Mayor uso de teleconsultas programadas y mensajería asincrónica del portal en atención primaria / Increased Use of Scheduled Teleconsultations and Asynchronous Portal Messaging in Primary Care

Introducción: durante la pandemia de COVID-19 hubo un auge sin precedentes de la telemedicina, probablemente por la forzada adopción de tecnología ante las medidas restrictivas. El presente estudio se propuso comparar la interacción y la comunicación entre médicos de cabecera (MC) y pacientes, antes y durante el período de pandemia, en términos de consultas ambulatorias programadas y mensajes del Portal de Salud. Materiales y métodos: corte transversal con muestreo consecutivo de turnos programados y mensajes, ocurridos entre las semanas epidemiológicas (SE) 10 y 23, de 2019 y 2020, respectivamente. Se incluyeron 147 médicos del Servicio de Medicina Familiar y Comunitaria, y una cápita de 73 427 pacientes afiliados al Plan de Salud del Hospital Italiano de Buenos Aires. Se realizó análisis cuantitativo y cualitativo. Resultados: hubo una reducción del 70% de las consultas presenciales (de 76 375 en 2019 a 23 200 en 2020) y un aumento concomitante de teleconsultas (de 255 en la SE13 a 1089 en la SE23). En simultáneo, los mensajes aumentaron sustancialmente (de 28 601 en 2019 a 84 916 en 2020), con un inicio abrupto al comienzo del confinamiento, y una tendencia decreciente a lo largo del tiempo. Antes de la pandemia, el contenido estuvo relacionado con órdenes electrónicas de estudios complementarios, control de resultados, recetas de medicación crónica y/o interconsultas a especialistas, mientras que los dominios más frecuentes durante la pandemia fueron necesidades informativas epidemiológicas, como medidas preventivas para COVID-19, vacuna antineumocócica, vacuna antigripal, casos o sospechas, resultados de hisopados, entre otras. Conclusión: el auge de las tecnologías de la comunicación e información durante la pandemia permitió dar continuidad a los procesos asistenciales en salud pese al distanciamiento físico. Hubo mayor utilización de mensajería por necesidades informativas de los pacientes, y la relación médico-paciente se ha modificado. (AU)

Introduction: during the COVID-19 pandemic, there was an unprecedented boom in telemedicine, probably due to the forced adoption of technology in the face of restrictive measures. This study aimed to compare the interaction and communication between general practitioners and patients before and during the pandemic based on scheduled outpatient consultations and Health Portal messages. Materials and methods: Cross-sectional study with a consecutive sampling of scheduled appointments and messages, occurring between epidemiological weeks (EW) 10 and 23 of 2019 and 2020, respectively. We included 147 physicians from the Family and Community Medicine Service and a capita of 73427 patients affiliated with the Hospital Italiano de Buenos Aires health plan. We conducted a quantitative and qualitative analysis. Results: there was a 70% reduction in face-to-face consultations (from 76375 in 2019 to 23200 in 2020) and a concomitant increase in teleconsultations (from 255 in EW13 to 1089 in EW23). Concurrently, messages increased substantially (from 28601 in 2019 to 84916 in 2020), with an abrupt onset at the beginning of confinement and a decreasing trend over time. Before the pandemic, the content involved electronic orders for complementary studies, outcome monitoring, chronic medication prescriptions, or expert consultations. The most frequent domains during the pandemic were epidemiological information needs, such as preventive measures for COVID-19, pneumococcal vaccine, influenza vaccine, cases or suspicions, and swab results, among others. Conclusion: the rise of communication and information technologies during the pandemic allowed the continuity of healthcare processes despite the physical distance. There was increased use of messaging for patients' information needs, and the doctor-patient relationship has changed. (AU)

Teledentistry protocol for the elderly in the context of the covid-19 pandemic through a web platform/mobile app: approach from the general dentist / Protocolo de teleodontología para adultos mayores en el contexto de la pandemia de covid-19 a través de una plataforma web/aplicación móvil: abordaje desde el odontólogo general

Objective: To generate teledentistry protocols for urgent and priority dental care for the elderly population through a technological web platform and mobile application in the context of the COVID-19 pandemic. Material and Methods: Teledentistry protocols were developed in five sequential steps: Staff training, Patient recruitment, Patient admission, Patient reception and Patient care. Reasons for admission were categorized in urgencies and priority dental treatment. Results: The most prevalent reasons for consultation were prosthesis mismatch (18.37%), dental pain (16.33%) and fractured teeth (14.29%). In urgencies by need for treatment: due to infection or pain (24.44%) or to avoid pulp involvement (26.67%). The rest of the care did not require immediate attention. Regarding the OHIP-14Sp survey prior to care, in which patients were consulted for problems with their teeth, mouth or prosthesis, two questions were answered per dimension, for each dimension the following values were obtained: functional limitation (71.30% and 50.44%), physical pain (68.97% and 70.18%), psychological discomfort (75.00% and 74.14%), physical disability (57.39% and 46.09%), psychological disability (37.72% and 53.91%), social disability (33.91% and 30.97%) and handicap (27.83% and 25.86%). Conclusion: A teledentistry protocol for urgent and priority dental care of the elderly in the context of the COVID-19 pandemic with a focus on a general dentist remotely supported specialists was a useful tool to effectively systematize the care of elderly patients, reducing risk of exposure to COVID-19 and solving dental urgencies in this population

Objetivo: Generar protocolos de teleodontología para la atención odontológica urgente y prioritaria de la población adulta mayor a través de una plataforma web tecnológica y aplicación móvil en el contexto de la pandemia del COVID-19. Material y Métodos: Los protocolos de teleodontología se desarrollaron en cinco pasos secuenciales: capacitación del personal, reclutamiento de pacientes, admisión de pacientes, recepción de pacientes y atención al paciente. Los motivos de ingreso se categorizaron en urgencias y tratamiento odontológico prioritario. Resultados: Los motivos de consulta más prevalentes fueron desajuste de prótesis (18,37%), dolor dental (16,33%) y dientes fracturados (14,29%). En urgencias por necesidad de tratamiento por infección o dolor (24,44%) o para evitar afectación pulpar (26,67%). El resto de los cuidados no requirieron atención inmediata. En cuanto a la encuesta OHIP-14Sp previa a la atención, en la que se consultaba a los pacientes por problemas en sus dientes, boca o prótesis, se respondieron dos preguntas por dimensión, para cada dimensión se obtuvieron los siguientes valores: limitación funcional (71,30% y 50,44%), dolor físico (68,97% y 70,18%), malestar psicológico (75,00% y 74,14%), discapacidad física (57,39% y 46,09%), discapacidad psicológica (37,72% y 53,91%), discapacidad social (33,91% y 30,97%) y handicap (27,83% y 25,86%). Conclusión: Un protocolo de teleodontología para la atención odontológica urgente y prioritaria del adulto mayor, en el contexto de la pandemia de COVID-19 con un enfoque en un odontólogo general con especialistas apoyados de forma remota, fue una herramienta útil para sistematizar de manera efectiva la atención de los pacientes adultos mayores, reduciendo el riesgo de exposición al COVID-19 y resolviendo las urgencias odontológicas en esta población.

Urgência e emergência clínico-cirúrgica odontológica na atenção primária / Urgency and clinical-surgical dental emergency in primary care

Atenção Primária em Saúde Bucal é um assunto abrangente que aborda desde a atuação da equipe de saúde bucal, passando por medidas de prevenção e controle em tempos de pandemia, atenção à gestante e pré-natal, à saúde da pessoa idosa, a doenças crônicas, pacientes com HIV/AIDS e hepáticas virais, pessoas com deficiência e câncer de boca, emergências e urgências odontológicas. Cada profissional da equipe de saúde bucal tem suas próprias competências e atribuições, e a equipe como um todo tem um amplo campo de atuação na atenção primária à saúde bucal. As medidas preventivas e de controle incluem cuidados com pacientes e profissionais, higiene das mãos, limpeza e desinfecção de superfícies e materiais odontológicos. A atenção à gestante e ao pré-natal inclui acompanhamento dos cuidados com a cavidade oral durante a gestação e prevenção de doenças como gengivite gravídica e granuloma gravídico. A atenção à saúde da pessoa idosa destaca a importância da saúde bucal para a qualidade de vida deste grupo. A atenção especial às doenças crônicas inclui hipertensão arterial e diabetes, e a atenção a pacientes com HIV/AIDS e hepáticas virais destaca a importância do acompanhamento bucal nestes casos. As emergências e urgências odontológicas são definidas pela American Dental Association e incluem alterações na consciência e respiração.

Oral Health Primary Care is a comprehensive subject that covers the performance of the oral health team, including measures for prevention and control during pandemics, care for pregnant and prenatal women, elderly health, chronic diseases, patients with HIV/AIDS and viral hepatitis, people with disabilities, and oral cancer, as well as dental emergencies and urgencies. Each member of the oral health team has their own competencies and responsibilities, and the team as a whole has a broad field of action in oral health primary care. Preventive and control measures include patient and professional care, hand hygiene, cleaning and disinfection of surfaces and dental materials. Care for pregnant and prenatal women includes monitoring oral cavity care during pregnancy and prevention of diseases such as pregnancy gingivitis and pregnancy granuloma. Attention to elderly health highlights the importance of oral health for the quality of life of this group. Special attention to chronic diseases includes hypertension and diabetes, and attention to patients with HIV/AIDS and viral hepatitis emphasizes the importance of oral health follow-up in these cases. Dental emergencies and urgencies are defined by the American Dental Association and include changes in consciousness and breathing.

La Atención Primaria en Salud Bucal es un tema amplio que abarca desde la actuación del equipo de salud bucal, pasando por medidas de prevención y control en tiempos de pandemia, atención a la gestante y pre-natal, la salud de la persona mayor, las enfermedades crónicas, pacientes con VIH / SIDA y hepatitis víricas, personas con discapacidad y cáncer de boca, emergencias y urgencias odontológicas. Cada profesional del equipo de salud bucal tiene sus propias competencias y responsabilidades, y el equipo en su conjunto tiene un amplio campo de actuación en la atención primaria a la salud bucal. Las medidas preventivas y de control incluyen cuidados con pacientes y profesionales, higiene de manos, limpieza y desinfección de superficies y materiales odontológicos. La atención a la gestante y el pre-natal incluye el seguimiento de los cuidados con la cavidad oral durante el embarazo y prevención de enfermedades como la gingivitis gravídica y el granuloma gravídico. La atención a la salud de la persona mayor destaca la importancia de la salud bucal para la calidad de vida de este grupo. La atención especial a las enfermedades crónicas incluye hipertensión arterial y diabetes, y la atención a pacientes con VIH / SIDA y hepatitis víricas destaca la importancia del seguimiento bucal en estos casos. Las emergencias y urgencias odontológicas se definen por la Asociación Dental Americana e incluyen cambios en la conciencia y la respiración.

Brechas en telemedicina: caracterización de consultas ambulatorias a teledermatología en Chile entre 2018-2020 / Gaps in telemedicine: characterization of ambulatory teledermatology consultations in Chile, between 2018 and 2020

Introducción: La teledermatología (TD) se ha desarrollado de manera importante en los últimos años. Además de mejorar el acceso de la población a consultas médicas, permite el diagnóstico precoz de lesiones complejas. En Chile, la TD forma parte de la plataforma Hospital Digital del Ministerio de Salud desde el 2018, en modalidad asincrónica. El objetivo de este estudio es la caracterización epidemiológica de las consultas ambulatorias a TD en Chile entre los años 2018-2020. Materiales y Métodos: Estudio descriptivo retrospectivo. Se analizaron las consultas ambulatorias a TD y a dermatología en el período 2018-2020, a partir de los datos del Departamento de Estadísticas e Información de Salud, y los datos de población total a partir del Instituto Nacional de Estadísticas, por lo que no se requirió comité de ética. Resultados: Del total de teleconsultas realizadas entre 2018-2020, un 14,2% correspondió a TD. De ellas, el 86,1% corresponden a consultas nuevas, y el 13,9% a controles. Del total de pacientes, el 63,0% fueron mujeres, mientras que el 78,9% fueron mayores de 15 años. Se realizaron 20,35 consultas a TD por cada 10.000 habitantes a nivel nacional, y 17,21 consultas dermatológicas por cada consulta a TD. Discusión: La TD es una de las principales aplicaciones de la telemedicina en Chile. La variación entre las regiones con respecto al número de consultas a TD podría deberse a factores que requieren mayor estudio. Es probable que la TD mantenga un rol creciente debido al desarrollo tecnológico y los beneficios demostrados de esta herramienta.

Introduction: Teledermatology (TD) has greatly developed in recent years. Besides improving access to medical consultations, it also allows the early diagnosis of complex lesions. In Chile, TD forms part of the Digital Hospital platform of the Ministry of Health since 2018, in a store-and-forward form. The objective of this study is to characterize ambulatory consultations with TD in Chile between 2018 and 2020. Materials and Methods: A retrospective descriptive study was performed. Ambulatory consultations with TD and dermatology between 2018-2020 were analyzed from data obtained from the Department of Statistics and Health Information, and population data were obtained from the Statistics National Institute, which did not require ethical approval. Results: Of the total teleconsultations made in the 2018-2020 period, 14.2% belonged to TD. From that, 86.1% were new consultations, and 13.9% were controls. Women represented 63.0% of the patients, while 78.9% were older than 15 years old. For every 10,000 inhabitants, 20.35 total consultations were made with TD nationwide, and 17.21 dermatological consultations were made for each consultation with TD. Discussion: TD is one of the main applications of telemedicine in Chile. The variation in the number of consultations with TD between regions could be caused by factors that require further study. It is likely that TD will keep a growing role due to technological development and benefits shown by this tool.

Representações sociais do autocuidado na percepção de homens com diabetes / Representaciones sociales del autocuidado en la percepción de hombres con diabetes / Social representations of self-care in the perception of men with diabetes

RESUMO Objetivo: compreender as representações sociais de homens com diabetes sobre o seu autocuidado. Método: abordagem processual das representações sociais com amostra por tipicidade (n=50), composta de homens atendidos num serviço ambulatorial mineiro. Coletaram-se dados de caracterização e realizaram-se entrevistas individuais em profundidade durante três meses. Foram tratados os dados, usando softwares SPPS versão 26, NVivo Pro11® e Iramuteq com análise de conteúdo (coeficiente de Pearson ≥0,70), e atendidos os requisitos ético-legais. Resultados: idade predominante ≥50 anos. Emergiram dos discursos duas categorias: 1) Possibilidade do diabetes: atitudes adotadas ou negligenciadas - enfocando adequações em hábitos alimentares; 2) Diabetes e autocuidado: prática social do cuidado enfocando a necessidade de controle da alimentação e prática de atividade física, visando à prevenção de complicações associadas. Conclusão: a adesão/negligência ao autocuidado evidenciadas remetem à necessidade de fortalecimento dos sistemas de apoio ao grupo referente às ações de prevenção de doença e promoção da saúde, visando a controle dos fatores de risco modificáveis e dos níveis glicêmicos e diagnóstico precoce para o adiamento/manejo das possíveis complicações.

RESUMEN Objetivo: comprender las representaciones sociales de hombres con diabetes sobre su autocuidado. Método: enfoque procesal de las representaciones sociales con muestreo por conveniencia (n=50), compuesta de hombres atendidos en un servicio ambulatorio de Minas Gerais-Brasil. Se recogieron datos de caracterización y se realizaron entrevistas individuales en profundidad durante tres meses. Fueron tratados los datos, usando softwares SPPS versión 26, NVivo Pro11® e Iramuteq con análisis de contenido (coeficiente de Pearson ≥0,70), y atendidos los requisitos ético-legales. Resultados: edad predominante ≥50 años. Surgieron, de los discursos, dos categorías: 1) Posibilidad de la diabetes: actitudes adoptadas u olvidadas - enfocando adecuaciones en hábitos alimenticios; 2) Diabetes y autocuidado: práctica social del cuidado enfocando la necesidad de control de la alimentación y práctica de actividad física, teniendo por objetivo la prevención de complicaciones asociadas. Conclusión: la adhesión/negligencia evidenciada al autocuidado remiten a la necesidad de fortalecimiento de los sistemas de apoyo al grupo referente a las acciones de prevención de enfermedad y promoción de la salud, buscando controlar los factores de riesgo modificables y los niveles glucémicos y diagnóstico precoz para el aplazamiento/manejo de las posibles complicaciones.

ABSTRACT Objective: to understand the social representations of men with diabetes concerning their self-care. Method: a procedural approach to social representations with sampling by typicity (N=50), composed of men treated in an outpatient service in Minas Gerais. The study collected characterization data and performed in-depth individual interviews for three months. The data were processed using the software SPPS version 26, NVivo Pro11®, and Iramuteq with content analysis (Pearson's coefficient ≥0.70), and ethical-legal requirements were met. Results: predominant age of 50 years. Two categories emerged from speeches: 1) possibility of diabetes: attitudes adopted or neglected - focusing on adjustments in eating habits; 2) Diabetes and self-care: social practice of care focusing on the need for food control and practice of physical activity, aimed at preventing complications associated. Conclusion: the adherence/neglect to self-care evidenced refer to the need to strengthen the support systems to the group regarding the actions of disease prevention and health promotion, aiming at control of modifiable risk factors and glycaemic levels and early diagnosis for the postponement/management of possible complications.

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Epidemiología de las urgencias oftalmológicas / Epidemiology of ophthalmological emergencies

Objetivo: Determinar el comportamiento de las urgencias oftalmológicas en los pacientes que arriban al Cuerpo de Guardia. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, en 194 285 pacientes (103 859 en el año 2017 y 90 426 en el 2018). Resultados: El 52,3 por ciento perteneció al sexo masculino y 116 444 (59,9 por ciento) tenía entre 19 y 59 años de edad. La conjuntivitis fue el diagnóstico más frecuente, realizado en 72 574 (37,4 por ciento) pacientes, 43 186 (41,6 por ciento) en el año 2017 y 29 388 (32,5 por ciento) en el 2018, seguida de los cuerpos extraños superficiales en la córnea, con un total de 24 920 (12,8 por ciento), dividido en 12 544 (12,1 por ciento) en el año 2017 y 12 376 (13,7 por ciento) en el año 2018. En el 2017, 13 500 pacientes fueron diagnosticados de conjuntivitis hemorrágica como consecuencia de una epidemia que afectó a La Habana. Necesitaron ingreso 573 pacientes y de ellos 327 tuvieron cirugía mayor de urgencia, con una edad media de 45,11 años, y como diagnóstico más frecuente el trauma ocular a globo abierto con o sin cuerpo extraño intraocular. Conclusión: La conjuntivitis, los cuerpos extraños superficiales corneales y la hemorragia subconjuntival fueron los diagnósticos más frecuentes, y el trauma ocular a globo abierto con o sin cuerpo extraño intraocular fue la primera causa de ingreso y de cirugía mayor de urgencia(AU)

Objective: Determine the behavior of ophthalmological emergencies in patients attending the emergency service. Methods: A cross-sectional observational descriptive study was conducted of 194 285 patients (103 859 in the year 2017 and 90 426 in 2018). Results: Of the patients studied, 52.3 percent were male and 116 444 (59.9 percent) were 19-59 years old. The most common diagnosis was conjunctivitis, with 72 574 patients (37.4 percent), of whom 43 186 (41.6 percent) were diagnosed in the year 2017 and 29 388 (32.5 percent) in 2018, followed by superficial corneal foreign bodies with 24 920 (12.8 percent): 12 544 (12.1 percent) in the year 2017 and 12 376 (13.7 percent) in 2018. A total 13 500 patients were diagnosed with hemorrhagic conjunctivitis in the year 2017 due to an epidemic affecting Havana in that year. Of the patients studied, 573 required hospitalization, 327 of them undergoing major emergency surgery. Mean age was 45.11 years and the most common diagnosis was open globe ocular trauma with or without an intraocular foreign body. Conclusions: Conjunctivitis, superficial corneal foreign bodies and subconjunctival hemorrhage were the most common diagnoses, whereas open globe ocular trauma with or without an intraocular foreign body was the leading cause of admission and major emergency surgery(AU)

Cuidados en los servicios de Prótesis frente a la pandemia por covid-19 / Cares in the Prosthetic services toward COVID-19 pandemic

RESUMEN La covid-19 es una enfermedad infecciosa causada por el virus SARS-CoV-2, y es capaz de provocar un cuadro clínico variable. Los individuos que están en contacto estrecho con pacientes positivos de esta enfermedad, tienen un mayor riesgo de infección. Así les sucede a los trabajadores de la salud que atienden directamente a pacientes. Al igual que otros servicios de salud, la atención estomatológica requiere del contacto estrecho entre el profesional y el paciente. El objetivo de este trabajo fue describir las principales recomendaciones para la prevención y control de infecciones por SARS-CoV-2 en los servicios de Prótesis. En la práctica dental, la prevención, el control y la reducción de la transmisión de infecciones se realiza a través del uso del equipo de protección personal y de un conjunto de procedimientos de descontaminación, desinfección y esterilización en cualquier superficie o instrumento. La constante actualización científica y la adopción de medidas de protección antes, durante y después de la atención estomatológica, podrán garantizar el éxito de la atención médica con el mínimo riesgo de contagio (AU).

ABSTRACT COVID-19 is an infectious diseases caused by SARS-CoV-2 virus, and it is able to provoke variable clinical characteristics. The individuals that are in close contact with this disease positive patients are at higher infection risk. That is the case of the heath care workers directly caring for patients. As in any health service, dentistry care requires the narrow contact between the professional and the patient. The aim of this paper was describing the main recommendations for preventing and control SARS-CoV-2 in Prosthetic services. In the dental practice, the prevention, control and reduction of infection transmission is achieved using the personal protection equipment and a whole of decontamination, disinfection and sterilization procedures in any surface or device. The constant scientific updating and adopting protection measures before, during and after the dentistry care can ensure the success of health care with the minimal risk of contagion (AU).

La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19. Un estudio de abordaje integral / The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study

Resumen Introducción: Los pacientes con diabetes experimentan dificultades para mantener el control glucémico durante el confinamiento por la pandemia de COVID-19, con el riesgo de presentar complicaciones crónicas de la diabetes y COVID-19 grave. Objetivo: El propósito de este estudio fue evaluar la conversión de un centro de atención primaria presencial de diabetes a un servicio de telemedicina por llamada telefónica. Métodos: Se realizaron consultas médicas por llamada telefónica durante la etapa inicial del confinamiento (abril a junio de 2020), para continuar el seguimiento de pacientes ingresados a un programa de atención multicomponente en diabetes. Resultados: Se realizaron 1118 consultas por llamada telefónica para continuar el seguimiento de 192 pacientes con diabetes tipo 2. Participaron diferentes profesionales de distintas áreas de la salud: atención médica, educación en diabetes, nutrición, psicología y podología. Conclusiones: La atención multicomponente en diabetes se transformó con éxito de un esquema de atención presencial a un servicio de telemedicina. Numerosos pacientes de atención primaria pueden ser candidatos a telemedicina. Se debe considerar un rediseño del modelo de atención que incorpore la telemedicina para mitigar la carga de morbimortalidad en enfermedades crónicas impuesta por la pandemia de COVID-19, pero también para la era pos-COVID-19.

Abstract Introduction: Patients with diabetes experience difficulties to maintain glycemic control during the confinement due to the COVID-19 pandemic, with the risk of developing diabetes chronic complications and severe COVID-19. Objective: The purpose of this study was to evaluate the conversion of an outpatient diabetes primary care center from a face-to-face care modality to a telemedicine care service by telephone. Methods: Medical consultations were made by telephone during the initial phase of confinement (April to June 2020), to then continue the follow-up of patients admitted to a multicomponent diabetes care program. Results: A total of 1,118 consultations were made by telephone and follow-up was subsequently continued in 192 patients with type 2 diabetes. Different professionals from different health areas participated, including medical care, diabetes education, nutrition, psychology and podiatry. Conclusions: Multicomponent diabetes care was successfully transformed from a face-to-face care modality to a telemedicine service. Many primary care patients may be candidates for telemedicine. A redesign of the care model that incorporates telemedicine should be considered to mitigate chronic diseases burden of morbidity and mortality imposed by COVID-19 pandemic, but also for the post-COVID-19 era.

Effectiveness, safety and cost reduction of long-term tunneled central venous catheter insertion in outpatients performed by an interventional nephrologist / Eficácia, segurança e redução de custos no implante de cateter venoso central de longa permanência em pacientes dialíticos realizado por nefrologista

Abstract Introduction: Invasive procedures performed by trained nephrologists can reduce delays in making a definitive vascular access, complications, number of procedures on the same patient, and costs for the Public Health System. Objective: to demonstrate that a long-term tunneled central venous catheter (LTCVC) implanted by a nephrologist is safe, effective, and associated with excellent results. Methods: A retrospective study analyzed 149 consecutively performed temporary-to-long-term tunneled central venous catheter conversions in the operating room (OR) from a dialysis facility from March 2014 to September 2017. The data collected consisted of the total procedures performed, demographic characteristics of the study population, rates of success, aborted procedure, failure, complications, and catheter survival, and costs. Results: the main causes of end stage renal disease (ESRD) were systemic arterial hypertension and diabetes mellitus, 37.9% each. Patients had a high number of previous arteriovenous fistula (1.72 ± 0.84) and temporary catheter (2.87 ± 1.9) attempts until a definitive vascular access was achieved, while the preferred vascular site was right internal jugular vein (80%). Success, abortion, and failure rates were 93.3%, 2.7% and 4%, respectively, with only 5.36% of complications (minors). Overall LTCVC survival rates over 1, 3, 6, and 12 months were 93.38, 71.81, 54.36, and 30.2%, respectively, with a mean of 298 ± 280 days (median 198 days). The procedure cost was around 496 dollars. Catheter dysfunction was the main reason for catheter removal (34%). Conclusion: Our analysis shows that placement of LTCVC by a nephrologist in an OR of a dialysis center is effective, safe, and results in substantial cost savings.

Resumo Introdução: Procedimentos invasivos realizados por nefrologistas podem reduzir o número de procedimentos no mesmo paciente, complicações e atrasos na obtenção de acesso vascular definitivo, bem como proporcionar menor custo para o Sistema de Saúde. Objetivo: Demonstrar a segurança, a eficácia e os resultados dos implantes de cateteres venosos centrais de longa permanência (CLP) realizados por nefrologista sem fluoroscopia. Métodos: Estudo retrospectivo que analisou 149 implantes de CLP por nefrologista no centro cirúrgico de clínica de diálise, sem auxílio de fluoroscopia, no período de março/2014 a setembro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxas de sucesso, procedimento abortado, falha no procedimento, complicações observadas, patência do cateter e custos. Resultados: Houve um elevado número de tentativas fístulas arteriovenosas (1,72 ± 0,84) e de cateter de curta permanência (2,87 ± 1,9) até a realização de um acesso vascular definitivo. O sítio vascular preferido foi a veia jugular interna direita (80%). Taxas de sucesso, procedimentos abortados e falhas foram de 93,3%, 2,7% e 4,0%, respectivamente, com apenas 5,36% de pequenas complicações. A patência dos CLP com 1, 3, 6 e 12 meses foram de 93,38%, 71,81, 54,36% e 30,2%, respectivamente, com média de 298 ± 280 dias (mediana 198 dias). Os custos dos procedimentos foram em torno de US$ 496. Disfunção foi o principal motivo da remoção do cateter (34%). Conclusão: Nossa análise mostra que o implante de CLP por nefrologista no centro cirúrgico de clínica de diálise é eficaz e seguro e está associado à redução significativa de custos.

Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.

The Impact of the Off-site Monitoring Clinic (Virtual Monitoring Clinic) on the Practice of Outpatient Rheumatology in a Tertiary Centre during the COVID-19 Pandemic

The ongoing pandemic in Singapore is part of a global pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To control the spread of COVID-19 and prevent the healthcare system from being overwhelmed, 'circuit breaker' measures were introduced between 7 April and 1 June 2020 in Singapore. There is thus a crucial need for innovative approaches to the provision and delivery of healthcare in the context of safe-distancing by harnessing telemedicine, especially for patients with chronic diseases who have traditionally been managed in tertiary institutions. We present a summary of how the Virtual Monitoring Clinic has benefited the practice of our outpatient rheumatology service during the COVID-19 pandemic. The virtual consultations address the need for safe-distancing by limiting face-to-face appointments and unnecessary exposure of patients to the hospital where feasible. This approach ensures that the patients are monitored appropriately for drug toxicities and side-effects, maintained on good disease control, and provided with patient education.

Eficacia de la miel para el tratamiento de la tos aguda en niños atendidos en forma ambulatoria / Efficacy of honey for treatment of acute cough in pediatric outpatients

A partir de una consulta en la central de emergencias de un niño con tos aguda, el autor del artículo realiza una búsqueda bibliográfica para revisar la evidencia sobre el uso de la miel para aliviar este síntoma. Luego de la lectura crítica de una revisión sistemática, el autor concluye que ésta podría ser una alternativa elegible frente a los jarabes para la tos, por su perfil de seguridad y su posible beneficio en el alivio de la tos. (AU)

Based on a consultation at the emergency room of a child with acute cough, the author of this article performs a bibliographic search to review the evidence on the use of honey to alleviate this symptom. After the critical appraisal of a systematic review, the author concludes that honey could be an eligible alternative to cough syrups, due to its safety profile and its possible benefit in cough relief. (AU)

Recomendaciones para la atención de pacientes con diabetes mellitus con factores de riesgo o enfermedad cardiovascular establecida y SARS-CoV-2 / Recommendations for the care of patients with diabetes mellitus with risk factors or established cardiovascular disease and SARS-CoV-2

Resumen Se realiza una revisión sobre el riesgo de los pacientes que padecen diabetes mellitus en el contexto de morbimortalidad general y relacionada a infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2). Así mismo se repasan las recomendaciones generales, de alimentación y de la prevención de las comorbilidades que más frecuentemente padecen dichos enfermos. Finalmente se hace una revisión de las recomendaciones farmacológicas sobre el tratamiento tanto oral como parenteral en el paciente ambulatorio, en la hospitalización y en estados críticos infectados por el SARS-CoV-2.

Abstract A review is carried out to examine the risk of patients suffering from diabetes mellitus in the context of general morbidity and mortality and related to infection by SARS-CoV-2. Likewise, the general recommendations for food and the prevention of comorbidities that most these patients suffer most frequently are also studied. Finally, a review of the pharmacological recommendations on both oral and parenteral treatment in the outpatient, in hospitalization and in critical states infected with SARS-CoV-2 is made.