Prevalencia de riesgo de apnea obstructiva del sueño en población adulta chilena / Prevalence of risk of obstructive sleep apnea in Chilean adult population

Introducción: En Chile la apnea obstructiva del sueño (AOS) es una enfermedad crónica insuficientemente reconocida, que probablemente emerge bajo condiciones epidemiológicas apropiadas. Nuestro objetivo fue estimar su prevalencia en nuestra población adulta. Pacientes y Métodos: A través de la 2ᵃ Encuesta Nacional de Salud (ENS) 2010, estimamos la prevalencia de riesgo de AOS en población ≥ 18 años de edad. Derivada del STOP-Bang Questionnaire construimos una regla de predicción clínica-RPC: ronquido habitual, somnolencia diurna, pausas respiratorias nocturnas, hipertensión arterial, IMC > 35 kg/m2, edad > 50 años, circunferencia cervical ≥ 43 cm (hombres) y ≥ 41 cm (mujeres), sexo: hombre. Según el puntaje total, el riesgo de los sujetos se clasificó como: Bajo (< 3), Medio (3-4) y Alto (≥ 5). Para obtener prevalencia e intervalos de confianza al 95%, usamos el módulo para muestras complejas del Software SPSS (v22). Resultados: Obtuvimos 5.069 registros, edad promedio: 48 ± 18 años, 60% mujeres. Una submuestra de 4.234 cumplió los criterios de la RPC. La muestra expandida (representando 11.279.865 personas) arrojó los siguientes resultados: riesgo Bajo 60,7% (CI 95%, 58-63,4), Medio 31,1% (28,7-33,6) y Alto 8,2% (7-9,5). Riesgo en hombres: Bajo 45,8% (41,7-49,9), Medio 41,1% (37,3-45,1), Alto 13,1% (11-15,5). Riesgo en mujeres: Bajo 74,6% (71,6-77,4), Medio 21,8% (19,4-24,4), Alto 3,6% (2,5-5,1). Observamos un incremento del riesgo Alto de AOS desde 0,3% (0-1,8) en el grupo etario de 18-24 años, a 22,9% (18,4-28,2) en las personas mayores de 65 años. Los hombres con la mayor prevalencia de Alto riesgo de AOS provenían de 7 de las 15 Regiones de Chile: Araucanía (24%), Aysén (21,3%), Coquimbo (18%), Maule (17,8%), Bio-Bío (17%), Arica (16,2%) y O'Higgins (15,7%). Conclusiones: La AOS es una condición prevalente en la población chilena, es mayor en hombres que en mujeres y se observó que el riesgo Alto tiende a aumentar con la edad.

Introduction: Obstructive sleep apnea (OSA) is a neglected chronic disease probably emerging under appropriate epidemiological conditions in Chile. Our goal was to estimate the prevalence of OSA risk in adult population. Patients and Methods: From the 2nd Chilean Health Survey 2010 (NHS), we estimate the prevalence of risk of OSA in population ≥ 18 years, as a derived proxy from STOPBang Questionnaire. A clinical prediction rule-CPR: habitual snoring, daytime sleepiness, nocturnal breathing pauses, blood hypertension, BMI > 35 kg/m2, age > 50 y.o., neck circumference ≥ 43 cm (men) and ≥ 41 cm (women) and male, was constructed. According to the total score subjects were classified as: Low (< 3), Medium (3-4), and High Risk (≥ 5). SPSS Software (v22) modules for complex survey was used to obtain population prevalence and 95% confidence intervals. Results: 5,069 records were obtained, mean age 48 ± 18 years, 60% women. A subsample of 4,234 fulfil the criteria per the CPR. The expanded sample (representing 11,279,865 persons), yielded the following results: Low risk 60.7% (CI 95%, 58-63.4), Medium 31.1% (28.7-33.6) and High 8.2% (7-9.5). Men with Low risk 45.8% (41.7-49.9), Medium 41.1% (37.3-45.1), High 13.1% (11-15.5). Women with Low risk 74.6% (71.6-77.4), Medium 21.8% (19.4-24.4), High 3.6% (2.5-5.1). We observed an increasing trend in High risk of OSA from 0.3% (0-1.8) in 18-24 years old group to a 22.9% (18.4-28.2) in people aged > 65 years old. Men with the highest prevalence of High risk OSA are in 7 of the 15 Regions: Araucanía (24%), Aysén (21.3%), Coquimbo (18%), Maule (17.8%), Bio-Bio (17%), Arica (16,2%) and O'Higgins (15.7%). Conclusion: OSA is a prevalent condition in Chilean Population, is higher in men than in women and a positive age trend of high risk OSA was observed.

Tasa de reingreso no programado en cirugía colorrectal electiva / Hospital readmission rates in complex colorrectal surgery

Background: Non programmed hospital readmission rates are a quality indicator of colorectal surgery. Aim: To analyze the causes of readmission of patients subjected to surgical procedures including intestinal anastomoses. Material and Methods: Analysis of a database of patients subjected to elective intestinal anastomoses in a period of 10 years. All non-programmed readmissions that occurred within 30 days after patient discharge were analyzed. Results: Overall non-programmed readmission rate was 7 percent and it was due to medical causes in 55 percent of patients. Nine percent of readmitted patients required a new surgical intervention. The figure among patients readmitted due to surgical causes, was 20 percent. Sixty one percent of patients were admitted at less than six days after discharge and 84 percent at less than 10 days. A non-programmed readmission duplicated the total hospitalization lapse and triplicated the rates of new surgical procedures. Conclusions: In this series of patients, the only predictor of a non-programmed readmission was the need for reoperation during the first admission.

Antecedentes: La readmisión no programada de un paciente operado es un evento frecuente en la práctica quirúrgica y se considera un indicador de calidad de la atención. El objetivo de este estudio es revisar las causas relevantes de reingreso en nuestro medio, establecer una tasa (TR) que permita una comparación prospectiva de los resultados y, eventualmente, identificar factores de riesgo modificables. Pacientes y Método: Se incluyen todos los pacientes sometidos a cirugía mayor electiva con una anastomosis intestinal en un período de 10 años. Se define como readmisión la re-hospitalización no planificada en el período de 30 días a contar del alta del paciente categorizada como causa médica o quirúrgica. Para el análisis estadístico se empleó el test de regresión logística. Resultados: La TR en la serie fue 7 por ciento (56/791), el 55 por ciento son por causa médica. La tasa de re-operación global durante el reingreso fue 9 por ciento (5/56), cifra que se eleva al 20 por ciento (5/25) en el grupo con alguna causa quirúrgica de re-admisión. El 61 por ciento de los pacientes reingresan antes de los 6 días del egreso y el 84 por ciento antes de los diez días. Un reingreso no planificado duplica el tiempo total de hospitalización (9 vs 19 días; p = 0,001) y casi triplica la tasa de reoperación (p = 0,001). Conclusión: En nuestra serie el único factor de riesgo de un reingreso fue el antecedente de una reoperación durante la cirugía índice. La TR es un indicador complejo y los factores predictivos de una re-hospitalización son motivo de controversia.

Uso de ácido tranexámico en el postoperatorio de cirugía cardiaca / Use of tranexamic acid in postoperative cardiac surgery

El objetivo de este estudio prospectivo, doble ciego y aleatorizado fue evaluar el impacto de la administración de ácido tranexámico (AT) después de cirugía cardiaca con circulación extracorpórea en el sangrado postoperatorio. Material y Método: Durante la inducción de la anestesia los pacientes recibieron un bolo de 10 mg•kg-1 de AT, más 50 mg en el cebado de la máquina de circulación extracorpórea, seguido de una infusión continua de 1 mg•kg-1•h-1 hasta el término de la cirugía. En ese momento los pacientes fueron aleatoriamente distribuidos en 2 grupos: el grupo control recibió 10 ml•h-1 de suero fisiológico, y el grupo de estudio una dosis de 1 mg•kg-1•h-1 de AT, en ambos casos durante el trascurso de 10 horas. El objetivo primario fue observar alguna diferencia en el sangrado durante el primer día de postoperatorio. El objetivo secundario fue observar alguna diferencia en la transfusión de sangre (glóbulos rojos, plaquetas) durante el primer día del postoperatorio y en la incidencia de reoperaciones. Tanto el anestesista como el cirujano fueron ciegos a la distribución de los pacientes en cada grupo. Se utilizó el t-test para el análisis de diferencias en las medias de las variables continuas y el z-test para las proporciones. Se consideró estadísticamente significativo un valor de p < 0,05. Se efectuó análisis de regresión múltiple para encontrar variables capaces de predecir sangrado durante el primer día postoperatorio...

The objective of this prospective, double blind, randomized trial is to evaluate the impact of tranexamic acid (TA) administration after cardiac surgery with cardiopulmonary bypass in postoperative bleeding. Materials and Methods: During induction of general anesthesia, patients received a bolus of TA of 10 mg•kg-1 plus 50 mg in the CPB priming followed by a continuous infusion of 1 mg•kg-1•h-1 until the end of the surgery. Then, patients were randomly allocated into one of two groups: the isotonic saline (IS) group received 10 ml•h-1 of isotonic saline and the TA group received an infusion of 1 mg•kg-1•h-1 of TA. Both groups received their infusions for 10 hours. Primary outcome was bleeding during first postoperative day (POD1). Secondary outcomes were blood transfusion (PRBC, platelets) during POD1 and surgical re-exploration. Anesthesiologists and surgeons were blind to patient allocation. A t-test was used to analyze differences in means of continuous variables and z-test for proportions. A p value < 0.05was considered statistically significant. Multiple regression analysis was performed to find variables able to predict bleeding in the POD1. Results: 273 patients were included, there were 15 lost per group. 125 patients in the TA group and 118 patients in the IS group were analyzed. Both groups were compared in their demographics characteristics, comorbidity and lab tests and no significant differences were found. No statistically significant differences between groups in the primary and secondary outcomes were found. Multiple regression analysis establishes the variable minutes in cardiopulmonary bypass was able to predict bleeding in the POD1. Conclusions: Postoperative infusion of TA does not decrease bleeding, transfusions and re-explorations during the POD1 of cardiac surgery with cardiopulmonary bypass...

Reversión de la anticoagulación en pacientes con dosis altas de heparina: protamina en dosis standard versus dosis reducidas / Reversal anticoagulation in patients with high doses heparin: protamine in standard doses versus small doses

Evaluar y comparar, en pacientes sometidos a circulación extracorpórea (CEC), la reversión de la anticoagulación con dos dosis distintas de protamina: una dada en forma proporcional a la heparina usada versus una dosis calculada según peso del paciente, independiente de la heparina administrada. Material y Método: Se incorporaron los pacientes que para la CEC requirieron una dosis de heparina superior a 300 U•kg-1. Los criterios de exclusión fueron: alteraciones de las pruebas de coagulación preoperatorias y paro circulatorio hipotérmico. La técnica anestésica, el uso de fármacos y el uso de hemoderivados fue de decisión del anestesista. Para la reversión con protamina los pacientes fueron aleatorizados en dos grupos: Grupo A o dosis estándar: Reversión con 0,8 mg protamina por cada 100 U de heparina usada. Grupo B o dosis reducida: Reversión con 2,4 mg protamina•kg-1, independiente de la dosis de heparina usada. La protamina fue preparada por una persona ajena al pabellón y el equipo tratante era ciego al grupo del paciente. El seguimiento de los pacientes las primeras 24 h en UTI fue realizado por una persona ciega al grupo del paciente. Resultados: Hubo solamente una diferencia demográfica: más mujeres en el grupo B (p = 0,029). En el preoperatorio no hubo diferencias en hematocrito, recuento de plaquetas, tratamiento anticoagulante oral (TACO) y heparina preoperatoria, tipo de cirugía y uso de aspirina. En el intraoperatoriono hubo diferencias en el tiempo de coagulación activada (TCA) basal, hematocritos en CEC, TCA en CEC y duración de CEC. La dosis de heparina por kg de peso fue mayor en el grupo B (p = 0,0433). La relación protamina/heparina total fue 0,81 para el Grupo A y 0,44 para el Grupo B, las que fueron diferentes (por el diseño del estudio)...

Objective: To evaluate and compare reversal of anticoagulation with different dose regimens of protamine in patients undergoing to CPB (cardiopulmonary bypass), one given according to the heparin dose administered and another calculated according to patient’s weight. Patients y Methods: Patients subjected to CPB and receiving a heparin dose greater than 300 IU/kg were enrolled. Exclusion criterias were: preoperative coagulopathy and hypothermic circulatory arrest. The anesthetic technic, drugs given and blood products transfusion were decided by the attending anesthesiologist. Patients were randomized to: Group A or standard dose: Reversal with 0.8 mg of protamine for each 100 IU of heparin given. Group B or reduced dose: Reversal with 2.4 mg of protamine per kilogram of patient’s weight, independent of heparin dose used. The protamine was prepared for a person blinded to group allocation, same as the team taking care of the patient. The patient’s follow up in the ICU during the first 24 hours was also done by someone blinded to group allocation. Results: There was only one demographic difference at baseline: more women in Group B (p = 0.029). There were no differences among the preoperative: hematocrit, platelets count, oral anticoagulant treatment, heparin administration, aspirin consumption and surgical plan. In the intraoperative course there were no differences in the baseline ACT, hematocrit during CBP, ACT in CBP and CBP duration. The average heparin dose (adjusted per kilogram) was greater in Group B (p = 0.0433).The protamine/heparin ratios were different among groups (Group A 0.81; Group B 0.44), as expected in this study design. The activated coagulation time (ACT)...

Impacto de la contaminación del aire por PM10 sobre la mortalidad diaria en Temuco / Impact of air pollution by fine particulate matter (PM10) on daily mortality in Temuco, Chile

Background: Temuco (304,000 inhabitants) has high levels of air pollution, mainly due to fine particulate matter of less than 10 µm (PM10). The effects of this pollution on population health have not been studied. Aim: To study the short-term effects of PM10 on daily mortality in Temuco, in Southern Chile, due to respiratory and cardiovascular causes. Material and methods: We followed the APHEA methodology (Air Pollution and Health European Approach) by estimating poisson multivariate regression models and controlling by trends, seasonality and meteorology. The PM10 variable was introduced after controlling by the confounders and checking by statistical adjustment and autocorrelation of errors. Mortality data was obtained from the Ministry of Health, registering age, gender, place of residence and cause of death. Cancer, respiratory and cardiovascular deaths, occurring between 1997 and 2002, were recorded for this study. Results: There was a significant and positive association between PM10 concentration and daily mortality caused by respiratory disease (p-value=0.046, relative risk (RR) 1.236, 95% confidence interval (CI) 1.004-1.522) and cardiovascular diseases in people aged 65 years and more (p-value=0.042; RR 1.176 95% CI 1.006-1.374). Conclusions: There is a significant association between daily air pollution by PM10 particulate matter and mortality in Temuco, Chile.

Mortalidad diaria en Santiago y su relación con la contaminación del aire / Daily mortality in Santiago and its relationship with air pollution

Background: Santiago de Chile, due to meteorological and topographic factors, is one of the most polluted cities in the world. The adverse effects of contamination on health are relatively well known, but they may be overvalued. Aim: To evaluate the short term effects of exposure to air pollution on mortality of people over 65 years old. Material and methods: Daily mortality data in Santiago, from 1988 to 1993, was obtained from the National Statistics Institute. Daily concentrations of contaminants in Santiago and meteorological variables, were obtained from SESMA the Metropolitan Envinonmental Health Services. An association between contamination and mortality due to respiratory or cardiovascular diseases in subjects over 65 years old was searched, using temporal series analysis. Results: There was a significant association between air pollution, meteorological variables on the same and previous days and mortality. PM10 had the strongest association with mortality. The relative risk of a 100 µg/m3 increment in PM10 was 1.052 for the elderly, 1.025 for cardiovascular and 1.061 for respiratory mortality. The relative risk of SO2 was 1.006 for all deaths and 1.017 for respiratory deaths. The figures for O3 were 1.015 for all deaths and 1.008 for cardiovascular deaths. Conclusions: This work confirms a consistent association between air pollution and daily mortality, specially for particulate matter, even for levels below Chilean norms