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Introducción: El equilibrio del medio interno, es esencial para mantener un adecuado estado de salud. En el paciente críticamente enfermo, las alteraciones de los líquidos corporales hacia la depleción como hacia la sobrecarga es una condición frecuente y que se asocia con incremento de la mortalidad, el manejo de esta condición exige un conocimiento holístico de la fisiología y fisiopatología de la homeostasis corporal por parte del personal médico y de enfermería. Objetivo: describir una visión fisiológica, fisiopatológica de las pérdidas insensibles, con el fin de homogenizar y mejorar el manejo por parte del personal de enfermería. Métodos: investigación de diseño documental con revisión bibliográfica en las bases de datos: PubMed, Scielo, Latindex, Lilacs y Google académico, con los descriptores de ciencias de la salud (DeCS) de Bireme: pérdidas insensibles, balance hídrico, paciente crítico. Desarrollo: En condiciones no patológicas nuestro organismo es capaz de mantener un equilibrio hidroelectrolítico y ácido-base gracias a los mecanismos adaptativos del mismo, el paciente en estado crítico pierde dicho equilibrio, y las pérdidas insensibles se maximizan por situaciones como la taquipnea, la cirugía abdominal abiera, entre otros. Es por este motivo que uno de los roles fundamentales de enfermería en la Unidad de Terapia Intensiva es tener el conocimiento de la importancia del cálculo de las perdidas insensibles, así como de su impacto en la evolución del paciente críticamente enfermo. Conclusiones: El conocimiento de las perdidas insensibles en situaciones especiales, se convierte en un recurso de buena práctica clínica y su conocimiento profundo permite el manejo adecuado del paciente en estado crítico Palabras clave: pérdida insensible de agua, medio interno, paciente crítico ABSTRACT Background: The balance of the internal environment is essential to maintain an adequate state of health. In the critically ill patient, alterations of body fluids towards depletion as well as towards overload is a frequent condition and is associated with increased mortality, the management of this condition requires a holistic understanding of the physiology and pathophysiology of homeostasis by medical and nursing staff. Objective: give a physiological, pathophysiological and compensation vision of insensible losses, in order to homogenize and improve their management by nursing staff. Methods: documentary design research with bibliographic review in the databases: PubMed, Scielo, Latindex, Lilacs and academic Google, with Bireme's health sciences (DeCS) descriptors: insensible losses, water balance, critical patient. Development: In non-pathological conditions, our body is capable of maintaining a hydroelectrolytic and acid-base balance thanks to its adaptive mechanisms. The critically ill patient loses said balance, and insensible losses are maximized by situations such as tachypnea, surgery abdominal open, among others. It is for this reason that one of the fundamental roles of nursing in the Intensive Care Unit is to be aware of the importance of calculating insensible losses, as well as their impact on the evolution of critically ill patients. Conclusions: The knowledge of insensible losses in special situations becomes a resource of good clinical practice and its deep knowledge allows the adequate management of the patient in critical condition. Keywords: insensible water loss, internal environment, critical patient.

Objective To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults. Methods A total of 60 participants (60–80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group). Results No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = −1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89). Conclusion The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.

The Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial (REDUCE-IT) demonstrated the efficacy of icosapent ethyl (IPE) for high-risk patients with hypertriglyceridemia and known cardiovascular disease or diabetes and at least 1 other risk factor who were treated with statins.To estimate the cost-effectiveness of IPE compared with standard care for high-risk patients with hypertriglyceridemia despite statin treatment.An in-trial cost-effectiveness analysis was performed using patient-level study data from REDUCE-IT, and a lifetime analysis was performed using a microsimulation model and data from published literature. The study included 8179 patients with hypertriglyceridemia despite stable statin therapy recruited between November 21, 2011, and May 31, 2018. Analyses were performed from a US health care sector perspective. Statistical analysis was performed from March 1, 2018, to October 31, 2021.Patients were randomly assigned to IPE, 4 g/d, or placebo and were followed up for a median of 4.9 years (IQR, 3.5-5.3 years). The cost of IPE was $4.16 per day after rebates using SSR Health net cost (SSR cost) and $9.28 per day with wholesale acquisition cost (WAC).Main outcomes were incremental quality-adjusted life-years (QALYs), total direct health care costs (2019 US dollars), and cost-effectiveness.A total of 4089 patients (2927 men [71.6%]; median age, 64.0 years [IQR, 57.0-69.0 years]) were randomly assigned to receive IPE, and 4090 patients (2895 men [70.8%]; median age, 64.0 years [IQR, 57.0-69.0 years]) were randomly assigned to receive standard care. Treatment with IPE yielded more QALYs than standard care both in trial (3.34 vs 3.27; mean difference, 0.07 [95% CI, 0.01-0.12]) and over a lifetime projection (10.59 vs 10.35; mean difference, 0.24 [95% CI, 0.15-0.33]). In-trial, total health care costs were higher with IPE using either SSR cost ($18 786) or WAC ($24 544) than with standard care ($17 273; mean difference from SSR cost, $1513 [95% CI, $155-$2870]; mean difference from WAC, $7271 [95% CI, $5911-$8630]). Icosapent ethyl cost $22 311 per QALY gained using SSR cost and $107 218 per QALY gained using WAC. Over a lifetime, IPE was projected to be cost saving when using SSR cost ($195 276) compared with standard care ($197 064; mean difference, -$1788 [95% CI, -$9735 to $6159]) but to have higher costs when using WAC ($202 830) compared with standard care (mean difference, $5766 [95% CI, $1094-$10 438]). Compared with standard care, IPE had a 58.4% lifetime probability of costing less and being more effective when using SSR cost and an 89.4% probability of costing less than $50 000 per QALY gained when using SSR cost and a 72.5% probability of costing less than $50 000 per QALY gained when using WAC.This study suggests that, both in-trial and over the lifetime, IPE offers better cardiovascular outcomes than standard care in REDUCE-IT participants at common willingness-to-pay thresholds.

Objetivo: Determinar la prevalencia de sobrepeso-obesidad y su relación con el nivel de adherencia a la dieta mediterránea en estudiantes de Medicina de la Universidad Central del Ecuador en el periodo lectivo 2019-2020. Metodología: Diseño epidemiológico analítico transversal en una población de 2730 estudiantes que acuden con regularidad a clases en la Universidad Central del Ecuador en el período 2019–2020, con una muestra de 287 estudiantes seleccionadas aleatoriamente. Se evaluó el nivel de adherencia a la dieta mediterránea mediante la encuesta KIDMED. Para medir el nivel de actividad física y estado nutricional se utilizó el cuestionario IPAQ de la OMS y el IMC (kg/m2) respectivamente. Resultados: Del total de alumnos encuestados el 79.1% (n=227) IC95%: 74.36-84.83, presentan un nivel de adherencia medio-bajo a la dieta mediterránea. El 20.9% (n=60) IC95%: 16.17-25.64, presentan sobrepeso o algún grado de obesidad. Y el 38% (n=110) IC95%: 32.67-43.99, son inactivos. No existe relación entre nivel de adherencia a la dieta mediterránea e índice de masa corporal (p=0.381), ni entre nivel de actividad física e índice de masa corporal (p=0.764). Sin embargo, se encontró una relación entre tipo de vivienda o residencia y nivel de adherencia a la dieta mediterránea (p=0.001). Conclusiones: El estudio demuestra que no existe relación entre el nivel de adherencia a la dieta mediterránea y el índice de masa corporal referente a sobrepeso-obesidad, aunque no descarta déficits nutricionales; sin embargo, se evidencia relación con el tipo de residencia donde demuestra que los hábitos alimenticios pueden estar condicionados al ambiente familiar. Palabras clave: Obesidad; Dieta Mediterránea; Adulto Joven; Índice de Masa Corporal