Democratic quality and excess mortality during the COVID-19 pandemic.

The aim of this study is to analyse the relationship between democratic quality and excess mortality produced in the year 2020 before COVID-19 vaccinations were generalised. Using cross-sectional data from 80 countries on five continents, multiple linear regression models between excess mortality, the general democracy index and its disaggregation into five categories: electoral process and pluralism, government functioning, political participation, political culture and civil liberties were estimated. The analysis also considered, public health spending per capita, overweight inhabitants, the average temperature of the country, population over 65 years of age, The KOF Globalisation Index, and the Gross National Income per capita as control variables. It was possible to establish a strong inverse association between excess mortality per million inhabitants and the general democracy index and four of its five categories. There was a particularly strong relationship between excess mortality and the political culture dimension (-326.50, p < 0.001). The results suggest that the higher the democratic quality of the political institutions of a State and particularly of their political culture the more improved the response and management of the pandemic was in preventing deaths and protecting their citizens more effectively. Conversely, countries with lower democracy index values have higher excess mortality. Quality democratic political institutions provide more effective public health policies in the face of the COVID-19 pandemic.

Spanish Adaptation of the Self- and Other-Interest Inventory in Academic Settings.

In the study of human motivations, self-interest is often seen as a determining factor and opposed to other-interest. Recently a new conceptualization has been proposed in which both interests can occur at the same time. In order to measure these constructs, the Self-and Other-Interest Inventory (SOII; Gerbasi & Prentice, 2013) was created, which has one version for adults and one for students. Due to the absence of similar measurement instruments in Spain, the aim of this work is to adapt the SOII to Spanish university students. Several studies were conducted. First, the construct was analyzed through rational-analytical procedures. Second, the items were translated following an iterative forward-translation design. Finally, evidence of validity was obtained through analytical procedures. Specifically, two pilot studies were carried out in which two independent samples of Spanish students participated (N1 = 119; N2 = 165). In both studies descriptive analyzes of the items were performed, reliability was estimated and the factor structure of the SOII was explored from an exploratory factor analysis. The results showed adequate reliability and a two-factor solution consistent with the original.

Spatiotemporal shoreline dynamics of Marismas Nacionales, Pacific coast of Mexico, based on a remote sensing and GIS mapping approach.

Within the last few decades, tropical coastal systems such as beaches, dunes, and mangrove forests have experienced high annual rates of loss worldwide due to natural and anthropogenic impacts. Historical remote sensing data have been used to map and monitor these fragile systems, as well as to track specific events through time. The purpose of this study was to examine coastal trends along Marismas Nacionales in Mexico, which is the largest wetland complex of the western coast of the Pacific Ocean. The opening of the Cuautla Canal in 1976 and the construction of several hydroelectric power dams have severely impacted this wetland system. Shoreline variability was estimated based on representative remote sensing images over half a century (1970 to 2019). Results indicate that, after 49 years, 805 ha of beach deposits have been lost in the Cuautla Canal and at the beach ridge region that should otherwise be an accretional coastal zone. Conversely, the southern section of the study site shows 406 ha of constant accretion during the same period due to the presence of the unobstructed San Pedro River. Our study highlights the adverse effects of engineering projects, such as inlets and hydroelectric dams throughout tropical coastal systems that have strongly depended on freshwater input from upstream rivers.

A study of the graduates of health economics masters programs in Spain / Estudio de los egresados de los programas de máster en economía de la salud en España

Objective: To identify the characteristics, motivations and employment implications among graduates of Masters programmes in health-economics (MPHE). Method: The most renowned MPHE in Spain were contacted to assist in this research study. Participants submitted an online survey comprising 30 items designed specifically for the purpose. Our sample consisted of 439 graduates. Different statistical analysis, including a logistic model, were performed to describe the sample. Results: The main motivation for undertaking an MPHE is academic, and to acquire new or enhance previous knowledge. The general profile of graduates is that of a woman aged 37.8 and a health professional. Those looking for a job in Health Economics generally found employment in the first (54.9%) or second year (29.7%). MPHE were very highly assessed. The most useful subject was health management (46.3%). Conclusions: Undertaking an MPHE is a good investment because most of the graduates believed that their training enabled them to find a job. The graduates showed a high degree of confidence in the usefulness of the training. MPHE are highly evaluated irrespective of consequent employment. The subjects in which the curriculum vitae of the health professionals were weaker, such as those concerning management, were evaluated the highest as they were assumed to enhance promotion opportunities

Objetivo: Identificar las características, las motivaciones y las implicaciones laborales que aparecen entre los egresados de programas de máster en economía de la salud (PMES). Método: Se solicitó colaboración a los másteres más relevantes de España para esta investigación. Los participantes completaron un cuestionario on line de 30 ítems específicamente diseñado para este propósito. La muestra estuvo formada por 439 egresados. Se realizaron diferentes análisis estadísticos, incluyendo modelos logísticos. Resultados: La principal motivación para hacer un PMES es la académica. Las personas lo hacen con el fin de adquirir nueva formación o mejorar conocimientos previos. El perfil general de egresado es el de una mujer de 37,8 años, profesional sanitaria. Las personas que buscaban trabajo en economía de la salud lo encontraron principalmente en el primer (54,9%) o segundo (29,7%) año. La valoración de los PMES es muy elevada. La materia más útil fue gestión sanitaria (46,3%). Conclusiones: Hacer un PMES es una buena inversión porque la mayoría de los egresados consideran que obtuvieron un empleo gracias a su formación. Los graduados muestran un alto grado de confianza en la utilidad de la formación. Los PMES son altamente valorados independientemente de las consecuencias laborales. Las materias en las que los curricula vitae de los sanitarios son más débiles, como las relativas a gestión, son las mejor valoradas, ya que suponen mejores oportunidades de promoción

The opportunity costs of caring for people with dementia in Southern Spain / Costes de oportunidad del cuidado de personas con demencia en el sur de España

Objective: The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced. Method: 778 surveys were analyzed. Data was collected using a questionnaire specifically designed for the purpose, with the collaboration of Alzheimer's Diseases Associations in Andalusia (Spain). For the indirect cost, we used the reveal preferences method. For the comparison between groups an ANOVA and a MANOVA was done. Results: The hypotheses were confirmed. The OC exponentially increases with severity. More than 55% of costs are assumed by families. Occupied people have higher educational level and incomes and contract more external support. Costs are significantly higher for male caregivers. Cohabiting reduces all kinds of costs. Conclusions: The relationship between educational level and employment situation lead to think that if these variables are greater more people will seek professional support. Cultural reasons still maintain women as main caregivers for all educational levels. The existence of these informal caregivers as the main care providers is a saving for the State, and a brake for the development of professional supply

Objetivo: Estudiar los costes de oportunidad de ser cuidador, y comparar los costes directos asumidos por el Estado y las familias. Evaluamos los costes directos (los que suponen desembolso) e indirectos (los que suponen dedicación en tiempo). Planteamos la hipótesis acerca de que los costes se incrementan con la gravedad de la demencia, con el nivel educativo y con la situación laboralmente activa del cuidador. Dichos costes son superiores si el cuidador es varón, y se reducen con la convivencia. Método: Se analizaron 778 cuestionarios. Los datos se recolectaron mediante un cuestionario específicamente diseñado para este fin, contando con la colaboración de las asociaciones de Alzheimer de Andalucía (España). Para el estudio de los costes indirectos se usó el método de preferencias reveladas. Para la comparación de grupos se realizó ANOVA y MANOVA. Resultados: Las hipótesis se confirmaron. Los costes de oportunidad se incrementan exponencialmente con la gravedad. Más del 55% de los costes son asumidos por las familias. Los ocupados tienen un mayor grado de formación e ingresos y contratan más apoyo externo. Los costes son significativamente superiores para cuidadores varones. La convivencia reduce todos los tipos de costes. Conclusión: La relación entre el nivel educativo y el empleo lleva a pensar que, si estas variables crecen, un mayor número de personas buscará apoyo profesional. Las razones culturales mantienen a las mujeres como cuidadoras principales, independientemente del nivel formativo. La existencia de estos cuidadores informales como principales proveedores de cuidados suponen un ahorro para el Estado y un freno para el desarrollo de la oferta profesional

A study of the graduates of health economics masters programs in Spain.

OBJECTIVE: To identify the characteristics, motivations and employment implications among graduates of Masters programmes in health-economics (MPHE). METHOD: The most renowned MPHE in Spain were contacted to assist in this research study. Participants submitted an online survey comprising 30 items designed specifically for the purpose. Our sample consisted of 439 graduates. Different statistical analysis, including a logistic model, were performed to describe the sample. RESULTS: The main motivation for undertaking an MPHE is academic, and to acquire new or enhance previous knowledge. The general profile of graduates is that of a woman aged 37.8 and a health professional. Those looking for a job in Health Economics generally found employment in the first (54.9%) or second year (29.7%). MPHE were very highly assessed. The most useful subject was health management (46.3%). CONCLUSIONS: Undertaking an MPHE is a good investment because most of the graduates believed that their training enabled them to find a job. The graduates showed a high degree of confidence in the usefulness of the training. MPHE are highly evaluated irrespective of consequent employment. The subjects in which the curriculum vitae of the health professionals were weaker, such as those concerning management, were evaluated the highest as they were assumed to enhance promotion opportunities.

The opportunity costs of caring for people with dementia in Southern Spain.

OBJECTIVE: The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced. METHOD: 778 surveys were analyzed. Data was collected using a questionnaire specifically designed for the purpose, with the collaboration of Alzheimer's Diseases Associations in Andalusia (Spain). For the indirect cost, we used the reveal preferences method. For the comparison between groups an ANOVA and a MANOVA was done. RESULTS: The hypotheses were confirmed. The OC exponentially increases with severity. More than 55% of costs are assumed by families. Occupied people have higher educational level and incomes and contract more external support. Costs are significantly higher for male caregivers. Cohabiting reduces all kinds of costs. CONCLUSIONS: The relationship between educational level and employment situation lead to think that if these variables are greater more people will seek professional support. Cultural reasons still maintain women as main caregivers for all educational levels. The existence of these informal caregivers as the main care providers is a saving for the State, and a brake for the development of professional supply.

Influence of changes in the Spanish labor market during the economic crisis (2007-2011) on perceived health.

PURPOSE: We analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population. METHODS: We use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences. RESULTS: Unemployment (OR 1.75; p < 0.001), job insecurity (OR 1.38; p < 0.001), and being part of a household with severe material deprivation (OR 1.87; p = 0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p < 0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure. CONCLUSIONS: This study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.

Másteres en economía de la salud en España. Una formación útil y bien valorada / Masters in health economics in Spain. Highly valued and useful training

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Efficacy of the Treatments Used in Multiple Sclerosis: From Meta-analysis to Number Needed to Treat.

The aim of this study was to analyze the efficacy of drugs used in relapsing-remitting multiple sclerosis, first- and second-line drugs, using the number needed to treat (NNT) as a measure of efficacy. METHODS: Data from randomized clinical trials were analyzed for 3 categories of clinical efficacy outcomes: relapse, change in Expanded Disability Status Scale, and number of new lesions in magnetic resonance imaging. Meta-analysis results are expressed as odds ratios. RESULTS: The global odds ratio was 0.41 (95% confidence interval [CI], 0.34-0.49). For analyzed clinical outcomes, the odds ratio was less for second-line drugs (odds ratio, 2.0). For all studied clinical conditions, in the control group, 47 of 100 patients do not get benefits, compared with 25 (95% CI, 18-32 patients) of 100 for the active treatment group. The NNT was 5 patients (95% CI, 4-7 patients). For the proportion of patients free of relapses, in the control group, 56 of 100 patients had a relapse at 2 years, compared with 37 of 100 patients in the treatment group, with an NNT of 6 patients (95% CI, 5-8 patients). CONCLUSIONS: Active treatments produced statistically significant improvements compared with placebo.

Implementación y evaluación de un curso de accesos venosos centrales ecoguiados para hemodiálisis con simuladores / Implementation and evaluation of a course on central venous access for hemodialysis with simulators

Introducción: el uso de simuladores en el aprendizaje de maniobras invasivas contribuye a la seguridad del paciente. Objetivos: diseñar y evaluar un curso para aprendizaje de la realización de vías venosas centrales con ecografía Doppler y uso de simuladores. Material y método: se definieron objetivos de aprendizaje, contenidos y metodología didáctica. Se realizaron pruebas de evaluación de destrezas, inicial y final, mediante una evaluación clínica objetiva estructurada (ECOE). Se evaluó la opinión de los estudiantes y el nivel de autoconfianza adquirido. El impacto en la práctica clínica se determinó a través del registro de las maniobras de colocación de vía venosa central (VVC) en el semestre siguiente. Resultados: el curso se realizó en el primer semestre 2015 para los siete estudiantes de posgrado de Nefrología de primer año y constó de cuatro instancias (tres horas), con introducción teórica y actividades prácticas con retroalimentación docente inmediata. La encuesta de satisfacción fue Muy Satisfactorio-Excelente en 7/7 y el nivel de autoconfianza aumentó en 4/7 participantes. Se observó una mejora significativa en los ECOE inicial vs final (test de t muestras pareadas p < 0,05). Se realizó una instancia de reparación. Se registraron las 64 VVC realizadas por los participantes, en el semestre siguiente al curso, y las complicaciones experimentadas: dos punciones arteriales, tres hematomas localizados, un aneurisma arterial y un neumotórax (10%), todos con buena evolución. Conclusiones: el uso de simuladores en el aprendizaje de maniobras invasivas logró un alto grado de satisfacción de los participantes, un aumento de su autoconfianza y una mejora significativa en el aspecto técnico

Abstract Introduction: the use of simulators for learning invasive maneuvers contributes to patients’ safety. Objectives: to design and evaluate a course for learning how to introduce central venous catheters with Doppler ultrasound and the use of simulators. Method: learning objectives, contents and didactics were defined. Initial and final skills were evaluated by means of an objective structured clinical evaluation (OSCE). The opinion of students and the level of self confidence achieved were evaluated. The impact on the clinical practice was determined by means of a record of the maneuvers of introduction of the central venous line in the following semester. Results: the course was carried our in the first semester of 2015 for the seven Nephrology postgraduate students. It consisted of four modules (three hours) which comprised a theoretical introduction and practical activities, with the immediate feedback by professors. The satisfaction survey revealed the following: very satisfactory-excellent in 7/7 and the level of self-confidence increased in 4/7 participants. A significant improvement was noticed in the initial vs final OSCE (paired samples T-Test 0.05). A repairing instance was prepared. 64 central central venous lines were introduced by participants in the following course, and complications found included the following: two artery punctures, three hematomas localized, an artery aneurysm and a pneumothorax (10%), all of them evidenced a positive evolution. Conclusions: the use of simulators in the learning of invasive maneuvers achieved a high level of satisfaction among participants, an increase in self-confidence and a significant improvement in technical aspects.

Resumo Introdução: o uso de simuladores para a aprendizagem de manobras invasivas contribui para a segurança do paciente. Objetivos: planejar e avaliar um curso para aprendizagem da realização de vias venosas centrais com ultrassom Doppler e uso de simuladores. Material e método: foram definidos os objetivos de aprendizagem, conteúdos e metodologia didática. Foram realizadas provas de avaliação de destrezas, inicial e final, utilizando uma avaliação clínica objetiva estruturada (ECOE). Também foram avaliados a opinião dos estudantes e o nível de autoconfiança adquirido. O impacto na prática clínica foi determinado pelo registro das manobras de colocação de via venosa central (VVC) no semestre seguinte. Resultados: o curso foi realizado no primeiro semestre de 2015 com os sete estudantes do primeiro ano de pós-graduação em Nefrologia constava de quatro módulos de três horas cada, com introdução teórica e atividades práticas com retroalimentação docente imediata. A pesquisa de satisfação mostrou um resultado Muito Satisfatório-Excelente em 7/7 e o nível de autoconfiança aumentou em 4 dos 7 participantes. Foi observada uma melhoria significativa nos ECOE inicial vs final (teste de t para amostras pareadas p < 0,05). Também foi realizada um módulo de reparação. No semestre seguinte ao curso foram registradas as 64 VVC realizadas pelos participantes e as complicações observadas: duas punções arteriais, três hematomas localizados, um aneurisma arterial e um pneumotórax (10%), todos com boa evolução. Conclusões: o uso de simuladores na aprendizagem de manobras invasivas teve um alto grado de satisfação dos participantes, mostrou um aumento da autoconfiança dos mesmos e uma melhoria significativa dos aspectos técnicos.

Sombras y sombras en la aplicación de la ley de dependencia / Shades and shadows in the application of the long-term care law

El objetivo del presente trabajo es realizar un breve repaso a los aspectos más controvertidos de la Ley 39/2006, de Promoción de la Autonomía y Atención a las Personas en Situación de Dependencia, que han protagonizado en los últimos años fuertes debates entre el Estado y las comunidades autónomas. Los problemas de financiación surgidos tras una mala planificación inicial, el declive en las aportaciones de la Administración General del Estado en los últimos años, incluyendo la supresión del nivel acordado, y una baja recaudación del usuario mediante copago, han colmado de esfuerzo económico a las comunidades autónomas por mantener dicha política social, en un ambiente gobernado por la falta de transparencia del sistema. Por otro lado, las reformas normativas de mediados de 2012, con la finalidad de aliviar los presupuestos estatales y autonómicos, han supuesto un claro retroceso en el espíritu de la ley y una pérdida de bienestar de los dependientes y sus familias. Todas estas premisas han contribuido a un panorama muy heterogéneo de aplicación territorial de la norma, en el que se observan claras diferencias en las listas de espera, abuso de concesión de prestaciones económicas por parte de algunas regiones y disparidades en el número de solicitudes de acceso a las prestaciones y los servicios (AU)

The aim of this study was to provide a brief overview of the most controversial aspects of the Spanish Act of Promotion of Personal Autonomy and Long-Term Care 39/2006, which, in the last few years, has led to heated debates between the state and the autonomous regions. Because of the funding problems due to initial poor planning, the decline of contributions from the Spanish Government in the last few years, including the suppression of the agreed level, and low cash collection from the user through copayment, the autonomous regions have had to provide significant economic resources to maintain this social policy in an environment characterised by a lack of transparency of the system. In addition, the regulatory reforms of mid-2012 to ease the burden on state and autonomous budgets have represented a clear setback to the spirit of the act and a loss of welfare to dependent individuals and their families. All these circumstances have contributed to a widely heterogeneous picture in the territorial implementation of the act, with clear differences in waiting lists, abuse in the granting of cash benefits in some regions, and differences in the number of applications for benefits and services (AU)

[Shades and shadows in the application of the long-term care law]. / Sombras y sombras en la aplicación de la ley de dependencia.

The aim of this study was to provide a brief overview of the most controversial aspects of the Spanish Act of Promotion of Personal Autonomy and Long-Term Care 39/2006, which, in the last few years, has led to heated debates between the state and the autonomous regions. Because of the funding problems due to initial poor planning, the decline of contributions from the Spanish Government in the last few years, including the suppression of the agreed level, and low cash collection from the user through copayment, the autonomous regions have had to provide significant economic resources to maintain this social policy in an environment characterised by a lack of transparency of the system. In addition, the regulatory reforms of mid-2012 to ease the burden on state and autonomous budgets have represented a clear setback to the spirit of the act and a loss of welfare to dependent individuals and their families. All these circumstances have contributed to a widely heterogeneous picture in the territorial implementation of the act, with clear differences in waiting lists, abuse in the granting of cash benefits in some regions, and differences in the number of applications for benefits and services.

Comparación del efecto cardioprotector del preacondicionamiento farmacológico con anestésicos halogenados: sevoflurano versus isoflurano in vivo / Comparison of the cardioprotective effect of pharmacological preconditioning with halogenated anaesthetic agents: sevofluorane vs isofluorane in vivo

Fundamento: los anestésicos halogenados inducen preacondicionamiento y se utilizan en cirugía cardíaca. Muestran diferente poder preacondicionador, lo que se adjudica en parte a sus propiedades fisicoquímicas, al modelo animal utilizado y a su uso en distintas concentraciones. Objetivo: generar estrategias aplicables de protección frente al daño isquemia-reperfusión miocárdica. Comparar el efecto preacondicionador de sevoflurano e isoflurano in vivo. Material y método: estudiamos cuatro grupos de seis ratas cada uno (n = 24). Se utilizó un modelo en rata Wistar de isquemia-reperfusión miocárdica mediante infarto por ligadura de la arteria coronaria izquierda. Se realiza monitoreo hemodinámico y electrocardiograma (ECG) continuo, tinción histológica de área de infarto y en riesgo de infarto. El preacondicionamiento isquémico se realizó mediante ligadura seriada intermitente de la arteria coronaria izquierda previa al episodio de infarto de 30 minutos de duración; el preacondicionamiento farmacológico se realiza por exposición intermitente a halogenados previo a evento de infarto: 1 MAC de isoflurano y sevoflurano. Se comparan resultados con control. Resultados: se expresan como porcentaje del área de infarto isquémico (15,8±3,1); sevoflurano (21,8±1,3); isoflurano (28,3±1,3). Punta-control (41,3±2,0); preacondicionamiento en relación con el área de riesgo de infarto (media ± desvío estándar). Las zonas donde fue más evidente el fenómeno fueron: centro-control (33,7±2,2); preacondicionamiento isquémico (18,5±1,4); sevoflurano (26,5±1,9); isoflurano (33,9±2,3). Hubo significación con p<0,05 (ANOVA - Bonferroni) para todos los grupos entre sí. Conclusiones: el sevoflurano fue más efectivo que el isoflurano en la protección frente al daño por isquemia reperfusión. El preacondicionamiento isquémico mostró mayor protección que ambos halogenados.

Background: halogenated anesthetics induce preconditioning and are used in cardiac surgery. They show different preconditioning effect, in part due to their distinct physical and chemical properties, animal model chosen and different concentrations, utilized.Objectives: To develop applicable strategies of myocardial protection against ischemia-reperfusion injury. To compare the preconditioning effect of sevoflurane and isoflurane in vivo. Methods: four groups of 6 Wistar rats each (n=24) were studied using a myocardial ischemia-reperfusion model with infarct produced by occlusion of the left coronary artery. Continuous hemodynamic and electrocardiographic monitoring, and histological staining of infarct and at-risk areas were performed. Ischemic preconditioning was performed by intermittent serial occlusion of the left coronary artery before the 30-minute infarct occlusion; pharmacological preconditioning was performed by intermittent exposure to volatile anesthetic before the infarct: 1 Minimal Alveolar Concentration of isoflurane and sevoflurane. Results were compared with control. Results: they are expressed as percentage of infarct area in relation to area at risk (mean ± standard deviation). Preconditioning was more evident in these areas: center- control (33,7±2,2); ischemic preconditioning (15,8±3,1); sevoflurane (21,8±1,3); isoflurane (28,3±1,3). apex- control (41,3±2,0); ischemic preconditioning (18,5±1,4); sevoflurane (26,5±1,9); isoflurane (33,9±2,3). Statistically significant differences were found between all groups with p<0.05 (ANOVA-Bonferroni). Conclusions: sevoflurane was more effective than Isoflurane in protecting against ischemia reperfusion injury. Ischemic preconditioning prove to be more protective than both halogenated anesthetics.

Cuidados en terapia intensiva de un paciente en asistencia biventricular como puente al trasplante cardiaco / Intensive care in a patient under biventricular assistance prior to cardiac transplantation

Masculino de 21 años, en insuficiencia multiorgánica consecutiva a cardiomiopatía dilatada extrema. Con el manejo farmacológico máximo tuvo sólo discreta mejoría y persistió con síndrome de bajo gasto acompañado de insuficiencia renal y hepática moderada. Se implantó un sistema neumático paracorpóreo de asistencia biventricular (Thoratec), posterior a lo cual se logró la resolución inmediata de la hipoperfusión sistémica y pudo iniciarse rápidamente su rehabilitación, egresando de la sala de cuidados intensivos siete días después. Durante el soporte mecánico ventricular tuvo sepsis por estafilococo y un episodio de isquemia cerebral resuelto ad intergrum. Se mantuvo en soporte biventricular satisfactorialmente durante 140 días, hasta su transplante ortotópico; el paciente falleció al segundo día posterior al trasplante o consecuencia de coagulopatia grave