Desafios do enfermeiro no tratamento aos pacientes com tuberculose pulmonar nos espaços de assistência à saúde / Nurse challenges in treating pulmonary tuberculosis patients in healthcare spaces / Desafíos de enfermería en el tratamiento de pacientes con tuberculosis de pulmón en espacios de asistencia sanitaria

Introdução: A tuberculose é causada pelo bacilo de Koch que atinge principalmente os pulmões. Contudo, uma pequena parcela, cerca de 15%, se desenvolve em outras estruturas corporais, como na laringe, gânglios, pleura, pele, intestinos, ossos e meninge, sendo denominada, tuberculose extrapulmonar. Sua transmissão ocorre por meio de aerossóis provenientes do sistema respiratório que após eliminadas, ficam suspensas no ar e/ou permanecem viáveis por um período no ambiente. No Brasil, no ano de 2020 estima-se que o número de óbitos foi de 4.543 pessoas, o coeficiente de mortalidade manteve-se de 2,3 por 100.000 habitantes e ao todo 36.000 foram infectadas. Objetivo: Evidenciar os principais desafios do enfermeiro no tratamento aos pacientes com tuberculose pulmonar nos espaços de assistência à saúde. Material e métodos: O estudo constitui-se de uma revisão de literatura, do tipo narrativa e de natureza descritiva, tendo como base teórica artigos científico acadêmicos. Para conduzir a revisão foram selecionadas as bases de dados Scielo e Biblioteca Virtual em Saúde: LILACS. Nisso, foram pautados artigos completos para levantamento de pesquisa em um período de até 5 anos. Resultados/Discussão: O modelo final desta revisão foi composto por nove artigos publicados entre os anos de 2019 e 2022. O presente estudo torna notório o importante papel da enfermagem no diagnóstico precoce na assistência primária, assim como na atuação de atividades para educação dos civis sobre promoção de saúde e prevenção de doenças. Entretanto, a falta de profissionais capacitados e a necessidade de maior participação da equipe multiprofissional representam as maiores problemáticas que cercam este estudo. A partir da leitura dos artigos tornou-se relevante segregar quatro tópicos que nortearam a discussão desta análise, são eles: Acessibilidade, incompletude de prontuários, renda familiar/estigma social e fortalecimento das estratégias de atendimento. Em relação a incompletude dos prontuários, notou-se que os enfermeiros que participaram da pesquisa delimitavam-se aos sinais e sintomas físicos dos pacientes e negligenciaram outros fatores, sendo uma influência do histórico do modelo biomédico, o que prejudica a integralidade da assistência à saúde. Esses indícios devem ser corrigidos, visto que outros métodos devem ser incluídos como fonte de informação para a assistência integral ao paciente. Identificou-se a necessidade de otimizar os registros no prontuário e reiterar a importância dessa prática para evitar que a real situação a respeito da TB seja disfarçada e haja tomada de decisões não condizentes e errôneas. Ademais, o fortalecimento das estratégias de enfrentamento da atenção primária é de tamanha importância, já que sua falta compromete a detecção precoce da doença, o tratamento adequado e a prevenção da disseminação da doença. Por fim, o enfermeiro tem o papel de orientar a população sobre meios de contaminação, buscar casos de TB e educar sobre os benefícios e malefícios do tratamento e da não adesão dele. Considerações finais: Conclui-se ser necessário uma padronização da conduta do enfermeiro, que deve incluir acesso integral aos doentes, acompanhamento do uso da medicação, teste rápidos, além de incentivar uma abordagem individualizada para os pacientes com tuberculose.

Introduction: Tuberculosis is caused by Koch's bacillus that mainly affects the lungs. However, a small portion, about 15%, develops in other body structures, such as the larynx, ganglia, pleura, skin, intestines, bones, and meninges, and is termed extrapulmonary tuberculosis. Its transmission occurs by means of aerosols coming from the respiratory system that, after being eliminated, remain suspended in the air and/or remain viable for a period in the environment. In Brazil, in the year 2020 it is estimated that the number of deaths was 4,543 people, the mortality coefficient remained 2.3 per 100,000 inhabitants and in all 36,000 were infected. Objective: To highlight the main challenges of the nurse in the treatment of patients with pulmonary tuberculosis in the health care spaces. Material and methods: The study consists of a review of literature, narrative type and descriptive nature, based on theoretical academic scientific articles. To conduct the review, the Scielo and Virtual Health Library databases were selected: LILACS. In this respect, full papers for the survey of research in a period of up to 5 years were drawn up. Results/Discussion: The final model of this review was composed of nine articles published between 2019 and 2022. The present study makes well known the important role of nursing in early diagnosis in primary care, as well as in the performance of activities for educating civilians about health promotion and disease prevention. However, the lack of skilled professionals and the need for greater participation of the multiprofessional team represent the biggest problems surrounding this study. From the reading of the articles, it became relevant to segregate four topics that guided the discussion of this analysis, are: Accessibility, incompleteness of medical records, family income/social stigma and strengthening of care strategies. Regarding the incompleteness of the medical records, it was noted that the nurses who participated in the research were limited to the physical signs and symptoms of the patients and neglected other factors, being an influence of the history of the biomedical model, which impairs the completeness of the health care. These indications should be corrected, as other methods should be included as a source of information for comprehensive patient care. The need to optimize the records in the medical record was identified and the importance of this practice was reiterated, to avoid the real situation with regard to TB being disguised and inconsistent and erroneous decisions being taken. Furthermore, the strengthening of strategies for coping with primary care is of such importance, since its lack compromises the early detection of the disease, the adequate treatment and the prevention of the dissemination of the disease. Finally, the nurse has the role of giving guidance to the population about means of contamination, of looking for cases of TB, and of educating about the benefits and harms of the treatment and of not adhering to it. Conclusion: It is concluded that a standardization of the nurse's conduct is necessary, which should include full access to patients, follow-up of the use of medication, rapid tests, besides encouraging an individualized approach for patients with tuberculosis.

Introducción: La tuberculosis es causada por el bacilo de Koch que afecta principalmente a los pulmones. Sin embargo, una pequeña porción, cercana al 15%, se desarrolla en otras estructuras corporales, como la laringe, ganglia, pleura, piel, intestinos, huesos y meninges, siendo llamada tuberculosis extrapulmonar. Su transmisión se realiza por medio de aerosoles procedentes del sistema respiratorio que, después de ser eliminados, se suspenden en el aire y/o permanecen viables durante un período en el medio ambiente. En el Brasil, en el año 2020, se estima que el número de fallecimientos fue de 4.543 personas, que el coeficiente de mortalidad se mantuvo en 2,3 por 100.000 habitantes y que en total 36.000 resultaron infectados. Objetivo: poner de relieve los principales retos del tratamiento de enfermería para pacientes con tuberculosis pulmonar en las áreas de atención de la salud. Material y métodos: El estudio es una revisión de la literatura, del tipo narrativo y de naturaleza descriptiva, basada en artículos teóricos académicos científicos. Para llevar a cabo el examen, se seleccionaron las bases de datos de Scielo y Virtual Library on Health: LILACS. A este respecto, se elaboraron artículos completos para un estudio de investigación en un período de hasta cinco años. Resultados/Debate: El modelo final de esta revisión se compone de nueve artículos publicados entre 2019 y 2022. En este estudio se destaca el importante papel de la enfermería en el diagnóstico precoz en la atención primaria, así como en las actividades de educación de los civiles sobre la promoción de la salud y la prevención de enfermedades. Sin embargo, la falta de profesionales cualificados y la necesidad de una mayor participación del equipo multiprofesional son los mayores problemas que rodean este estudio. A partir de la lectura de los artículos, se hizo relevante separar cuatro temas que guiaron el debate de este análisis, a saber: accesibilidad, registros incompletos, ingresos familiares/estigma social y el fortalecimiento de las estrategias de asistencia. En relación con la inexhaustividad de los registros médicos, se observó que las enfermeras que participaron en la investigación se limitaban a los signos y síntomas físicos de los pacientes y descuidaban otros factores, siendo una influencia de la historia del modelo biomédico, lo que daña la integridad de la atención sanitaria. Estas indicaciones deben corregirse, ya que se deben incluir otros métodos como fuente de información para la atención completa del paciente. Se ha identificado la necesidad de optimizar los registros médicos digitales y de reiterar la importancia de esta práctica para evitar que la situación real de la tuberculosis sea disfrazada, indigna y errónea. Además, el fortalecimiento de las estrategias de atención primaria es de tal importancia, ya que su ausencia pone en peligro la detección precoz de la enfermedad, el tratamiento adecuado y la prevención de la diseminación de la enfermedad. Finalmente, la enfermera tiene el papel de guiar a la población sobre los medios de contaminación, buscando casos de tuberculosis y educándolos sobre los beneficios y daños del tratamiento y de su falta de cumplimiento. Consideraciones finales: Se concluye que es necesaria la estandarización de la conducta de la enfermera, que debe incluir el pleno acceso a los pacientes, el seguimiento del uso de medicamentos, las pruebas rápidas y el fomento de un enfoque individualizado para los pacientes de tuberculosis.

Características clínicas y epidemiológicas asociadas con internación en niños con COVID-19 en un hospital pediátrico de alta complejidad: Estudio de cohorte enero-marzo 2022 / Clinical and epidemiologic characteristics associated with hospital admission in children with COVID19 in a tertiary-care pediatric hospital: A January-March 2022 cohort study

Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)

Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)

Appropriateness of Hospital Admissions in a University Hospital in Egypt: Analyzing a Preintervention Phase

Background: Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work: To measures the rate of inappropriate admissions at the Ain Shams University Hospital. Methods: This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients’ medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. Results: The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am–2:00 pm). The remaining other factors that were studied also proved insignificant. Conclusion: It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient’s gender, shifts during which admission occurred, and the affected body systems. Recommendations: Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.

Impacto del abandono de la lactancia materna exclusiva sobre la salud de los lactantes / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: El abandono de la lactancia materna es uno de los problemas que enfrenta el Sistema Nacional de Salud en Cuba por las consecuencias desfavorables que representa para la salud de los lactantes. Objetivo: Identificar la relación entre el abandono de la lactancia materna exclusiva y las afectaciones en la salud de los lactantes. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en 105 lactantes del Policlínico Aleida Fernández Chardiet nacidos en 2019, cuyas madres dejaron de utilizar la lactancia materna exclusiva antes del sexto mes. Las variables utilizadas fueron edad materna, tiempo de duración de la lactancia materna exclusiva, las enfermedades más frecuentes diagnosticadas en el niño y la necesidad de ingresos hospitalarios. Se aplicó la prueba no paramétrica de independencia Chi Cuadrado para demostrar la relación entre variables. Resultados: Predominó el abandono de la lactancia materna exclusiva antes de los 3 meses y no se encontró relación estadísticamente significativa entre esta y las afecciones más frecuentes de los lactantes (las IRA en 40 por ciento y las EDA en 23,8 por ciento). El 55,2 por ciento necesitó ingreso hospitalario antes del sexto mes y la relación con el abandono precoz de la lactancia materna exclusiva fue estadísticamente significativa. Conclusiones: El abandono precoz de la lactancia materna exclusiva afecta la salud de los lactantes y aunque las afecciones no tuvieron una relación estadísticamente significativa con aquella sí tienen una elevada frecuencia en estos niños de tan corta edad(AU)

Introduction: Breastfeeding withdrawal is one of the challenges faced by the Cuban National Health System due to its adverse consequences on the health of babies. Objective: To identify the relationship between exclusive breastfeeding withdrawal and health disorders in babies. Material and Methods: A descriptive, retrospective, cross-sectional study was carried out on 105 breastfed babies from "Aleida Fernández Chardiet" Policlinic who were born in 2019 and were precociously weaned from exclusive breastfeeding before the sixth month. The variables used were: maternal age, duration of exclusive breastfeeding, most frequent diseases diagnosed in the child, and need for hospital admission. The chi-squared non-parametric independence test was used to show the relationship among variables. Results: Exclusive breastfeeding withdrawal before the third month was predominant (71, 4 percent); the most frequent diseases diagnosed were respiratory diseases and diarrheas (40 percent and 23,8 percent, respectively); about half the babies required hospital admission (55,2 percent) before the sixth month; the relationship with early withdrawal of breastfeeding was statistically significant. Conclusions: Early withdrawal of breastfeeding has negative effects on the health of babies. Although the illnesses did not have a statistically significant relationship with it, a high frequency of their incidence was found in such young babies(AU)

Instrumento para la estratificación de pacientes con neumonía adquirida en la comunidad en el Departamento de Urgencias: su utilidad en la valoración pronóstica al ingreso / Instrument for the Stratification of Patients with Community-Acquired Pneumonia in the Emergency Department: its Usefulness in the Prognostic Assessment on Admission

Introducción: La estratificación de riesgo del paciente con neumonía adquirida en la comunidad constituye una acción médica de mucho valor en la evaluación integral del enfermo. Objetivo: Determinar la utilidad de un instrumento para la estratificación de pacientes con neumonía en la valoración pronóstica al momento del ingreso. Material y métodos: Investigación descriptiva, que abarcó 2203 pacientes con diagnóstico de neumonía comunitaria, divididos en cinco series entre los años 2009 y 2020; se calculó la letali dad por clase y por categoría de estratificación. En el análisis estadístico, se utilizó la razón de productos cruzados (Odds Ratio) con su intervalo de confianza de 95%. Resultados: Se observó un incremento progresivo de la letalidad desde la clase ligera hasta la grave, tanto para el total de casos (ligera: 5%; moderada: 17%; grave: 59%), como en cada una de las series. Hubo significación estadística en las diferencias en la letalidad entre la neumonía grave y la neumonía moderada (OR 7[5,6;8,6]). En los pacientes con neumonía moderada y en los pacientes con neumonía grave al ingreso, la letalidad fue mayor en la categoría B que en la A (neumonía moderada: 18% vs. 11%, OR 1,7[1;2,7]; neumonía grave: 68% vs. 29%, OR 5,2[3,4;8]). Conclusiones: Se demostró la utilidad del instrumento empleado en la predicción del curso evolutivo del paciente con neumonía, además de su valor orientador para la toma de decisiones. El comportamiento de la letalidad en los diferentes estratos del instrumento avala la manera en que ha sido concebido.

Background: Risk stratification of patients with community-acquired pneumonia is a very important process for the comprehensive evaluation of the patient. Objective: To determine the usefulness of a tool that was created for the stratifica tion of patients with pneumonia in the prognostic assessment on admission. Materials and Methods: Descriptive research including 2,203 patients diagnosed with community pneumonia, divided in five series between 2009 and 2020; the mortality rate was calcu lated according to the stratification class and category. For the statistical analysis, we used the cross-product ratio (Odds Ratio) with its 95% confidence interval. Results: We observed a progressive increase in mortality from mild to severe class, both in the total number of cases (mild: 5%; moderate: 17%; severe: 59%) and in each one of the series. There was statistical significance in the mortality differences between severe and moderate pneumonia (OR 7[5.6;8.6]). In patients who had moderate and severe pneumonia on admission, the mortality in category B was higher than in cat egory A (moderate pneumonia: 18% vs. 11%, OR 1.7[1;2.7]; severe pneumonia: 68% vs. 29%, OR 5.2[3.4;8]). Conclusions: We have proven the usefulness of the tool in predicting the progression of patients with pneumonia and its importance in guiding the decision-making process. The behavior of the mortality rate in the different strata of the tool supports the purpose envisioned for it.

Instrument for the Stratification of Patients with Community- Acquired Pneumonia in the Emergency Department: its Usefulness in the Prognostic Assessment on Admission / Instrumento para la estratificación de pacientes con neumonía adquirida en la comunidad en el Departamento de Urgencias: su utilidad en la valoración pronóstica al ingreso

ABSTRACT Background: Risk stratification of patients with community-acquired pneumonia is a very important process for the comprehensive evaluation of the patient. Objective: To determine the usefulness of a tool that was created for the stratifica tion of patients with pneumonia in the prognostic assessment on admission. Materials and Methods: Descriptive research including 2,203 patients diagnosed with community pneumonia, divided in five series between 2009 and 2020; the mortality rate was calcu lated according to the stratification class and category. For the statistical analysis, we used the cross-product ratio (Odds Ratio) with its 95% confidence interval. Results: We observed a progressive increase in mortality from mild to severe class, both in the total number of cases (mild: 5%; moderate: 17%; severe: 59%) and in each one of the series. There was statistical significance in the mortality differences between severe and moderate pneumonia (OR 7[5.6;8.6]). In patients who had moderate and severe pneumonia on admission, the mortality in category B was higher than in cat egory A (moderate pneumonia: 18% vs. 11%, OR 1.7[1;2.7]; severe pneumonia: 68% vs. 29%, OR 5.2[3.4;8]). Conclusions: We have proven the usefulness of the tool in predicting the progression of patients with pneumonia and its importance in guiding the decision-making process. The behavior of the mortality rate in the different strata of the tool supports the purpose envisioned for it.

RESUMEN Introducción: La estratificación de riesgo del paciente con neumonía adquirida en la comunidad constituye una acción médica de mucho valor en la evaluación integral del enfermo. Objetivo: Determinar la utilidad de un instrumento para la estratificación de pacientes con neumonía en la valoración pronóstica al momento del ingreso. Material y métodos: Investigación descriptiva, que abarcó 2203 pacientes con diagnóstico de neumonía comunitaria, divididos en cinco series entre los años 2009 y 2020; se calculó la letali dad por clase y por categoría de estratificación. En el análisis estadístico, se utilizó la razón de productos cruzados (Odds Ratio) con su intervalo de confianza de 95%. Resultados: Se observó un incremento progresivo de la letalidad desde la clase ligera hasta la grave, tanto para el total de casos (ligera: 5%; moderada: 17%; grave: 59%), como en cada una de las series. Hubo significación estadística en las diferencias en la letalidad entre la neumonía grave y la neumonía moderada (OR 7[5,6;8,6]). En los pacientes con neumonía moderada y en los pacientes con neumonía grave al ingreso, la letalidad fue mayor en la categoría B que en la A (neumonía moderada: 18% vs. 11%, OR 1,7[1;2,7]; neumonía grave: 68% vs. 29%, OR 5,2[3,4;8]). Conclusiones: Se demostró la utilidad del instrumento empleado en la predicción del curso evolutivo del paciente con neumonía, además de su valor orientador para la toma de decisiones. El comportamiento de la letalidad en los diferentes estratos del instrumento avala la manera en que ha sido concebido.

A systematic review of clinical characteristics, co-morbidities and outcomes of COVID-19 in children and adolescents

Background: COVID-19 is a major global health challenge that has affected all age groups and gender, with over 5 million deaths reported worldwide to date. The objective of this study is to assess available information on COVID-19 in children and adolescents with respect to clinical characteristics, co-morbidities, and outcomes, and identify gaps in the literatures for appropriate actions. Methodology: Electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for observational studies such as case series, cross-sectional and cohort studies published from December 2019 to September 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide. Data extracted included (i) patient demography (age and gender), (ii) clinical characteristics including vaccination status and presence of co-morbidities, (iii) clinical management including the use of sequential organ failure assessment (SOFA) scores, oxygen requirement, use of mechanical ventilation, and (iv) disease outcomes including length of hospital and intensive care unit (ICU) admission, recovery, complications with sequelae, or death. Data were analyzed using descriptive statistics. Results: A total of 11 eligible studies were included with a total of 266 children and adolescents; 137 (51.5%) females and 129 (48.5%) males. The mean age of the children was 9.8 years (range of 0 ­ 19 years), and children ≥ 6 years were more affected (40.7%) than age groups 1 ­ 5 years (31.9%) and < 1 year (27.4%). The major co-morbidities were respiratory diseases including pre-existing asthma (3.4%), neurologic conditions (3.4%) and cardiac pathology (2.3%). Majority (74.8%, 199/266) of the patients were discharged without sequelae, 0.8% (2/266) were discharged with sequalae from one study, and mortality of 1.9% (5/266) was reported, also from one study. SOFA scores of patients at admission were not stated in any of the study, while only one study reported patient vaccination status. Conclusion: It is recommended that safe vaccines for children < 1 year of age should be developed in addition to other preventive measures currently in place. SOFA scores should be used to assess risk of COVID-19 severity and monitor prognosis of the disease, and vaccination status of children should be documented as this may impact the management and prognosis of the disease.

Air Temperature Affects the Hospital Admission for Cardiovascular Diseases among Rural Residents in Dingxi City / 中国医学科学院学报

Objective To explore the effect of air temperature on the hospitalization of rural residents with cardiovascular diseases and its lag effect in Dingxi city. Methods The meteorological data and air pollution data of Dingxi city from 2018 to 2019,as well as the daily hospitalization data of rural residents due to cardiovascular diseases,were collected.The distributed lag non-linear models were employed to analyze the relationship between daily mean air temperature and the number of inpatients with cardiovascular diseases.Meanwhile,stratified analysis was carried out according to gender,age,and disease. Results There was a non-linear relationship between air temperature and the number of hospitalized rural residents with cardiovascular diseases in Dingxi city.The exposure-response curve approximated a bell shape.The curves for different cardiovascular diseases appeared similar shapes,with different temperature thresholds.Low temperature(-7 ℃) and moderately low temperature(0 ℃) exhibited a cumulative lag effect on the number of patients hospitalized with cardiovascular diseases.With a cumulative lag of 7 days at -7 ℃ and 14 days at 0 ℃,the RR values peaked,which were 1.121(95% CI=1.002-1.255) and 1.198(95% CI=1.123-1.278),respectively.With a cumulative lag of 14 days at 0 ℃,the RR values were 1.034(95% CI=1.003-1.077) and 1.039(95% CI=1.004-1.066) for the number of hospitalized patients with ischemic heart disease and heart rhythm disorders,respectively.The cumulative lag effects of moderately high temperature(17 ℃) and high temperature(21 ℃) on ischemic heart disease,heart rhythm disorders,and cerebrovascular disease all peaked on that day.Specifically,the RR values at 17 ℃ and 21 ℃ were 1.148(95% CI=1.092-1.206) and 1.176(95% CI=1.096-1.261) for ischemic heart disease,1.071(95% CI=1.001-1.147) and 1.112(95% CI=1.011-1.223) for heart rhythm disorders,and 1.084(95% CI=1.025-1.145) and 1.094(95% CI=1.013-1.182) for cerebrovascular disease,respectively.There was no cumulative lag effect of air temperature on the number of hospitalized patients with heart failure.In addition,stratified analysis showed that low temperature(-7 ℃) and moderately low temperature(0 ℃) affected the number of hospitalized female patients with cardiovascular diseases,and only moderately low temperature(0 ℃) affected males.The cumulative lag effect of high temperature on females was higher than that on males.Air temperature exhibited a stronger impact on female patients than on male patients. Additionally,the population aged<65 years old was more sensitive to low temperature and high temperature than that aged ≥65 years old. Conclusions Air temperature changes increase the hospitalization risk of rural residents with cardiovascular diseases in Dingxi city,which presents a lag effect.The effects of air temperature on patients hospitalized due to cardiovascular diseases varied among different etiologies,genders,and ages.It is necessary to emphasize on the impact of temperature changes on health in residents,especially for key populations such as females,people aged<65 years old,and those with ischemic heart disease.

Association of short-term exposure to ambient air pollution with hospital admission for ischemic stroke among older adults / 公共卫生与预防医学

Objective To investigate the association between short-term exposure to ambient air pollution and hospital admission for ischemic stroke among older adults. Methods Using clinical monitoring data from China National Health Commission, we identified 124 297 individuals from Guangzhou, Guangdong province, China who were 60 years or older and were admitted to hospital for ischemic stroke in 2016-2019. We used a time-stratified case-crossover design and employed the conditional logistic regression model to investigate the exposure-response association between short-term exposure to air pollution and hospital admission for ischemic stroke. Based on each subject's residential address and pollutant data from its neighboring air quality monitoring stations, we used an inverse distance weighting method to assess individual-level exposure to PM2.5, PM10, SO2, NO2, CO and O3 on each of the case and control days. Results In single-pollutant models, each 10 µg/m3 increase of PM2.5, PM10, SO2, NO2, CO and O3 was associated with a 0.46% (95% confidence interval [CI]: 0.13-1.36%, lag 2 d), 0.66% (1.38-2.93%, lag 02 d), 3.39% (0.07-0.21%, lag 2 d), 1.47% (0.07-0.21%, lag 02 d), 0.06% (0.07-0.21%, lag 02 d) and 0.18% (0.07-0.21%, lag 3 d) increase in odds of hospital admission, respectively. The results of 2-pollutant models showed that the association of exposure to SO2, NO2 and O3 with hospital admission for ischemic stroke remained stable with adjustment for each of the other air pollutants. Conclusions Short-term exposure to ambient air pollution, especially SO2, NO2 and O3, was associated with increased risk of hospital admission for ischemic stroke in older adults.

Efectividad de una unidad de dolor torácico en el primer nivel de atención en salud con telecardiología: un estudio cuasiexperimental de series de tiempo interrumpidas / Effectiveness of the chest pain unit at primary level of health care with telecardiology: a quasi-experimental study of interrupted time series

Resumen Introducción: Las unidades de dolor torácico disminuyen la morbimortalidad de los pacientes con síndrome coronario agudo. No obstante, se desconoce su efectividad en el primer nivel de atención con el apoyo de la telecardiología. Objetivo: Evaluar la efectividad de las unidades de dolor torácico sobre los tiempos de atención, la concordancia diagnóstica y la frecuencia de reconsultas a urgencias y hospitalización. Método: Estudio cuasiexperimental de series de tiempo interrumpidas, robusto, que incluyó 20,412 pacientes que consultaron al servicio de urgencias por dolor torácico, antes y después de implementar una unidad de dolor torácico. Se analizaron los cambios en la pendiente, el nivel, la autocorrelación y la varianza de los desenlaces estudiados entre ambos periodos (previo y posterior a las unidades de dolor torácico) a 30 días. Resultados: El promedio de edad fue de 44.9 ± 17.6 años y el 45.8% fueron hombres. La proporción global de pacientes remitidos para hospitalización fue del 9.0%. La pendiente de las tasas de reconsultas a urgencias disminuyó (diferencia: −1.23; intervalo de confianza del 95% [IC95%]: −2.46 a −0.01; p = 0.049) al comparar los dos periodos de observación. Igualmente, la proporción de pacientes remitidos sin síndrome coronario agudo y que finalmente tuvieron este diagnóstico en el tercer nivel de atención disminuyó en el periodo posterior a las unidades de dolor torácico con relación al previo (diferencia: −8.31; IC95%: −15.52 a −1.11; p = 0.020). Conclusiones: Las unidades de dolor torácico incrementaron los egresos de forma segura, con disminución de las reconsultas a urgencias en los siguientes 30 días por la misma causa. Además, mejoró la concordancia diagnóstica del síndrome coronario agudo, sin modificar los tiempos de atención ni la frecuencia de rehospitalización por enfermedad cardiovascular en el seguimiento.

Abstract Introduction: Chest pain units (CPU) decrease morbi-mortality in patients with acute coronary syndrome (ACS). Nevertheless, its effectiveness at primary level of health care with telecardiology support is unknown. Objective: To evaluate effectiveness of CPU on times of observation, diagnostic agreement and emergency department re-admission and hospitalizations. Method: Quasi-experimental study of robust interrupted time series, which included 20,412 patients admitted to the emergency department for chest pain, before and after the implementation of a CPU. Changes in slope, level, autocorrelation and, variance between both periods (before-CPU and after-CPU) in outcomes at 30 day follow-up were analyzed. Results: Subjects had a mean age of 44.9 ± 17.6 years-old and 45.8% were men. The overall rate of hospital admission was 9.0%. The slope of emergency re-consultation rates decreased (difference: −1.23; 95% CI: −2.46 to −0.01; p = 0.049), when comparing the two observation periods. Also, the level of proportion of patients admitted without ACS who finally had an inpatient diagnosis of ACS decreased after-CPU implementation (difference: −8.31; 95% CI: −15,52 to −1.11; p = 0.020). Conclusions: The CPU increased patient discharge safely with a reduction of 30-day re-admissions. In addition, an improvement in the ACS diagnostic agreement without affecting the time of observation or the frequency of re-hospitalization for cardiovascular disease was obtained during the follow-up.

Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants

BACKGROUND@#Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants.@*METHODS@#We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM@*RESULTS@#A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM@*CONCLUSIONS@#Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM

Differences in hospitalization due to infectious causes between patients with hemodialysis and those with peritoneal dialysis / Diferencias en la hospitalización por causas infecciosas entre pacientes con hemodiálisis y diálisis peritoneal

Abstract Introduction: approximately 50% of the annual health care expenditure of patients with chronic kidney disease on dialysis is related to hospitalizations. Infections represent the second reason for consultation, with a high morbidity and mortality. There are no studies comparing hospitalization time due to infectious causes between the different dialysis options. Objective: to determine the difference in hospitalization time for treatment of infectious diseases in patients with chronic kidney disease on dialysis, comparing patients on hemodialysis vs. peritoneal dialysis. Materials and methods: a retrospective, dynamic cohort study of patients on hemodialysis and peritoneal dialysis who were admitted to the emergency department at the Hospital Universitario Mayor due to infectious diseases. The study patients were included using nonprobabilistic methods. The sample size was calculated by comparison of means. A total of 172 hemodialysis patients and 85 peritoneal dialysis patients were included for statistical analysis. Results: hospitalization time is greater in patients on hemodialysis than in patients on peritoneal dialysis; 12 (IQR 8-21) vs. 10 (IQR 6.5-13) days, respectively, p= 0.004. Conclusions: hospitalization time due to infectious causes is greater in patients on hemodialysis than in patients on peritoneal dialysis. In addition, the incidence of treatment-related infections in our population is lower than the globally reported incidence.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).

Resumen Introducción: aproximadamente el 50% del gasto anual en salud de los pacientes con enfermedad renal crónica en diálisis está relacionada con hospitalizaciones; las causas infecciosas representan la segunda causa de consulta con una alta morbilidad y mortalidad. No existen estudios donde se compare el tiempo de hospitalización por causas infecciosas entre las diferentes opciones de diálisis. Objetivo: determinar las diferencias en tiempos de hospitalización que se deriva del manejo de patologías infecciosas en pacientes con enfermedad renal crónica en diálisis, comparando los pacientes que se encuentran en hemodiálisis vs diálisis peritoneal. Material y métodos: estudio de cohorte retrospectiva, dinámica, de pacientes en hemodiálisis y diálisis peritoneal que ingresan al servicio de urgencias del Hospital Universitario Mayor por patologías infecciosas. Los pacientes que ingresaron al estudio se incluyeron por métodos no probabilísticos. El cálculo de tamaño de muestra se realizó por comparación de medias. Para el análisis estadístico se incluyeron 172 pacientes en hemodiálisis y 85 en diálisis peritoneal. Resultados: el tiempo de hospitalización es mayor en pacientes con hemodiálisis en comparación con los pacientes en diálisis peritoneal, 12 (RIC 8-21) vs 10 (RIC 6.5-13) días respectivamente, p= 0.004. Conclusiones: el tiempo de hospitalización por causas infecciosas es mayor en los pacientes con hemodiálisis que los de diálisis peritoneal, adicionalmente la incidencia de infecciones asociadas a la terapia en nuestra población es menor que lo reportado a nivel mundial.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).

Efecto de las medidas preventivas asociadas a la COVID-19 en la frecuencia de egresos hospitalarios por infección respiratoria aguda / Effect of preventive measures related to COVID-19 in the frequency of hospital discharges after an acute respiratory infection

Introducción: Las infecciones agudas del aparato respiratorio constituyen un importante problema de salud a nivel mundial y en el contexto cubano. Objetivo: Examinar el efecto de las medidas preventivas asociadas a la COVID-19 en la frecuencia de egresos hospitalarios por infección respiratoria aguda. Método: Estudio descriptivo realizado en el servicio de afecciones respiratorias del Hospital Pediátrico Universitario "Paquito González Cueto" de Cienfuegos, en los años 2019-2020. La morbilidad por infección respiratoria aguda se expresó a través de la frecuencia de los egresos hospitalarios. Se examinó el número de egresos por esta afección en los seis primeros meses de los años citados. La información se obtuvo del Departamento de Estadísticas de la institución hospitalaria. Resultados: Se observó franco descenso del número de egresos por infección respiratoria aguda en los meses de abril, mayo y junio del año 2020 (en junio, el 75 por ciento de reducción de los egresos ocurridos en enero), lo cual contrasta con lo observado en este periodo del año precedente, con discreta variación numérica en el número de egresos. Estos resultados son independientes de la edad y el sexo. Conclusiones: Las medidas de carácter poblacional para la prevención y control de la COVID-19 aplicadas en Cuba, a partir del diagnóstico de los primeros casos de la enfermedad parecen haber incidido en la disminución de la morbilidad por infección respiratoria aguda en el servicio de afecciones respiratorias del Hospital Pediátrico Universitario de Cienfuegos(AU)

Introduction: Acute respiratory infections are an important health problem globally and in the Cuban context. Objective: Study the effect of preventive measures related to COVID-19 in the frequency of hospital discharges by acute respiratory infection. Method: Descriptive study carried out in the service of respiratory conditions of ´´Paquito González Cueto´´ Pediatric University Hospital in Cienfuegos province, during the years 2019-2020. Morbidity by acute respiratory infections was expressed through the frequency of hospital discharges. It was studied the number of discharges by this infection in the six first months of the above mentioned years. The information was collected in the Statistics Department of the Hospital. Results: It was observed a marked drop in the number of discharges after acute respiratory infections in the months of April, May and June of 2020 ( in June, there was 75 percent less that the discharges occurred in January), which contrasts with what happened in this period of the previous year, with a discreet numerical variation in the number of discharges. These results are independent from the age and sex. Conclusions: The population measures taken to prevent and control COVID-19 that were implemented in Cuba after the first cases of the disease were diagnosed seem to have influenced in the decrease of morbidity by acute respiratory infections in the service of respiratory conditions of the Pediatric University Hospital of Cienfuegos province(AU)

Relationship between temperature indicators and hospital admission for childhood pneumonia / 预防医学

Objective@#To explore the relationship between different temperature indicators and hospital admission for childhood pneumonia.@*Methods@#The hospital admissions for pneumonia in children aged 0-14 years and meteorological data in Ningbo from 2015 to 2017 were collected. A distributed lag non-linear model combined with a generalized linear model was employed to analyze the exposure-response relationships between different temperature indicators（daily average,minimum and maximum temperature;the first percentile as low temperature and the 99th percentile as high temperature）and hospital admission for childhood pneumonia.@*Results@#A total of 4 542 cases of childhood pneumonia were recruited. There were obvious seasonal fluctuations found in the inpatient volume of childhood pneumonia,which peaked in winter and bottomed in summer. After adjusting for potential confounding variables such as relative humidity,PM2.5,long term trend and seasonal trend,the results suggested that after exposed to whether low or high temperature,the inpatient volume of childhood pneumonia would increase. When the daily average temperature and daily minimum temperature were employed,the effect of high temperature on the increase of inpatient volume for childhood pneumonia was statistically significant and the cumulative relative risk for a lag of 0-7 days were 1.52（95%CI：1.04-2.23）and 1.59（95%CI：1.08-2.34）,respectively. When the daily maximum temperature was employed,the effect of low temperature on the increase of inpatient volume for childhood pneumonia was statistically significant and the cumulative relative risk for a lag of 0-7 days were 1.30（95%CI：1.02-1.66）.@*Conclusion@#Our findings suggested that an increased risk of hospital admission for childhood pneumonia was associated with both low and high temperature.

Factores asociados al fracaso del tratamiento en pacientes hipertensos que requieren ingreso hospitalario / Factors associated to treatment failure in hypertensive patients requiring hospital admission

RESUMEN Introducción: La hipertensión es una enfermedad muy frecuente que, a pesar de los múltiples adelantos terapéuticos, sigue siendo mal controlada y frecuentemente lleva a descompensaciones que requieren hospitalización o atención en los servicios de emergencia. Objetivos: Identificar los factores relacionados con el fracaso terapéutico en los pacientes hipertensos que requirieron ingreso hospitalario a causa de afectaciones relacionadas con el control de la presión arterial. Método: Se estudiaron los 40 pacientes hipertensos ingresados en el área de salud Marta Abreu durante el año 2016, se tomaron los datos de las historias clínicas y se entrevistaron los pacientes y familiares para identificar las causas que influyeron en el fracaso del tratamiento. Resultados: Predominaron los pacientes del sexo masculino y mayores de 60 años, los factores de riesgo más frecuentes fueron: el hábito de fumar, la diabetes mellitus y la cardiopatía isquémica, y se encontraron como principales causas del mal control de la presión arterial los tratamientos inadecuados (45%) y la no adherencia al tratamiento (30%). Las tres primeras causas de ingreso fueron: accidentes cerebrovasculares (40%), síndrome coronario agudo (27,5%) y crisis hipertensiva (7,5%). Después de corregir la estratificación de riesgo la coincidencia con la estratificación previa fue solo del 10%, y el 95% de los pacientes fueron de alto riesgo. Conclusiones: Las causas de ingreso más frecuentes fueron de origen cardiovascular. Los tratamientos fracasaron por ser inadecuados o por la falta de adherencia de los pacientes. La mayoría de ellos tenían una estratificación incorrecta, por lo que los tratamientos fueron en su mayoría inadecuados y el control deficiente.

Abstract Introduction: High blood pressure is a very frequent disease that, in spite of multiple advances in therapy, continues to be poorly controlled and frequently leads to decompensation requiring hospitalization or emergency services. Objectives: To identify the factors associated to treatment failure in hypertensive patients requiring hospital admission, due to disturbances related to blood pressure control. Method: There were studied 40 hypertensive patients who were admitted in the Marta Abreu health area, during 2016; the data of clinical histories were taken into account and patients and relatives were interviewed in order to identify the causes that influenced the treatment failure. Results: Admissions of males and patients over 60 years predominated. The most frequent risk factors were smoking, diabetes mellitus and ischemic heart disease, and the main causes of poor control of blood pressure were the inadequate treatments (45%) and non-adherence to treatment (30%). The first three causes of admission were stroke (40%), acute coronary syndrome (27.5%) and hypertensive crisis (7.5%). After correcting the risk stratification, the coincidence with the previous stratification was only 10% and 95% of the patients were at high risk. Conclusions: The most frequent causes of admission were of cardiovascular origin. Treatments failed for being inadequate or the lack of patient adherence. Most of them had incorrect stratification, thus, treatments were mostly inadequate and the control was poor.

Paro cardíaco extrahospitalario. Presentación y supervivencia al ingreso hospitalario en algunos centros urbanos y suburbanos del departamento de Maldonado, Uruguay. Análisis de 12 años / Out-of-hospital cardiac arrest. Presentation and survival at hospital admission in some urban and suburban centers of the department of Maldonado, Uruguay. 12 year analysis

Resumen: Introducción: no se dispone de un registro de muerte súbita en Uruguay. Extrapolando datos de otros países se estima que fallecen súbitamente entre 2.000 y 3.000 personas cada año, entre cinco y seis veces más que en los accidentes de tránsito. Objetivo: describir la presentación y la supervivencia al ingreso hospitalario (SIH) de los pacientes asistidos por una emergencia médica móvil (EMM) por paro cardíaco extrahospitalario no traumático (PCEH) en algunos centros urbanos y suburbanos del departamento de Maldonado; analizar variables que se asocian a mayor SIH. Material y método: estudio retrospectivo, descriptivo-analítico, de todos los PCEH en pacientes mayores de 14 años asistidos en el período comprendido entre enero de 2005 y agosto de 2017 en el departamento de Maldonado por una EMM. Para el análisis de asociación de variables se realizó test de chi cuadrado para las variables categóricas y test de t para las variables continuas. Resultados: se asistieron 347 pacientes; 242 hombres (69,7%), edad media 66 años (DE±12,5 años) y 105 mujeres (30,3%), edad media 71,6 años (DE±13,5 años), p=0,002. La mediana del tiempo recepción del llamado-arribo fue de 7 minutos. El PCEH se presentó en 82,4% en el hogar. Diez pacientes fueron asistidos con desfibrilador externo automático (DEA). Los ritmos al arribo fueron: asistolia 56,2%, fibrilación ventricular (FV) 29,4%, actividad eléctrica sin pulso (AESP) 13,5% y taquicardia ventricular sin pulso (TVSP) 0,9%. El 44,6% recibió desfibrilación con un promedio de 3,5 descargas por paciente. La SIH fue 21,9%. En el análisis univariado las variables que se asociaron a mayor SIH fueron: vía pública (VP) como lugar del evento (p<0,001), ritmo desfibrilable al arribo (p<0,001) y las edades menores (p<0,001). Conclusiones: el ritmo más frecuente al arribo del equipo de salud fue la asistolia seguido de la FV. La menor edad, la VP como lugar del evento y la presencia de ritmos desfibrilables al arribo de la EMM se asociaron a mayor SIH.

Summary: Introduction: currently there is not a registry of sudden death in Uruguay. Extrapolating data from other countries it is estimated that between 2.000 and 3.000 people die suddenly every year, five or six times more than in traffic accidents. Objective: to describe the presentation of patients with out-of-hospital cardiac arrest (OHCA) assisted by a Mobile Medical Emergency (MME) in some urban and suburban centers in Maldonado; and to analize variables associated with greater survival at hospital admission (SHA). Material and method: a retrospective, descriptive-analytical study of all OHCA in patients older than 14 years assisted in the period between January 2005 and August 2017, in Maldonado department, by a MME was performed. For analysis, the chi-square test was performed for the categorical variables and the t-test for the continuous variables. Results: 347 patients were recruited in the study period. 69,7% were men, with a mean age of 66 years old (SD±12,5 years) and 30,3% were women, mean age 71,6 years old (SD±13,5 years), p=0,002. The median time of call reception-arrival was 7 minutes. The OHCA presented in 82,4% of cases at home. Ten patients were assisted with automatic external defibrillator (AED). The rhythms at arrival were: asystole 56,2%, ventricular fibrillation 29,4%, pulseless electrical activity 13,5% and ventricular tachycardia without pulse 0,9%. 44,6% received defibrillation with an average of 3,5 discharges per patient. SHA was 21,9%. In the univariated analysis, the variables that were associated with higher SHA were: public settings as the site of the event (p <0,001), shockable rhythm at arrival (p <0,001), and younger age (p <0,001). Conclusions: the most frequent rhythm at the arrival of the health team was asystole followed by ventricular fibrillation. Younger age, public settings as the place of the event and the presence of shockable rhythms at the arrival of the MME, were associated with higher SHA.

Bombas de insulina en diabetes tipo 2, del fundamento a la práctica / Pumps in Type 2 diabetes, from basics to practice

Resumen Las bombas de insulina han sido usadas por más de 35 años, principalmente en pacientes con diabetes tipo 1 y en menor medida en diabetes tipo 2. En esta última población hay una liberación más funcional de insulina, se puede prevenir el fenómeno de alba y mantener por más tiempo los niveles adecuados de glucemia. Las indicaciones de bomba en diabetes tipo 2 son poco claras, pero los que tal vez más se benefician son aquellos con historia de mal control metabólico, hipoglucemias severas o asintomáticas. El uso de esta tecnología durante la hospitalización ha sido difícil, principalmente por el desconocimiento del personal de salud en su uso; no obstante, se ha demostrado que es factible mantener a los pacientes en esta terapia mientras están hospitalizados, siempre y cuando se tenga un adecuado protocolo, disposición del personal y educación del paciente. El costo ha sido una de las cuestiones más controversiales con el uso de estos sistemas. Los análisis de costo-efectividad han encontrado una disminución del número de hipoglucemiantes orales, las visitas a urgencias y las dosis de insulina, llegando algunos a aseverar que en tres años podrían compensarse los costos.

Abstract Insulin pumps have been used for over 35 years, mostly in patients with type 1 diabetes and to a lesser extent in type 2 diabetes. The use of pumps in this population is supported by a more physiological release of insulin, prevention of the dawn phenomenon and enabling patients to achieve better glucose targets. Pump indications in type 2 diabetes are less clear than in patients with type 1, but perhaps those who benefit most, are patients with a history of significant glycemic excursions, severe or asymptomatic hypoglycemia. Pump management as inpatient has been limited by lack of personal knowledge, however it has been reported that it is feasible to keep patients who are using this technology to continue it while they are in the hospital provided that a suitable protocol has been standardized and the patient has enough knowledge. Costs have been one of the most controversial issues with the use of these technology, cost-effectiveness analysis have found that there is a decrease in the number of oral agents, emergency room visits and insulin doses, reaching some studies to conclude that three years could offset the pump cost.

A internação psiquiátrica compulsória e involuntária: aspectos técnicos e éticos / Psychiatric compulsory and involuntary hospital admission: ethical and technical issues

Introdução: A internação psiquiátrica pode ser: voluntária; involuntária; compulsória. Esta última é determinada pela autoridade judicial não podendo ser questionada em seu aspecto legal, entretanto cabem questionamentos quanto aos aspectos técnicos e éticos. Objetivo: Discutir como a Equipe Multiprofissional de uma enfermaria psiquiátrica que vivencia o cuidado ao paciente em internação compulsória. Método: estudo de caso descritivo, compreensivo, por meio de pesquisa quantiqualitativa, no Serviço de Internação Psiquiátrica do Hospital de Clínicas Dr. Alberto Lima, no município de Macapá- AP. Participaram os servidores maiores de 18 anos, de ambos os sexos, de locais e níveis socioeconômicos variados e que assinaram o Termo de Consentimento Livre e Esclarecido. Coleta de dados: utilizou-se o questionário sociodemográfico e econômico e foram feitas entrevistas semiestruturadas. Foi realizado Grupo Focal (GF), em que se apresentaram os discursos elaborados, a fim de que, diante dos diferentes entendimentos, os discursos espontâneos analisados fossem apresentados aos entrevistados da equipe multiprofissional e, para isso, foi estabelecida uma conversa sobre a realidade vivenciada. Para o tratamento dos dados qualitativos, aplicou-se a técnica do Discurso do Sujeito Coletivo (DSC); os dados quantitativos foram expressos pelo pacote Excel e analisados por meio do software Bioestat 5.3. Resultados: Destacaram-se características da Enfermaria Psiquiátrica e a caracterização sociodemográfica e clínica das internações. A equipe é predominantemente do sexo feminino, a maior parte trabalha em outros serviços e possui nível de escolaridade superior completo. A partir das entrevistas, emergiram os DSCs, apresentados por categoria, as ancoragens, vistas como desafios éticos identificados sob a ótica da vivência do cuidado. O estudo mostrou que há empatia dos profissionais com o sofrimento das mães e familiares das pessoas com transtornos mentais e que precisam internação compulsória e consideram que a internação compulsória é uma forma de tratamento, desde que bem indicada. Os participantes destacaram que a ordem médica deveria valer mais que a ordem judicial na determinação da internação compulsória. O Grupo Focal fez emergir as categorias: A difícil experiência do cuidar em internação involuntária/ compulsória; Incipiência da RAPS; Obstáculos para o cuidar de qualidade na internação compulsória e involuntária. Os desafios éticos de cuidar dos pacientes psiquiátricos internados contra a vontade foram revelados pelas ancoragens isoladas nos DSCs: os apenados são pessoas com comportamento inadequado; autoritarismo e paternalismo no tratamento da pessoa com transtorno mental; empatia com o sofrimento familiar; internação psiquiátrica compulsória amparada em sólida avaliação e indicação técnicas; judicialização da saúde e as questões éticas e técnicas desta prática; internação psiquiátrica é necessária, mas somente por avaliação da equipe técnica; justiça não tem poder para avaliar a pessoa se tem ou não indicação para a internação psiquiátrica. Considerações Finais: os profissionais, diante de fatos impositivos pela justiça nas internações psiquiátricas involuntárias/ compulsórias, elegem como prioridade o diálogo entre o Judiciário e os profissionais de saúde como caminho para um possível consenso entre esses segmentos, sem minimizar a responsabilidade de cada um, com o intuito único de prestar atenção adequada e com qualidade à pessoa envolvida no processo de internação compulsória.

Introduction: Psychiatric hospital admission can be: voluntary; involuntary; compulsory. The last one is legally enforced, it cannot be questioned in its legal aspect, however there can be questioning on technical and ethical issues. Objective: To discuss how the Multiprofessional Team of a Psychiatric Ward to experience a patients health care in compulsory hospitalization. Method: descriptive, comprehensive case study by means of quanti-qualitative research at the Psychiatric Admission Service of Hospital de Clínicas Dr. Alberto Lima in the municipality of Macapá Amapá State, Brazil. Male and female healthcare professionals over 18 years of age from varied places and socioeconomic status participated in the study, who signed the Free Informed Consent Form. Data collection: the questionnaire on economic and sociodemographic status was used, as well as semi-structured interviews were carried out. The Focus Group (FG) was held and the elaborated discourses were presented so that the analyzed spontaneous accounts, due to their different understandings, were presented to the participants of the multiprofessional team. Thus, a conversation on the experienced reality was established. The technique of the Discourse of the Collective Subject (DCS) was applied to analyze the qualitative data; quantitative data were expressed by the Excel package and analyzed by means of the Bioestat 5.3 software. Results: Psychiatric Nursing characteristics as well as the sociodemographic and clinical profile of the hospital admissions stood out. Females prevail in the team, most of them work in other services and have complete Higher Education level. From the interviews, the DCSs emerged, presented by category, the anchorages viewed as ethical challenges and identified in the light of lived caring. The study showed the empathy between the professionals and the suffering of mothers and family members of the mentally-ill who need compulsory hospital admission, and they consider it a way of treatment as long as it is well referred. The participants pointed out that a medical order should outstand a legal order in order to determine compulsory admission. The following categories emerged from the Focus Group: The hard experience of caring for the involuntary/compulsory admitted ones; The incipience of the Psychosocial Care Network; Obstacles for the quality care of those undergoing involuntary and compulsory hospital admission. The ethical challenges to care for psychiatric patients hospitalized against their will were unfolded by the isolated anchorages in the DCSs: the convicts are improperly behaved people; authoritarianism and patronizing in the treatment of people with mental disorders; empathy towards family suffering; compulsory psychiatric admission grounded in sound assessment and technical referral; healthcare judicialization and ethical and technical issues in this practice; psychiatric admission is necessary, but only if assessed by a technical team; justice has no power to assess whether a person can be referred to a psychiatric hospital admission or not. Final considerations: due to court orders for involuntary/compulsory hospital admissions, professionals find dialogue as the priority between judicial officers and healthcare professionals as a way for them to come to an agreement, without minimizing the responsibility of any parties, aiming at delivering proper and quality care to the person involved in the process of compulsory hospital admission.

El sistema español de triaje en la evaluación de los neonatos en las urgencias pediátricas / The Spanish triage system in the evaluation of neonates in paediatric emergency departments

El triaje en el departamento de urgencias clasifica a los pacientes en niveles según prioridad en la atención. Los neonatos constituyen una población vulnerable y requieren una rápida evaluación. Objetivo: Correlacionar los niveles de prioridad en neonatos que consultan en el departamento de urgencias pediátricas con la hospitalización, consumo de recursos y tiempos de atención. Pacientes y Método: Estudio observacional, utilizando la base de datos del modelo andorrano de triaje (MAT-SET) con el software ePATV4 en las urgencias pediátricas. Se incluyó a neonatos clasificados en los 3 niveles de atención establecida: nivel i resucitación, nivel ii emergencia y nivel iii urgencia. Se analizó la correlación entre los niveles de prioridad, la hospitalización y el consumo de recursos. Además, se analizaron los tiempos de atención médica y estadía en urgencias. Resultados: Se incluyeron 1.103 neonatos. Se encontró que el mayor nivel de prioridad se correlacionó positivamente con la hospitalización (r = 0,66; p < 0,005) y con el consumo de recursos (r = 0,59; p < 0,005). Los tiempos de atención fueron 126 ± 203, 51 ± 119 y 33 ± 81 min para los niveles i, ii, y iii, respectivamente y los de estadía 150 ± 203, 80 ± 131 y 55 ± 86 min, respectivamente para dichos niveles (p < 0,05). Conclusiones: El mayor nivel de prioridad en la atención de los neonatos en la urgencia pediátrica se correlacionó positivamente con una mayor necesidad de hospitalización y consumo de recursos. Además, requirieron mayor tiempo de atención y estadía en la urgencia.

The triage system in the emergency department classifies patients according to priority levels of care. Neonates are a vulnerable population and require rapid assessment. Objective: To correlate the priority levels in newborns seen in the paediatric emergency department with admissions, resource consumption, and service times. Patients and Method: Observational study, using the Andorran triage model (MAT-SET) with ePATV4 software database, in paediatric emergencies. Neonates were classified into 3 levels of care established for them as level I resuscitation, level II emergency, and level iii urgent. The correlation between levels of priority and admission and resource consumption were analysed, as well as the time spent on medical care and stay in the emergency department. Results: The study included 1103 infants. The highest priority level was positively correlated with hospital admission (r = 0.66, P<.005) and resource consumption (r = 0.59, P < .005). The medical care times were 126 ± 203, 119 ± 51, and 33 ± 81 min for levels i, ii, and iii, respectively and the stay in emergency department was 150 ± 203, 131 ± 80, and 55 ± 86 min, respectively for these levels (P < .05). Conclusion: The higher level of priority in the care of neonates in the paediatric emergency department was positively correlated with increased need for hospital admission and resource consumption. They also required a longer time for medical care and stay in the emergency department.

Pattern of hospital admission and outcome in Parkinson’s disease: A study from Punjab, India

Background: The hospitalization rates of patients with Parkinson’s disease (PD) are 1.45 times higher than for age matched controls. We studied the causes for admission, hospital course and outcomes in PD population so that preventive measures could be developed. Methods: We prospectively studied patients with the diagnosis of PD admitted to a tertiary care hospital in Ludhiana, India from January, 2012 to December, 2014. Etiology for hospitalization was determined and the patients were divided into two groups, admission due to causes related to PD or not associated with PD. The PD related admissions were further categorized into Group I: directly disease related causes and Group II: indirectly disease related causes. The primary outcome was mortality. The secondary outcome measures were duration of hospitalization, requirement for ICU, need for mechanical ventilation and complications. Results: There were 146 patients of PD out of 25,326 hospital admissions. Forty two patients (28.7%) had direct cause, 73(50%) had indirect cause and 31(21.2%) were non-PD related admissions. The mean age was 68.5+9.9 years, 97males (66.7%). There were 16(10.9%) deaths. The commonest cause of admission was infections and encephalopathy. The indirect PD related admission had significantly higher age (p= 0.0014), increased risk of ICU admission (p=0.011), need for mechanical ventilation (p < 0.005) and longer duration of hospital stay (p=0.0001) as compared to group I. Also there was a six fold increased risk of death in this group (p 0.034). Conclusion: As disease progresses, the indirect reasons for admission becomes more troublesome than the initial motor complaints.