of the existing social taboos and can foster attitudes that are far from its explicit approach in relation to care. Objective: To analyze attitudes towards death in nursing professionals according to scientific publications in the Latin American context in the period 2018 to 2022. Methodology: An integrative literature review was conducted of Latin American scientific publications regarding attitudes towards death in the context of Nursing, using the following standardized terms: attitude, death, nursing and nursing care. Eight articles published in the defined period were included, in Spanish and Portuguese, in which the subject of the review was explicitly addressed. The information in the articles was analyzed using the concepts of the theory of transitions as a reference. Results: Both quantitative (50 %) and qualitative (50 %) designs were found, all of them elaborated in the hospital setting. The main results show the predominance of indifference to death in the context of care. In relation to the theory of transitions, most of the articles address the conditions under which these occur, in addition to the concepts of nursing therapeutics and response patterns. Conclusions: The production of research on the attitude towards death in nursing professionals is scarce in Latin America. Experiences of close losses, training and institutional support are the basis for contributing to a better attitude towards death

Desfechos obstétricos adversos durante a COVID-19: uma série de casos retrospectiva / Adverse obstetric outcomes during COVID-19: a retrospective case series / Resultados obstétricos adversos durante el COVID-19: serie de casos retrospectiva

Objetivo: analisar as características e os desfechos obstétricos adversos em gestantes/puérperas infectadas pelo SARS-CoV-2 em serviço de referência. Método: série de casos retrospectiva entre gestantes com Covid-19 em um hospital universitário em Minas Gerais, Brasil, atendidas no serviço de 2020 a 2021, coletados em abril de 2022, empregando-se estatística descritiva para análise dos dados através do Statistical Package for the Social Science. Resultados: incluídas 26 gestantes, em sua maioria brancas, que tiveram como principais desfechos obstétricos adversos a internação em UTI (43,5%), parto prematuro (34,6%), dado reestratificado de semanas para dias para investigar o encurtamento da gestação, onde constatou-se média de 38,6 dias potenciais de gravidez perdidos dos 280 dias ideais, e ainda 15,4% evoluíram para óbito materno. Conclusão: o estudo proporcionou evidenciar a necessidade de vigilância e atenção às gestantes com foco nos principais desfechos adversos, podendo-se intervir em tempo oportuno para diminuir adversidades.

Objective: to analyze the characteristics and adverse obstetric outcomes in pregnant/puerperal women infected by SARS-CoV-2 at a reference service. Method: a retrospective case series conducted among pregnant women with Covid-19 in a university hospital from Minas Gerais, Brazil, treated at the service from 2020 to 2021. The cases were collected in April 2022 employing descriptive statistics for data analysis in the Statistical Package for the Social Science. Results: a total of 26 pregnant women were included, mostly white-skinned, whose main adverse obstetric outcomes were admission to the ICU (43.5%), premature birth (34.6%) and data restratified from weeks to days to investigate shortening of pregnancy, where a mean of 38.6 potential days of pregnancy were lost out of the ideal 280 days, and 15.4% resulted in maternal death. Conclusion: the study provided evidence of the need for surveillance and care for pregnant women with a focus on the main adverse outcomes, enabling timely intervention to reduce adversities.

Objetivo: analizar las características y resultados obstétricos adversos en gestantes/puérperas infectadas por SARS-CoV-2 en un servicio de referencia. Método: serie de casos retrospectiva entre gestantes con Covid-19 en un hospital universitario de Minas Gerais, Brasil, atendidas en el servicio de 2020 a 2021. Los datos se recolectaron en abril de 2022, se utilizó estadística descriptiva para analizar los datos mediante el Statistical Package for the Social Science. Resultados: se incluyeron 26 gestantes, la mayoría de raza blanca, cuyos principales resultados obstétricos adversos fueron ingreso a UCI (43,5%), parto prematuro (34,6%), dato reestratificado de semanas a días para investigar el acortamiento de la gestación, que arrojó como resultado un promedio de 38,6. Se comprobó que se perdieron en promedio 38,6 días potenciales de embarazo de los 280 días ideales, y muerte materna (15,4%). Conclusión: la evidencia que proporcionó el estudio indica que es necesario vigilar y atender a las gestantes enfocándose en los principales resultados adversos, lo que permite intervenir de forma oportuna para reducir adversidades.

Out of hospital cardiac arrest, first steps to know and follow in Mexico to have cardioprotected territories. A point of view of a group of experts / Paro cardiaco extrahospitalario, primeros pasos que se deben conocer y hacer en México para tener espacios cardioprotegidos. Punto de vista de un grupo de expertos

Abstract Sudden cardiac death is a common occurrence. Out-of-hospital cardiac arrest is a global public health problem suffered by ≈3.8 million people annually. Progress has been made in the knowledge of this disease, its prevention, and treatment; however, most events occur in people without a previous diagnosis of heart disease. Due to its multifactorial and complex nature, it represents a challenge in public health, so it led us to work in a consensus to achieve the implementation of cardioprotected areas in Mexico as a priority mechanism to treat these events. Public access cardiopulmonary resuscitation (CPR) and early defibrillation require training of non-medical personnel, who are usually the first responders in the chain of survival. They should be able to establish a basic and efficient CPR and use of the automatic external defibrillator (AED) until the emergency services arrive at the scene of the incident. Some of the current problems in Mexico and alternative solutions for them are addressed in the present work.

Resumen La muerte súbita cardíaca (SCD) es un acontecimiento común. El paro cardiaco extrahospitalario (OHCA) es un problema de salud pública mundial que sufren ≈3.8 millones de personas al año. Se ha avanzado en el conocimiento de esta enfermedad, su prevención y tratamiento, sin embargo, la mayoría de los eventos se producen en personas sin diagnóstico previo de cardiopatía. Debido a su carácter multifactorial y complejo, representa un reto en salud pública, lo que obliga a trabajar en un consenso para lograr la implementación de "Espacios Cardio protegidos" en México, como mecanismo prioritario de atención a estos eventos. La reanimación cardiopulmonar básica (RCPB) y la desfibrilación temprana de acceso público requieren de entrenamiento al personal no médico, que suelen ser los primeros respondientes para iniciar la cadena de la supervivencia. Ellos deberían instaurar una RCPB eficiente y el uso del desfibrilador automático externo (AED) hasta que lleguen al lugar del incidente los servicios de emergencias. El presente trabajo menciona algunos de los problemas actuales en México y algunas opciones de solución para los mismos.

Pulmonary strain and end-expiratory lung volume during apnea test: a comparative analysis using electrical impedance tomography / Stress pulmonar y volumen pulmonar de fin de es piración durante el test de apnea: estudio compara tivo utilizando tomografía por impedancia eléctrica

Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.

Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.

Use of antimicrobials in patients in Palliative Care admitted to the Intensive Care Unit: A retrospective study

Introduction: Palliative care (PC) improves the quality of life of patients and their families. The use of antimicrobials is controversial in PC patients, especially in those admitted to the intensive care unit (ICU). Objective: To evaluate the use of antimicrobials in PC patients admitted to the ICU. Methods: This is a retrospective study, performed from August 2019 to September 2020. Data on demographic profile, hospitalization, PC, and use of antimicrobials were collected from the Erasto Gaertner Hospital database, in Curitiba, Brazil. Results: 182 patients were studied, median age of 65 years and 52% men. The median length of stay in the ICU was 3 days; the median total length of stay in the hospital was 6 days and 89.5% of the patients died. The time in ICU of patients treated with antibiotics (14.8%) was significantly longer (p=0.033) than for patients who were not (85.2%). Using or not using antibiotics did not change the outcome. Among those who took antibiotics, death occurred in 81.5% of cases and among those who did not use, 74.8% died (p=0.627). Between the cases that used broad-spectrum antibiotics 17/19 (89.5%) died and the mean hospital stay was 16.2 days. Among cases that used narrow-spectrum 5/9 (62.5%) died and the mean hospital stay was 6.4 days (p=0.033). Conclusion: The administration and/or the spectrum of antibiotics in PC patients admitted to the ICU did not change the mortality rate. The administration of antibiotics increased the length of stay in the ICU.

Time trends of avoidable deaths in Brazil, 1996 to 2019

Introduction: The known achievements of the Brazilian Unified Health System (SUS) stand out in an adverse context. This makes it necessary to examine the effect of the SUS on the population's health, using indicators such as deaths by avoidable causes. Objective: To describe the time trends of mortality from avoidable causes in Brazil and to compare them to those of non-avoidable causes. Methods: Ecological time-series study with official mortality data, during years 1996-2019, in the age group 5-74 years. Time trends in mortality were estimated as the annual percent reduction in mortality rates, and the impact of the SUS was calculated as the difference in trend between avoidable (immunopreventable, infectious and noncommunicable diseases, maternal and external causes) and non-avoidable causes. The analyses consisted of multivariable binomial regression models, by quadrennium. Results: Death rates for each avoidability group remained stable or declined throughout the study period. The probability of a positive impact was greater than 90% for immunopreventable diseases throughout the study period; infectious diseases in 1996-2003 and 2016-2019; noncommunicable diseases in 1996-2003 and 2008-2019; maternal causes in 1996-1999; and external causes in 1996-2007. This probability was less than 10% for maternal deaths in 2016-2019; and external causes in 2008-2015. Conclusion: The SUS has had a positive impact in reducing deaths from immunopreventable, infectious and noncommunicable diseases in Brazil, although not so much for maternal and external causes.

Síndrome de QT largo congénito y bradicardia fetal: la importancia del diagnóstico

Antecedentes: El síndrome de QT largo es una canalopatía que afecta a la repolarización ventricular y aumenta el riesgo de sufrir arritmias ventriculares graves. Puede ser congénito o adquirido, y es una causa conocida de muerte súbita. Caso clínico: Gestante primigesta, de 28 años, sin antecedentes de interés. En ecografías prenatales se objetivó en el feto bradicardia sinusal mantenida desde la semana 28, sin repercusión hemodinámica, que persistió hasta la finalización de la gestación (semana 37+3). Al nacimiento se realizaron electrocardiogramas seriados que mostraron alteraciones en la repolarización con alargamiento del intervalo QT corregido. Se realizó estudio genético que confirmó síndrome de QT largo tipo 1 y se inició tratamiento oral con beta-bloqueantes, con buena respuesta. Conclusiones: El síndrome de QT largo suele diagnosticarse posnatalmente. Es importante conocer sus características clínicas prenatales para poder establecer un diagnóstico precoz y minimizar así el riesgo de muerte súbita de estos pacientes.

Background: Long QT syndrome is a channelopathy that affects ventricular repolarization and increases the risk of severe ventricular arrhythmias. It can be congenital or acquired, and is a known cause of sudden cardiac death. Case report: A 28-year-old primigravida with no significant medical history. Prenatal ultrasounds revealed sustained fetal sinus bradycardia from week 28, without hemodynamic repercussion, which persisted until the end of gestation (at 37+3 weeks). Serial electrocardiograms were performed after birth, showing repolarization abnormalities with prolonged corrected QT interval. A genetic study confirmed long QT syndrome type 1, and oral treatment with beta-blockers was initiated, showing a positive response. Conclusions: Long QT syndrome is often diagnosed postnatally. It is important to be aware of his prenatal clinical features in order to establish an early diagnosis and minimize the risk of sudden death in these patients.

Causas Múltiplas de Morte Associadas à Parada Cardiorrespiratória Pediátrica de 1996 a 2019 no Brasil / Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil

Resumo Fundamento: Em pediatria, a parada cardiorrespiratória (PCR) está associada a alta mortalidade e graves sequelas neurológicas. Informações sobre as causas e mecanismos de morte abaixo de 20 anos poderiam fornecer subsídios teóricos para a melhoria da saúde de crianças e adolescentes. Objetivos: Realizar uma análise populacional das taxas de mortalidade por causas primárias e múltiplas de morte abaixo de 20 anos, em ambos os sexos, no período de 1996 a 2019, no Brasil, e identificar a frequência com que a PCR foi registrada nas declarações de óbito (DOs) desses indivíduos e os locais de ocorrência dos óbitos, a fim de promover estratégias para melhorar a prevenção de mortes. Método: Estudo ecológico de séries temporais de óbitos em indivíduos menores de 20 anos, no período de 1996 a 2019, avaliando as taxas de mortalidade (TMs) e a mortalidade proporcional (MP) por causa básica de morte. Foram analisados os percentuais de PCR registrados em qualquer linha da DO e o local de ocorrência dos óbitos. Foram calculadas as TMs por 100 mil habitantes e a MP por causa básica de morte nos menores de 20 anos segundo sexo e faixa etária, os percentuais de óbito por causas básicas por faixa etária quando a PCR foi descrita em qualquer linha das Partes I e II da DO, e o percentual de óbitos por causas básicas segundo o local de ocorrência. Os dados foram retirados do DATASUS, IBGE e SINASC. Resultados: De 1996 a 2019, ocorreram 2.151.716 óbitos de menores de 20 anos, no Brasil, gerando uma taxa de mortalidade de 134,38 por 100 mil habitantes. A taxa de óbito foi maior entre os recém-nascidos do sexo masculino. Do total de óbitos, 249.334 (11,6%) tiveram PCR registrada em qualquer linha da DO. Especificamente, a PCR foi registrada 49.178 vezes na DO na faixa etária entre 1 e 4 anos e em 88.116 vezes entre 29 e 365 dias, correspondendo, respectivamente, a 26% e 22% dos óbitos nessas faixas etárias. Essas duas faixas etárias apresentaram as maiores taxas de PCR registradas em qualquer linha da DO. As principais causas básicas de óbito quando a PCR foi registrada na sequência de óbitos foram doenças respiratórias, hematológicas e neoplásicas. Conclusão: As causas perinatais e externas foram as principais causas de morte, com maior TM nos menores de 20 anos no Brasil de 1996 a 2019. Quando consideradas as causas múltiplas de morte, as principais causas primárias associadas à PCR foram as doenças respiratórias, hematológicas e neoplásicas. A maioria dos óbitos ocorreu no ambiente hospitalar. Melhor compreensão da sequência de eventos nesses óbitos e melhorias nas estratégias de ensino em ressuscitação cardiopulmonar pediátrica são necessárias.

Abstract Background: In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. Objectives: To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. Method: Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. Results: From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. Conclusion: Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

Implementing palliative care, based on family-centered care, in a highly complex neonatal unit

Abstract Objective: To describe the causes and circumstances of neonatal mortality and determine whether the implementation of a palliative care protocol has improved the quality of end-of-life care. Methods: A retrospective observational study including all patient mortalities between January 2009 and December 2019. Cause of death and characteristics of support during the dying process were collected. Two periods, before and after the implementation of a palliative care protocol, were compared. Results: There were 344 deaths. Congenital malformations were the most frequent cause of death (45.6 %). Most patients died after the transition to palliative care (74.4 %). The most frequently cited criteria for initiating transition of care was poor neurocognitive prognosis (47.2 %). Parents accompanied their children in the dying process in 72 % of cases. Twenty-three percent of patients died outside the Neonatal Intensive Care Unit after being transferred to a private room to enhance family intimacy. After the addition of the palliative care protocol, statistically significant differences were observed in the support and patient experience during the dying process. Conclusions: The most frequent causes of death were severe congenital malformations. Most patients died accompanied by their parents after the transition to palliative care. The implementation of a palliative care protocol helped to improve the family-centered end-of-life care.

Análise das informações sobre cuidados paliativos divulgadas na televisão / Analysis of palliative care information broadcasted on television / Análisis de la información sobre cuidados paliativos emitida en televisión

Este estudo de abordagem qualitativa teve como objetivo analisar, a partir do referencial teórico da Análise Institucional, as informações sobre cuidados paliativos veiculadas nos programas da Rede Globo de televisão. A partir da busca no site Globoplay, foram identificados trinta vídeos relacionados ao assunto entre os anos de 2013 e 2020. Entre outros aspectos, foi observado o predomínio de informações divulgadas no mês de outubro, em programas locais da região sudoeste e presença dos profissionais de saúde como a principal fonte de consulta. A televisão se mostrou um importante dispositivo de divulgação de informações sobre cuidados paliativos com os mais variados sentidos, a saber: espiritualidade, alívio da dor e protagonismo dos sujeitos e seus familiares na busca por um processo de morrer com qualidade. Entretanto, nenhum vídeo citou o Sistema Único de Saúde (SUS), o que demonstrou sua invisibilidade nesse meio. Recomenda-se que os meios de comunicação acelerem a divulgação do assunto e que enfatizem o SUS nos conteúdos divulgados.

This qualitative study analyzes the information on palliative care broadcasted by Rede Globo de Televisão's programs based on the theoretical framework of Institutional Analysis. A search on the "Globoplay" website retrieved 30 videos related to the subject between 2013 and 2020. Among other aspects, information was mainly broadcasted in the month of October and in local southwestern programs, having health professionals presented as their main source of information. Television proved to be an important device for disseminating information on palliative care aspects such as spirituality, pain relief and the role of patients and their families in the search for a quality dying process. However, no video mentioned the Unified Health System (SUS), showing its media invisibility. Media conglomerates should increase the dissemination of palliative care information, emphasizing the role played by the SUS.

Este estudio cualitativo tuvo por objetivo analizar, a partir del referencial teórico del Análisis Institucional, las informaciones transmitidas sobre cuidados paliativos en los programas de la Red Globo de Televisión. A partir de la búsqueda en el sitio web Globoplay se identificaron treinta videos relacionados con el tema entre los años 2013 y 2020. Se observó, entre otros aspectos, el predominio de informaciones difundidas en el mes de octubre y en programas locales de la región Suroeste, y los profesionales de la salud se presentaron como la principal fuente de información. La televisión demostró ser un importante dispositivo de difusión de información sobre los cuidados paliativos con los más variados sentidos, como la espiritualidad, el alivio del dolor y el papel de las personas y sus familias en la búsqueda de una muerte digna. Sin embargo, no se mencionó al Sistema Único de Salud (SUS) en ningún video, lo que lo invisibilizó en los medios. Se recomienda que los medios de comunicación avancen en la difusión sobre el tema y que se haga énfasis en el SUS en los contenidos difundidos.

Análisis de la la muerte súbita cardíaca por prolapso de la válvula mitral en una autopsia de una mujer sin antecedente de cardiopatía. Reporte de caso / Analysis of sudden cardiac death due to mitral valve prolapse in an autopsy of a woman with no history of heart disease. Case report

Resumen En Costa Rica, el Reglamento de la Autopsia Hospitalaria y Médico Legal establece que la autopsia médico legal es obligatoria para toda muerte súbita. La patología cardíaca es responsable aproximadamente del 80 % de las muertes súbitas que requieren una autopsia forense; el prolapso de la válvula mitral (degeneración mixomatosa de la válvula mitral) es una de las formas más comunes de valvulopatía cardíaca, es relativamente común (2%-3% de la población general), y a menudo se considera benigno, la tasa anual de muerte cardíaca súbita (MSC) en individuos con MVP (0,2%-0,4% /año) es aproximadamente el doble que el observado en la población general (0,1%-0,2% año).

Abstract In Costa Rica, the Hospital and Legal Autopsy Regulations establish that a legal medical autopsy is mandatory for all sudden deaths. Cardiac pathology is responsible for approximately 80% of sudden deaths requiring a forensic autopsy; Mitral valve prolapse (myxomatous mitral valve degeneration) is one of the most common forms of heart valve disease, is relatively common (2%-3% of the general population), and is often considered benign, the annual rate of Sudden cardiac death (SCD) in individuals with MVP (0.2%-0.4%/year) is approximately twice that observed in the general population (0.1%-0.2%/year).

Liporoteínas de baja densidad y grados de riesgo cardiovascular en adultos mayores de 40 años: estudio de casos y controles

Fundamento: Las enfermedades cardiovasculares constituyen la principal causa de muerte y discapacidad en el mundo. Su incidencia y prevalencia ha aumentado durante la última década y representa un tercio de todas las muertes. Objetivo: Determinar la asociación de LDL-C y grados de riesgo cardiovascular en adultos mayores de 40 años en la Unidad de Medicina Familiar # 43 del Instituto Mexicano del Seguro Social. Método: Se realizó una investigación con un diseño de casos y controles durante el 2023, mediante la fórmula de relación caso-control 1:1, (230 sujetos) que reunieron los criterios de selección. La recolección de la información se realizó por medio de una base de datos en Excel, el contraste de variables se realizó con la fórmula de X2. Mediante el programa de SPSS versión 25 de Windows. Resultados: El género femenino fue el de mayor frecuencia, la media de edad fue de 62 años, el colesterol total elevado presentó 109 (94,8) pacientes con alto riesgo cardiovascular, se calculó una RM: 43.279, IC: 95 %, (17.347-107.980), el colesterol LDL presentó un 68 % (59,1) con riesgo cardiovascular y una RM: 1.28, IC: 95% (0.760-2.158), la evaluación de los triglicéridos con cifras elevadas presentó un 50,4 % (58), RM: 0.037, IC 95 % (0.013-0.106). Conclusiones: La edad media de los sujetos fue, 62 años, predominó el sexo femenino, con mayor proporción de casados, el nivel de escolaridad que prevaleció fue la preparatoria, la religión católica tuvo mayor frecuencia y los sujetos de la zona urbana. Las variables de lípidos como el colesterol total y LDL-C presentaron significancia estadística en relación a riesgo cardiovascular.

Foundation: Cardiovascular diseases are the main cause of death and disability in the world. Its incidence and prevalence has increased over the last decade and accounts for a third of all deaths. Objective: Determine the association of LDL-C and degrees of cardiovascular risk in adults over 40 years of age in the Family Medicine Unit # 43 of the Mexican Social Security Institute. Method: An investigation was carried out with a case-control design during 2023, using the 1:1 case-control ratio formula, (230 subjects) who met the selection criteria. Information collection was carried out through an Excel database, the contrast of variables was carried out with the X2 formula. Using the SPSS version 25 Windows program. Results: The female gender was the most frequent, the average age was 62 years, elevated total cholesterol presented 109 (94.8) patients with high cardiovascular risk, an MRI was calculated: 43,279, CI: 95 %, (17,347-107,980), LDL cholesterol presented 68 % (59.1) with cardiovascular risk and an MRI: 1.28, CI: 95 % (0.760-2.158), the evaluation of triglycerides with high figures presented 50.4 % (58), OR: 0.037, 95 % CI (0.013-0.106). Conclusions: The average age of the subjects was 62 years, the female sex predominated, with a greater proportion of married people, the level of schooling that predominated was high school, the catholic religion was more frequent and the subjects were from the urban area. Lipid variables such as total cholesterol and LDL-C presented statistical significance in relation to cardiovascular risk.

Características de los casos de óbito fetal en un hospital público de Perú: estudio descriptivo / Characteristics of cases of fetal death in a public hospital in Peru: a descriptive study

Objetivo: Describir las características de los casos de óbito fetal reportados entre el año 2017 y 2021 en un hospital público de Perú. Métodos: Estudio descriptivo y transversal, que se realizó en los casos confirmados de muerte fetal en madres con edad gestacional mayor a 22 semanas presentados en el Hospital de Vitarte de Lima, Perú. La muestra estuvo conformada por 137 casos durante el periodo de 2017 a 2021. Se presentaron frecuencias y porcentajes. Resultados: La muerte fetal tuvo una tasa de 14,8 por 1 000 nacidos vivos. La mayoría de las mujeres tenía entre 20 y 24 años (27 %), además, el 70,1 % era conviviente, 92 % era ama de casa y 83,2% estudió hasta secundaria. Por otra parte, 50,4 % era multigesta y 29,9 % tuvo antecedente de aborto y 16,7 % antecedente de cesárea. La asistencia al servicio prenatal fue el más frecuente (67,2 %) y 29,2 % tenía sobrepeso. Respecto a las patologías maternas, el 38 % tuvo infección del tracto urinario, 17,5 % preeclampsia sin signos de seguridad y 2,9 % diabetes gestacional. Las malformaciones congénitas se presentaron en el 19 % de los casos; además, el 23,4 % de muertes fetales tuvo una causa materna. Conclusiones: La tasa de muerte fetal es alta. Los casos estuvieron caracterizados mayormente por madres con cualidades de vulnerabilidad social, además de presentar características de mayor riesgo obstétrico. Las causas maternas de muerte fetal fueron las más frecuentes(AU)

Objective: To describe the characteristics of fetal death cases reported between 2017 and 2021 in a public hospital in Peru. Methods: Descriptive and cross-sectional study, which was conducted in confirmed cases of fetal death in mothers with gestational age greater than 22 weeks presented at the Vitarte Hospital in Lima, Peru. The sample consisted of 137 cases during the period from 2017 to 2021. Frequencies and percentages were presented. Results: Fetal death had a rate of 14,8 per 1000 live births. Most of the women were between 20 and 24 years old (27%), in addition, 70,1% were cohabiting, 92% were housewives and 83,2% studied up to high school. On the other hand, 50,4% were multigestational and 29,9% had a history of abortion and 16,7% had a history of cesarean section. Prenatal service attendance was the most frequent (67,2%) and 29,2% were overweight. Regarding maternal pathologies, 38% had urinary tract infection, 17,5% had preeclampsia without signs of safety and 2,9% had gestational diabetes. Congenital malformations were present in 19% of cases; in addition, 23,4% of fetal deaths had a maternal cause. Conclusions: The rate of fetal death is high. The cases were characterized mostly by mothers with qualities of social vulnerability, in addition to presenting characteristics of higher obstetric risk. Maternal causes of fetal death were the most frequent(AU)

Alteraciones de la placenta y sus anejos en muestras procedentes de muertes fetales. Cienfuegos, 2021-2023

Fundamento la placenta humana es un misterio. El diagnóstico anatomopatológico cobra importancia en la búsqueda de factores en los que se pueda trabajar para evitar las muertes fetales. Objetivo determinar las alteraciones macroscópicas y microscópicas de la placenta y sus anejos en especímenes procedentes de muertes fetales. Métodos se realizó un estudio descriptivo, retrospectivo y trasversal, en el Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, en el período comprendido entre 2021 y 2023. Fueron analizadas 58 placentas y sus anejos, recibidos en el departamento de Anatomía Patológica. Se estudiaron las alteraciones macroscópicas y microscópicas de la placenta. Resultados tuvieron mayor representación las placentas y cordones anormalmente pequeños (24,14 % y 63,79 % respectivamente); la inserción marginal del cordón (36,21 %), las rupturas, las torciones (8,62 %), los quistes (6,90 %), el edema (77,59 %), la necrosis fibrinoide (72,41%), las vellosidades inmaduras, la villitis (43,10 %), el excesivo número de nudos sincitiales (3,48 %), la esclerosis fibromuscular (20,69 %), la presencia de fibrina (82,76 %), la funisitis (29,31%), la esclerosis fibromuscular (20,69 %) y la corioamnionitis (31,03 %). Conclusiones los resultados evidenciaron predominio de las alteraciones microscópicas, como son la fibrina, la necrosis fibrinoide y el edema. Teniendo en cuenta estos factores, se podrán tomar las medidas necesarias para evitar una muerte fetal.

Foundation the human placenta is a mystery. The anatomopathological diagnosis becomes important in the search for factors that can be worked on to avoid fetal deaths. Objective to determine the macroscopic and microscopic alterations of the placenta and its annexes in specimens from fetal deaths. Methods a descriptive, retrospective and cross-sectional study was carried out at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, from 2021 to 2023. 58 placentas and their annexes, received in the Pathological Anatomy Department, were analyzed. Macroscopic and microscopic alterations of the placenta were studied. Results abnormally small placentas and cords were more represented (24.14 % and 63.79 % respectively); marginal cord insertion (36.21 %), ruptures, twists (8.62 %), cysts (6.90 %), edema (77.59 %), fibrinoid necrosis (72.41 %), immature villi, villitis (43.10 %), excessive number of syncytial knots (3.48 %), fibromuscular sclerosis (20.69 %), the presence of fibrin (82.76%), funisitis (29.31 %), fibromuscular sclerosis (20.69 %) and chorioamnionitis (31.03 %). Conclusions the results showed a predominance of microscopic alterations, such as fibrin, fibrinoid necrosis and edema. Taking these factors into account, the necessary measures can be taken to avoid fetal death.

Probability and trend of premature death of four major chronic diseases in Linyi City in 2013-2021 / 公共卫生与预防医学

Objective To analyze the mortality rate and probability of premature death caused by four major noninfectious chronic diseases (NCDs)in Linyi City from 2013 to 2021, and to provide data support for scientific formulation of chronic disease prevention and control strategy. Methods The mortality data of major chronic diseases in Linyi City from 2013 to 2021 were analyzed. The crude mortality, age-standardized mortality and premature death probability were calculated. The annual percent change (APC) was adopted to analyze the temporal trend of mortality and probability of premature death. Results The average annual crude mortality of four major NCDs was 538.98/100,000, and the age-standardized mortality was 387.3/100,000. The crude mortality rate increased from 517.37/100 000 in 2013 to 563.13/100 000 in 2021 (APC=0.89％, P=0.01). The age-standardized mortality rate decreased from 410.19/100,000 to 364.92/100,000 (APC=-1.8％, P=0.01). The crude mortality and age-standardized mortality of four major NCDs in males were higher than those in females (P<0.05). The average annual probability of premature death caused by four major NCDs was 13.37%. The probability of premature death decreased from 14.49％ in 2013 to 12.32％ in 2021（APC=-2.1％, P=0.00）. From 2013 to 2021, the probability of premature death from malignant tumors, cardiovascular and cerebrovascular diseases, and chronic respiratory diseases in Linyi City dropped from 6.14%, 7.47%, and 1.21% to 5.52%, 6.46%, and 0.5%, respectively (APCs were -1.2%, -2.1%, and -11.3%, respectively, and P values were 0.04, 0.00, and 0.00, respectively). The probability of premature death from diabetes remained stable. The probability of premature death caused by four major NCDs in males was higher than that in females (P<0.05). Conclusion The probability of premature death of the four major NCDs in Linyi has showed a downward trend during 2013-2021. It is suggested to strengthen the prevention and control of diabetes in the next step.

Construction and self-activation detection of yeast two-hybrid bait plasmid of human programmed cell death ligand 1 immunoglobulin variable region domain gene / 中国生物制品学杂志

@#Objective To construct a yeast two-hybrid recombinant bait plasmid of human programmed cell death ligand 1(PD-L1)immunoglobulin variable region(IgV)domain gene,detect its expression in yeast and detect the cytotoxicity and self-activation of PD-L1 IgV protein as well as the interaction between PD-L1 IgV and human thioredoxin(hTrx).Methods Human PD-L1 was analyzed by bioinformatics method,and primers were designed to amplify PD-L1 IgV domain based on the coding region of PD-L1 gene registered in NCBI GenBank database. PCR amplification was carried out with pENTERPD-L1 plasmid as template,and then cloned into yeast two-hybrid bait vector pGBKT7. The recombinant bait plasmid and pGBKT7 empty vector were transformed into Y2HGold yeast cells respectively,and the PD-L1 IgV gene and its expression were detected by PCR and Western blot;Meanwhile,the protein toxicity and self-activation of PD-L1 IgV were detected,and the interaction between PD-L1 IgV and hTrx was detected by drip plate method.Results The bioinformatics analysis results of PD-L1 were consistent with related reports. The recombinant bait plasmid pGBKT7-PD-L1 IgV was correctly constructed,and Y2HGold positive clone was obtained,in which PD-L1 IgV was stably expressed. The empty vector pGBKT7 and recombinant bait plasmid pGBKT7-PD-L1 IgV grew well on SD/-Trp and SD/-Trp/X-α-Gal plates with the same colony size and number and white colony,but they did not grow on SD/-Trp/X-α-Gal/AbA plates,which indicated that PD-L1 IgV protein had no toxicity and no self-activation effect on yeast. The results of drip plates test showed that all experimental groups grew well on SD/-Trp/-Leu plate,while only positive control group grew on SD/-Trp/-Leu/X-α-Gal/AbA plate and showed blue color,which indicated that bait protein PD-L1 IgV and hTrx did not self-activate,and there was no interaction between them.Conclusion Recombinant human PD-L1 IgV bait plasmid was successfully constructed. PD-L1 IgV protein showed no toxicity and self-activation effect on yeast cells,and there was no interaction between PD-L1 IgV and hTrx. Subsequently,hTrx can be used to construct a peptide aptamer library,from which peptide aptamers that specifically bind to PD-L1 IgV can be screened.

Research advances in traditional Chinese medicine regulation of programmed cell death in intervening against hepatic fibrosis / 临床肝胆病杂志

Hepatic fibrosis （HF） is a pathological process of abnormal repair of liver tissue structure caused by chronic liver injury， and its pathogenesis has not been fully clarified. Related studies have shown that programmed cell death may be associated with the onset of HF， and traditional Chinese medicine （TCM） has a significant effect in regulating programmed cell death to intervene against HF. This article reviews the main mechanism of the influence of programmed cell death on HF and discusses the possible mechanism of TCM regulation of programmed cell death in improving HF， which provides new ideas for TCM prevention and treatment of HF.

Individual and interactive effects of atmospheric PM2.5 and O3 on mortality of circulatory system diseases in Ningxia / 环境与职业医学

Background The impact of atmospheric fine particulate matter (PM2.5) and ozone (O3) on the mortality of circulatory system diseases cannot be ignored. However, whether the interaction between PM2.5 and O3 can affect population health is rarely reported and requires study. Objective To investigate the individual and interactive impacts of atmospheric PM2.5 and O3 on the mortality of circulatory system diseases in the population of Ningxia region. Methods The data of 119647 deaths due to circulatory system diseases, daily average concentrations of atmospheric pollutants, and meteorological data in Ningxia from 2013 to 2020 were retrieved. PM2.5 was divided into low, medium, and high concentrations according to the primary and secondary national limits (35 and 75 μg·m−3) of the Ambient air quality standards. Similarly, O3 was divided into low, medium, and high concentrations according to the national limits (100 and 160 μg·m−3). Using a generalized additive mixed model based on quasi Poisson distribution, the impacts of atmospheric PM2.5 and O3 as well as their interaction on the mortality of circulatory system diseases were analyzed using the population data of Ningxia region. Results During the target period, males and the ≥ 65 year group accounted for larger proportions of deaths due to circulatory system diseases (55.47% and 79.87% respectively). The daily average concentration of PM2.5 (40.25 μg·m−3) exceeded the national primary limit. In the single pollution model, the highest cumulative lag effects for mortality from circulatory system diseases were PM2.5 exposure over previous 1 d (lag01) and O3 exposure for previous 2 d (lag02), and their excess risk (ER) values were 1.03% (95%CI: 0.67%, 1.40%) and 1.02% (95%CI: 0.57%, 1.50%), respectively. The results of concentration stratification analysis showed that the most significant risks of death from circulatory system diseases [ER (95%CI): 1.12% (0.32%, 1.92%) and 0.95% (0.13%, 1.79%) respectively] were found at medium PM2.5 and O3 concentrations. The interaction analysis revealed that under, a synergistic effect on the risk of death from circulatory system diseases was identified (relative excess risk due to interaction=3.08%, attributable proportion of interaction=2.90%, synergy index=1.89) when considering the coexistence of PM2.5 and O3 above the primary limit. As the concentrations of PM2.5 and O3 increased, the synergistic effect increased the risk of death from circulatory system diseases in the general population, men, women, and the ≥ 65 years group. Conclusion Both atmospheric PM2.5 and O3 can increase the risk of death from circulatory system diseases, and the two pollutants have a synergistic effect on the risk of death from circulatory system diseases.

The question of death criteria in human organ donation / 器官移植

Donation after death is the most important ethical principle to carry out organ donation after citizens’ death. The newly-revised <i>Regulations on Human Organ Donation and Transplantation</i> does not define death, and avoids the key question of “whether to recognize brain death”. Certain legal risks or damages to the rights and interests of donors may exist in organ donation. Death is an inevitable part of human life. It is necessary to establish specific criteria, which is also the only approach, to define death in any era. Death criteria are established based on the view of death, and restricted by the development level of productive forces and other social factors. The determination of death criteria hugely varies between China and the West. To standardize organ donation and transplantation and promote high-quality development of organ donation, medical staff must adhere to the principle of pure motivation, take informed consents as the premise, respect the donors' and their close relatives' rights to choose their own death criteria, strictly follow the death judgment procedures and operating norms, and ensure the scientificity, accuracy and fairness of death determination.