Resumen Introducción: conocer la seguridad de las drogas actualmente disponibles para el tratamiento de las enfermedades reumáticas es muy importante al momento de tomar decisiones terapéuticas objetivas e individualizadas en la consulta médica diaria. Asimismo, datos de la vida real amplían el conocimiento revelado por los ensayos clínicos. Objetivos: describir los eventos adversos (EA) reportados, estimar su frecuencia e identificar los factores relacionados con su desarrollo. Materiales y métodos: se utilizaron datos BIOBADASAR, un registro voluntario y prospectivo de seguimiento de EA de tratamientos biológicos y sintéticos dirigidos en pacientes con enfermedades reumáticas inmunomediadas. Los pacientes son seguidos hasta la muerte, pérdida de seguimiento o retiro del consentimiento informado. Para este análisis se extrajeron datos recopilados hasta el 31 de enero de 2023. Resultados: se incluyó un total de 6253 pacientes, los cuales aportaron 9533 ciclos de tratamiento, incluyendo 3647 (38,3%) ciclos sin drogas modificadoras de la enfermedad biológicas y sintéticas dirigidas (DME-b/sd) y 5886 (61,7%) con DME-b/sd. Dentro de estos últimos, los más utilizados fueron los inhibidores de TNF y abatacept. Se reportaron 5890 EA en un total de 2701 tratamientos (844 y 1857 sin y con DME-b/sd, respectivamente), con una incidencia de 53,9 eventos cada 1000 pacientes/año (IC 95% 51,9-55,9). La misma fue mayor en los ciclos con DME-b/sd (71,1 eventos cada 1000 pacientes/año, IC 95% 70,7-77,5 versus 33,7, IC 95% 31,5-36,1; p<0,001). Las infecciones, particularmente las de la vía aérea superior, fueron los EA más frecuentes en ambos grupos. El 10,9% fue serio y el 1,1% provocó la muerte del paciente. El 18,7% de los ciclos con DME-b/sd fue discontinuado a causa de un EA significativamente mayor a lo reportado en el otro grupo (11,5%; p<0,001). En el análisis ajustado, las DME-b/sd se asociaron a mayor riesgo de presentar al menos un EA (HR 1,82, IC 95% 1,64-1,96). De igual manera, la mayor edad, el mayor tiempo de evolución, el antecedente de enfermedad pulmonar obstructiva crónica, el diagnóstico de lupus eritematoso sistémico y el uso de corticoides se asociaron a mayor riesgo de EA. Conclusiones: la incidencia de EA fue significativamente superior durante los ciclos de tratamientos que incluían DME-b/sd.

Abstract Introduction: knowing the efficacy and safety of the drugs currently available for the treatment of rheumatic diseases is very important when making objective and individualized therapeutic decisions in daily medical consultation. Likewise, real-life data extends the knowledge revealed by clinical trials. Objectives: to describe the reported adverse events (AEs), estimate their frequency and identify factors associated to them. Materials and methods: BIOBADASAR data were used, which is a voluntary, prospective follow-up registry of AEs of biological and synthetic treatments in patients with immune-mediated rheumatic diseases. Patients are followed until death, loss of followup, or withdrawal of informed consent. To carry out this analysis, the data collected up to January 31, 2023 was extracted. Results: a total of 6253 patients were included, who contributed with 9533 treatment periods, including 3647 (38.3%) periods without b/ts-DMARDs and 5886 (61.7%) with b/ts-DMARDs. Among the latter, the most used were TNF inhibitors and abatacept. A total of 5890 AEs were reported in a total of 2701 treatments (844 and 1857 without and with b/ts-DMARDs, respectively), with an incidence of 53.9 events per 1000 patients/ year (95% CI 51.9-55.9). It was higher during the periods with b/ts-DMARDs (71.1 events per 1000 patients/year, 95% CI 70.7-77.5 vs 33.7, 95% CI 31.5-36.1, p<0.001). Infections, particularly those of the upper respiratory tract, were the most frequent AEs in both groups. 10.9% were severe and 1.1% were associated with the death of the patient. 18.7% of the periods with b/ts-DMARDs were discontinued due to an AE, significantly higher than that reported in the other group (11.5%; p<0.001). In the adjusted analysis, b/ts-DMARDs were associated with a higher risk of presenting at least one AE (HR 1.82, 95% CI 1.64-1.96). Similarly, older age, longer evolution time, history of chronic obstructive pulmonary disease, diagnosis of systemic lupus erythematosus, and use of corticosteroids were associated with a higher risk of AE. Conclusions: the incidence of AEs was significantly higher during those treatment periods that included DME-b/sd.

Resumen: La emergencia sanitaria COVID-19 impactó en los/as trabajadores de salud, dejando en evidencia: el malestar subjetivo y altos índices de ansiedad y depresión. El objetivo del presente trabajo es analizar las experiencias y vivencias de trabajadores/as de la salud durante la pandemia. La misma se realizó a partir del análisis de las respuestas obtenidas en la pregunta abierta del formulario autoadministrado del proyecto Héroes Uruguay. La población objetivo fue el personal de los servicios de salud integrados al Sistema Nacional Integrado de Salud en los tres niveles de atención. Las respuestas fueron agrupadas y categorizadas en base a su frecuencia. La categoría condiciones de trabajo fue la temática más mencionada, seguida de organización del trabajo y vivencias. Realizamos otra categorización sobre los sentidos subjetivos durante la pandemia, nueve categorías son las frecuentes, siendo el 86% de los sentidos subjetivos: ansiedad y estrés, miedo, cansancio, no apoyo social y sobrecarga son los más mencionados. Los resultados muestran que la mayoría de las respuestas remite a las condiciones y a la organización del trabajo, se trata de dimensiones claves en la salud del trabajador, en su entorno, y en los procesos de asistencia al paciente y su familia. Este estudio nos permite afirmar la importancia a nivel organizacional y de políticas de salud, de generar entornos laborales seguros y saludables. La emergencia sanitaria generada por el COVID 19, expuso y agudizó la tensión de los sistemas sanitarios y su impacto en la salud y bienestar del personal.

Summary: The COVID-19 health emergency impacted health workers, revealing: subjective discomfort and high rates of anxiety and depression. The objective of this work is to analyze the experiences of health workers during the pandemic. It was carried out from the analysis of the answers obtained in the open question of the self-administered form of the Héroes Uruguay project. The target population was the staff of the health services integrated into the National Integrated Health System at the three levels of care. The responses were grouped and categorized based on recurring themes. The working conditions category was the most mentioned theme, followed by work organization and experiences. We carry out another categorization of the subjective senses during the pandemic, nine categories are the most frequent, with 86% of the subjective senses: anxiety and stress, fear, tiredness, lack of social support and overload are the most mentioned. The results show that most of the answers refer to the conditions and organization of work, these are key dimensions in the worker's health, in his environment, and in the patient assisted and his family. This study allows us to affirm the importance at the organizational and health policy level of generating safe and healthy work environments. The health emergency generated by COVID 19 exposed and exacerbated the tension in health systems and its impact on the health and well-being of personnel.

Resumo: A emergência sanitária da COVID-19 impactou os trabalhadores da saúde, revelando: desconforto subjetivo e altos índices de ansiedade e depressão. O objetivo deste trabalho é analisar as vivências dos trabalhadores da saúde durante a pandemia. Foi realizada a partir da análise das respostas obtidas na questão aberta do formulário autoaplicável do projeto Héroes Uruguai. A população alvo foram os trabalhadores dos serviços de saúde integrados no Sistema Único de Saúde Integrado nos três níveis de cuidados. As respostas foram agrupadas e categorizadas com base em temas recorrentes. A categoria condições de trabalho foi o tema mais citado, seguido de organização do trabalho e experiências. Realizamos outra categorização dos sentidos subjetivos durante a pandemia, nove categorias são as mais frequentes, com 86% dos sentidos subjetivos: ansiedade e estresse, medo, cansaço, falta de apoio social e sobrecarga são os mais citados. Os resultados mostram que a maioria das respostas se refere às condições e organização do trabalho, dimensões fundamentais na saúde do trabalhador, em seu ambiente, e no paciente assistido e sua família. Este estudo permite afirmar a importância a nível organizacional e da política de saúde de gerar ambientes de trabalho seguros e saudáveis. A emergência de saúde gerada pelo COVID 19 expôs e exacerbou a tensão nos sistemas de saúde e seu impacto na saúde e bem-estar do pessoal.

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Summary: The new Coronavirus SARS CoV-2 pandemic was declared at the beginning of March 2020 when the Uruguayan government appointed the National Contingency Plan for the COVID-19 disease caused by this virus. This plan included non-pharmacological preventive measures such as: hand hygiene, physical distancing, use of different types of masks according to the risk of who should wear them, in some periods, restrictions to mobility, educational activities or public shows, and movement by land, air or sea. Responsible freedom was strongly called for. In December 2020, the Vaccination Strategy was included as a primary prevention mechanism. On 3/1/2021, the COVID-19 2021 Vaccination Campaign began, it was non-mandatory, population-based, initially for people over 19 years of age, and for adolescents between 12 and 17 years of age and pregnant women since June. The National Honorary Scientific Advisory Group (GACH) together with the National Vaccine Advisory Committee (CNAV) of the Ministry of Public Health (MSP) that has vast experience in advising health authorities in scientific decisions on the introduction of vaccines, and an ad-Hoc Commission created for COVID-19 vaccines, brought together experts to advise on the vaccination strategy. The Honorary Commission for the Fight Against Tuberculosis and Prevalent Diseases (CHLA-EP), as the operational branch of the MSP’s Department of Immunizations, has participated with all stakeholders since December to implement the COVID-19 Population Vaccination Campaign without neglecting their tasks regarding the vaccination to prevent other infectious diseases. Methodology: a descriptive, retrospective study was carried out regarding the strategies implemented by the Immunization Operational Department (operational branch of the Ministry of Health’s Immunization Department), A. Calmette Laboratory, Honorary Commission, General Coordination and Administrative Departments between November, 2020 and July 2021. Data source: reports were issued or provided specially for this work by the Immunization Operational Department, A. Calmette Laboratory, by the Ministry of Public Health’s immunization Department, Human Resources, Material Resources, Support, Communication and Design Service, Peripheral Centers, Executive Board and General secretariat. Results: the results of the 4 periods are as follows: 1- Planning (Period November - December 2020), 2- Training, hiring of human resources and advice for the acquisition of qualitative and quantitative material resources (January - February 2021), 3- Opening of COVID-19 vaccination centers (Hubs), posts and launch of the COVID-19 Campaign (March 2021), 4- Overlap of the 2021 flu campaign (April-June) and maintenance of vaccine coverage (National Immunization Programme - PNI). 1- Planning: The characteristics of the different vaccines (dead virus vaccines, vector vaccines and in particular mRNA vaccines, with storage requirements of -70ºC, transfer and distribution requirements of -25ºC, and reconstitution and use of +2 + 8ºC) were taken into account in the different scenarios. Risk and costs analysis were performed. We interchanged data with different companies that provided this service, we participated in training activities with some of them, mainly in the design of a solid cold chain without failures (e.g. a Vac-Q-tec training activity). The transfer of vaccines to hubs, tertiary vaccination centers or peripheral vaccination centers was designed. The different destination site of the vaccines, the different possible scenarios were taken into account, both at local central level (Montevideo - Carrasco International Airport), but also at National level using the different air terminals. Similarly, strategies for the distribution of vaccines by land were planned involving different public or private actors based on the institutions’ experience, both regarding the vaccination campaign and in the PNI maintenance. We made a supply acquisition plan for the vaccine’s storage and distribution, for the vaccination itself, and for the purchase of supplies jointly with the Procurement Department of the Ministry of Economy and Executive Secretariat of the MSP. Six-people vaccination teams were created with clear roles and with the slogan of rapid, universal, free and safe vaccination for all. 2- Training: Courses and materials were organized for the staff to acquire updated knowledge about SARS CoV 2 and COVID-19, transmission mechanisms, use and planning of use of personal protective equipment (PPE) and of course, a detailed monitoring of the vaccines being developed. We carried out a thorough analysis of the vaccine companies to arrive in Uruguay, we focused on 3 of them (Pfizer BioNtech, CoronaVac, Oxford AZ). Training was carried out by roles (vaccinators, preppers, administrators, position referents, backups). Special emphasis was placed on the training of the care of the person to be vaccinated, registration of the vaccination act, end-to-end cold chain, disposal of used materials and filing out inspection forms. All the contents and materials were available on the Institution’s webpage. Human resources: human resources were allocated for the creation, signature and registration of the paperwork for 1,463 new contracts for teams across the country. These resources were allocated not only to vaccination itself, but also to actively participate in each of the vaccination posts. This meant that the work was multiplied by 6 for the tasks required during this period. The Department of Material Resources, went from packaging and distributing from 7 to 15 packages a month to 80 packages a month for each Peripheral/Vaccination Center. Material shipment quadrupled at the beginning of the campaign and it eventually grew by five and sixfold. Some of the key figures to highlight are: 3, 300,000 needle syringes, 8,800 liters of Eucalyptus Alcohol, 852,000 latex and nitrile gloves and 141,000 isolation gowns. 3. COVID-19 Vaccination Hubs, Posts and Campaigns. We gradually opened maximum response mass vaccination Hubs in Montevideo (8), Canelones (1) and Maldonado (1). Since it was had been decided to vaccinate 3 to 5 people every 15 minutes, the primary results at the Hospital de Clínicas Hub were 211,153 doses administered in 32 vaccination posts, and at Antel Arena Hub 615,637 doses were administered in its 15 vaccination posts. As of July 31, there were 144 COVID 19 vaccination posts throughout the national territory. The distribution was made nationwide: 3,229,320 Sinovac vaccine doses, 97,790 Oxford-Astra Zeneca vaccine doses, and 1,585,452 Pfizer-BioNtech vaccine doses. We devised 60 teams including a referent (identification, registration, control), a trainer, 2 vaccinators and vaccination driver for Homes for the Elderly at ELEPEM and people needing special care. They actively participated in the vaccination at ELEPEM, Shelters and Schools for Children with Special Needs and visited a total of 1679 Institutions and overall, 35,006 people were vaccinated. 4- Overlap of the 2021 flu campaign (April-June) and the maintenance of the COVID vaccine coverage (National Immunization Programme - PNI). Since 04/24/2021, the Anti-Flu Campaign began, and it overlapped the COVID-19 campaign described above, which meant reinforcing strategies and expanding actions to be able to carry out both campaigns simultaneously, always with the objective of maintaining the National Immunization Program. Vaccination was carried out at the ELEPEM, as it is performed annually by the commission and vaccination of COVID-19, influenza and PNI was performed on the territory. According to the data received on July 17 in the Ministry of Public Health Immunization Unit Report (week 12), there were 605,802 registered doses, of which at least 87,802 had been administered by the Institution. This difference regarding previous campaigns could have been caused by the intense work carried out during the COVID19 Vaccination Campaign. Within the framework of the inter-institutional activity “Barrio a Barrio” (Vaccination in all Neighborhoods), 7,225 people were vaccinated with the influenza vaccine at the CHLA-EP mobile vaccination bus in Montevideo. The CHLA-EP has contributed with logistics and vaccination with a 2-dose schedule for the 3 platforms and a booster dose for those who received virus vaccines. The CHLA-EP has contributed to achieving the target of the COVID-19 Vaccination Campaign between 1/3 and 8/29/21: 5,487,181 doses were applied, 2,065,269 people received 1 dose of vaccine and 2,496,290 of them received 2 doses and 333,662 have received booster doses. Conclusion: the planning, training, provision of human and material resources has enabled us to successfully carry out two historical simultaneous vaccination campaigns in hubs, vaccination centers, ELEPEM and all along the territory.

Resumo: A pandemia causada pela infecção pelo novo Coronavírus SARS CoV-2 determinou que no Uruguai no início de março de 2020 o governo elaborasse o Plano Nacional de Contingência para a doença COVID-19 causada por este vírus. Este plano incluía medidas preventivas não farmacológicas como: higiene das mãos, distanciamento físico, uso de diferentes tipos de máscaras dependendo do risco de quem as deve usar, em alguns períodos várias restrições à circulação de pessoas, atividades educativas ou espetáculos públicos e a trânsito por terra, ar ou mar). Foi feito um forte apelo à liberdade responsável. A partir de dezembro de 2020, decidiu-se incorporar uma Estratégia de Vacinação à prevenção primária. Em 01/03/2021 teve início a Campanha de Vacinação COVID-19 2021, não obrigatória, de base populacional, inicialmente para maiores de 18 anos e a partir de junho contempla adolescentes entre 12 e 17 anos e gestantes. O Grupo Honorário de Assessoramento Científico do Governo Nacional juntamente com a Comissão Nacional de Assessoramento de Vacinas (CNAV) do Ministério da Saúde Pública (MSP), que assessora autoridades de saúde em decisões científicas sobre a introdução de vacinas, e uma Comissão ad hoc criada para vacinas contra a COVID-19 reuniu especialistas do país para aconselhar sobre a estratégia de vacinação. A Comissão Honorária de Luta contra a Tuberculose e Doenças Prevalentes (CHLA-EP) como braço operacional do Departamento de Vacinação do MSP envolveu-se desde dezembro com todos os intervenientes na implementação da Campanha de Vacinação da População COVID-19, aliás de realizar as tarefas de vacinação para prevenir outras doenças infecciosas. Metodologia: foi realizado um estudo descritivo e retrospectivo das estratégias implementadas pelo Departamento Operacional de Imunizações (braço operacional do Departamento de Imunizações do MSP), Laboratório A. Calmette, Comissão Honorária, Coordenação Geral e departamentos administrativos: entre os meses de novembro de 2020 a julho de 2021. Fonte de dados: relatórios divulgados ou oferecidos especialmente para este trabalho pelo Departamento Operacional de Imunizações, Laboratório A. Calmette, Departamento de Imunizações do Ministério da Saúde Pública, Recursos Humanos, Recursos Materiais, Serviço de Apoio, Comunicação e Design, Centros Periféricos, Direção Executiva e Secretaria Geral. Resultados: são apresentados os resultados de 4 períodos: 1- Planejamento (novembro - dezembro de 2020), 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade (janeiro - fevereiro de 2021), 3- Abertura de centros (Hubs), postos de vacinação COVID-19 e implementação da Campanha COVID-19 (março 2021), 4- Sobreposição da campanha da gripe 2021 (abril-junho 2021) e manutenção da cobertura vacinal (PNI) 1- Planejamento: As características das vacinas a receber eram vacinas de vírus mortos, vacinas vetoriais e em particular mRNA com requisitos de armazenamento de temperaturas de -70ºC, transferência e distribuição de -25ºC, e reconstituição e uso de +2 +8ºC nos diferentes cenários. Análise de risco e análise de custo foram realizadas. Realizaram-se intercâmbios com diferentes empresas que prestam este serviço, participando em ações de formação com algumas delas, essenciais na criação de uma cadeia de frio sólida e sem falhas (ex. ação de formação com Vac-Q-tec). Foi projetada a transferência de vacinas para os hubs, centros de vacinação terciários ou periféricos. Tendo em conta o local de chegada das vacinas, foram considerados os diferentes cenários possíveis, não só a nível central (Montevidéu - Aeroporto Internacional de Carrasco), mas também a nível nacional utilizando os diferentes terminais aéreas. Da mesma forma, foram planejadas estratégias de distribuição de vacinas por via terrestre envolvendo diferentes atores (públicos ou privados), com base na experiência da instituição, tanto na campanha de vacinação quanto na manutenção do PNI. A previsão de compra de insumos foi feita tanto para o armazenamento e distribuição da vacina, quanto para a própria vacinação, como também na tomada de decisão na compra de insumos, atuando em conjunto com o Departamento de Compras do Ministério da Economia e Gestão Secretário do MSP. Eles participaram da formação de equipes de 6 pessoas com funções especificas de vacinação com o slogan de vacinação rápida, universal, gratuita e segura. 2- Capacitação, contratação de recursos humanos e assessoria para aquisição de recursos materiais em qualidade e quantidade. Foram organizados cursos e materiais para que os funcionários adquirissem conhecimento atualizado sobre SARS CoV2 e COVID-19, mecanismos de transmissão, uso e planejamento de uso de equipamentos de proteção individual (EPI) e também para o acompanhamento minucioso das vacinas em desenvolvimento. Fizemos a análise minuciosa das possíveis vacinas candidatas para chegar ao Uruguai, e focamos em 3 delas (Pfizer BioNtech, CoronaVac, Oxford AZ). O treinamento foi realizado por funções (vacinadores, treinadores, administradores, posição de referência, backup). Foi dado especial destaque à formação no cuidado da pessoa a vacinar, registo do ato vacinal, rede de frio em todos os seus pontos, eliminação de materiais utilizados e preenchimento de fichas de controlo. Todos os conteúdos e materiais foram disponibilizados na página web da Instituição. Recursos humanos: funcionários foram alocados para a preparação, assinatura e registro de 1.463 novos contratos para complementar as equipes em todo o país, estes recursos humanos estiveram dedicados não apenas à vacinação em si, mas a participar ativamente de cada um dos postos de vacinação. Isso significou que o trabalho se multiplicou por 6 para as tarefas exigidas durante esse período. O Departamento de Recursos Materiais, passou de embalar e distribuir de 7 para 15 embalagens por mês, passando para 80 embalagens para cada Periférico/Centro de Vacinação. A remessa habitual de materiais se quadruplicou e no início da campanha aumentou cinco e seis vezes. Alguns dos números a destacar são: 3.300.000 seringas com agulha, 8.800 litros de álcool de eucalipto, 852.000 luvas de látex e nitrílica e 141.000 túnicas. 3. Abertura de centros e postos de vacinação COVID-19 e lançamento da Campanha COVID-19. Isso gerou progressivamente o estabelecimento de centros de resposta máxima (Hubs) (vacinação em massa) 8 em Montevidéu, um em Canelones e um em Maldonado. Já que decidiu-se vacinar de 3 a 5 pessoas a cada 15 minutos, no Hub. O Hospital de Clínicas administrou 211.153 doses em seus 32 postos de vacinação e na Arena Hub Antel foram administradas 615.637 doses em seus 15 postos de vacinação. Até 31 de julho, havia 144 postos de vacinação contra a COVID 19 habilitados em todo o território nacional. A distribuição foi realizada, 3.229 foram distribuídos em todo o país, 320 doses de vacina Sinovac, 97.790 doses de vacinas AstraZeneca e 1.585452 de vacina Pfizer. Participaram no treinamento de 60 equipes de referência (identificação, registo, controle), treinador, 2 vacinadores e motorista para vacinação em estabelecimentos de longa permanência para idosos (ELEPEM) e pessoas com situações especiais em albergues e escolas especiais, visitando um total de 1.679 Instituições e vacinando a 35.006 pessoas. 4- Sobreposição da campanha de gripe de 2021 (abril a junho de 2021) e manutenção da cobertura vacinal (PNI). A partir de 24/04/2021 teve início a Campanha da Gripe 2021, sobrepondo-se à campanha COVID-19 descrita, o que implicou o reforço de estratégias e ampliação das ações para poder cumprir ambas campanhas em paralelo, sempre com o objetivo de não descurar o Programa Nacional de Imunizações. Foi realizada a vacinação no ELEPEM, conforme anualmente realizada pela comissão e a vacinação no território das vacinas COVID-19, influenza e PNI. De acordo com os dados recebidos até 17 de julho no relatório da Unidade de Imunizações dos Ministérios da Saúde Pública (semana 12), foram registradas 605.802 doses, das quais pelo menos 87.802 doses foram administradas pela Instituição. Essa diferença em relação às campanhas anteriores pode ser atribuída ao intenso trabalho realizado na estratégia de Vacinação COVID19. No âmbito da atividade interinstitucional Bairro a Bairro, 7.225 pessoas foram vacinadas com a vacina contra gripe no celular do CHLAEP de Montevidéu. O CHLA-EP tem contribuído desde a logística e vacinação com um esquema de 2 doses para as 3 plataformas e uma dose de reforço para quem recebeu vacinas de vírus mortos. O CHLA-EP contribuiu para atingir os números da Campanha de Vacinação COVID-19 entre 1/3 e 29/8/21: 5.487.181 doses aplicadas, 2.065.269 pessoas que receberam 1 dose de vacina e delas 2.496.290 têm 2 doses e 333.662 receberam doses de reforço. Conclusões: O planejamento, capacitação, disponibilização de recursos humanos e materiais permitiram a realização de duas campanhas de vacinação coexistentes nos hubs, vacinatórios, ELEPEM e no território, o que pode ser considerado um processo bem sucedido e histórico.

Resumen La pancreatitis post-CPRE (PPC) es la complicación más frecuente de la colangiopancreatografía endoscópica (CPRE), la cual ocurre en el 8 al 15% de los casos; el diagnóstico se establece con la presencia de dolor dentro de las siguientes 24 horas posterior al procedimiento acompañado de elevación de las enzimas pancreáticas (> 3 veces el valor normal). Se han identificado factores de riesgo del paciente (sexo femenino, edad < 60 años, episodios previos de PPC, sospecha de disfunción de esfínter de Oddi) y factores de riesgo asociados al procedimiento (canulación difícil, manometría del esfínter de Oddi, ampulectomía, opacificación y/o canulación del conducto pancreático, mayor número de intentos de canulación de la papila de Vater, esfinteroplastia hidroneumática). También se han investigado varias medidas profilácticas; sin embargo, las que han mostrado eficacia en la profilaxis para PPC se dividen en farmacológicas (antiinflamatorios no esteroideos por vía rectal) y no farmacológicas (precorte temprano, prótesis pancreática, hidratación endovenosa agresiva). Es importante identificar los factores de riesgo y llevar a cabo las medidas profilácticas necesarias para disminuir la incidencia de PPC.

Abstract Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is the most common and serious complication of ERCP, its incidence varies from 8-15%; diagnosis is established with abdominal pain and elevated pancreatic enzymes (> 3 times upper limit value) the next 24 hours posterior to ERCP. There are some risk factors associated to patient (female gender, young age, previous post-ERCP pancreatitis, suspected of Oddi dysfunction) and risk factors related to procedure (difficult bile duct cannulation, ampullectomy, main pancreatic duct opacification, multiple attempts of cannulation, sphincteroplasty). Methods proven to reduce post-ERCP pancreatitis are pharmacological (rectal non-steroidal anti-inflammatory drugs) and non-pharmacological (Ringer lactate hyperhydration, early precut, pancreatic stent). It is very important to evaluate risk factors in order to apply necessary measures to reduce the incidence.

ABSTRACT Introduction: Chronic kidney disease is one of the great challenges for health professionals; it constitutes a health problem that generates functional disability, decreased quality of life and high costs to health systems. Objective: To determine the level of knowledge about chronic kidney disease in patients treated at the Riobamba Provincial General Teaching Hospital, their families and the nursing staff. Methodology: A basic, non-experimental, descriptive, cross-sectional research with a mixed approach was developed. The universe consisted of 96 patients with a diagnosis of chronic kidney disease and the sample was made up of a total of 78 patients. Likewise, 78 family members and 40 nursing professionals who care for patients with this disease were investigated. Questionnaires were applied to identify clinical characteristics and level of knowledge about the management of the disease in the people participating in the study. Results: There is a high percentage of patients with chronic kidney disease less than 40 years old (15.38%). All the family members and the nursing staff have not received training courses on disease management. Conclusions: There is a medium level of knowledge in the nursing staff and low in the patients and their families in relation to the management of patients with chronic kidney disease. Training activities aimed at each of the groups of people included in the study need to be carried out.

RESUMEN Introducción: La enfermedad renal crónica es uno de los grandes retos para los profesionales de la salud; constituye un problema que causa discapacidad funcional, disminución de la calidad de vida y elevados costos a los sistemas sanitarios. Objetivo: Determinar el nivel de conocimiento sobre la enfermedad renal crónica de los pacientes atendidos en el Hospital Provincial General Docente de Riobamba, sus familiares y el personal de enfermería. Métodos: Investigación básica, no experimental, descriptiva, de corte transversal y con enfoque mixto. El universo estuvo constituido por 96 pacientes con diagnóstico de enfermedad renal crónica y la muestra quedó conformada por un total de 78 pacientes. Igualmente se investigaron 78 familiares y 40 profesionales de enfermería que atienden pacientes con esta enfermedad. Se aplicaron cuestionarios para identificar características clínicas y nivel de conocimiento sobre el manejo de la enfermedad en las personas participantes en el estudio. Resultados: Existe un porciento elevado de pacientes con enfermedad renal crónica inferior a 40 años (15,38 %). La totalidad de los familiares y del personal de enfermería no han recibido cursos de capacitación sobre el manejo de la enfermedad. Conclusiones: Existe un nivel de conocimiento medio en el personal de enfermería y bajo en los pacientes y sus familiares en relación con el manejo de pacientes con enfermedad renal crónica. Se necesita realizar actividades de capacitación orientadas a cada uno de los grupos de personas incluidas en el estudio.

Introduction: rheumatoid arthritis (RA) and its treatments can affect the response to the SARS-CoV-2 vaccine. However, we still do not have local data. Objectives: to evaluate the humoral response of the SARS-CoV-2 vaccine and its safety in this population. Materials and methods: observational study. Patients ≥18 years of age, with RA ACR/EULAR 2010 who had received vaccination for SARS-CoV-2 were included. Detection of anti-protein S IgG (COVIDAR Kit). Results: a total of 120 patients with RA were included. A quarter was receiving glucocorticoids, 50.9% biological drugs and 13.3% JAK inhibitors (janus kinases). Only 6% had a history SARS-CoV-2 infection. The most used vaccine was Sputnik V (52.9%) and 25% received mixed regimenes. After the first dose, 59% had a non-reactive or indeterminate test, and after the second, 18% were still having this result. The application of homologous Sinopharm vaccine regimen (63.6% vs 13.3%, p<0.0001) and the use of abatacept (27.3% vs 5.1%, p=0.005) and rituximab (18.2% vs 0%, p=0.001) at vaccination was associated with a non-reactive or indeterminate result. Conclusions: similar to other international populations, in this cohort, two out of 10 patients did not develop antibodies. A lower response was associated with the Sinopharm vaccine and treatment with abatacept and rituximab.

Introducción: la artritis reumatoidea (AR) y los tratamientos indicados para su manejo pueden afectar la respuesta a la vacuna para SARS-CoV-2. Sin embargo, aún no se cuenta con datos locales. Objetivos: evaluar la respuesta humoral de la vacuna para SARS-CoV-2 y su seguridad en esta población. Materiales y métodos: estudio observacional. Se incluyeron pacientes ≥18 años, con AR ACR/EULAR 2010 que recibieron la vacunación para SARS-CoV-2. Detección de IgG anti-proteína S (kit COVIDAR). Resultados: se incluyeron 120 pacientes con AR. El 24,4% recibió tratamiento con glucocorticoides, 50,9% drogas biológicas y 13,3% inhibidores de JAK (janus kinases). El 6% había tenido infección por SARS-CoV-2 previamente. La vacuna más utilizada en la primera dosis fue Sputnik V (52,9%). El 25% recibió esquemas heterólogos. Luego de la primera dosis, el 59% presentó una prueba no reactiva o indeterminada, y un 18% luego de la segunda dosis. La aplicación de esquemas homólogos de vacuna Sinopharm (63,6% vs 13,3%, p<0,0001), y el uso de abatacept (27,3% vs 5,1%, p=0,005) y rituximab (18,2% vs 0%, p=0,001) al momento de la vacunación se asociaron a un resultado no reactivo o indeterminado. Conclusiones: similar a lo reportado en otras poblaciones internacionales, en esta cohorte, dos de cada 10 pacientes no desarrollaron anticuerpos. Una menor respuesta se asoció con la vacuna Sinopharm y al tratamiento con abatacept y rituximab.

Abstract Individuals with malignancies and COVID-19 have a lower survival compared with the general population. However, the information about the impact of COVID-19 on the whole hematological population is scarce. We aimed to describe the 30th day overall survival (OS) after COVID-19 infection in pa tients with a hematological disease in Argentina. A completely anonymous survey from the Argentine Society of Hematology was delivered to all the hematologists in Argentina; it started in April 2020. A cut-off to analyze the data was performed in December 2020 and, finally, 419 patients were reported and suitable for the analysis (average age: 58 years, 90% with malignant diseases). After the COVID-19 diagnosis, the 30-day OS for the whole population was 80.2%. From the entire group (419), 101 (24.1%) individuals required intensive care unit admission, where the 30-day OS was 46.6%. Among allogeneic stem cell transplant recipients, the 30-day OS was 70.3%. Factors associated with a low OS were two or more comorbidities, an active hematological disease and history of chemotherapy. In individuals with the three factors, the 30-day OS was 49.6% while the 30-day OS in those without those factors was 100%. Patients with hematological diseases have a higher mortality than the general population. This group represents a challenge and requires careful decision-making of the treatment in order not to compromise the chances of cure.

Resumen El presente estudio tuvo por objetivo primario conocer la mortalidad de pacientes con enfermedad hematológica que presentaron infección por COVID-19 en Argentina. Para ello se difundió una encuesta desde la Sociedad Argentina de Hematología (SAH) entre los hematológos para informar sobre los pacientes con enfermedades hematológicas y diagnóstico de infección por SARS- CoV-2, entre el 19/4/2020, y el 7/12/2020. Se incluyeron individuos de todas las edades con diagnóstico de enfermedad hematológica benigna o maligna e infección por SARS-CoV-2 confirmada por técnica de RT-PCR. Se analizaron 419 pacientes (mediana 58 años; 90% enfermedades malignas). La supervivencia al día 30 fue de 80.2%. La supervivencia fue menor en aquellos que requirieron internación (74.2%), cuidados intensivos (46.6%) y asistencia respiratoria mecánica (36.8%). Entre los trasplantados alogénicos la supervivencia fue 70.3%. Los factores vinculados a la supervivencia global fueron las comorbilidades, el estado de la enfermedad al momento de la infección y el antecedente de quimioterapia. Se pudo establecer un score en el que aquellos que tuvieron un puntaje de 4 alcanzaron una supervivencia del 49.6% al día 30, mientras que la de los pacientes con score 0 fue del 100% a 30 días. En comparación con la población general, los pacientes con enfermedades hematológicas presentan una mayor mortalidad vinculada al COVID-19, motivo por el cual es primordial definir pautas destinadas a disminuir la exposición de los mismos sin comprometer las posibilidades de beneficiarse del tratamiento de la enfermedad de base.

Abstract Medical attention of patients with a diabetic foot has been disrupted since de COVID-19 pandemic began, because health systems had to provide care to those patients affected by this disease to the detriment of the control of chronic diseases. Several reports show an increase in amputations during the pandemic, primarily due to the lack of health controls in patients suffering from diabetes or diabetic foot. This could have resulted in later consultation and more severe presentations. We describe three medical cases that had recently been affected by COVID-19 and developed a rare and rapidly evolving diabetic foot that required a major amputation. One possible explanation for this atypi cal presentation could be that COVID-19 predisposes patients to vein and arterial thrombosis due to systemic inflammation, platelet activation, endothelial dysfunction and stasis from prolonged immobility. This could have exacerbated chronic ischemia secondary to diabetes in which metabolic disturbances often seen in these patients predispose to atherosclerosis.

Resumen La atención de pacientes con pie diabético se vio afectada luego de la aparición de COVID-19, ya que los sistemas de salud debieron dar prioridad a la atención de dicha enfermedad y se restringió el control de las enfermedades crónicas. Existen algunas comunicaciones sobre el aumento de las amputaciones durante la pandemia, el cual fue atribuido principalmente a la falta de controles de los pacientes con diabetes y pie diabético. Esto pudo haber influido en la consulta tardía y en la aparición de presentaciones más graves. Presentamos los casos de tres pacientes con reciente enfermedad por COVID-19 que desarrollaron una forma atípica de pie diabético grave y rápidamente evolutiva cuyo desenlace fue la amputación mayor. Una posible explicación estaría relacionada a que los pacientes con COVID-19 tienen mayor riesgo de enfermedad trombótica, tanto venosa como arterial, debido a la intensa respuesta inflamatoria, la activación plaquetaria, la disfunción endotelial y la estasis sanguínea por inmovilización, que se asocia a esta enfermedad. Esto podría agravar la isquemia crónica que desarrollan las personas con diabetes, causada por el estado metabólico anormal que favorece la ateroesclerosis de todo el árbol vascular.

Abstract This paper aims to analyze the moral problems of the use of non-human animals in scientific research. To this end, four representative positions are examined within this debate: 1) unrestricted, 2) balanced, 3) moral dilemma, and 4) abolitionist, which arise from compromises made with respect to certain key premises with which one may or may not agree. These premises refer to the importance given by each position to i) the affectation of animal interests, ii) the moral relevance of these interests, iii) the justification by benefits of animal experimentation, and iv) the importance of human interest compared to that of other animals. Each position accepts and rejects a particular pattern of these points, and making these commitments explicit, we can analyze the problems and contradictions that each position has. In the end we find that the first three positions contain important incongruities regarding the difference of treatment they allow between humans and animals subject to experimentation, besides that they must accept in different degrees human exceptionalism and speciesism to explain themselves. While the abolitionist position-despite having more practical difficulties-is more consistent, it protects human and non-human animals from being harmed by these practices.

Resum Aquest article té l'objectiu d'analitzar els problemes morals de l'ús d'animals no humans en recerca científica. Per a això s'examinen quatre postures representatives a l'interior d'aquest debat: 1) irrestricta, 2) equilibrada, 3) dilemàtica i 4) abolicionista, les quals sorgeixen dels compromisos que es prenen respecte a certes premisses clau amb les quals s'està d'acord o no. Aquestes premisses es refereixen a la importància que li dóna cada postura a i) l'afectació d'interessos en animals, ii) la rellevància moral d'aquests interessos, iii) la justificació per beneficis de l'experimentació animal i iv) la importància de l'interès humà comparat amb el dels altres animals. Cada postura accepta i rebutja un patró particular d'aquests punts, i en fer explícits aquests compromisos podem analitzar els problemes i contradiccions que posseeix cadascuna. Al final es troba que les tres primeres postures contenen incongruències importants respecte a la diferència de tractes que permeten entre humans i els animals subjectes a experimentació, a més de que han d'acceptar en diferent grau l'excepcionalisme humà i l'especisme per a explicar-se. Mentre que la postura abolicionista -malgrat tenir més dificultats pràctiques- és més consistent, alhora que protegeix a animals humans i no humans de ser danyats per aquestes pràctiques.

Resumen Este artículo tiene el objetivo de analizar los problemas morales del uso de animales no humanos en investigación científica. Para esto se examinan cuatro posturas representativas al interior de este debate: 1) irrestricta, 2) equilibrada, 3) dilemática y 4) abolicionista, las cuales surgen de los compromisos que se toman respecto a ciertas premisas clave con las cuales se está de acuerdo o no. Dichas premisas se refieren a la importancia que le da cada postura a i) la afectación de intereses en animales, ii) la relevancia moral de estos intereses, iii) la justificación por beneficios de la experimentación animal y iv) la importancia del interés humano comparado con el de los otros animales. Cada postura acepta y rechaza un patrón particular de estos puntos, y al hacer explícitos estos compromisos podemos analizar los problemas y contradicciones que posee cada una. Al final se encuentra que las tres primeras posturas contienen incongruencias importantes respecto a la diferencia de tratos que permiten entre humanos y los animales sujetos a experimentación, además de que deben de aceptar en diferente grado el excepcionalismo humano y el especismo para explicarse. Mientras que la postura abolicionista -pese a tener más dificultades prácticas- es más consistente, a la vez que protege a animales humanos y no humanos de ser dañados por estas prácticas.

RESUMEN La mayoría de los suelos de la Mixteca Alta presentan altos niveles de degradación. Una estrategia para su manejo y conservación es a través de integrar el conocimiento local y el análisis espacial para delimitar zonas aptas para la producción de café. El objetivo fue evaluar la aptitud de las tierras para cultivar café en la Mixteca Alta, del estado de Oaxaca considerando el conocimiento local y sistemas de información geográfica. Se desarrolló un modelo de aptitud de tierras para el cultivo de café con base en el análisis de la altitud, la inclinación de la pendiente y el suelo. Los cafetales no aptos se localizan en las zonas con menor altitud, la cuales también fueron las más cálidas y con la mayor presencia de roya. También la altitud del terreno mayor a 2 200 msnm no es apta para el cultivo del café debido a la presencia de heladas. La inclinación de la pendiente del terreno mayor a 80o no es apta para el cultivo del café. Las tierras muy aptas ocupan solo 258.1 ha; las aptas 2 030.4 ha; las medianamente aptas 3 162.3 ha; marginalmente aptas ocupan 2 558.8 ha; y las no aptas 5 123.9 ha. Las tierras aptas para el cultivo del café tienen suelos profundos con texturas franco-arcillo-arenosas y un espesor de hojarasca promedio de 5 cm. Este trabajo puede servir de referencia para la evaluación de tierras en zonas con escases de información geográfica del medio físico.

ABSTRACT Most of the soils of the Mixteca Alta show high levels of degradation. A strategy for its management and conservation is through integrating local knowledge and spatial analysis to delimit areas suitable for coffee production. The objective was to evaluate the aptitude of the lands to grow coffee in the Mixteca Alta, Oaxaca State, considering local knowledge and geographic information systems. A land suitability model for coffee cultivation was developed based on the analysis of the altitude, the steepness of the slope and the soil. The unsuitable coffee plantations are located in the areas with the lowest altitude, which were also the warmest and with the highest presence of rust. Also, the altitude of the land higher than 2200 meters above sea level is not suitable for growing coffee due to the presence of frost. The slope of the land greater than 80o is not suitable for growing coffee. The very suitable lands occupy only 258.1 ha; the suitable 2 030.4 ha; the moderately suitable 3 162.3 ha; marginally suitable occupy 2 558.8 ha; and the unsuitable 5 123.9 ha. Land suitable for growing coffee have deep soils with loamy-clay-sandy textures and an average leaf thickness of 5 cm. This work can serve as a reference for land evaluation in areas with scarce geographic information on the physical environment.

Abstract Memory complaints are the reason for consultation in many cases of neurological injuries and in the majority of aged people who attend the neurological clinic. The presence of memory complaints is a diagnostic criterion for mild cognitive impairment, for which it is necessary to have an appropriate and specific instrument, which would allow us to quantify and scientifically investigate it. The aim of the present study is to analyze the psychometric properties of an Argentine version of the Prospective and Retrospective Memory Questionnaire: the factorial structure of the test; its internal consistency; correlations of the questionnaire with an objective measurement of retro and prospective memory; and correlations of the questionnaire with affective-emotional variables. The Mexican version of the Prospective and Retrospective Memory Questionnaire was administered individually to 192 healthy participants who achieved more than 27 point in the Mini Mental State Examination. A modification was made to the syntax of two sentences in order to increase the comprehensibility. A Global, Prospective and a Retrospective Index of the questionnaire was calculated for each participant. Anxiety (the State-Trait Anxiety Inventory: STAI) and depression (the Beck’s Depression Inventory-II) scales were also administered. The mean age was 39.67 years (SD = 12.3). The average of schooling was 14.5 years (SD = 2.72). We also selected a subgroup of participants (n = 45) with a mean age of 37.58 years (SD = 11.4), and an average schooling in years of 14.36 (SD = 3). In addition to the memory questionnaire, this subgroup, called the A Subgroup, was administered prospective (El Cóndor test) and retrospective (The Selective Memory Test) objective memory tests. The mean in the Global Index was 32.25 (SD = 8.49), in the Prospective Index it was 17.3 (SD = 5.01) and in the Retrospective Index it was 14.95 (SD = 4.07). The test for normality of the distribution of the Global Index Kolmogorov-Smirnov (K-S) was Z = 1.031, p = .238. In the same way, the other two scores of the questionnaire show a normal curve, K-S of the Prospective Index Z = 1.109, p = .171; K-S of the Retrospective Index Z = 1.264, p = .082. According to the exploratory factor analysis through the Maximum Likelihood extraction method, a single factor explained 35.19 % of the variance. The Cronbach’s α coefficient was .87. The reliability estimated by the split-half method was .73 and .84 after correction with the Spearman-Brown formula. There was a significant positive correlation of mild degree between the Global Questionnaire Index and the STAI Trait, r = .33, p = .013, and with the IDB-II, e = .23, p = .127. There was no significant correlation between the questionnaire responses and the retro and prospective memory objective tests in the A Subgroup. The Prospective and Retrospective Memory Questionnaire presents adequate reliability indexes and a single factor structure. The results indicate that the questionnaire associates with anxiety and depression in a positive way, but not with the objective measures of retro and prospective memory, in coincidence with the literature about the relationship between cognitive complaints and cognitive tests performance. In sum, this study shows that the questionnaire is an appropriate instrument to quantify patient’s memory complaints and particularly for its use in the study region. This study is the first in the country to investigate the psychometric properties of the Prospective and Retrospective Memory Questionnaire, widely used in neuropsychological clinic and research around the world. Efforts should be made to obtain normative data and validation in the pathological population of interest.

Resumen Para poder cuantificar e investigar científicamente las quejas mnésicas de los pacientes, se hace necesario contar con un instrumento adaptado y que presente análisis psicométricos adecuados. El objetivo del presente trabajo fue estudiar propiedades psicométricas de una versión argentina del Cuestionario de Memoria Prospectiva y Retrospectiva. Para ello se administró el Cuestionario de Memoria Prospectiva y Retrospectiva de forma individual a 192 participantes sanos con más de 27 puntos en el Mini Mental State Examination. La media de edad fue de 39.67 años (DE = 12.3). La media de escolaridad fue de 14.5 años (DE = 2.72). A un subgrupo de participantes (n = 45) denominado Subgrupo A, también se les administraron pruebas de memoria prospectiva y retrospectiva. El Índice Global del Cuestionario presentó una distribución normal. Según el análisis factorial exploratorio se estableció la extracción de un factor que explicó el 35.19 % de la varianza. El coeficiente α de Cronbach fue de .87. La confiabilidad estimada por el método de la división por mitades fue de .73 y de .84 luego de la corrección con la fórmula de Spearman-Brown. No hubo correlación significativa entre las respuestas del cuestionario y los test de memoria retro y prospectiva en el subgrupo A. Estos resultados permiten concluir que el Cuestionario de Memoria Prospectiva y Retrospectiva presenta adecuados índices de confiabilidad y una estructura de un solo factor. Si bien no se asocia con el rendimiento objetivo en pruebas de memoria, muestra ser apropiado para el registro de las quejas subjetivas de los pacientes en la región de estudio.

Abstract We present the results of 105 patients with life-threatening hemoptysis who were treated with the systemic arterial and/or pulmonary artery routes. We also describe the procedure techniques and the angiographic findings. We show the usefulness of the flexible fiberoptic bronchoscopy and chest radiography to identify the bleeding zone previous to the procedure. From May 2000 to September 2015, a total of 105 patients were admitted to the Catheterization Laboratory with a diagnosis of life-threatening hemoptysis; 76 were male (72.4%) and mean age was 41 ± 18.65 years. Treatment was successful in 93% (98/105). In 90% (88/98) the approach was via the bronchial arteries and/or non-bronchial systemic arteries, and in 10% (10/98) the approach was via the pulmonary artery. In bilateral affection angiographic images alone could not identify accurately the site of the lung bleeding. Flexible fibrobronchoscopy was performed in 60% (63/98) and located the bleeding area in 84% (56/63). In unilateral affection, chest radiography previous to the procedure located the bleeding area in 47%. No complications or death were related to the procedure. The treatment of life threatening hemoptysis by a percutaneous way has a high percentage of primary success with a very low incidence of complications. Pulmonary arterial route treatment is an alternative approach. Flexible fibrobronchoscopy is an important complement to this entity.

Resumen Se presentan los resultados de 105 pacientes con hemoptisis amenazante tratados mediante embolización arterial por cateterismo percutáneo por vía arterial sistémica y/o arterial pulmonar. Se describe la técnica del procedimiento y los hallazgos angiográficos. Se muestra la utilidad de la fibrobroncoscopía y de la radiografía de tórax para identificar la zona sangrante como diagnóstico previo al procedimiento. Entre mayo 2000 y septiembre 2015 se admitieron en el Servicio de Hemodinamia 105 pacientes con diagnóstico de hemoptisis amenazante, 76 masculinos (72.4%); edad media: 41 (±18.65 DS) años. El 93% (98/105) fue tratado con éxito. En el 90% (88/98) se efectuó embolización por arterias bronquiales y/o no bronquiales sistémicas y en el 10% (10/98) por vía arterial pulmonar. Cuando la afección era bilateral la angiografía sola no posibilitó identificar el sitio de sangrado. Al 60% (63/98) se le hizo fibrobroncoscopía flexible y se pudo ubicar el pulmón sangrante en el 84% (56/63). Cuando la afección era unilateral, la radiografía de tórax previa al procedimiento facilitó la ubicación del área de sangrado en el 47%. No se observaron complicaciones graves ni muertes vinculadas al procedimiento. El tratamiento de la hemoptisis masiva por vía percutánea tiene alto porcentaje de éxito primario con muy baja tasa de complicaciones. El tratamiento por vía arterial pulmonar es un abordaje alternativo. La fibrobroncoscopía flexible es un importante complemento en esta entidad.

Cystic Fibrosis (CF) is the most frequent hereditary disease in whites, with a reserved prognosis. Since 2003, Chile began a comprehensive National Cystic Fibrosis Program, directed by the Respiratory Health Unit of the Ministry of Health. To date, the main results of the Program record a significantly longer survival (average 27 years) and a significant reduction in the age of diagnosis of patients admitted from 2006 onwards. Access to Chilean Explicit Health Guarantees, the implementation of neonatal screening in some regions of the country, the organization and setting up of CF-trained teams of various specialties, has contributed to improving results. Although the main manifestations are of the respiratory and digestive system, the multisystemic nature of CF makes it necessary to know the different aspects involved in its management, in order to optimize the results of the treatment and the resources invested, both in the public and private sectors. This document is a review and an update on the main aspects of the diagnosis, monitoring and treatment of the respiratory and non-respiratory manifestations of CF.

Resumen La Fibrosis Quística (FQ) es la enfermedad hereditaria de pronóstico reservado más frecuente en raza blanca. Desde el año 2003, Chile inicia un Programa Nacional de Fibrosis Quística, de carácter integral, dirigido por la Unidad de Salud Respiratoria del Ministerio de Salud. Hasta la fecha, los principales resultados del Programa registran una significativa mayor sobrevida (promedio 27 años) y una significativa reducción en la edad de diagnóstico de los pacientes ingresados desde 2006 en adelante. El acceso a la canasta GES (Garantías Explícitas en Salud), la implementación del tamizaje neonatal en algunas regiones del país, la organización y la constitución de equipos entrenados en FQ de diversas especialidades, ha contribuido a mejorar los resultados. Si bien las principales manifestaciones son del aparato respiratorio y digestivo, el carácter multisistémico de la FQ obliga a conocer los distintos aspectos involucrados en su manejo, a fin de optimizar los resultados del tratamiento y los recursos invertidos, tanto en el sector público como privado. Este documento es una revisión y actualización sobre los principales aspectos del diagnóstico, seguimiento y tratamiento de las manifestaciones respiratorias y no respiratorias de la FQ.

Abstract This article uses cross-sectional data to analyze whether coffee producers in the municipality of Santa María Yucuhiti, Oaxaca -whose farmland is characterized by heterogeneous biophysical and socioeconomic conditions- have greater possibilities of accessing credit and improved productive management practices in an organic production context. Better access allows them to raise their prices, increase their production, and reduce the presence of diseases by belonging to an organization affiliated with a consolidated organization. The results indicate that producers belonging to these organizations have increased their production capabilities, as well as their income. However, it was also found that there are various socioeconomic and biophysical conditions that may well prevent such possibilities from materializing.

Resumen Este artículo analiza con datos de corte transversal, si productores de café con tierras de cultivo en condiciones biofísicas heterogéneas y características socioeconómicas distintas, en el municipio de Santa María Yucuhiti, Oaxaca, tienen mayores posibilidades de acceder a crédito y a mejores prácticas de manejo productivo en un contexto de producción orgánica que les permita obtener precios más altos, incrementar su producción y reducir la presencia de enfermedades, al pertenecer a una organización afiliada a una organización consolidada. Los resultados indican que los productores pertenecientes a dichas organizaciones han incrementado sus posibilidades productivas, así como de sus ingresos. Sin embargo, también se encontró que existen diferentes condiciones socioeconómicas y biofísicas que bien pueden impedir que estas posibilidades se concreten.

Abstract The intraductal papillary mucinous neoplasm of the pancreas is a pancreatic tumor with high malignant potential. It usually presents with nonspecific symptoms, being frequently found as an incidental finding, however, in rare occasions it can present as a biliary tract obstruction. We present a case of a male patient with clinical features of cholangitis, with intraductal papillary mucinous neoplasia of the pancreas as cause of the biliary obstruction.

Resumen La neoplasia papilar mucinosa intraductal de páncreas es una tumoración pancreática de elevado potencial maligno. Suele presentarse como síntomas inespecíficos y comúnmente es un hallazgo incidental, sin embargo, en raras ocasiones puede presentarse como un cuadro de vías biliares. Se presenta el caso de un paciente de sexo masculino que acudió a atención por cuadro de colangitis, detectándose como causa obstrucción de vías biliares por tumoración papilar mucinosa de páncreas.