Eating habits, anthropometry, lifestyle, and hypertension of a group of non-village indigenous women in Amazon, Brazil

SUMMARY OBJECTIVE: The aim of this study was to describe the anthropometric characteristics, eating habits, and lifestyle of non-village indigenous women living in Manaus, AM, and their association with hypertension. METHODS: This cross-sectional (descriptive-analytical) study was carried out from January 2020 to December 2021 using a questionnaire for clinical, sociodemographic, and behavioral data. Non-pregnant women who belonged to Parque das Tribos for more than a year, declared themselves indigenous, and were over 18 years of age were included in the study. RESULTS: In total, 21 ethnicities were identified, and 95 indigenous women were evaluated. The average age group was 36±12.1 years, the average height was 157 cm, and the body mass index was 28.8 kg/m2. The prevalence of systemic arterial hypertension was ±40%, and 68.5% had excess weight, with 29.1% having class I obesity. In all, 35.8% consumed a lot of salt, sugar, and industrialized foods, and 88.4% were sedentary. CONCLUSION: Much of the sample presented excess weight, and almost all were sedentary. More than one-third had unappropriated eating habits. Hypertension was present in more than one-third of these indigenous women. There was an association between higher body mass index and hypertension. Knowing the characteristics of this group of non-village indigenous women may help determine the best health approach. The data demonstrate the necessity of preventive measures.

Association between multimorbidity, intensive care unit admission, and death in patients with COVID-19 in Brazil: a cross-section study, 2020

ABSTRACT BACKGROUND: Multimorbidity can influence intensive care unit (ICU) admissions and deaths due to coronavirus disease (COVID-19). OBJECTIVE: To analyze the association between multimorbidity, ICU admissions, and deaths due to COVID-19 in Brazil. DESIGN AND SETTING: This cross-sectional study was conducted using data from patients with severe acute respiratory syndrome (SARS) due to COVID-19 recorded in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) in 2020. METHODS: Descriptive and stratified analyses of multimorbidity were performed based on sociodemographic, ventilatory support, and diagnostic variables. Poisson regression was used to estimate the prevalence ratios. RESULTS: We identified 671,593 cases of SARS caused by COVID-19, of which 62.4% had at least one morbidity. Multimorbidity was associated with male sex, age 60-70 and ≥ 80 years, brown and black skin color, elementary education and high school, ventilatory support, and altered radiologic exams. Moreover, all regions of the country and altered computed tomography due to COVID-19 or other diseases were associated with death; only the northeast region and higher education were associated with ICU admission. CONCLUSION: Our results showed an association between multimorbidity, ICU admission, and death in COVID-19 patients in Brazil.

COVID-19 em pessoas com deficiências do desenvolvimento: uma revisão de escopo / COVID-19 en personas con trastornos en el desarrollo: una revisión de alcance / COVID-19 in people with developmental disabilities: a scoping review

Resumo Objetivo Examinar a evidência emergente sobre os tipos e a frequência de deficiências do desenvolvimento na população afetada pela COVID-19, identificando formas de categorização, incidência/prevalência e comorbidades mais frequentes. Métodos Para esta revisão de escopo realizou-se busca por estudos observacionais nas bases de dados Medline (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), Lilacs (BVS) e 'literatura cinzenta'. Como critérios de elegibilidade, os estudos deveriam apresentar resultados de ocorrência de deficiência de desenvolvimento em pessoas com COVID-19, permitindo comparação com a população em geral, ou entre os grupos de deficiências. Dois revisores independentes fizeram o mapeamento das informações utilizando um instrumento de extração de dados previamente elaborado. Outros dois pesquisadores verificaram os dados e auxiliaram na elaboração dos quadros de apresentação dos resultados. Resultados Observou-se diversidade de terminologias empregadas para categorizar as DD. As pessoas com DD e com comorbidades que representam maior risco para a COVID-19 necessitaram de internação hospitalar com maior frequência do que a população em geral. De um total de 4930 estudos, 14 foram selecionados para avaliação. Destes, 5 artigos foram estudos longitudinais. Conclusão Em pessoas com DD, a COVID-19 apresentou taxas de morbidade, letalidade e mortalidade mais altas em faixas etárias mais jovens, na população mais pobre, na população institucionalizada e que requer tecnologias de suporte de vida e cuidados especializados. A vulnerabilidade das pessoas com DD à COVID-19 depende do tipo e da gravidade da deficiência e da presença de comorbidades, evidenciando a necessidade de atenção no diagnóstico e nas medidas preventivas, como a vacinação.

Resumen Objetivo Examinar la evidencia emergente sobre los tipos y la frecuencia de trastornos en el desarrollo (TD) en la población afectada por COVID-19 e identificar formas de categorización, incidencia/prevalencia y comorbilidades más frecuentes. Métodos Para esta revisión de alcance se realizó una búsqueda de estudios observacionales en las bases de datos Medline (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), Lilacs (BVS) y 'literatura gris'. Como criterio de elegibilidad, los estudios debían presentar resultados de casos de TD en personas con COVID-19 y permitir la comparación con la población general, o entre los grupos de trastornos. Dos revisores independientes realizaron el mapeo de la información con la utilización de un instrumento de extracción de datos previamente elaborado. Otros dos investigadores verificaron los datos y ayudaron a elaborar los cuadros de presentación de resultados. Resultados Se observó diversidad en la terminología empleada para categorizar los TD. Las personas con TD y con comorbilidades que representan mayor riesgo de COVID-19 necesitaron internación hospitalaria con mayor frecuencia que la población general. De un total de 4930 estudios, 14 fueron seleccionados para el análisis, de los cuales 5 artículos fueron estudios longitudinales. Conclusión En personas con TD, el COVID-19 presentó índices de morbilidad, letalidad y mortalidad más altos en rangos de edad más jóvenes, en la población más pobre, en la población institucionalizada y que requiere tecnologías de soporte vital y cuidados especializados. La vulnerabilidad de las personas con TD depende del tipo y gravedad del trastorno y de la presencia de comorbilidades, lo que deja en evidencia la necesidad de atención en el diagnóstico y en las medidas preventivas, como la vacunación.

Abstract Objective To examine the emerging evidence on developmental disability type and frequency in the population affected by COVID-19, identifying more frequent forms of categorization, incidence/prevalence and comorbidities. Methods For this scoping review, we searched for observational studies in the MEDLINE (PubMed), Scopus (Elsevier), ISI Web of Science (Clarivate), LILACS (VHL) and grey literature databases. As eligibility criteria, studies should present results of developmental disability (DD) occurrence in people with COVID-19, allowing comparison with the general population, or between groups of disabilities. Two independent reviewers mapped the information using a previously elaborated data extraction instrument. Two other researchers verified the data and assisted in table elaboration to present the results. Results There was a diversity of terminologies used to categorize DD. People with DD and comorbidities that represent a higher risk for COVID-19 required hospitalization more frequently than the general population. Out of a total of 4930 studies, 14 were selected for assessment. Of these, 5 articles were longitudinal studies. Conclusion In people with DD, COVID-19 had higher morbidity, lethality and mortality rates in younger age groups, in the poorest population, in the institutionalized population, requiring life support technologies and specialized care. The vulnerability of people with DD to COVID-19 depends on disease type and severity and the presence of comorbidities, highlighting the need for attention in diagnosis and preventive measures, such as vaccination.

Cirurgia de Endocardite Infecciosa. Análise de 328 Pacientes Operados em um Hospital Universitário Terciário / Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Resumo Fundamento A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. Objetivo Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo - Brasil. Método Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020 Resultados Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. Conclusão Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Abstract Background Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. Objective This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. Method Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020 Results The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. Conclusion For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

Antimalarials and macrolides: a review of off-label pharmacotherapies during the first wave of the SARS-CoV-2 pandemic

Abstract We critically analyzed clinical trials performed with chloroquine (CQ) and hydroxychloroquine (HCQ) with or without macrolides during the first wave of COVID-19 and discussed the design and limitations of peer-reviewed studies from January to July 2020. Seventeen studies were eligible for the discussion. CQ and HCQ did not demonstrate clinical advantages that justified their inclusion in therapeutic regimens of free prescription for treatment or prophylactic purposes, as suggested by health authorities, including in Brazil, during the first wave. Around August 2020, robust data had already indicated that pharmacological effects of CQ, HCQ and macrolides as anti-SARS-CoV-2 molecules were limited to in vitro conditions and largely based on retrospective trials with low quality and weak internal validity, which made evidence superficial for decision-making. Up to that point, most randomized and nonrandomized clinical trials did not reveal beneficial effects of CQ or HCQ with or without macrolides to reduce lethality, rate of intubation, days of hospitalization, respiratory support/mechanical ventilation requirements, duration, type and number of symptoms, and death and were unsuccessful in increasing virus elimination and/or days alive in hospitalized or ambulatory patients with COVID-19. In addition, many studies have demonstrated that side effects are more common in CQ-or HCQ-treated patients.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Advances in research of multimorbidity among HIV-positive individuals / 上海预防医学

Multimorbidity is the co‑existing of two or more chronic diseases or health problems. Widespread access to antiretroviral therapy has led to a marked improvement in the immune status and life expectancy among HIV-positive individuals. HIV-positive individuals suffer from higher burden of chronic non-communicable diseases and are more likely to show a premature aging and frailty trend compared with the general population. The consequent increase in the prevalence of multimorbidity leads to the increasing in medical and economic burden， and different comorbidity patterns may indicate different risk factors and have different effects on health outcomes， posing challenges to healthcare and comprehensive management for HIV-positive individuals. This review summarizes research advances in prevalence， associated factors and patterns of comorbidities among HIV-positive individuals.

Prevalence and risk factors of dry eye patients with corneal epithelial defects: A hospital-based retrospective study / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the characteristics and correlated risk factors of dry eye patients with corneal epithelial defects.METHODS: Outpatient medical records of dry eye patients with corneal epithelial defects at Peking University Third Hospital from July 2018 to June 2019 were retrospectively analyzed. The patients' data including sex, age, visit date, presence of comorbidities, and meteorological indicators at the same period were statistically analyzed.RESULTS: A total of 291 dry eye patients with corneal epithelial defects, of whom 75.3% were female, were retrospectively analyzed. Young patients aged 21-30 made up the most(26.5%), while the proportion of teenagers(<18 years, 5.8%)and the elderly(≥61 years, 17.2%)was low. However, as the largest proportion of this population, young and middle-aged patients tend to experience fewer visits(5.4±12.4). Spring and winter were the main seasons of complaints. The meteorological indicators at the same period including fine-particulate matter with a median aerometric diameter of less than 10μm(PM10), sulfur dioxide(SO2), nitrogen dioxide(NO2), and reduced average relative humidity were found significantly correlated with dry eye corneal epithelial defects(P<0.05). Conjunctivitis, cataracts, blurred vision, and trichiasis ranked the top four comorbidities.CONCLUSION: Dry eye corneal epithelial defects of young and female population cannot be ignored. PM10, SO2, NO2, and reduced humidity are found significantly correlated with dry eye corneal epithelial defects. For dry eye patients with conjunctivitis, cataracts, blurred vision, and trichiasis, more attention should be paid to their corneal conditions.

Characteristics of pulmonary tuberculosis patients complicated by diabetes mellitus in Quzhou City / 预防医学

Objective@#To analyze the epidemiological and clinical characteristics of pulmonary tuberculosis patients complicated by diabetes mellitus (PTB-DM), so as to provide insights into PTB-DM control.@*Methods@#The data pertaining to PTB cases in Quzhou City from 2016 to 2020 were extracted from Tuberculosis Information Management System of Chinese Disease Prevention and Control Information System. The demographic features, diagnosis and treatment of PTB-DM patients were descriptively analyzed, and compared with PTB patients.@*Results@#The incidence of PTB-DM was 6.79/105 to 9.27/105 in Quzhou City from 2016 to 2020, with an annual increase rate of 8.09%. Among all PTB-DM patients, there were 674 men (76.94%), 620 cases at ages of 60 years and older (70.78%), 564 cases living in urban areas (64.38%), 619 farmers (70.66%), 537 cases with delay in healthcare-seeking (61.30%), 802 treatment-naïve cases (91.55%), 547 cases positive for pathogenic tests (62.44%), 11 cases with rifampicin resistance (1.26%), 695 cases with negative conversion of sputum smears 2 months post-treatment (79.34%), and 783 cases with successful treatment (89.38%). The proportions of men, ages of 60 years and older, living in urban areas, farmers, delay in healthcare-seeking, positive pathogenic tests and rifampicin resistance were significantly higher among PTB-DM patients than among PTB patients, and the negative conversion rate of sputum smears 2 months post-treatment was significantly lower among PTB-DM patients than among PTB patients (all P<0.05).@*Conclusions@#The incidence of PTB-DM increased year by year in Quzhou City from 2016 to 2020, and PTB-DM cases were predominantly found among elderly men. The proportion of delay in healthcare-seeking, positive pathogenic tests and rifampicin resistance was higher among PTB-DM patients than among PTB patients.

Assessment of SARS-CoV-2 infection in a basic health service unit in Araçatuba, São Paulo, Brazil / Incidência de infecção por SARS-Cov-2 em uma unidade básica de Saúde de Araçatuba, São Paulo, Brasil

Objective: to describe risk factors associated with SARS-CoV-2 infection. Methods: this is a retrospective descriptive cross-sectional study aimed at describing the epidemiological profile of laboratory and clinical diagnosis of unvaccinated patients seen at a basic health unit in Araçatuba ­ SP, infected with SARS-CoV-2 between June 2020 and January 2021.The results were analyzed through inferential and descriptive statistics. Additionally, Chi-square and Fisher exact tests were used (p<0.05). Results: of 313 patients, 128 were positive for COVID-19, with 68.75% diagnosed by RT-PCR and the others by immunochromatography. Women were 51.56% of those infected with adults corresponding to the main age group (76.56%), and 57% of patients had only a basic educational level concluded. A total of 88.26% of the patients progressed to cure without complications; eight patients died, most of whom were men and elderly. Of the variables analyzed for positive/negative outcomes, only "basic educational level" was significant for a positive result(p=0.0019). Conclusion: the deaths of infected patients may be associated with the existence of at least one comorbidity and advanced age of men.

Objetivo: descrever os fatores de risco associados com a infecção por SARS-CoV-2. Métodos: trata-se de um estudo descritivo retrospectivo e transversal, voltado a descrever o perfil epidemiológico de diagnóstico laboratorial e clínico, de pacientes não vacinados, atendidos em uma unidade básica de saúde de Araçatuba-SP, infectados por SARS-CoV-2, no período entre junho de 2020 e janeiro de 2021. Os resultados foram analisados por estatística inferencial e descritiva. Adicionalmente, foram aplicados os testes de Qui-quadrado e exato de Fisher (p<0.05). Resultados: dos 313 pacientes, 128 apresentaram resultado positivo para COVID-19, com 68,75% diagnosticados por RT-PCR e o restante por imunocromatografia. Mulheres foram 51,56% dos infectados, com adultos correspondendo à principal faixa etária (76,56%), 57% dos pacientes apresentavam apenas o nível educacional básico concluído. O quadro de 88.26%dos pacientes evoluiu para cura sem complicações;8 pacientes foram a óbito, sendo, em sua maioria, homens e idosos. Das variáveis analisadas para grau de dependência de resultado positivo/negativo, apenas "nível escolar básico" apresentou resultado significante para resultado positivo (p=0.0019). Conclusão: os óbitos dos pacientes infectados podem ser associados à existência de, pelo menos, uma comorbidade e à idade avançada de homens.

Características y factores de riesgo de mortalidad por COVID-19 en Tamaulipas, a un año de pandemia / Characteristics and risk factors of COVID-19 mortality in Tamaulipas, one year after the pandemic

Resumen Coronavirus 19 (COVID-19), es una enfermedad viral prevalente y diseminada a nivel mundial, considerada una pandemia con alta tasa de mortalidad. A la fecha no existen estudios que describan la influencia de las variables asociadas a la enfermedad en el estado fronterizo de Tamaulipas, México. El objetivo del presente estudio fue evaluar y analizar las características, complicaciones, tasas de letalidad y factores de riesgo asociados a mortalidad en paciente positivos a COVID-19 en el estado de Tamaulipas, a un año de la emergencia local. Se utilizó la frecuencia de casos observados en relación a características, complicaciones y comorbilidades para estimar prevalencias y tasas de letalidad. Se ajustó un modelo de regresión logística multivariada para estimar los factores de riesgo significativos y se utilizaron curvas de supervivencia de Kaplan-Meier para describir las comorbilidades más importantes. Los análisis indicaron una mayor infección en pacientes en edad productiva, con una probabilidad significativa de muerte a partir de los 40 años, más evidente en pacientes masculinos. Los riesgos asociados a la hospitalización, como intubación endotraqueal y neumonía, son factores muy importantes. Las comorbilidades con alta prevalencia (diabetes, hipertensión y obesidad) y enfermedad renal crónica (ERC) están asociados significativamente (P < 0.01) a mayor mortalidad por COVID-19 en pacientes positivos. El presente estudio demostró algunos patrones generales de prevalencia y tasas de letalidad por COVID-19, por lo que se sugieren particularidades en los factores asociados a mortalidad en la población de Tamaulipas que requieren atención en sus grupos vulnerables, sobre todo en posibles casos de rebrotes de la enfermedad.

Abstract Coronavirus 19 (COVID-19) is a prevalent and globally disseminated viral disease that has become a pandemic associated with a high case fatality rate. To date, there are no published studies that describe the influence of the variables associated with the disease, specifically in the border state of Tamaulipas, Mexico. The objective of the present study was to assess the characteristics, complications, fatality rates and risk factors associated to mortality in patients positive to COVID-19 in Tamaulipas, one year after the local emergency. Descriptive frequency of characteristics, complications for prevalence and case fatality rates were used. A multivariate logistic regression model was adjusted to estimate the meaningful risk factors, and Kaplan-Meier survival curves were used to describe the most important comorbidities. The analysis indicated higher infection rates in patients of productive age, with a significant death probability in male patients from the age of 40. The risks associated with hospitalization, such as endotracheal intubation and the presence of pneumonia are important risk factors. Comorbidities with high prevalence; diabetes, hypertension, obesity, and chronic kidney disease (CKD) were significantly associated (P < 0.01) with higher COVID-19 mortality risk in the assessed population. The present study demonstrated some COVID-19 general patterns on frequency and mortality rates. It also suggested particularities in factors associated to mortality in the Tamaulipas population, which require proper attention in vulnerable groups, especially in future outbreaks of the disease.

Transtorno mental e transplante hepático: um estudo de coorte de 2 anos / Mental disorders and liver transplantation: a 2-year cohort study

ABSTRACT Background Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. Objective The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. Methods: We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. Results: Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. Conclusion: This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.

RESUMO Contexto: A avaliação psicossocial é essencial na avaliação para transplante hepático; ela pode afetar as taxas de sobrevida e outros desfechos. Objetivo: O objetivo principal deste estudo foi investigar o impacto de transtornos mentais prévios e impulsividade nos índices de sobrevivência após o transplante hepático. Métodos: Foi realizado um estudo prospectivo de coorte com indivíduos em estágio avançado da doença hepática com e sem comorbidades psiquiátricas no pré-transplante, acompanhados por 2 anos após o transplante. Na fase pré-transplante foi realizado o diagnóstico psiquiátrico através do Mini-Plus 5.0.0 e avaliada a impulsividade através da Escala de Impulsividade Barratt. Os pacientes foram acompanhados por 2 anos após o transplante. O desfecho principal foi óbito. Foi utilizada regressão logística para avaliar a associação entre comorbidades psiquiátricas e óbito. Também foi realizada análise de sobrevida com Kaplan-Meier e modelo de regressão Cox. Resultados: Entre junho de 2010 e julho de 2014 foram transplantados 93 pacientes entre os 191 candidatos. Dos 93 pacientes transplantados, 21 tinham comorbidade psiquiátrica e 72 não tinham. Durante o período de acompanhamento houve 25 óbitos. A presença de comorbidade psiquiátrica (P=0.353) e alta impulsividade (P=0.272) não foram associadas a óbito pós-transplante até segundo ano de cirurgia. Conclusão: Este estudo não encontrou evidências de que a presença de transtorno mental e impulsividade pioram o prognóstico pós-transplante hepático.

Factores clínicos y socioeconómicos asociados a bronquiolitis severa en lactantes menores de 24 meses. Estudio de caso control

Introducción: En países en desarrollo, además de las comorbilidades, otros factores podrían aumentar el riesgo de enfermedad respiratoria severa. El objetivo del presente estudio fue analizar los factores de riesgo clínicos, sociodemográficos y ambientales asociados al ingreso a la unidad de cuidados intensivos pediátricos (UCIP) de lactantes menores de 24 meses con diagnóstico de bronquiolitis. Materiales y métodos Diseño: caso- control. Se incluyó a lactantes de 0 a 24 meses de edad con el diagnóstico de bronquiolitis severa que ingresaron a la UCIP y los controles fueron lactantes bronquiolitis leve a moderada, sin requerimiento de UCIP. Se excluyeron las historias clínicas incompletas e imposibilidad de comunicación con los padres. Variables: bajo peso de nacimiento, parto pretérmino y presencia de enfermedades de base (EB), nivel socioeconómico, lactancia materna exclusiva hasta los 6 meses de edad, exposición al humo ambiental y al tabaco. Los datos fueron analizados en SPSS V21. El comité de ética aprobó el estudio con consentimiento informado de los padres. Resultados : Fueron incluidos 220 pacientes. Caso control 1:1. En el análisis bivariado los casos se asoció la presencia de EB, bajo peso de nacimiento, prematuridad, bajo estrato socioeconómico y ausencia de LME hasta 6 meses En el análisis ajustado la bronquiolitis severa se asoció a presencia de EB, bajo estrato socioeconómico y ausencia de LME hasta los 6 meses. Conclusiones La bronquiolitis severa en lactantes menores de 24 meses, se asoció a la presencia de comorbilidades, falta de lactancia materna exclusiva y a la pertenencia a estratos socioeconómicos bajo.

Introduction: In developing countries, in addition to comorbidities, other factors could increase the risk of severe respiratory disease. The objective of this study was to analyze the clinical, sociodemographic, and environmental risk factors associated with admission to the pediatric intensive care unit (PICU) of infants younger than 24 months with a diagnosis of bronchiolitis. Materials and methods: the study design was case-control. Infants from 0 to 24 months of age with a diagnosis of severe bronchiolitis who were admitted to the PICU were included, and the controls were infants with mild to moderate bronchiolitis, without PICU requirement. Cases with incomplete medical records and the inability to communicate with parents were excluded. Variables: low birth weight, preterm delivery and presence of underlying diseases (UD), socioeconomic level, exclusive breastfeeding (EBF) up to 6 months of age, exposure to environmental smoke and tobacco. Data were analyzed in SPSS V21. The hospital ethics committee approved the study and parental informed consent was obtained. Results: 220 patients were included. Control case 1:1. In the bivariate analysis, the cases were associated with the presence of UD, low birth weight, prematurity, low socioeconomic status, and absence of EBF for up to 6 months. In the adjusted analysis, severe bronchiolitis was associated with the presence of UD, low socioeconomic status, and absence of EBF up to 6 months. Conclusions: Severe bronchiolitis in infants under 24 months of age was associated with the presence of comorbidities, lack of exclusive breastfeeding, and belonging to low socioeconomic strata.

Caracterização de traqueostomia em crianças e adolescentes em um serviço de atenção terciária / Characterization of tracheostomy in children and adolescents in a tertiary care service / Caracterización de la traqueotomía en niños y adolescentes en un servicio de tercer nivel de atención

Objetivo: descrever o perfil de indicações, comorbidades e complicações pós-operatórias precoces de crianças e adolescentes submetidos à traqueostomia em um hospital referência brasileiro. Método: estudo retrospectivo,transversale quantiativo, com análise de prontuários eletrônicos de crianças e adolescentes submetidos à traqueostomia em um hospital de Botucatu, São Paulo, Brasil, no periodo de 2013 a 2019. A amostra foi comparada mediante a divisão de presença e ausência de complicações pós-operatórias precoces, no que se refere ao sexo, idade, síndrome, óbito, caráter eletivo ou de urgência/emergência e peso ao nascer. Resultados: entre100 prontuários, 55% do sexo masculino, com média de 3,03±3,10 anos. Foram identificadas 12 diferentes síndromes em 16 pacientes. No que se refere às complicações pós-operatórias precoces, a rolha foi a mais frequente (13%), e esteve associada a presença de síndromes (p=0,01). O motivo mais identificado da traqueostomia foi a intubação orotraquealprolongada, enquanto 44% evoluíram a óbitodevido a gravidade da doença de base. Conclusão: a traqueostomia em crianças é um procedimento seguro, com indicação mais frequente por intubação prolongada, em portadores de síndromes genéticas menores de um ano de idade. Complicação como rolha é comum, associado a síndrome.

Objective: to describe the profile of indications, comorbidities and early postoperative complications of children and adolescents undergoing tracheostomy in a Brazilian referral hospital. Method: retrospective, cross-sectional and quantitative study, with analysis of electronic medical records of children and adolescents who underwent tracheostomy in a hospital in Botucatu, São Paulo, Brazil, from 2013 to 2019. The sample was compared by dividing the presence and absence of post-operative complications. early operative procedures, with regard to sex, age, syndrome, death, elective or urgency/emergency character and birth weight. Results:among 100 records, 55% were male, with an average of 3.03±3.10 years.Twelve different syndromes were identified in 16 patients. With regard to early postoperative complications, cork was the most frequent (13%) and was associated with the presence of syndromes (p=0.01). The most identified reason for tracheostomy was prolonged orotracheal intubation, while 44% died due to the severity of the underlying disease.Conclusion:pediatric tracheostomy is a safe procedure, more frequently realized due to failure of extubation, in genetic syndrome children younger than one year old. Cork is a frequent complication, associated to syndromes.

Objetivo:describirel perfil de indicaciones, comorbilidades y complicaciones postoperatorias tempranas de niños y adolescentes sometidos a traqueotomía en un hospital de referencia brasileño. Método: estudio retrospectivo, transversal y cuantitativo, con análisis de historias clínicas electrónicas de niños y adolescentes operados de traqueotomía en un hospital de Botucatu, São Paulo, Brasil, de 2013 a 2019. La muestra fue comparada dividiendo la presencia y ausencia de complicaciones postoperatorias. .procedimientos operatorios tempranos, con respecto al sexo, edad, síndrome, muerte, carácter electivo o urgencia/emergencia y peso al nacer. Resultados: entre 100 registros, 55% eran del sexo masculino, con una media de 3,03±3,10 años. Se identificaron 12 síndromes diferentes en 16 pacientes. En cuanto a las complicaciones postoperatorias tempranas, el corcho fue la más frecuente (13%) y se asoció a la presencia de síndromes (p=0,01). El motivo de traqueostomía más identificado fue la intubación orotraqueal prolongada, mientras que el 44% fallecieron debido a la gravedad de la enfermedad de base.Conclusión: la traqueotomía en niños es un procedimiento seguro, con indicación más frecuente de intubación prolongada, en pacientes con síndromes genéticos menores de un año. La complicación como el corcho es común, asociada con el síndrome.

Caracterização genética, clínica e epidemiológica de pacientes com Covid-19 em uma região do Sul do Brasil / Genetic, clinical and epidemiological characterization of Covid-19 patients in South Brazil

Caracterizar o perfil epidemiológico, clínico e genético de pacientes com Covid-19. Realizou-se um estudo observacional e transversal com voluntários que tiveram diagnóstico de Covid-19 no período de abril de 2020 a maio de 2021 no município de Santa Cruz do Sul (RS, Brasil), no qual foram coletados dados clínicos e epidemiológicos, além de amostras de sangue para a identificação de polimorfismos no gene ACE2. Foram recrutados 87 indivíduos e destes, 16,7% necessitaram de internação hospitalar, sendo a maioria do sexo masculino. A obesidade foi a comorbidade mais frequente, no entanto, doenças cardiovasculares, hipertensão e diabetes apresentaram maior significância quando associadas às internações. Em relação à características genéticas, entre os voluntários não foram encontrados polimorfismos no gene ACE2. A pesquisa sugere que o sexo masculino e presença de comorbidades são importantes fatores de risco para a severidade da Covid-19.

Current paper characterizes the epidemiological, clinical and genetic profile of patients with Covid-19. An observational and cross-sectional study was carried out with volunteers diagnosed with Covid-19 between April 2021 and May 2021 in the municipality of Santa Cruz do Sul, Brazil; a blood sample also identified polymorphism in the ACE2 gene. 87 patients were recruited; 6.7% required hospitalization, the majority being male. Although obesity was a more frequent co-morbidity, cardiovascular diseases, hypertension and diabetes were more significant when associated with hospitalizations. In the case of genetic characteristics, polymorphisms were found in the ACE2 gene among volunteers. Important research suggests male gender and co-morbidities are risk factors for the severity of Covid-19.

The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis

Abstract Background: The close relationship between psoriasis and concomitant diseases is widely accepted. However, a comprehensive analysis of organ-based comorbidities in psoriasis is still lacking. Objective: The authors aimed to present the risk of organ-based comorbidities in psoriasis by comparing the general population. Methods: The authors retrieved a search of Pubmed, EMBASE, and Cochrane databases for studies reporting organ-based comorbidities in psoriasis versus the general population. Observational studies that met the following criteria were assessed: 1) Psoriasis diagnosis; 2) Cardiovascular or kidney or liver or respiratory or cerebrovascular outcomes; 3) Comparison group of individuals without psoriasis. Pooled Relative Risks (pRRs) and 95% Confidence Intervals (CIs) were calculated by using the random-effect model. Results: Fifteen observational studies with 216,348 psoriatic patients and 9,896,962 individuals from the general population were included. Psoriasis showed a greater risk of organ-based comorbidities. Compared to the general population, pRR for all organ-based comorbidities was 1.20 (95% CI 1.11-1.31) in psoriasis, and pRR was lower in mild 0.61 (95% CI 0.46-0.81) than in moderate/severe patients. pRR was 1.20 (95% CI 1.11-1.30) for cardiovascular, 1.56 (95% CI 1.20-2.04), and 1.75 (95% CI 1.33-2.29) for cerebrovascular and liver diseases, respectively. pRR for coexisting renal and cardiovascular events was 1.09 (95% CI 1.01-1.18). pRR for coexisting renal and cerebrovascular events was 1.28 (95% CI 0.99-1.66). pRR for coexisting renal and liver diseases was 1.46 (95% CI 1.10-1.94). pRR for coexisting cardiovascular and liver diseases was 1.41 (95% CI 1.11-1.80). Study limitations: There is heterogeneity. Conclusion: Psoriasis has a higher risk of single and multiple organ-based comorbidities than the general population. The present study will further improve attention to psoriasis as a systemic inflammatory disease.

Glycated Haemoglobin Levels and Its Effect on Outcomes in Cardiac Surgery

Abstract There remains a significant paucity of information evaluating the effect of glycated HbA1c levels and its theorized effect on mortality and morbidity rates following cardiac surgery. Diabetes is a very common comorbidity in patients undergoing open heart surgery, as there is a shift in patient characteristics and greater risk. Currently, there is no clear consensus that an increase in HbA1c level is associated with increased perioperative mortality rate. However, the reported literature is more commonly able to demonstrate that elevated HbA1c levels is associated with increased rates of wound infection, cardiovascular events and renal failure, and thus, higher post-operative morbidities. This review aims to examine and synthesis the evidence behind each of the morbidities and mortalities associated with open heart surgery and the impact of high HbA1c on the reported outcomes.

Caracterización clinicoepidemiológica de pacientes operados de duodenopancreatectomía cefálica con enfermedad del confluente biliopancreático / Clinical epidemiological characterization of patients operated on cephalic pancreaticoduodenectomy with disease of the biliopancreatic confluent

Introducción: La duodenopancreatectomía cefálica continúa siendo una intervención quirúrgica compleja. Objetivo: Caracterizar a los pacientes operados de duodenopancreatectomía cefálica según variables epidemiológicas, clínicas e histológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de una serie de 15 casos operados de duodenopancreatectomía cefálica en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el quinquenio 2016-2020. Las variables analizadas fueron edad, sexo, comorbilidades, hábitos tóxicos, síntomas y signos, así como tipo histológico de las lesiones. Resultados: Predominaron los pacientes del sexo masculino (80,0 %) y el grupo de 50 a 55 años de edad (40,0 %). Las comorbilidades más frecuentes fueron la hipertensión arterial en 80,0 % de la casuística, seguida de la diabetes mellitus en 53,3 %. Prevalecieron el tabaquismo (66,7 %) y el alcoholismo (60,0 %), así como los signos de obstrucción biliar (73,3 %). El diagnóstico histológico principal fue adenocarcinoma de páncreas en 60,1 % de los afectados. Conclusiones: La duodenopancreatectomía cefálica se realiza predominantemente en pacientes con adenocarcinomas de páncreas y, en menor medida, con adenocarcinomas de duodeno y otras afecciones benignas; en afectados del sexo masculino, con edades intermedias y avanzadas de la vida, hipertensión arterial y diabetes mellitus, así como tiempo prolongado de ser fumadores y consumidores de alcohol. Los signos de obstrucción biliar son de importancia capital en el diagnóstico clínico.

Introduction: The cephalic pancreaticoduodenectomy continues being a complex surgical intervention. Objective: To characterize patients operated on cephalic duodenopancreatectomy according to selected epidemiological, clinical and histologic variables. Methods: An observational, descriptive and retrospective study of a series of 15 cases operated on cephalic pancreaticoduodenectomy was carried out in the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, during the five year period 2016-2020. The analyzed variables were age, sex, comorbidities, toxic habits, symptoms and signs, as well as histologic type of the lesions. Results: There was a prevalence of the male sex patients (80.0 %) and the 50 to 55 age group (40.0 %). The most frequent comorbidities were hypertension in 80.0 % of the case material, followed by the diabetes mellitus in 53.3 %. Nicotine addiction (66.7 %) and alcoholism (60.0 %) prevailed, as well as the signs of biliary obstruction (73.3 %). The main histologic diagnosis was pancreas adenocarcinoma in 60.1 % of those affected. Conclusions: The cephalic pancreaticoduodenectomy is carried out predominantly in patients with pancreas adenocarcinomas and, to a lesser extent, in patients with duodenum adenocarcinomas and other benign affections; in those affected of the male sex, with intermediate and advanced ages of life, hypertension and diabetes mellitus, as well as long time of being smokers and alcohol consumers. The signs of biliary obstruction are of capital importance in the clinical diagnosis.

Características clínicas de los pacientes con parálisis cerebral infantil portadores de gastrostomía atendidos en un instituto especializado de salud de Lima, Perú

Introducción: La parálisis cerebral infantil constituye una condición importante de discapacidad, y el trastorno motor suele acompañarse de otras comorbilidades como los trastornos de deglución. La gastrostomía en pacientes que son incapaces de alimentarse de manera satisfactoria es una intervención importante y cada vez más frecuente. Objetivo: Determinar las características clínicas de los pacientes con parálisis cerebral infantil portadores de gastrostomía atendidos en el Instituto Nacional de Salud del Niño entre 2013 y 2017. Métodos: Estudio tipo serie de casos de pacientes con diagnóstico de PCI portadores de gastrostomía atendidos en el Instituto de Salud del Niño durante 2013 - 2017. Resultados: Se incluyeron 74 pacientes. La edad promedio de colocación de gastrostomía fue a los 5,8 años, la indicación más frecuente fue el trastorno de deglución. El PCI tipo espástico (74,3%) y el nivel funcional IV y V (96%) fueron las principales características clínicas. El sexo masculino (58,1%), el antecedente de parto pretérmino (54%) y la etiología perinatal (45,9%) fueron hallazgos similares a las descritas en la población con PCI. El promedio de atenciones por consulta externa fue 5,8 atenciones/año, por emergencia 1,8 atenciones/año y el de hospitalizaciones 1,3 veces/año. Conclusiones: La gastrostomía se colocó en pacientes con un gran compromiso motor, y alta dependencia para sus actividades. El tipo espástico, y la etiología perinatal, fueron los hallazgos clínicos más frecuentes. Las atenciones anuales por consulta externa fueron en promedio bajas, lo que muestra que falta mucho para implementar un trabajo multidisciplinario en este grupo de pacientes.

Introduction: Cerebral palsy is an important disability condition, and the motor disorder is usually accompanied by other comorbidities such as swallowing disorders. Gastrostomy in patients who are unable to feed satisfactorily is an important and increasingly common intervention. Objective: To determine the clinical characteristics of patients with infantile cerebral palsy with gastrostomy treated at the National Institute of Children's Health between 2013 and 2017. Methods: Case series study of patients diagnosed with PCI with gastrostomy treated at the Children's Health Institute during 2013 2017. Results: 74 patients were included. The average age of gastrostomy placement was 5,8 years, the most frequent indication was swallowing disorder. Spastic type PCI (74,3%) and functional level IV and V (96%) were the main clinical characteristics. Male sex (58,1%), history of preterm delivery (54%) and perinatal etiology (45.9%) were findings like those described in the population with PCI. The average number of outpatient visits was 5,8 times/year, for emergencies 1,8 times/year and for hospitalizations 1,3 times/year. Conclusions: The gastrostomy was placed in patients with a great motor commitment, and high dependency for their activities. The spastic type and perinatal etiology were the most frequent clinical findings. Annual outpatient visits were low on average, which shows that there is still a long way to go to implement multidisciplinary work in this group of patients.