Abstract INTRODUCTION Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings. OBJECTIVE Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery.

ABSTRACT Relative risk and odds ratio are two measures of the association strength in clinical and epidemiological investigations. The relative risk corresponds to the ratio of two incidence rates, those exposed to a possible risk factor and those not exposed to that factor. Odds correspond to the ratio of two odds to one odds. The latter is a quotient between the probability that a certain event occurs and the probability that said event does not occur. Relative risk can be estimated in prospective and retrospective designs, while odds ratio can be calculated in analytical prospective, retrospective and cross-sectional studies, and under certain conditions they can replace relative risk. Relative risk can be estimated in prospective and retrospective designs, while odds ratio can be calculated in analytical prospective, retrospective and cross-sectional studies, and under certain conditions they can replace relative risk. By means of some questions and didactic examples, this article presents the methodological and statistical bases about these two measures, in a simple way, aiming to help researchers to make a correct interpretation and use of them, in the field of health sciences.

RESUMEN El riesgo relativo y el odds ratio son dos medidas de la fuerza de asociación en las investigaciones clínicas y epidemiológicas. El riesgo relativo corresponde a la razón de dos tasas de incidencia, las personas expuestas a un posible factor de riesgo y la de los no expuestos a ese factor. El odds corresponde a la razón entre dos odds y un odds. Este último es un cociente entre la probabilidad de que ocurra un evento determinado y la probabilidad de que no ocurra dicho evento. El riesgo relativo puede ser estimado en diseños prospectivos y retrospectivos, mientras que el odds ratio se puede calcular en estudios prospectivos, retrospectivos y transversales analíticos, y bajo ciertas condiciones pueden reemplazar al riesgo relativo. Por medio de algunas interrogantes y ejemplos didácticos, este artículo expone las bases metodológicas y estadísticas de manera sencilla, acerca de estas dos medidas, con el propósito de que en el ámbito de las ciencias de la salud, los investigadores puedan hacer una correcta interpretación y uso de ellos.

OBJETIVO: Verificar o processo de gerenciamento dos resíduos odontológicos do serviço público de saúde em 11 municípios brasileiros. MATERIAL E MÉTODO: Uma única pesquisadora realizou as visitas e as observações foram anotadas em um roteiro previamente elaborado e testado. RESULTADO: Foram visitadas 50 unidades de saúde, sendo que nenhuma apresentou cópia do plano de gerenciamento de resíduos. Do total de estabelecimentos, 62% realizavam a correta segregação dos resíduos no momento da sua geração. A presença de recipientes adequados a cada tipo de resíduo gerado no consultório odontológico foi observada em 74% dos estabelecimentos e, destes, 94% apresentavam capacidade adequada ao tipo de resíduo gerado. A identificação do tipo de resíduo nas embalagens plásticas bem como anotações identificando o estabelecimento gerador dos resíduos foram encontradas em 8% e 6%, respectivamente. Somente 21% dos estabelecimentos apresentavam locais apropriados, de acordo com as normas vigentes, para o armazenamento dos resíduos até que fosse feita a coleta externa. CONCLUSÃO: Constatou-se na presente pesquisa que a rotina adotada pela rede pública de saúde bucal, no que tange ao gerenciamento de resíduos de saúde, apresentou falhas.

OBJECTIVE: was to investigate the process of waste management of dental public health service in eleven counties. MATERIAL AND METHOD: one researcher conducted the visits, and observations were recorded on a previously elaborated and tested. RESULT: We visited 50 health units, and none presented a copy of the waste management plan. Of the total 62% of businesses held the correct segregation of waste at the time of his generation. The presence of containers suitable for each type of waste generated at the dental office was observed in 74% and of those, 94% had adequate capacity for the type of waste generated. The identification of the type of waste in plastic containers and annotations identifying the establishment from which the waste was found in 8% and 6% respectively. Only 21% of establishments had appropriate locations, according to the current regulations for the storage of waste until collection was done outside. CONCLUSION: It was found in this study that the routine adopted by public oral health, regarding the management of healthcare waste had flaws.

INTRODUCTION. The surgical myocardial revascularization with beating heart and without extracorporeal circulation (ECC) is a potential strategy to decrease the mortality and the morbidity in patients presenting with ischemic heart disease. The objective of present research was to describe the results of surgical myocardial revascularization with beating heart, with or without ECC. METHODS. A prospective, longitudinal and descriptive study was conducted of cases series type where the sample included 159 patients underwent beating heart myocardial revascularization (143 without ECC and 16 with EEC) en the "Hermanos Ameijeiras" Clinical Surgical Hospital in 2007. RESULTS. The mean age of the 159 patients operated on was of 63,9 years. There was predominance of male sex (74,2%), white race (81,1%), chronic and stable exertion angina (86,8%), dyslipidemia (84,3%), high blood pressure (81,2%), use of two or more anti-ischemia drugs (83,0%), III functional class (64,2%), sinus cardiac rhythm (98,1%), trunk lesion associated to multi-vessel disease (54,1%) and sternotomy approach (93,1%). There were statistically significant differences in favor of the patients without ECC as regards the complete revascularization (p = 0,006), inotropic drugs (p = 0,000), haemoderivatives (p = 0,022), surgical time (p = 0,000) and anesthetics (p = 0,000), use of contrapulsation balloon (p = 0,001), medium extubation (p = 0,003) and intensive care unit stay (p = 0,011). The overall mortality was of 5,0%, more significant when ECC was used (p = 0,001) and similar when both techniques were compared in relation to respiratory sepsis, renal dysfunction, pleural effusion, low cardiac output, postoperative hemorrhage and decompensation of diabetes mellitus. CONCLUSIONS. We conclude that the use of extracorporeal circulation as help in beating heart myocardial revascularization yielded unsatisfactory results.

INTRODUCCIÓN. La revascularización miocárdica quirúrgica con el corazón latiendo y sin el empleo de circulación extracorpórea es una potencial estrategia para la disminución de la mortalidad y morbilidad en los pacientes con cardiopatía isquémica. El objetivo de esta investigación fue describir los resultados de la revascularización miocárdica quirúrgica con corazón latiendo, con circulación extracorpórea (CEC) o sin ella. MÉTODOS. Se realizó un estudio descriptivo, longitudinal y prospectivo, de tipo serie de casos, cuya muestra estuvo conformada por 159 pacientes, a los cuales se les realizó revascularización miocárdica con el corazón latiendo (143 sin CEC y 16 con CEC) en el Hospital «Hermanos Ameijeiras», en el año 2007. RESULTADOS. La media de edad de los 159 pacientes operados fue de 63,9 años. Hubo predominio del sexo masculino (74,2 %), piel blanca (81,1 %), angina de esfuerzo estable crónica (86,8 %), dislipidemia (84,3 %), hipertensión arterial (81,2 %), uso de dos o más fármacos antiisquémicos (83,0 %), clase funcional III (64,2 %), ritmo cardíaco sinusal (98,1 %), lesión de tronco asociado a enfermedad multivaso (54,1 %) y acceso por esternotomía (93,1 %). Se encontraron diferencias estadísticamente significativas en favor de los pacientes en los que no se usó la CEC en cuanto a revascularización completa (p = 0,006), fármacos inotrópicos (p = 0,000), hemoderivados (p = 0,022), tiempo quirúrgico (p = 0,000) y anestésico (p = 0,000), uso de balón de contrapulso (p = 0,001), extubación mediana (p = 0,003) y estadía en la unidad de cuidados intensivos (p = 0,011). La mortalidad global fue del 5,0 %, más significativa cuando se usó la CEC (p = 0,001), e igual ocurrió al comparar ambas técnicas en relación con sepsis respiratoria, disfunción renal, derrame pleural, bajo gasto cardíaco, hemorragia posoperatoria y diabetes mellitas descompensada. CONCLUSIONES. Concluimos que el uso de la circulación extracorpórea como ayuda en la revascularización miocárdica con el corazón latiendo arrojó resultados insatisfactorios.

The favorable evolution of the patients after the implantation of intracoronary stents is shadowed by the presence of major adverse cardiac complications. A study of prognostic factors was conducted to identify predictors of these processes and to calculate the cardiac death-free survival and the major adverse cardiac complications. 189 patients treated with conventional coronary stents were included. The survival rates were estimated by Kaplan Mejer method and compared by Log Rank's test. The mean follow-up was 13 ± 4.5 months. It was found that 41 of the patients presented some adverse event and 29 required new revascularization of the target lesion. A year later, the cardiac death-free survival rates and the combined processes were 96.8 and 77.7 %, respectively. The left ventricular dysfunction and the diameter of the stent over 3 mm were independent predictors of major cardiovascular complications.

La evolución favorable de los pacientes tras la implantación de stents intracoronarios se ensombrece por la presencia de complicaciones cardíacas adversas mayores (ECAM). Se realizó un estudio de factores pronósticos para identificar predictores de estos procesos y estimar la supervivencia libre de muerte cardíaca y ECAM. Se incluyeron 189 pacientes tratados con stents coronarios convencionales. Las tasas de supervivencia fueron estimadas por el método de Kaplan Meier y comparadas mediante el test de Log Rank. El seguimiento medio fue de 13 ± 4,5 meses. Se halló que 41 de los pacientes presentaron algún acontecimiento adverso y 29 requirieron nueva revascularización de la lesión diana. Al año, las tasas de supervivencia libre de muerte cardíaca y procesos combinados resultaron 96,8 y 77,7 %, respectivamente. La disfunción ventricular izquierda y el diámetro del stent menor de 3 mm constituyeron predictores independientes de complicaciones cardiovasculares mayores.