Resumen Los trastornos de salud mental tienen impacto significativo sobre la calidad de vida de las personas, y la pandemia del COVID-19 incrementó estos problemas. El objetivo de este estudio ha sido analizar los factores de mayor riesgo asociados a la sintomatología de trastornos de salud mental en estudiantes de las universidades públicas y privadas como impacto del COVID-19. Es un estudio cuantitativo de diseño no experimental y corte transversal. Se administró el DASS- 21 a una muestra de 833 estudiantes de universidades de Paraguay, con una media de edad de 22,7 años. Para el análisis de datos se realizó una regresión logística ordinal. Los resultados hallados ponen de manifiesto que los factores de mayor riesgo asociados a depresión, ansiedad y/o estrés son: disponer de antecedentes familiares, ser estudiantes de Medicina, ser mujer y de rango etario más joven. A partir de estos hallazgos se considera necesaria la promoción de la salud mental y una intervención temprana de las personas universitarias, mediante el acompañamiento psicológico y/o psiquiátrico, en específico, en las estudiantes mujeres y estudiantes del grado de medicina.

Abstract Mental health disorders have a significant impact on the quality of life of individuals, and the COVID-19 pandemic increased these problems. The aim of this study was to analyze the factors of greater risk associated with the symptomatology of mental health disorders in students of public and private universities as an impact of COVID-19. It is a quantitative study of non-experimental and cross- sectional design. The DASS-21 was administered to a sample of 833 students from universities in Paraguay, with a mean age of 22.7 years. An ordinal logistic regression was used for data analysis. The results showed that the risk factors associated with depression, anxiety and/or stress were: having a family history, being a medical student, being a woman and being younger. Based on these findings, it is considered necessary to promote mental health and early intervention of university students, through psychological and/or psychiatric support, specifically in female students and medical students.

ABSTRACT Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical “dyssynchronopathy” with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chronic effect of abnormal impulse conduction and nonphysiological ectopic activation by artificial cardiac pacing is suspected to affect metabolism and myocardial perfusion, triggering regional differences in the activation/contraction processes that cause electrical and structural remodeling due to damage, inflammation, and fibrosis of the cardiac tissue. The effect of artificial cardiac pacing on ventricular function and structure can be multifactorial, and biological factors underlying PiCM could affect the time and probability of developing the condition. PiCM has not been included in the traditional classification of cardiomyopathies, which can hinder detection. This article reviews the available evidence for pacing-induced cardiovascular disease, the current understanding of its pathophysiology, and reinforces the adverse effects of right ventricular pacing, especially right ventricular pacing burden (commonly measured in percentage) and its repercussion on ventricular contraction (reflected by the impact on left ventricular systolic function). These effects might be the main defining criteria and determining mechanisms of the pathophysiology and the clinical repercussion seen on patients.

Resumo Fundamento A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). Objetivos Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. Métodos Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). Resultados De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). Conclusão A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.

Abstract Background Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing). Objectives To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP). Methods The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%. The resulting cardiac synchronization was compared using an electrocardiographic algorithm that analyzed QRS variation and the technical characteristics of non-selective Hisian pacing (DDD-His) and para-Hisian pacing (DDD-Var). Results Of 51 total patients (men: 28), 66.7% (34) were allocated to the DDD-Var group and 33.3% (17) to the DDD-His group. The mean ages in each group were 74 and 79 years, respectively. In the DDD-Var group, QRS variation (ventricular synchrony) improved after implantation (p < 0.001). In post-implantation ECG, 91.2% of the DDD-Var group presented a physiological pacing pattern, which was similar to the DDD-His group (88.2%; p = 0.999). The paced QRS axis was also similar (physiological) for both groups. Intraoperative fluoroscopy time (XRay) during implantation was lower for the para-Hisian technique (median 7 min in the DDD-Var group vs 21 min in the DDD-His group, p < 0.001). The mean QRS duration increased in the DDD-Var group (114.7 ms pre-implantation vs 128.2 ms post-implantation, p = 0.044). The mean post-implantation R-wave amplitude was 11.2 mV in the DDD-Var group vs 6.0 mV in the DDD-His group, p = 0.001. Conclusion Para-Hisian pacing appears to indirectly recruit the His bundle, which would make this an effective and comparable strategy for physiological pacing, resulting in synchronous ventricular contraction similar to that of non-selective Hisian pacing.

ABSTRACT Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical “dyssynchronopathy” with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chronic effect of abnormal impulse conduction and nonphysiological ectopic activation by artificial cardiac pacing is suspected to affect metabolism and myocardial perfusion, triggering regional differences in the activation/contraction processes that cause electrical and structural remodeling due to damage, inflammation, and fibrosis of the cardiac tissue. The effect of artificial cardiac pacing on ventricular function and structure can be multifactorial, and biological factors underlying PiCM could affect the time and probability of developing the condition. PiCM has not been included in the traditional classification of cardiomyopathies, which can hinder detection. This article reviews the available evidence for pacing-induced cardiovascular disease, the current understanding of its pathophysiology, and reinforces the adverse effects of right ventricular pacing, especially right ventricular pacing burden (commonly measured in percentage) and its repercussion on ventricular contraction (reflected by the impact on left ventricular systolic function). These effects might be the main defining criteria and determining mechanisms of the pathophysiology and the clinical repercussion seen on patients.

RESUMO Este artigo discute o papel que a moeda representa nas relações de poder dos Estados em relação aos agentes privados, bem como em relação aos seus pares no sistema internacional, a partir do caso da moeda digital chinesa. A análise do “e-Renminbi” parte do entendimento de que os Estados são a unidade básica do sistema internacional, de que eles disputam poder entre si e de que suas moedas são simultaneamente uma manifestação e uma fonte de poder. Esta pesquisa argumenta que as evidências existentes não autorizam qualquer diagnóstico definitivo de que o “e-Renminbi” representará uma ruptura iminente no sistema monetário e financeiro internacional centrado no dólar.

ABSTRACT This study discusses the role currencies play in the power relations of States regarding private agents and their peers in the international system, based on the case of the Chinese digital currency. The “e-Renminbi” analysis starts by understanding that States are the basic unit of the international system, that they dispute power among themselves, and that their currencies simultaneously manifest and produce power. This study argues that existing evidence fails to warrant any definite diagnosis that the “e-Renminbi” will represent an imminent rupture in the dollar-centered international monetary and financial system.

Resumo A pandemia da COVID-19 no mundo tem impactado a área da saúde, os setores da economia e da política e também tem gerado consequências psicossociais, repercutindo de forma significativa no campo da saúde mental. Este estudo de revisão sistemática analisou diversos documentos e pesquisas abordando saúde mental e COVID-19, bem como problematicas geradas durante a pandemia. A metodologia de pesquisa envolveu revisão narrativa e integrativa da literatura científica. Na América Latina, os estudos mais recentes apresentam os inúmeros efeitos da COVID-19 em populações vulneráveis: imigrantes, mulheres, crianças, idosos, pessoas em situação de rua, trabalhadores informais, etc. Diante desse panorama, propõe-se que a abordagem dessas questões inclua a coordenação de políticas transnacionais e a definição de uma agenda de prioridades críticas a serem consideradas. Os resultados empíricos de estudos epidemiológicos realizados em âmbito regional contribuíram para o desenho de políticas públicas em saúde mental da população latino-americana com o objetivo de reduzir os efeitos negativos e prevenir riscos futuros de uma pandemia que ainda não terminou.

Abstract The COVID-19 pandemic has not only had health, economic, and political impacts, but also significant psychosocial and mental health consequences worldwide. In this article, different documentation and studies on mental health were analyzed, with the aim of identifying the various problems detected during the pandemic. Methodologically, a narrative and integrative review of the scientific literature was carried out. In Latin America, the most recent studies have documented and made patent effects on the various vulnerized populations such as migrants, women, children, the elderly, people living with significant disabilities, people experiencing marked housing and food insecurity, and temporary workers laboring in what has been referred to as the informal economy. In light of this, it is proposed that addressing these issues should involve the coordination of transnational policies and the definition of an agenda of critical priorities to focus and address. For this to come about, it is important that the empirical evidence generated by regional epidemiological studies contribute to the design of public policies on mental health of the Latin American population, so that they reduce the negative effects as well as prevent the future consequences of a pandemic that is not yet over.

Resumen La pandemia por el COVID-19 no sólo ha generado diversos impactos en materia de salud, economía y política, sino también importantes consecuencias psicosociales y de salud mental en el mundo. En este trabajo, se analizaron diferentes documentaciones y estudios sobre salud mental, con el objetivo de recuperar las diversas problemáticas detectadas durante la pandemia. Metodológicamente se realizó una revisión narrativa e integrativa de la literatura científica. En América Latina los estudios más recientes comienzan a visualizar diferentes afectaciones sobre las diversas poblaciones vulneralizadas: migrantes, mujeres, niños, los ancianos, personas quienes viven con una discapacidad significativa, personas en situación de calle, trabajadores informales, etc. Frente a este panorama, se plantea que el abordaje de estas cuestiones deberá contar con la coordinación de políticas trasnacionales y la definición de una agenda de prioridades críticas a focalizar y atender. Para esto resulta importante que la evidencia empírica generada por los estudios epidemiológicos regionales contribuya al diseño de las políticas públicas sobre salud mental de la población latinoamericana, de modo que las mismas logren reducir los efectos negativos como también puedan prevenir las consecuencias futuras de una pandemia que todavía no ha finalizado.

ABSTRACT INTRODUCTION In order to face the COVID-19 pandemic and organize the health attention demand, in Bahía Blanca, Argentina, was implemented a device based on information and communication technologies. A telephone triage system was created, directed to people with symptoms compatible with COVID-19, to offer advice and relevant information about the disease. The present article aims to describe this implemented service, so that it can be reproduced since its application is simple and does not require great resources. METHODS The telephone operators were trained to answer the phone calls received in the 147 phone number, complete a database in a specific software, and carry out a triage with the assistance of a health professional. The people who called – citizens with or without health coverage- were classified in order to the case definition and its severity. Finally, the operator indicated the caller a conduct to follow. RESULTS 2811 phone calls were received between the 07/01/2020 and the 10/20/2020. 81,6% were classified as green, 9% as yellow and 1,3% as red. The device offered attention to 17,3% of the COVID-19 positive cases in Bahía Blanca and 9% of the laboratory confirmed cases. The operators diagnosed 38% of the city positive cases defined by epidemiological or clinical criteria. This means that 605 patients were diagnosed and isolated, without the needing of going in person to a health institution. DISCUSSION The telephone triage is a versatile and affordable device that contributed to the functioning and performance of the health effectors in the context of COVID-19 pandemic.

RESUMEN INTRODUCCIÓN En el marco de la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés), y frente a la necesidad de ordenar la demanda de atención en el municipio de Bahía Blanca, Argentina, se implementó un dispositivo basado en tecnologías de la información y comunicación. Se introdujo un sistema de triaje telefónico dirigido a personas con síntomas compatibles con COVID-19, en el que se brindaba información y asesoramiento. El objetivo de este artículo es describir este servicio de aplicación no compleja y reproducible. MÉTODOS Los operadores recibieron capacitación para atender las consultas telefónicas realizadas al número 147, completar una base de datos con software propio y llevar a cabo un triaje, con asistencia de un profesional de salud. Los usuarios (ciudadanos con cobertura de salud pública o privada) fueron clasificados según las definiciones de caso y gravedad, y se consignó la conducta posterior. RESULTADOS Se recibieron 2811 llamados entre el 1 de julio y el 20 de octubre de 2020; 81,6% eran de código verde, 9% de código amarillo y 1,3% de código rojo. Se diagnosticó y se indicó aislamiento a 605 personas por vía telefónica, sin necesidad de acudir al sistema de salud. Este grupo estaba formado por el 17,3% del total de los casos positivos de Bahía Blanca, el 9% de los casos confirmados por laboratorio y el 38% de quienes fueron diagnosticados por criterios clínicos y epidemiológicos. DISCUSIÓN El triaje telefónico es un dispositivo versátil y asequible que contribuyó al buen funcionamiento de los efectores de salud en el contexto de la pandemia de COVID-19.

RESUMO A crise financeira internacional de 2007-2008 (IFC) e a “Grande Recessão” (GR) tiveram efeitos em todo o mundo. No caso da Argentina e do Brasil, a redução e melhoria da composição da dívida externa pública, a política anterior de acumulação de reservas internacionais combinada com a afinidade política de esquerda entre governos, proporcionou algum espaço para políticas macroeconômicas anticíclicas. Consequentemente, seus governos puderam enfrentar a IFC e a GR sem seguir políticas macroeconômicas tradicionais rígidas ou pró-cíclicas. Este artigo examina as consequências da IFC e da GR na Argentina e no Brasil e as políticas macroeconômicas anticíclicas que foram implementadas durante o período 2009-2014.

ABSTRACT The 2007-2008 international financial crisis (IFC) and the ‘Great Recession’ (GR) had worldwide effects. In the case of Argentina and Brazil, the reduction and improvement in composition of public external debt, the previous policy of international reserves accumulation combined with left-wing political affinity between governments, provided some space for countercyclical macroeconomic policies. Consequently, its governments were able to face the IFC and GR without following traditional tightened or pro-cyclical macroeconomic policies. This article examines the consequences of the IFC and the GR in Argentina and Brazil and the countercyclical macroeconomic policies that were implemented during the period 2009-2014.

RESUMO Este artigo avalia a relação entre liberalização financeira externa - tanto abertura quanto integração financeira - e desempenho macroeconômico da economia brasileira a partir da estimação de um modelo baseado em vetores autorregressivos com correção de erros (VEC). Como contribuição potencialmente original, foi encontrada a precedência, no sentido de Granger, dos movimentos do ciclo financeiro global diante do grau de integração financeira da economia brasileira, e deste diante do risco-país. Quanto aos demais resultados, um aumento do grau de abertura da conta capital e financeira não gerou efeitos macroeconômicos significativos. Já uma elevação do grau de integração financeira teve desdobramentos problemáticos em variáveis como volatilidade cambialenível de atividade.

ABSTRACT This paper discusses the relationship between external financial liberalization - both in terms of capital account liberalization and financial integration - and the macroeconomic performance of Brazil’s economy by estimating vector error correction model (VEC). As a potentially original contribution, it has been found a causal relation, in Grange sense, between the global financial movements and the degree of financial integration and between the latter and the country risk. Also, evidence has been found that an increased degree of capital account liberalization did not produce relevant macroeconomic effects. Additionally, results show that a high degree of financial integration had problematic repercussions in variables such as exchange rate volatility and activity level.

Resumo Fundamento: O implante valvar aórtico transcateter (TAVI) está bem estabelecido, porém, o bloqueio atrioventricular, com necessidade de marca-passo definitivo (MPD), é complicação frequente. Objetivo: Determinar a incidência, preditores e desfechos clínicos de implante de MPD após TAVI, focando em como a evolução da fração de ejeção do ventrículo esquerdo (FEVE), após o TAVI, é afetada pelo MPD. Métodos: No registro brasileiro foram incluídos 819 pacientes submetidos a TAVI por estenose aórtica severa em 22 centros entre janeiro/2008 e janeiro/2015. Após exclusões, os preditores de implante de MPD foram avaliados em 670 pacientes por regressão multivariada. Análise da curva ROC foi utilizada para medir a habilidade dos preditores; p < 0,05 foi considerado significativo. Resultados: Aos 30 dias, 135 pacientes (20,1%) necessitaram de MPD. Tais pacientes eram mais velhos (82,5 vs. 81,1 anos; p = 0,047) e predominantemente homens (59,3% vs 45%; p = 0,003). A permanência hospitalar foi maior no Grupo MPD (média= 15,7 ± 25,7 vs. 11,8 ± 22,9 dias; p < 0,001), mas o implante não afetou morte por qualquer causa (26,7% vs. 25,6%; p = 0,80) nem morte cardiovascular (14,1% vs. 14,8%; p = 0,84). Por análise multivariada, a presença prévia de bloqueio de ramo direito (BRD) (OR, 6,19; 3,56–10,75; p ≤ 0,001), o uso da prótese CoreValve® (OR, 3,16; 1,74–5,72; p ≤ 0,001) e gradiente transaórtico basal > 50 mmHg (OR, 1,86; 1,08–3,2; p= 0,025) foram preditores de implante de MPD. O risco estimado de implante de MPD foi 4%, quando nenhum dos fatores de risco estava presente, e 63% na presença de todos. O modelo mostrou boa habilidade de prever a necessidade de MPD: 0,69 (IC95%: 0,64 – 0,74) na curva ROC. Subestudo de 287 ecocardiogramas durante o seguimento de 1 ano mostrou pior evolução da FEVE no Grupo MPD (p = 0,01). Conclusão: Em crianças de 6 a 11 anos, circunferência da cintura aumentada está associada à PA elevada, mesmo quando o IMC é normal. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Abstract Background: Transcatheter aortic valve implantation (TAVI) is a well-established procedure; however, atrioventricular block requiring permanent pacemaker implantation (PPI) is a common complication. Objectives: To determine the incidence, predictors and clinical outcomes of PPI after TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF) after TAVI. Methods: The Brazilian Multicenter TAVI Registry included 819 patients submitted to TAVI due to severe aortic stenosis from 22 centers from January/2008 to January/2015. After exclusions, the predictors of PPI were assessed in 670 patients by use of multivariate regression. Analysis of the ROC curve was used to measure the ability of the predictors; p < 0.05 was the significance level adopted. Results: Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex (59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p < 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p = 0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of multivariate analysis, the previous presence of right bundle-branch block (RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤ 0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2; p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%, when none of those predictors was present, to 63%, in the presence of all of them. The model showed good ability to predict the need for PPI: 0.69 (95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms during the 1-year follow-up showed worse LVEF course in patients submitted to PPI (p = 0.01). Conclusion: BRD prévio, gradiente aórtico médio > 50 mmHg e CoreValve® são preditores independentes de implante de MPD pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de TAVI, o que prolongou a internação hospitalar, mas não afetou a mortalidade. O implante de MPD afetou negativamente a FEVE pós-TAVI.

Resumo Fundamento: Estudos Clínicos demonstram que até 40% dos pacientes não respondem à terapia de ressincronização cardíaca (TRC), assim a seleção apropriada dos pacientes é fundamental para o sucesso da TRC na insuficiência cardíaca. Objetivo: Avaliação de preditores de mortalidade e resposta à TRC no cenário brasileiro. Métodos: Estudo de coorte retrospectivo incluindo os pacientes submetidos à TRC em hospital terciário no Sul do Brasil entre 2008-2014. A sobrevida foi avaliada através de banco de dados da Secretaria Estadual de Saúde (RS). Os preditores de resposta ecocardiográfica foram avaliados utilizando método de regressão de Poisson. A análise de sobrevida foi feita por regressão de Cox e curvas de Kaplan Meyer. Um valor de p bicaudal inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Foram incluídos 170 pacientes com seguimento médio de 1011 ± 632 dias. A mortalidade total foi de 30%. Os preditores independentes de mortalidade identificados foram idade (hazzard ratio [HR] de 1,05; p = 0,027), infarto agudo do miocárdio (IAM) prévio (HR de 2,17; p = 0,049) e doença pulmonar obstrutiva crônica (DPOC) (HR de 3,13; p = 0,015). O percentual de estimulação biventricular em 6 meses foi identificado com fator protetor de mortalidade ([HR] 0,97; p = 0,048). Os preditores independentes associados à reposta ecocardiográfica foram ausência de insuficiência mitral, presença de bloqueio de ramo esquerdo e percentual de estimulação biventricular. Conclusão: A mortalidade nos pacientes submetidos à TRC em hospital terciário foi independentemente associada à idade, presença de DPOC e IAM prévio. O percentual de estimulação biventricular avaliado 6 meses após o implante do ressincronizador foi independentemente associado a melhora da sobrevida e resposta ecocardiográfica.

Abstract Background: Clinical studies demonstrate that up to 40% of patients do not respond to cardiac resynchronization therapy (CRT), thus, appropriate patient selection is critical to the success of CRT in heart failure. Objective: Evaluation of mortality predictors and response to CRT in the Brazilian scenario. Methods: Retrospective cohort study including patients submitted to CRT in a tertiary hospital in southern Brazil from 2008 to 2014. Survival was assessed through a database of the State Department of Health (RS). Predictors of echocardiographic response were evaluated using Poisson regression. Survival analysis was performed by Cox regression and Kaplan Meyer curves. A two-tailed p value less than 0.05 was considered statistically significant. Results: A total of 170 patients with an average follow-up of 1011 ± 632 days were included. The total mortality was 30%. The independent predictors of mortality were age (hazard ratio [HR] of 1.05, p = 0.027), previous acute myocardial infarction (AMI) (HR of 2.17, p = 0.049) and chronic obstructive pulmonary disease (COPD) (HR of 3.13, p = 0.015). The percentage of biventricular stimulation at 6 months was identified as protective factor of mortality ([HR] 0.97, p = 0.048). The independent predictors associated with the echocardiographic response were absence of mitral insufficiency, presence of left bundle branch block and percentage of biventricular stimulation. Conclusion: Mortality in patients submitted to CRT in a tertiary hospital was independently associated with age, presence of COPD and previous AMI. The percentage of biventricular pacing evaluated 6 months after resynchronizer implantation was independently associated with improved survival and echocardiographic response.

Resumen: Tannat es la principal variedad de uva tinta cultivada en Uruguay para la producción de vinos destinados al mercado local y la exportación. En un proceso de reconversión de antiguas plantaciones envirosadas, en la década de los 70s comienzan a introducirse clones seleccionados en Francia, siendo el 398 el más adoptado aún sin experiencia previa de su comportamiento en el país. A fin de comparar el desempeño cualitativo y cuantitativo, ocho clones ENTAV-INRA 398, 399, 472, 474, 475, 717, 794 y 944 fueron plantados, quince plantas por parcela, en bloques al azar con ocho repeticiones. El ensayo, conducido en espaldera alta, con poda larga y sobre portainjerto SO4, fue evaluado de 2005 a 2010. Diez plantas por parcela fueron raleadas antes de envero y cinco permanecieron con toda su producción. Se evaluó rendimiento, peso y número de racimos por planta junto a parámetros cualitativos de uvas y vinos. Se realizaron análisis sensoriales descriptivos anualmente sobre los vinos por panelistas especializados. Los clones 398, 399 y 475 fueron más productivos, exhibiendo diferencias significativas con el 474. Las uvas de los clones 474 y 717 tuvieron las mejores calidades independientemente del rendimiento. Sus uvas tuvieron los mayores contenidos de sólidos solubles y de antocianos totales y fácilmente extraíbles. Los vinos de estos clones, junto al 398, mostraron los aromas más frutados, más estructurados y menor astringencia. Ello sugiere que ambos deberían considerarse para futuras plantaciones destinadas a vinos de calidad en las condiciones agro-climáticas del Uruguay.

Summary: Tannat is the main red wine variety cultivated in Uruguay for the production of wines for the domestic market as well as for export. In a process of reconversion of old virus infected plantations, clones selected in France began to be introduced in the 70´s. Clone 398 was the most adopted, without previous experience of its behavior in the country. In order to compare qualitative and quantitative performance, eight French Tannat ENTAV-INRA clones 398, 399, 472, 474, 475, 717, 794 and 944 were planted, fifteen plants per plot, in a randomized block design with eight replicates. The trial conducted on VSP trellis, with long pruning, and on rootstock SO4, was evaluated from 2005 to 2010. Ten plants per plot were thinned before veraison, and five remained with all their production. Yield, weight, and number of clusters per plant were evaluated, along with qualitative parameters of grapes and wines. Descriptive sensorial analyzes were carried out annually on wines by specialized panelists. Clones 398, 399 and 475 were more productive, showing significant differences with 474. Clones 474 and 717 had the best grape and wine quality independently of crop load. Their grapes had the highest contents of soluble solids and total and easily removable anthocyanins. The wines of these clones, along with 398, had the most fruity aromas, structure, and minor astringency. This suggests that both clones should be considered for future plantations for high quality wines under the agro-climatic conditions of Uruguay.

El objetivo de la investigación es el diseño de una escala breve en español para la evaluación de la sabiduría en adultos mayores. Para ello, se llevaron a cabo tres estudios. En el primero, una muestra de 505 adultos mayores de 50 años completó un cuestionario de 45 ítems en relación con la sabiduría seleccionados por jueces expertos. Un análisis de componentes principales ofreció una solución de 20 ítems agrupados en tres componentes, que explicaba el 42% de la varianza con una consistencia interna satisfactoria (a = 0.85). Posteriormente se puso a prueba la validez estructural de la escala mediante un AFC aplicado a los datos aportados por una muestra de 290 adultos mayores de 50 años. La solución con tres dimensiones independientes era la que mostraba una mejor bondad de ajuste. Por último, en un tercer estudio con 409 adultos mayores de 50 años se obtuvieron datos respecto a la validez concurrente y estabilidad temporal de las puntuaciones de la escala. Se encontró una relación moderadamente alta con otras escalas similares (r=0.45), una relación baja con una escala de deseabilidad social (r = 0.26) y una correlación test-retest satisfactoria (r=0.75). Se comentan las implicaciones teóricas y posibles usos de escala, así como sus limitaciones.

The article is aimed at designing a brief scale in Spanish to assess wisdom among older people. To do that, three studies were carried out. In the first one, a sample made up of 505 people of 50 year-old and older completed a questionnaire that included 45 wisdom-related items selected by experts. The application of a principal component analysis yielded a 20-item solution grouped into three components, which accounted for 42% of the variance, and with a satisfactory internal consistency (a = 0.85). In a second study the structural validity of the scale was tested by means of a CFA applied to data gathered in a 290 people sample. Thee three independent dimension solution was the one that fitted best. Finally, in a third study involving 409 people 50 years and older, the concurrent validity and the stability of scale scores were tested. They were moderately related with scores of a conceptually related scale (r=0.45). Their relationship with a scale of social desirability was low (r = 0.26), while the test-retest correlation was satisfactory (r=0.75). Theoretical implications, possible uses and limitations of the scale were discussed.

In this paper, I will present certain characteristics of an archaeological site known as La Paya (SSalCac 1), located in northwest Argentina; more precisely in the North Calchaquí Valley. It features occupancies during the Late Intermediate Period and architectonical interventions belonging to the Inka Period. The latter consist of a series of remodelations, including the construction of an Inka structure known as Casa Morada, whose architectural properties have been conceptualized as intrusive regarding local layouts and construction techniques. Below, I summarize previous investigations and introduce new data to enrich our understanding of these interventions. I will argue that imperial interventions involved more structures than those previously reported, disrupting the local way of dwelling, demarcating the difference between colonizers and the colonized, and crystallizing new segments within the local population.

En este artículo presentaré ciertas características del sitio arqueológico La Paya (SSalCac 1), ubicado en el Noroeste Argentino; más precisamente en el Valle Calchaquí Norte. Se trata de un asentamiento que presenta ocupaciones del Período Intermedio Tardío e intervenciones arquitectónicas correspondientes al Período Inka. Éstas consisten en una serie de remodelaciones entre las que se incluyó la construcción de una estructura de neta filiación Inka conocida como Casa Morada, cuyas características arquitectónicas y localización han sido conceptualizadas como intrusivas respecto de la arquitectura local. A continuación, repasaré aquellas investigaciones y presentaré nuevos datos para enriquecer el entendimiento de estas intervenciones. Argumentaré que la intervención Inka involucró más estructuras que las que fueron previamente señaladas, trastocando así el modo de habitar local, demarcando la diferencia entre colonizadores y colonizados, y cristalizando nuevos segmentos dentro de la población local.

ResumoIntrodução:Os distúrbios do sistema de condução cardíaca são frequentes no pós-operatório de cirurgia de revascularização do miocárdio. Majoritariamente reversíveis, estão associados com alguma injúria do tecido de condução, causada pela própria cardiopatia isquêmica ou por fatores perioperatórios.Objetivo:Primário: investigar a associação entre fatores perioperatórios com o surgimento de bloqueio atrioventricular no pós-operatório de cirurgia de revascularização do miocárdio. Secundários: determinar a necessidade de estimulação cardíaca artificial temporária e de marca-passo definitivo no pós-operatório de cirurgia de revascularização do miocárdio e seu impacto na permanência e na mortalidade hospitalar.Métodos:Análise de Coorte retrospectiva de pacientes submetidos à cirurgia de revascularização do miocárdio, do banco de dados da unidade de Pós-Operatório de Cirurgia Cardíaca do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, pelo método de regressão logística.Resultados:No período de janeiro de 1996 a dezembro de 2012, foram realizadas 3532 cirurgias de revascularização do miocárdio. Duzentos e oitenta e oito (8,15%) pacientes apresentaram bloqueio atrioventricular durante o pós-operatório de cirurgia de revascularização do miocárdio, necessitando de estimulação cardíaca artificial temporária. Oito dos que apresentaram bloqueio atrioventricular evoluíram para implante de marcapasso definitivo (0,23% do total da amostra). A análise multivariada evidenciou associação significativa de bloqueio atrioventricular com idade acima de 60 anos (OR=2,34; IC 95% 1,75-3,12; P<0,0001), sexo feminino (OR=1,37; IC 95% 1,06-1,77; P=0,015), doença renal crônica (OR=2,05; IC 95% 1,49-2,81; P<0,0001), fibrilação atrial (OR=2,06; IC 95% 1,16-3,66; P=0,014), classe funcional III e IV da New York Heart Association (OR=1,43; IC 95% 1,03-1,98; P=0,031), infarto agudo do miocárdio perioperatório (OR=1,70; IC 95% 1,26-2,29; P<0,0001) e com o uso do balão intra-aórtico no pós-operatório de cirurgia de revascularização do miocárdio (OR=1,92; IC 95% 1,21-3,05; P=0,006). A presença de bloqueio atrioventricular acarretou um aumento significativo da mortalidade (17,9% vs. 7,3% nos que não desenvolveram bloqueio atrioventricular) (OR=2,09; IC 95% 1,46-2,99; P<0,0001) e um tempo mais prolongado de permanência hospitalar (12,75 dias vs. 10,53 dias nos que não desenvolveram bloqueio atrioventricular) (OR=1,01; IC 95% 1,00-1,02; P=0,01).Conclusão:O bloqueio atrioventricular, no pós-operatório de cirurgia de revascularização do miocárdio, é, na maioria dos casos, transitório, sendo associado a diversos fatores perioperatórios: idade acima de 60 anos, sexo feminino, doença renal crônica, fibrilação atrial, classe funcional III e IV da New York Heart Association, infarto agudo do miocárdio perioperatório e uso do balão intra-aórtico. Sua ocorrência prolonga a internação hospitalar e, sobretudo, duplica o risco de mortalidade.

AbstractIntroduction:Disturbances of the cardiac conduction system are frequent in the postoperative period of coronary artery bypass surgery. They are mostly reversible and associated with some injury of the conduction tissue, caused by the ischemic heart disease itself or by perioperative factors.Objective:Primary: investigate the association between perioperative factors and the emergence of atrioventricular block in the postoperative period of coronary artery bypass surgery. Secondary: determine the need for temporary pacing and of a permanent pacemaker in the postoperative period of coronary artery bypass surgery and the impact on hospital stay and hospital mortality.Methods:Analysis of a retrospective cohort of patients submitted to coronary artery bypass surgery from the database of the Postoperative Heart Surgery Unit of the Sao Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, using the logistic regression method.Results:In the period from January 1996 to December 2012, 3532 coronary artery bypass surgery were carried out. Two hundred and eighty-eight (8.15% of the total sample) patients had atrioventricular block during the postoperative period of coronary artery bypass surgery, requiring temporary pacing. Eight of those who had atrioventricular block progressed to implantation of a permanent pacemaker (0.23% of the total sample). Multivariate analysis revealed a significant association of atrioventricular block with age above 60 years (OR=2.34; CI 95% 1.75-3.12; P<0.0001), female gender (OR=1.37; CI 95% 1.06-1.77; P=0.015), chronic kidney disease (OR=2.05; CI 95% 1.49-2.81; P<0.0001), atrial fibrillation (OR=2.06; CI 95% 1.16-3.66; P=0.014), functional class III and IV of the New York Heart Association (OR=1.43; CI 95% 1.03-1.98; P=0.031), perioperative acute myocardial infarction (OR=1.70; CI 95% 1.26-2.29; P<0.0001) and with the use of the intra-aortic balloon in the postoperative period of coronary artery bypass surgery (OR=1.92; CI 95% 1.21-3.05; P=0.006). The presence of atrioventricular block resulted in a significant increase in mortality (17.9% vs. 7.3% in those who did not develop atrioventricular block) (OR=2.09; CI 95% 1.46-2.99; P<0.0001) and a longer hospital stay (12.75 days x 10.53 days for those who didn't develop atrioventricular block) (OR=1.01; CI 95% 1.00-1.02; P=0.01).Conclusions:In most cases, atrioventricular block in the postoperative period of coronary artery bypass surgery is transient and associated with several perioperative factors: age above 60 years, female sex, chronic kidney disease, atrial fibrillation, New York Heart Association functional class III or IV, perioperative acute myocardial infarction and use of an intra-aortic balloon. Its occurrence prolongs hospitalization and, above all, doubles the risk of mortality.