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Pregnancy Hypertensive Disorders (PHD), particularly Preeclampsia (PE), are significant contributors to maternal-fetal morbidity and mortality, with chronic arterial hypertension (CH) being a major risk factor. The prevalence of CH has risen alongside obesity and advanced maternal age. While antihypertensive treatment mitigates adverse pregnancy outcomes, the duration of effective blood pressure (BP) control, termed Time in Therapeutic Range (TTR), has not been extensively studied in pregnant women. TTR, reflecting the proportion of time BP remains within target ranges, predicts long-term cardiovascular and renal events in the general population but remains unexplored in pregnancy. This study investigates the association between TTR, assessed through office BP (OBP) and ambulatory BP monitoring (ABPM), and PE development in pregnant women with CH. In a retrospective longitudinal study, data from 166 pregnant women with HA referred to our hospital analyzed. BP was measured using OBP and ABPM from 10 weeks of gestation, with TTR calculated as the percentage of visits where BP remained within target ranges. The study defined four TTR control groups: 0%, 33%, 50-66%, and 100%. Results showed that 28% of the participants developed PE, with a higher incidence correlating with lower TTR in ABPM. TTR in ABPM was a significant predictor of PE risk, with the best-controlled group (100% TTR) demonstrating a 92% reduced risk compared to those with 0% TTR. The agreement between OBP and ABPM TTR was low, emphasizing the importance of ABPM for accurate BP monitoring in pregnancy. This study indicates that integrating ABPM for TTR assessment in high-risk pregnancies has the potential to reduce maternal and fetal complications.

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Patients with hypertensive disorders of pregnancy (HDP) are at increased risk of maternal-fetal complications and represent the third leading cause of maternal mortality. To date, it is known that women experiencing this condition during pregnancy have a higher future risk of cardiovascular events (CVD). Our objective was to report the incidence of new-onset hypertension in the postpartum period. We conducted a cohort study in high-risk pregnant patients who underwent ambulatory blood pressure monitoring (ABPM) between weeks 20-30. Patients were categorized as normotensive (NT) or gestational hypertensive (GH), excluding those with chronic hypertension, and were followed until the end of pregnancy with a postpartum assessment after 3months. Patients with HDP (39%) had a higher incidence of preeclampsia and newborns with low birth weight and preterm birth. A total of 177 pregnant women were analyzed for the primary outcome. Among those with GH, 33.3% vs 17.2% of NT (P=.014) reported new-onset hypertension. The odds ratio for developing new-onset hypertension was 2.3 (95%CI: 1.20-4.77), for those with GH. In conclusion, pregnant patients with GH assessed by ABPM between 20-30weeks are at higher risk of developing new-onset hypertension in the postpartum period, emphasizing the need for closer monitoring and control to prevent future cardiovascular complications.

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INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

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La hemorragia no compresible de torso continúa siendo unas de las principales causas de mortalidad del paciente víctima de trauma. El control de este tipo de sangrado requiere de procedimientos invasivos como la toracotomía de reanimación, la cual se realiza en el paciente in extremis. La utilización de REBOA se re-introduce desde el 2011, como una forma de oclusión endovascular de la aorta y con el tiempo ya forma parte de los implementos con que cuenta un centro de trauma nivel I. Actualmente REBOA se utiliza dentro del proceso de reanimación, mientras se realiza el control definitivo de un sangrado en el torso, con el fin de aumentar la perfusión de órganos como cerebro y corazón, existiendo dos zonas principales de oclusión a nivel aórtico. Múltiples investigaciones se han realizado para encontrar las indicaciones y beneficios de REBOA dentro de la atención integral de un paciente con trauma grave, estando aun estas en desarrollo. La utilización en un paciente con trauma grave se encuentra protocolizada en diferentes pasos que van desde el acceso arterial hasta el seguimiento de la extremidad post retiro del introductor. Por este último punto, REBOA se encuentra dentro de los implementos importantes de la reanimación, sin embargo, no reemplaza conceptos básicos como atención integral del paciente politraumatizado, control precoz del sangrado y el control de daños resucitativo. Su implementación requiere de un centro altamente protocolizado y con equipos de trauma establecidos con el objetivo de disminuir las complicaciones y optimizar la supervivencia.

Non compressible torso hemorrhage continues to be one of the main causes of mortality in trauma victims. The control of this type of bleeding requires invasive procedures such as resuscitation thoracotomy, that is performed on the patient "in extremis". The use of REBOA has been reintroduced since 2011, as a form of endovascular occlusion of the aorta and over time it is has already part of the implements that a level I trauma center. REBOA is used within the resuscitation process, while definitive control of bleeding in the torso is carried out, in order to increase the perfusion of organs such as the brain and heart, with two main areas of occlusion at the aortic level. Multiple investigations have been carried out to find the indications and benefits of REBOA within the comprehensive care of a patient with severe trauma, and these are still under development. Its use in a patient with severe trauma is protocolized in different steps that go from arterial access to follow-up of the extremity after removal of the sheath. For this last point, REBOA is among the important implements of resuscitation, however, it does not replace basic concepts such as comprehensive care of the polytraumatized patient, early control of bleeding and resuscitative damage control. Its implementation requires a highly protocolized center with established trauma teams with the aim of reducing complications and optimizing survival.

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Introducción: El trauma penetrante de la arteria vertebral es extremadamente infrecuente. Objetivo: Aportar evidencia clínica mediante la revisión de una serie de casos. Materiales y Método: Se analizan cuatro casos de trauma penetrante con compromiso de la arteria vertebral entre los años 2020 y 2021, manejados en la unidad de trauma y urgencias del Complejo Asistencial Dr. Sótero del Río. Resultados: Se presentan cuatro casos clínicos relatando su proceso diagnóstico y manejo. Discusión: La evidencia de compromiso traumático de arteria vertebral es escasa. Reconocer su compleja anatomía y variada clínica resultan trascendentales para su adecuado manejo. Ante sospecha de este tipo de lesión, la angiografía por tomografía computada es el estudio de elección cuando se presentan hemodinámicamente estables. El abanico de opciones terapéuticas incluyen: observación, terapia antitrombótica o con antiagregantes, terapia endovascular o cirugía abierta. Conclusión: El trauma penetrante de arteria vertebral es una condición infrecuente, sin embargo, su diagnóstico y manejo deben ser conocidos por el cirujano.

Introduction: Traumatic involvement of the vertebral artery is extremely rare and difficult to diagnose. Objective: To provide clinical evidence by reviewing a case series. Materials and Method: We analyze four cases of penetrating trauma with involvement of the vertebral artery between 2020 and 2021, managed in the trauma and emergency unit of the Dr. Sótero del Río Care Complex. Results: Four clinical cases are presented describing diagnosis and management process. Discussion: There is little evidence of traumatic involvement of the vertebral artery. Recognizing its complex anatomy and varied clinic are transcendental for its proper management. When this type of lesion is suspected, computed tomography angiography is the choice study when hemodynamically stable. The range of therapeutic options include observation, antithrombotic or antiplatelet therapy, endovascular therapy or open surgery. Conclusion: Penetrating trauma of the vertebral artery is an uncommon condition, however, its diagnosis and management should be known to the surgeon.

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La pandemia por COVID-19 expuso a los trabajadores de salud a una enorme exigencia y presión en su labor cotidiana. Objetivo: Evaluar el nivel de depresión, ansiedad y estrés en trabajadores de salud durante la pandemia por COVID-19 y su asociación con características personales, laborales,sentimientos, experiencias y conductas relacionadas a la pandemia. Materiales y métodos: Estudio analítico de corte transversal. Durante el mes de junio del 2020 se enviaron formularios vía e-mail y redes sociales a trabajadores de la salud del sector público de La Plata y Gran La Plata. Se evaluó el nivel de depresión, ansiedad, y estrés mediante el cuestionario DASS-21. Se relevaron variables personales, laborales, sentimientos, experiencias y conductas vinculados a la pandemia. Se analizó la asociación entre las características de los trabajadores y la presencia de síntomas psicológicos mencionados. Resultados: Participaron 515 trabajadores, 41 años (33;50), 83,3% femenino. El síntoma psicológico más frecuente fue el estrés (58,2 %), seguido por ansiedad (33,1%) y depresión (24,7%). Se hallaron mayores chances de presentar estos síntomas en trabajadores que percibieron sentimientos, experiencias y conductas negativas vinculados a la pandemia. Los trabajadores de enfermería y administración, y aquellos que convivían con personas de riesgo tuvieron mayores chances de presentar ansiedad. Conclusión: Los trabajadores de salud de La Plata y Gran La Plata presentaron diversos grados de depresión, ansiedad y estrés que se asocian a sentimientos negativos relacionados con la pandemia

The COVID-19 pandemic exposed health workers to enormous demands and pressure in their daily work. Objective: To evaluate the level of anxiety, depression and stress in health workers during the COVID-19 pandemic and its association with personal and work characteristics, feelings, experiences, and behaviors related to the pandemic. Materials and methods: Cross-sectional analytical study. During the month of June 2020, forms were sent via e-mail and social networks to health workers in the public sector of La Plata and Gran La Plata. The level of depression, anxiety, and stress was evaluated using the DASS-21 questionnaire. Personal and work variables, feelings, experiences and behaviors linked to the pandemic were surveyed. The association between the characteristics of the workers and the presence of the aforementioned psychological symptoms was analyzed. Results: 515 workers participated, 41 years old (33;50), 83.3% female. The most frequent psychological symptom was stress (58.2%), followed by anxiety (33.1%) and depression (24.7%). Greater chances of presenting these symptoms were found in workers who perceived negative feelings, experiences and behaviors linked to the pandemic. Nursing and administration workers, and those who lived with people at risk had a higher chance of presenting anxiety. Conclusion: Health workers from La Plata and Gran La Plata presented varying degrees of depression, anxiety, and stress that are associated with negative feelings related to the pandemic

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