Editorial de la revista número 3 del año 2021

Abstract

Choosing death is an act of self-determination that must be respected and accompanied. Mario Sebastiani, a member of the Ethics Committee of Hospital Italiano de Buenos Aires, reflects on the ethical dilemmas of medically assisted death.

During the period from July to October 2020, 51 students from the University Institute of Hospital Italiano de Buenos Aires participated in the “Volunteer Program for the Epidemiological Management of COVID-19 Cases and Detection of Close Contacts” as a strategy to interrupt the chain of virus transmission. Morena Díaz evaluated the personal experience, training, and coordination of the volunteer program.

Elongation or excessive medial curvature of the styloid process and calcification of the stylohyoid ligament can cause cervicofacial pain or neurological symptoms due to compression of neck vessels or nerves (Eagle syndrome). Resection of the styloid process can be performed via an external approach or through a transoral approach. Ivo Bedini describes the clinical case of a patient with Eagle syndrome who was successfully treated using a transoral approach.

Surgical treatment of posterior epistaxis is usually performed via an endonasal approach. Agustina Lorea describes a case of recurrent epistaxis due to Rendu-Osler-Weber disease in which, because of nasal cavity occlusion (Young’s operation), a paramaxillary transoral endoscopic approach was used to cauterize the internal maxillary artery.

“Post-COVID syndrome” includes fatigue and dyspnea persisting 45 days after infection. Measurement of oxygen consumption during maximal exercise allows the objective assessment, quantification, and interpretation of the origin of dyspnea (cardiovascular, pulmonary, and/or muscular). Leandro Ezequiel Barbagelata reports the experience developed jointly by the Departments of Cardiology and Pulmonology. Approximately one third of patients with post-COVID-19 syndrome showed decreased functional capacity on cardiopulmonary exercise testing.

Acute kidney injury (AKI) in the perioperative period of heart transplantation is a frequent complication. Pulmonary hypertension plays a role in its development. Increased pulmonary vascular resistance in the recipient may prevent the donor’s right ventricle from adapting to the sudden increase in afterload, triggering acute right ventricular failure. Juan C. Bianco comments on a retrospective analysis of the relationship between hemodynamic measurements and the development of AKI in 184 adult patients who underwent heart transplantation between 2009 and 2017 (J Cardiothorac Vasc Anesth). Of these, 29 patients (15.8%) required renal replacement therapy in the postoperative period, with indicators of right ventricular dysfunction being independent predictors of severe post-transplant AKI.

Increasingly, older adults, particularly those who are frail and vulnerable, may require emergency orotracheal intubation (OTI). Although invasive mechanical ventilation (IMV) may allow survival in the acute period, short- and medium-term in-hospital and out-of-hospital mortality is high. Even among survivors, IMV may be prolonged, as may hospital stay, with poor quality of life at discharge. In the absence of a clinical tool to predict poor prognosis in these cases, Vanesa Romina Ruiz, María Florencia Grande Ratti, and collaborators retrospectively analyzed the association between comprehensive geriatric assessment at admission and in-hospital mortality after orotracheal intubation in the Emergency Department between 2016 and 2018 (Enferm Intensiva). More than half of these elderly patients died during hospitalization.

Familial hypercholesterolemia is an autosomal dominant disease that causes premature coronary artery disease. In these patients, conventional cholesterol-lowering treatments are insufficient, as they act by increasing LDL receptors, which are not functional in patients with familial hypercholesterolemia. Gerardo Elikir (René Favaloro University Institute and School of Biomedical Sciences, Universidad Austral) analyzes a new treatment for homozygous familial hypercholesterolemia based on inhibition of angiopoietin-like 3 (ANGPTL3): evinacumab. Inhibition of ANGPTL3 increases the activity of extracellular lipases, enhancing the catabolism of LDL precursors (VLDL and IDL).

Daniel Matusevich, Dalia Szulik, and Aldo Calzolari analyze biographical aspects of Juan Carlos Stagnaro, founder of Vertex Revista Argentina de Psiquiatría, one of the few psychiatry journals published in Spanish included in PubMed. Through analysis of the keywords of his editorials and interviews, the authors explore biographical aspects of the young Stagnaro to understand the genesis of the journal in 1990, its scientific-political imprint, and the editorial lines it addressed.