Experiência e representação da escuta de vozes na expressão cotidiana / Experiencia y representación de escuchar voces y el expressión cotidiana / Experience and representation of hearing voices in the everyday expression

RESUMO. Escutar vozes ainda é considerado por profissionais da saúde como alucinação auditiva, uma experiência perturbadora que ocorre em condições de doença, reconhecida como uma sintomatologia psicopatológica de alteração da realidade. Entretanto, esta postura dificulta o acolhimento da pessoa que vivencia este fenômeno. O objetivo deste estudo foi de conhecer na literatura científica sobre a experiência e a representação da escuta de vozes na expressão cotidiana. O método utilizado foi de revisão narrativa, em fontes pesquisadas em periódicos. Encontramos 30 artigos em português e inglês, no período de 2003 a 2018, utilizando os descritores saúde mental, esquizofrenia, ouvidores de vozes e cotidiano. Os dados foram organizados em uma planilha temática e analisados com foco na narrativa da linguagem e apresentados descritivamente. A literatura estudada apresentou dois tipos de representação da escuta de vozes: a caracterização e tipologia da vivência, e como processo subjetivo de uma experiência biográfica. Entre os resultados identificamos a caracterização da experiência de ouvir vozes associada a vivências traumáticas e com consequências nas atividades laborativas, como o trabalho e a vida social, com um cotidiano ausente de papéis ocupacionais, reconhecendo esta pessoa apenas pela sua condição de doença mental. Ressaltamos a necessidade de estudos empíricos que abordem a compreensão da escuta de vozes, com foco fenomenológico da experiência do mundo da vida das pessoas, para a compreensão do reconhecimento no cotidiano de papéis ocupacionais, como também auxiliar nas práticas terapêuticas no cuidado em saúde mental.

RESUMEN. Los profesionales de la salud todavía consideran que escuchar voces es una alucinación auditiva, una experiencia perturbadora que ocurre en condiciones de enfermedad, reconocida como un síntoma psicopatológico de alteración de la realidad. Tal posición hace que sea difícil aceptar la experiencia del oyente de voz. Sin embargo, esta postura dificulta la recepción de la persona que experimenta este fenómeno. El objetivo de este estudio fue indagar en la literatura científica sobre la experiencia y representación de escuchar voces en la expresión cotidiana. El método utilizado fue la revisión narrativa, de fuentes investigadas en revistas. Encontramos 30 artículos en portugués e inglés, de 2003 a 2018, usando las palabras clave salud mental, esquizofrenia, oyentes y la vida cotidiana. Los datos se organizaron en una hoja de cálculo temática y se analizaron con un enfoque en la narrativa del lenguaje y se presentaron descriptivamente. La literatura estudiada presenta dos tipos de representación de la escucha de voces: la caracterización y tipología de la experiencia, y como el proceso subjetivo de una experiencia biográfica. Entre los resultados, identificamos la caracterización de la experiencia de escuchar voces asociadas con experiencias traumáticas y con consecuencias en las actividades laborales, como el trabajo y la vida social, con una ausencia diaria de roles ocupacionales, reconociendo a esta persona solo por su condición de enfermedad mental. Hacemos hincapié en la necesidad de estudios empíricos que aborden la comprensión de escuchar voces, con un enfoque fenomenológico en la experiencia de las personas del mundo de la vida, para comprender el reconocimiento de los roles ocupacionales en la vida cotidiana, así como ayudar en las prácticas terapéuticas en la atención de la salud mental.

ABSTRACT. Hearing voices is still considered by health professionals as auditory hallucination, a disturbing experience that occurs in conditions of illness, recognized as a psychopathological symptom of altering reality. Such a position makes it difficult to accept the voice hearer's experience. However, this posture makes it difficult to reception the person who experiences this phenomenon. The objective of this study was to find out in the scientific literature about the experience and representation of hearing voices in everyday expression. The method used was narrative review, from sources researched in periodical. We found 30 articles in Portuguese and English, from 2003 to 2018, using the keywords mental health, schizophrenia, voice hearers and everyday life. The data were organized in a thematic spreadsheet and analyzed with a focus on the language narrative and presented descriptively. The studied literature presented two types of representation of hearing to voices: the characterization and typology of the experience, and as the subjective process of a biographical experience. Among the results, we identified the characterization of the experience of hearing voices associated with traumatic experiences and with consequences in work activities, such as work and social life, with a daily absence of occupational roles, recognizing this person only because of his condition of mental illness. We emphasize the need for empirical studies that address the understanding of hearing to voices, with a phenomenological focus on people's experience of the world of life, for an understanding of the recognition of occupational roles in everyday life, as well as assisting in therapeutic practices in mental health care.

Análisis mediante variables instrumentales para establecer causalidad en investigaciones observacionales / Analysis through instrumental variables to establish causality in observational research

La identificación de relaciones causales es uno de los problemas fundamentales de la investigación científica en medicina y es necesaria para poder ejercerla en forma efectiva. Sin embargo, desde el punto de vista práctico es difícil establecer la existencia de relaciones causales en estudios de carácter observacional, en gran parte por la presencia de factores de confusión. El análisis a través de variables instrumentales es una de las estrategias que permite controlar el efecto confundidor y documentar la presencia de relaciones causa-efecto en estas situaciones. En este artículo, el autor resume los principales supuestos del análisis a través de variables instrumentales, haciendo foco en la aleatorización mendeliana. (AU)

The identification of causal relationships is one of the fundamental challenges in scientific research in medicine and is necessary for its effective practice. However, from a practical standpoint, establishing the existence of causal relationships in observational studies is difficult, largely due to the presence of confounding factors. Analysis through instrumental variables is one of the strategies that allows to control the confounding effect and documenting the presence of cause-and-effect relationships in these situations. In this article, the author summarizes the main assumptions of analysis through instrumental variables, with a focus on Mendelian randomization. (AU)

Sesgos en investigación quirúrgica / Biases in surgical research

Resumen Los resultados de diversos hallazgos de investigación han sido objeto de crítica, en especial en los últimos años, debido a presencia de errores sistemáticos (sesgos), los que ponen en duda la validez interna de los resultados obtenidos. Estos sesgos pueden ocurrir en cualquier etapa del curso de una investigación, es decir, desde la planificación del estudio hasta la presentación y publicación de sus resultados. Los sesgos se han clasificado de diferentes formas, intentado agruparlos bajo dimensiones conceptuales, objeto de organizar de mejor forma la información existente, que además es considerable. Los sesgos pueden ocurrir por diversos motivos, pero en general, los más frecuentes son aquellos originados por el observador (él o los que miden), por lo que es observado (sujeto en estudio); y aquello con lo que se observa (instrumento de medición). Por otra parte, varios de los múltiples sesgos existentes, se pueden agrupar en: sesgos de selección, de medición o información, y de confusión. El objetivo de este manuscrito fue comentar la importancia de los sesgos más comunes en la investigación quirúrgica, y su relación con algunos diseños de investigación; así como, conocer las estrategias existentes para minimizar su ocurrencia.

The results of many research findings have come under scrutiny in recent years due to the introduction of systematic errors (biases), which can occur at any stage during an investigation, from planning to presentation of results and their presentation and further publication. Biases have been classified in different ways, trying to group them under conceptual dimensions to better organize the existing information, which is considerable. Biases can occur for various reasons, but in general, the most frequent are those originated by the observer, what is observed; and what is observed with. I.e., the subject that is measured, who measures it and with what it measures it. On the other hand, several of the multiple biases can be grouped into selection, measurement or information, and confounding biases. The aim of this manuscript was to comment on the importance of the most common biases in surgical research, and their relationship with some research designs; as well as know the existing strategies to reduce its occurrence.

Clinical study on the predictive value of regional cerebral oxygen saturation for the occurrence of sepsis-associated encephalopathy / 中华危重病急救医学

Objective:To evaluate the predictive value of regional cerebral oxygen saturation (rScO 2) for the occurrence of sepsis-associated encephalopathy (SAE). Methods:The data of 94 patients with sepsis admitted to the intensive care unit of Nanjing Drum Tower Hospital from September 2019 to June 2021 were collected. The patients were divided into SAE group and non-SAE group according to the evaluation results of daily intensive care unit confusion assessment method (CAM-ICU) during ICU treatment. The general data such as age and gender of the patients, rScO 2 on 1, 2, 3, 5, and 7 days of ICU admission, and prognostics were recorded. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of rScO 2 on SAE during ICU stay. Results:All 94 patients were enrolled in the analysis, of whom 59.6% (56/94) were male, and the mean age was (50.1±15.1) years old; the incidence of SAE was 31.9% (30/94). The levels of rScO 2 within first 3 days of ICU admission in the SAE group were significantly lower than those in the non-SAE group (1 day: 0.601±0.107 vs. 0.675±0.069, 2 days: 0.592±0.090 vs. 0.642±0.129, 3 days: 0.662±0.109 vs. 0.683±0.091, all P < 0.05). However, there was no significant difference in rScO 2 level on the 5th or the 7th day between the SAE and non-SAE groups (5 days: 0.636±0.065 vs. 0.662±0.080, 7 days: 0.662±0.088 vs. 0.690±0.077, both P > 0.05). ROC curve analysis showed that 1-day rScO 2 had the greatest predictive value for SAE [1 day: area under the ROC curve (AUC) = 0.77, 95% confidence interval (95% CI) was 0.65-0.89, P < 0.01; 2 days: AUC = 0.60, 95% CI was 0.48-0.72, P > 0.05; 3 days: AUC = 0.55, 95% CI was 0.41-0.68, P > 0.05]; with 1-day rScO 2 = 0.640 as the diagnostic threshold, the sensitivity was 73.4%, the specificity was 80.0%. Compared with the non-SAE group, the length of ICU stay and hospital stay in the SAE group were significantly longer [length of ICU stay (days): 13.6±7.1 vs. 9.0±4.3, length of hospital stay (days): 20.1±8.0 vs. 15.8±6.1, both P < 0.05], but the ICU mortality between the two groups was not statistically different. Conclusions:The incidence of SAE is relatively high in ICU patients, and the occurrence of SAE can be predicted by monitoring rScO 2. The rScO 2 value on the first day of ICU admission is closely related to the occurrence of SAE, and may be the target of sepsis resuscitation to guide the treatment and improve the long-term prognosis.

Working in the time of COVID-19: Rehabilitation clinicians' reflections of working in Gauteng's public healthcare during the pandemic

Background: When the coronavirus disease 2019 (COVID-19) pandemic manifested in South Africa, rehabilitation services were seriously affected. The consequences of these were wide-ranging: affecting service users, their families and caregivers, rehabilitation practices and practitioners as well as the integrity and sustainability of rehabilitation systems. Objectives: This study aimed to explore the nature and consequences of disruption caused by the pandemic, based on the experience of rehabilitation clinicians who were working in public healthcare facilities in Gauteng. Methods: This was a phenomenology study that used critical reflection method. Trained and experienced in reflecting on barriers and enablers that affect their practices, a multidisciplinary group of rehabilitation clinicians captured their experience of working during the time of COVID-19. Data construction extended over 6 months during 2020. An inductive thematic analysis was performed using Taguette: an open-source qualitative data analysis tool. Results: The main themes captured the disorder and confusion with its resultant impact on rehabilitation services and those offering these services that came about at the beginning of the pandemic. The importance of teamwork and leadership in rehabilitation also emerged as themes. Other themes related to having to approach work differently, working beyond professional scopes of practice and pandemic fatigue. Conclusion: The COVID-19 pandemic disrupted the way rehabilitation was being performed, creating an opportunity to reconceptualise, strengthen and improve rehabilitation services offered at public healthcare. The presence of effective leadership with clear communication, dependable multidisciplinary teams and clinicians with robust personal resources were strategies that supported rehabilitation clinicians whilst working during COVID-19.

Sintomatología no respiratoria de COVID-19 / Non-respiratory symptoms of COVID-19

La sintomatología usual de COVID-19 incluye fiebre, dolor de garganta, tos seca, fatiga, dolores musculares, anosmia e hipogeusia. Al desarrollar neumonía los pacientes usualmente presentan disnea. La sintomatología atípica de la enfermedad, la cual es basta, no se ha narrado ampliamente. Esta incluye sintomatología del sistema nervioso, como agitación, confusión e incluso convulsiones; de aparato ocular, como la conjuntivitis y la epifora; del sistema auditivo, como la pérdida auditiva neurosensorial; de la piel, como son eritema con vesículas o pústulas (pseudo eritema pernio o pseudo-sabañones), otras erupciones vesiculares, lesiones urticariales, erupciones maculopapulares y la livedo o necrosis; del sistema cardíaco, como el daño agudo al miocardio y las arritmias; del sistema gastrointestinal, como las náuseas, el vómito y la diarrea; con el hecho epidemiológico importante que el 50 % de los individuos con diarrea excretan al virus en sus heces; del sistema renal, donde del 3 al 44 % de los individuos con neumonía grave por COVID-19 presentan daño renal agudo; del sistema hematológico, el cual presenta un estado de hipercoagulabilidad que pone en riesgo de trombosis a los pacientes con neumonía por COVID-19; y, finalmente, el síndrome inflamatorio multisistémico en niños y adolescentes, asociado a SARS-CoV-2

The usual symptoms of COVID-19 include fever, sore throat, dry cough, fatigue, muscle aches, anosmia, and hypogeusia. When developing pneumonia, patients usually have dyspnea. The atypical symptomatology of the disease, which is coarse, has not been widely reported. This includes symptoms of the nervous system, such as agitation, confusion and even seizures; ocular apparatus, such as conjunctivitis and epiphora; the auditory system, such as sensorineural hearing loss; of the skin, such as erythema with vesicles or pustules (pseudo erythema pernio or pseudo-chilblains), other vesicular eruptions, urticarial lesions, maculopapular eruptions and livedo or necrosis; of the heart system, such as acute myocardial damage and arrhythmias; from the gastrointestinal system, such as nausea, vomiting, and diarrhea; with the important epidemiological fact that 50% of individuals with diarrhea excrete the virus in their feces; from the renal system, where 3 to 44% of individuals with severe COVID-19 pneumonia have acute kidney damage; of the hematological system, which presents a state of hypercoagulability that puts patients with COVID-19 pneumonia at risk of thrombosis; and, finally, the multisystemic inflammatory syndrome in children and adolescents, associated with SARS-CoV-2

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation / Diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos: validação de conteúdo diagnóstico / Diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores: validación del contenido diagnóstico

ABSTRACT Objective: To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. Methods: We used a Diagnostic content validation using an online survey of expert clinical nurses. Results: 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. Conclusion: The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

RESUMO Objetivo: Validar as características definidoras dos diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos, testando as definições dos diagnósticos entre enfermeiros especialistas. Método: Validação de conteúdo diagnóstico utilizando um questionário online para enfermeiros clínicos especialistas. Resultados: 195 enfermeiras especialistas realizaram as validações diagnósticas. Os resultados demonstraram a validade de memória prejudicada com 11 características definidoras principais, e confusão crônica com 11 características definidoras principais e uma secundária. Em ambos os diagnósticos, o índice de validade de conteúdo foi de 0,85. A análise fatorial forneceu quatro para memória prejudicada e cinco fatores para confusão crônica. Conclusão: O estudo forneceu evidências de validade dos dois diagnósticos, tornando-os mais claros. Por meio do uso desses diagnósticos de enfermagem atualizados, os enfermeiros podem melhorar a precisão e a qualidade do atendimento a pacientes idosos, contribuindo para um cuidado gerontológico de enfermagem mais preciso.

RESUMEN Objetivo: Validar las características que definen los diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores, testeando las definiciones de los diagnósticos entre enfermeros especialistas. Método: Se trata de una validación del contenido diagnóstico realizado mediante un cuestionario en línea para enfermeros clínicos especialistas. Resultados: Las validaciones de diagnóstico las llevaron a cabo 195 enfermeras especialistas. Los resultados demostraron la validez del deterioro de la memoria con 11 características principales definidoras y la confusión crónica, con 11 principales definidoras y una secundaria. En ambos diagnósticos, la tasa de validez del contenido fue de 0,85. El análisis factorial proporcionó cuatro factores para el deterioro de la memoria y cinco para la confusión crónica. Conclusión: El estudio trajo evidencias de la validez de los dos diagnósticos y los dejó más claros. Al valerse de estos diagnósticos actualizados, los enfermeros pueden mejorar la precisión y la calidad de la atención de los pacientes adultos mayores y contribuir aún más con el cuidado gerontológico de enfermería.

COVID-19: The Ivermectin African Enigma / COVID-19: El enigma de la Ivermectina en Africa

Abstract Introduction: The low frequency of cases and deaths from the SARS-CoV-2 COVID-19 virus in some countries of Africa has called our attention about the unusual behavior of this disease. The ivermectin is considered a drug of choice for various parasitic and viral diseases and shown to have in vitro effects against SARS-CoV-2. Aims: Our study aimed to describe SARS-CoV2 infection and death rates in African countries that participated in an intensive Ivermectin mass campaign carried out to control onchocerciasis and compare them with those of countries that did not participate. Methods: Data from 19 countries that participated in the World Health Organization (WHO) sponsored African Programme for Onchocerciasis Control (APOC), from 1995 until 2015, were compared with thirty-five (Non-APOC), countries that were not included. Information was obtained from https://www.worldometers.info/coronavirus/ database. Generalized Poisson regression models were used to obtain estimates of the effect of APOC status on cumulative SARS-CoV-2 infection and mortality rates. Results: After controlling for different factors, including the Human Development Index (HDI), APOC countries (vs. non-APOC), show 28% lower mortality (0.72; 95% CI: 0.67-0.78) and 8% lower rate of infection (0.92; 95% CI: 0.91-0.93) due to COVID-19. Conclusions: The incidence in mortality rates and number of cases is significantly lower among the APOC countries compared to non-APOC countries. That a mass public health preventive campaign against COVID-19 may have taken place, inadvertently, in some African countries with massive community ivermectin use is an attractive hypothesis. Additional studies are needed to confirm it.

Resumen Introducción: La baja frecuencia de casos y muertes por el virus SARS-CoV-2 COVID-19 en algunos países de África llamó nuestra atención sobre el comportamiento inusual de esta enfermedad. La ivermectina se considera un fármaco de elección para diversas enfermedades parasitarias y virales, y se ha demostrado que tiene efectos in vitro contra el SARS-CoV-2. Objetivos: Nuestro estudio tiene el objetivo describir las tasas de infección y mortalidad del SARS-CoV-2 en los países africanos que participaron en una campaña intensiva masiva de ivermectina para el control de la oncocercosis y compararlas con las de los países que no participaron. Métodos: Los datos de 19 países que participaron en el Programa Africano para el Control de la Oncocercosis (APOC) patrocinado por la Organización Mundial de la Salud (OMS), desde 1995 hasta 2015, se compararon con 35 países que no fueron incluidos (NO APOC). La información sobre casos y muertes por COVID-19 se obtuvo de la base de datos https://www.worldometers.info/coronavirus/. Se utilizaron modelos de regresión de Poisson para obtener estimaciones del efecto del estado APOC sobre las tasas acumuladas de infección y mortalidad por SARS-CoV-2. Resultados: Después de controlar diferentes factores, incluido el Índice de Desarrollo Humano (IDH), los países APOC (frente a los no APOC) mostraron una mortalidad 28% menor (razón de tasas ajustada: RR= 0.72, IC 95%: 0.67-0.78) y una tasa de infección 8% menor (RR= 0.92, IC 95%: 0.91-0.93) por COVID-19. Conclusiones: Las tasas de mortalidad e infección son significativamente más bajas en países APOC en comparación con los países no APOC. Una campaña preventiva masiva de salud pública contra el COVID-19 pudo haber tenido lugar inadvertidamente en algunos países africanos con un uso masivo de ivermectina en la comunidad es una hipótesis atractiva. Se necesitan estudios adicionales para confirmarlo.

Serie de Redacción Científica: Estudio de Casos y Controles / Scientific Writing Series: Case-Control studies

Introducción: Un estudio de casos y controles es un estudio en el que se compara individuos que tuvieron un desenlace de interés o outcome (casos) versus individuos que no tuvieron dicho resultado (controles) con respecto a la exposición de interés, potencialmente un "factor de riesgo" o "factor de protección". El objetivo de un estudio de casos y controles es primariamente determinar si existe asociación entre una exposición (o varias) y un desenlace de interés. Esta asociación debe ser cuantificada y reportada como un odds ratio o razón de momios teniendo en cuenta sus fortalezas y limitaciones. En general, este tipo de estudios ofrece como ventajas su relativo bajo costo y rapidez con la que es posible realizarlos. Sin embargo, no son idóneos si lo que se quiere investigar son desenlaces de interés frecuente o con periodos de latencia largos. En el presente artículo se han revisado las principales consideraciones metodológicas del diseño de los estudios de casos y controles esperando con ello contribuir objeto de promover su correcta utilización e interpretación.

Introduction: A case-control study is a study comparing individuals who had an outcome of interest (cases) versus individuals who had no such outcome (controls) with respect to the exposure of interest, potentially a "risk factor "or" protection factor." The objective of a case-control study is primarily to determine if there is an association between one exposure (or several) and an outcome of interest. This association must be quantified and reported as an odds ratio or odds ratio taking into account its strengths and limitations. In general, this type of study offers as advantages its relatively low cost and speed with which it is possible to carry them out. However, they are not ideal if what you want to investigate are frequent outcomes or with long latency periods. In this article, the primary methodological considerations of the design of case-control studies have been reviewed, hoping thereby to contribute to promoting their correct use and interpretation.

Metodologías Cuantitativas 2: Sesgo de confusión y cómo controlar un confusor / Quantitative Methodologies 2: Confusion bias and how to control a confounding factor

Identificar el sesgo de confusión y cómo controlarlo es uno de los desafíos metodológicos más importantes en el diseño de estudios que buscan identificar la causalidad. Este sesgo está presente en cualquier análisis de la asociación entre una exposición y un resultado de interés, una asociación que puede estar sesgada o no por una tercera variable llamada confusor. Podemos diagnosticar un confusor en todos los casos en los que este crea una asociación espuria entre una variable de exposición o variable independiente y la variable de resultado o variable dependiente. Para controlar el sesgo de confusión, podemos usar diferentes métodos. Estos incluyen aquellas técnicas aplicadas en el diseño del estudio, tales como restricción, aleatorización y coincidencia, y aquellas técnicas empleadas en el análisis de datos, como la estratificación, el análisis multivariado, la estandarización, los puntajes de propensión, el análisis de sensibilidad y el inverso ponderación de probabilidad. En esta revisión, analizamos cómo identificar una variable de confusión y las principales técnicas para controlar el sesgo de confusión.

Addressing confounding bias is one of the challenges when conducting causality studies. This occurs when we report a causal association between an exposure and an outcome, when in fact it could be result of the effect of a third factor called confounding variable. That is, when a confounder variable creates a spurious relationship between the exposure or independent variable and the outcome of interest or dependent variable. By knowing the confounding variables and their association with the exposure of interest, the confounding bias could be controlled. To control for confounding bias, we can use different methods. These include techniques applied in study design, such as restriction, randomization, and coincidence, and techniques used in data analysis, such as stratification, multivariate analysis, standardization, propensity scores, analysis sensitivity and the inverse probability weighting. In this review, we discuss how to identify a confounding variable and the main techniques for controlling for confounding bias.

Intra-psychic disarray of gender identity and sexual orientation: in the process of coming out as transsexual

The present paper takes a step towards understanding the confusion that a transgender individual undergoes, while coming in terms with one抯 gender identity. Here, we will be presenting a case study with few anecdotes to put forward concepts of negotiation, self-understanding, and disclosure. We will refer to the individual as 慼im� as the person identifies himself as a male and is in the process of transition. Here, we have introduced the coming out process as a one-way and two-way process.

Hallazgos estructurales en imágenes cerebrales de pacientes con diagnóstico de delirium en un hospital de alta complejidad de Bogotá / Structural findings in cerebral images of patients with diagnosis of delirium in a high-complexity hospital in Bogota

RESUMEN INTRODUCCIÓN: El delirium es una falla cerebral de origen multifactorial, común, y en ocasiones relacionada con un desenlace fatal. Afecta principalmente a la población hospitalizada mayor de 65 años. La realización de imágenes cerebrales en delirium se encuentra en discusión, porque en la mayoría de los casos no se pone en evidencia una correlación entre los hallazgos de la imagen y la enfermedad. La literatura médica actual muestra que las imágenes de rutina (tomografía o resonancia cerebral) resultan negativas para lesiones agudas hasta en el 94 % de los pacientes que cumplen criterios diagnósticos. En Colombia no hay estudios descriptivos en pacientes que presenten delirium. Por lo anterior, nuestra idea es describir los principales hallazgos radiológicos en imagen cerebral en pacientes con diagnóstico de delirium en urgencias u hospitalización en un hospital de alta complejidad de Bogotá, valorados por el departamento de neurología. MÉTODOS: Se realizó un estudio de corte transversal que incluyó a los pacientes con diagnóstico de delirium atendidos por neurología en hospitalización o urgencias entre octubre del 2015 y octubre del 2016. RESULTADOS: Se incluyeron 97 pacientes y se realizaron imágenes cerebrales a 79 (81 %). De estos, tan solo en ocho (10 %) se encontró lesión aguda en imágenes cerebrales. En los pacientes que tienen signos de focalización este porcentaje aumentó a tres pacientes (27 %), y en los que no tenían signos de focalización fue de cinco pacientes (7,3 %). CONCLUSIONES: La presencia de lesiones cerebrales agudas en pacientes con delirium es baja. El hecho de tener signos de focalización en el examen aumenta la posibilidad de tener lesiones agudas.

SUMMARY INTRODUCTION: Delirium is a brain failure of multifactorial origin, common and sometimes related to a fatal outcome. It mainly affects hospitalized population over 65 years. Work-up with cerebral images is in discussion, because in most of of the occasions it is not related to the pathology. Current medical literature shows that routine imaging (tomography or brain resonance) are negative for acute injuries in up to 94 % of patients that meets delirium diagnostic criteria. In Colombia there are no descriptive studies in patients with delirium. Therefore, our objective was to describe the main radiological findings in brain imaging in patients diagnosed with delirium in the emergency room or admitted subjects in a high complexity hospital in Bogotá-Colombia, assessed by the department of neurology between October 2015 and October 2016. METHODS: A cross-sectional study was carried out, including all patients diagnosed with delirium treated by neurology in hospitalization or emergencies. RESULTS: This research showed a total of 97 patients diagnosed with delirium; 79 (81 %) had brain images; of these, only 8 (10 %) showed acute injury in brain images, in patients who have signs of focalization this percentage was higher to 3 (27 %) than in those who did not have them 5 (7.3 %). CONCLUSIONS: The presence of acute brain injuries in patients with delirium is low. The fact of having signs of focal injury on examination increases the possibility of having acute injuries.

Serie de Redacción Científica: Estudios Trasversales / Scientific Writing Series: Cross-Sectional studies

Los estudios transversales se caracterizan por la medición simultánea de la exposición y el outcome de interés. Son el diseño idóneo para estimar prevalencias, analizar la precisión diagnóstica de una prueba y validar instrumentos, para lo cual es esencial controlar los sesgos de información, selección y confusión ya sea por diseño o por análisis. Asimismo, es crucial escoger la medida de asociación idónea para cada outcome de interés, llámese el odds ratio para eventos raros y la razón de prevalencias para los eventos frecuentes. Finalmente, para su redacción y publicación se recomienda revisar las guías STROBE y STARD

Cross-sectional studies are characterized by the simultaneous measurement of exposure and the outcome of interest. They are the ideal design to estimate prevalence, analyze the diagnostic accuracy of a test and validate instruments, for which it is essential to control information bias, selection, and confusion either by design or by analysis. It is also crucial to choose the appropriate association measure for each outcome of interest, call the odds ratio for rare events, and the prevalence ratio for frequent events. Finally, for its writing and publication, it is recommended to review the STROBE and STARD guidelines

A study of etiological profile of acute confusional state

Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77�.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6�67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.

Visual processing of color and shape in people with leprosy

Abstract The aim of this study was to analyze the contrast sensitivity of spatial luminance and the color discrimination thresholds of the protan, deutan, and tritan axes of people with leprosy. This study included 8 subjects with leprosy (M = 4, W = 4, M = 33.38 ± 8.7) and 8 healthy subjects (M = 4, W = 4, M = 30.89 ± 5.8). The contrast sensitivity was evaluated by the Metropsis software version 11.0 with vertical sinusoidal grids of frequencies of 0.2, 0.5, 1, 5, 10, and 16 cycles per degree of visual angle (cpd) and color vision by the desaturated Lanthony D15 tests and the trivector and ellipse protocols of the Cambridge Color Test. The results showed significant differences between the groups in the processing of spatial frequencies of 0.2 (U = 14; p = .018); 5.0 (U = 45.0; p = .001); 10.0 (U = 45.0; p = .001), and 16.0 (U = 45.0; p = .001) cpd. The difference in color recognition through D15d (U = 4.0; p = .002). Ellipse 2 (U = 10.0; p = .012) and ellipse 3 (U = 9.0; p = .009) were discriminated against. Overall, the results indicate that leprosy changes the visual processing of low, medium, and high spatial frequencies, as well as the sensitivity of the short wavelength (tritan line of confusion) and long (protan line of confusion) cones.

Lost in Translation: Sesgos y la información en la pandemia de COVID-19 / Lost in Translation: Biases and information in the COVID-19 pandemic

The COVID-19 pandemic has produced an endless stream of information in relation to data, analysis and projections of all aspects of this disease. One of the characteristics of scientific information is that it is full of uncertainties, which are not correctly disclosed to the general population. In this essay, we describe the main cognitive biases that cause people to modify their perception of risk, where the most important are memory, novelty, and emotionality or affection. In addition, we review frequent errors that have been made in terms of collection, dissemination and analysis of information by scientific communicators, experts in other areas and the media in general. Ideally, these biases and confounders should be known to all who participate in the flow of information on the health problems of this pandemic, in order to integrate the uncertainty inherent in the data and the critical analysis of the information received.

La pandemia COVID-19 ha producido un caudal interminable de información en relación a datos, análisis y proyecciones de todos los aspectos de esta enfermedad. Una de las características de la información científica es que está llena de incertidumbres, las que no se divulgan correctamente a la población general. En este ensayo, hacemos una descripción de los principales sesgos cognitivos que hacen que las personas modifiquen su percepción de riesgo donde los más importantes son el de memoria, de novedad y emocionalidad o afecto. Además, revisamos errores frecuentes que se pueden cometer en términos de recolección, difusión y análisis de la información de parte de comunicadores científicos, expertos en otras áreas y medios de comunicación en general. Idealmente, estos sesgos y confundentes deben ser conocidos por todos los que participan en el flujo de información de los problemas de salud de esta pandemia, de manera de poder integrar la incertidumbre inherente a los datos y el análisis crítico de la información que se recibe.

Métodos actuales para asegurar la validez de los estudios de causalidad en Medicina / Current methods to assure the validity of the causality studies in Medicine

RESUMEN Fundamento: Los estudios de causalidad deben aportar resultados certeros, lo cual depende de la adecuación de los mismos, de ahí la necesidad de conocer los métodos que aseguren la validez de estas investigaciones. Objetivo: Sistematizar los métodos actuales para el estudio de causalidad en Medicina que incluye el diseño, los requerimientos que aseguran su validez y los métodos para el cumplimiento de estos requerimientos. Desarrollo: Se realizó una revisión bibliográfica en bases de datos biomédicas, se seleccionó la literatura de mayor actualidad, integralidad y cientificidad con la cual se organizó una síntesis crítica, a la que se le agregó la experiencia de las autoras. Se presentan técnicas para la detección y tratamiento de la confusión y la interacción y para garantizar la comparabilidad entre grupos. Entre las técnicas se destacan la aleatorización mendeliana, el puntaje de susceptibilidad, los G-métodos, los modelos estructurales marginales y anidados, la lógica difusa y el análisis estadístico implicativo. Conclusiones: A pesar del avance en los métodos estadísticos es el investigador el encargado de garantizar la no confusión residual y discernir entre lo estadísticamente significativo y lo clínicamente aceptable.

ABSTRACT Background: Causality studies must provide accurate results, which depends on their adequacy, therefore the need of knowing the methods that ensure the validity of these investigations. Objective: To systematize the current methods for the study of causality in Medicine that includes the design, the requirements that ensure its validity and the methods for complying with these requirements. Development: It was carried out a bibliographic review in biomedical databases and selected the most current, comprehensive, scientific literature, with this, a critical synthesis was organized, with the experience of the authors. Techniques for the detection and treatment of confusion and interaction were presented, also to ensure comparability between groups. Among the techniques, Mendelian randomization, susceptibility score, G-methods, marginal and nested structural models, fuzzy logic and implicative statistical analysis stand out. Conclusions: Despite the progress in statistical methods, the researcher is responsible for guaranteeing residual non-confusion and distinguishing between statistically significant and clinically acceptable.

A Fuzzy Rule-Based Model for Remote Monitoring of Preterm in the Intensive Care Unit of Hospitals

The use of Remote patient monitoring (RPM) systems to monitor critically ill patients in the Intensive Care Unit (ICU) has enabled quality and real-time healthcare management. Fuzzy logic as an approach to designing RPM systems provides a means for encapsulating the subjective decision-making process of medical experts in an algorithm suitable for computer implementation. In this paper, a remote monitoring system for preterm in neonatal ICU incubators is modeled and simulated. The model was designed with 4 input variables (body temperature, heart rate, respiratory rate, and oxygen level saturation), and 1 output variable (action performed represented as ACT). ACT decides whether an alert is generated or not and also determines the message displayed when a notification is required. ACT classifies the clinical priority of the monitored preterm into 5 different fields: code blue, code red, code yellow, code green, and code black. The model was simulated using a fuzzy logic toolbox of MATLAB R2015A. About 216 IF_THEN rules were formulated to monitor the inputs data fed into the model. The performance of the model was evaluated using the confusion matrix to determine the model’s accuracy, precision, sensitivity, specificity, and false alarm rate. The experimental results obtained shows that the fuzzy-based system is capable of producing satisfactory results when used for monitoring and classifying the clinical statuses of neonates in ICU incubators.

The Use of Medicines with Anti-cholinergic Properties and Their Health Impacts among Hospitalised Malaysian Geriatric Patients

@#Background: Studies have shown that the use of medicines with anti-cholinergic (Ach) properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known about the use of medicines with Ach properties and their impact on Malaysian elderly patients. This study aimed to investigate the use of medicines with Ach properties and their impact on fall risk, confusion, and longer LOS among hospitalised elderly patients. Methods: This study utilised a cross-sectional design and was conducted at a single centre where convenience sampling was employed to collect data from elderly patients (> 60 years) admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July 2017–August 2017). Patients were excluded from this study if their hospital admission was planned for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the hospital admission. Medicines with Ach properties were identified and classified according to the anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses were performed to assess its impacts on falls, confusion, and LOS. Results: A total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were included in the study. Fifty-two percent of the participants were female, and the average hospital stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% (n = 90) of the cases. The most commonly prescribed medicine with Ach properties was furosemide (n = 59), followed by ranitidine (n = 44), warfarin (n = 23), and methylprednisolone (n = 22). Compared to patients who did not receive medicines with Ach properties, patients who received them had a significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion (OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001). Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29, 7.07; P = 0.010). Conclusion: Medicines with Ach properties had a significant impact on elderly patients’ health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly patients need to be improved and be recognised as an important public health priority.