Estadísticas de mortalidad por covid 19: análisis de la calidad de la información sobre causas de fallecimiento / MORTALITY STATISTICS FOR COVID 19: ANALYSIS OF THE QUALITY OF THE INFORMATION ON CAUSES OF DEATH

El certificado médico de defunción (CMD) es la fuente de las estadísticas de causas de muerte en nuestro país. La falta de precisión de los datos que allí se registran afecta al análisis de las estadísticas de mortalidad y al diseño de políticas sanitarias basadas en dicho examen. La calidad de la información sobre causas de muerte se verá más o menos comprometida en la medida que el médico realice el registro de las causas de muerte acorde a los estándares establecidos por las autoridades sanitarias. La pandemia por COVID 19 ha resaltado la importancia de generar estadísticas confiables en salud, al mismo tiempo que la elaboración de esa información se ha visto afectada por diversos motivos. Se analizó la calidad del registro de causas de fallecimiento de pacientes con COVID 19 en el Hospital de Clínicas "José de San Martín". Se revisaron 488 certificados médicos de defunción (CMD) correspondientes a todos los fallecidos en el Hospital de Clínicas entre 13/04/2020 al 10/09/2020 (n: 373) y desde el 07/05/2021 al 08/06/2021 (n: 115). De todos ellos, 127 CMD informaban en al menos una de sus causas a la COVID 19 (códigos U.7 y siguientes del CIE 10). Hubo un 74,02% (n: 94) de causas de muerte "poco útiles" entre las causas inmediatas, 18,9% (n:24) entre las mediatas y 0% (n:0) en las originales. c) Se registró en forma completa el intervalo entre la enfermedad y la muerte en el 4,72% (n:6); y se registró la Causa Contribuyente (parte 2 del CMD) en un 11,02% (n: 14). La calidad de los registros de mortalidad por COVID 19 está comprometida. Se observó una alta proporción de "causas poco útiles" como registro en las causas de fallecimiento, y un déficit en el llenado del intervalo entre la enfermedad y la muerte, y en la causa contribuyente del fallecimiento. Debemos trabajar en todos los niveles para contribuir al mejoramiento de la certificación de las defunciones y por ende, a la obtención de estadísticas de mortalidad y de causas de muerte más precisas, que apoyen la evaluación de políticas públicas y la toma de decisiones acertadas en pro de la salud de la población.

The medical death certificate (CMD) is the source of the statistics of causes of death in our country. The lack of precision of the data recorded there affects the analysis of mortality statistics and the design of health policies based on said examination. The quality of the information on causes of death will be more or less compromised to the extent that the physician registers the causes of death in accordance with the standards established by the health authorities. The COVID 19 pandemic has highlighted the importance of generating reliable health statistics, at the same time that the preparation of this information has been affected for various reasons. The quality of the registry of causes of death of patients with COVID 19 at the Hospital de Clínicas "José de San Martín" was analyzed. We reviewed 488 medical death certificates (CMD) corresponding to all those who died at the Hospital de Clínicas between 04/13/2020 and 09/10/2020 (n: 373) and from 05/07/2021 to 06/08/ 2021 (no.: 115). Of all of them, 127 CMDs reported COVID 19 in at least one of their causes (ICD 10 codes U.7 and following). There were 74.02% (n: 94) of "not very useful" causes of death among the immediate causes, 18.9% (n: 24) among the mediate ones, and 0% (n: 0) in the original ones. c) The interval between illness and death was fully recorded in 4.72% (n:6); and the Contributing Cause (part 2 of the CMD) was registered in 11.02% (n: 14). The quality of COVID 19 mortality records is compromised. A high proportion of "unhelpful causes" was observed as a registry in the causes of death, and a deficit in filling the interval between illness and death, and in the contributing cause of death. We must work at all levels to contribute to improving the certification of deaths and, therefore, to obtaining more accurate mortality statistics and causes of death, which support the evaluation of public policies and the making of sound decisions in favor of the population health.

Parental feeding practices and ultra-processed food consumption in preschool children / Práticas alimentares parentais e consumo de alimentos ultraprocessados em pré-escolares

ABSTRACT: Objective: To investigate the association between parental feeding practices and the consumption of ultra-processed foods in preschool children. Methods: Cross-sectional study with 140 parents (father and mother) and their children (2-6 year-old). Parental feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire. Children's body weight and height were measured, and body mass index z-score per age was calculated. Parental anthropometric measurements (body weight and height) were obtained by self-report, and body mass index was calculated. The consumption of ultra-processed foods was assessed through the Child Food Frequency Questionnaire and the daily intake score was calculated. Multivariable linear regression analyses were performed to investigate the association between parental feeding practices and the consumption of ultra-processed foods. Results: Children's ultra-processed food consumption was negatively associated with the "Monitoring" parental feeding practices. On the other hand, "Emotion Regulation" and "Health restriction" parental feeding practices were positively associated with the ultra-processed food consumption score. Conclusion: Ultra-processed food consumption was associated to the "Monitoring", "Emotion regulation" and "Health restriction" parental feeding practices in preschool children. These results support the importance of using successful parental feeding practices to promote healthy eating in preschoolers.

RESUMO: Objetivo: O estudo buscou investigar a associação entre as práticas alimentares parentais e o consumo de alimentos ultraprocessados em crianças pré-escolares. Métodos: Estudo transversal realizado com 140 pares de pais e crianças de 2 a 6 anos de idade. As práticas parentais foram avaliadas pelo questionário Comprehensive Feeding Practices Questionnaire. O peso e a estatura das crianças foram aferidos e o escore z de índice de massa corporal para idade, calculado. A avaliação antropométrica dos pais foi realizada por meio do autorrelato de peso e altura e cálculo do índice de massa corporal. O consumo de alimentos ultraprocessados foi avaliado pelo Questionário de Frequência Alimentar da Criança e pelo cálculo de escore de consumo diário. Realizaram-se análises de regressão linear múltipla para avaliar a associação entre as práticas alimentares parentais e o consumo de alimentos ultraprocessados. Resultados: O consumo de alimentos ultraprocessados pelas crianças associou-se negativamente à prática parental de "Monitoramento". Por outro lado, as práticas alimentares parentais de "Regulação da emoção" e "Restrição para saúde" associaram-se positivamente ao escore de consumo de alimentos ultraprocessados. Conclusão: Conclui-se que o consumo de alimentos ultraprocessados por crianças pré-escolares relacionou-se às práticas alimentares parentais de "Monitoramento", "Regulação da emoção" e "Restrição para saúde". Esses resultados ressaltam a importância do uso de práticas alimentares parentais com desfecho positivo para a promoção de uma alimentação saudável em pré-escolares.

Incidencia de desnutrición y factores sociodemográficos asociados, en pacientes de del hospital universitario de Karbala / Incidence of malnutrition and sociodemographic factors associated, in patients from the Karbala Teaching Hospital

Antecedentes: La desnutrición es un importante problema de salud en el grupo de edad de pediatría que contribuye a aumentar la mortalidad y morbilidad de los pacientes ingresados. Pacientes y método: Estudio descriptivo, aleatorizado, transversal de 2965 casos entre 6 y 60 meses de los cuales 500 casos tenían desnutrición desde el 15 de noviembre de 2019 al 31 de enero de 2020, datos hospitalarios para evaluar la incidencia de desnutrición aguda severa y desnutrición aguda moderada y leve. Desnutrición y su relación con algunos factores sociodemográficos (trabajo paterno, peso al nacer, tipo de alimentación, edad, sexo). Resultados: la incidencia de desnutrición aguda severa es 1%, la incidencia de desnutrición aguda moderada es 10% y desnutrición leve 27% de la muestra de pacientes tomada 469 pacientes existe una fuerte relación de todos los grados de desnutrición con la edad paterna y bajo nacimiento peso con alguna relación con el tipo de alimentación. Conclusiones: si bien la incidencia de desnutrición aguda severa ha disminuido en los últimos años en el hospital universitario de Karbala, existe un marcado aumento en la incidencia de desnutrición aguda moderada y desnutrición leve con su impacto en la salud pediátrica general en cuanto a morbilidad y mortalidad se deben tomar esfuerzos para manejar la desnutrición aguda moderada y desnutrición leve ofreciendo asesoramiento y apoyo nutricional especialmente en personas que no son Empleadores gubernamentales.

Background: Malnutrition is a major health problem in pediatrics age group contribute to increase mortality and morbidity of admitted patients. Patients and method: A descriptive randomized cross sectional study of 2965 cases between 6 -60 months from which 500 cases had malnutrition from15th of November 2019 to 31st of January 2020 hospital-based data to evaluate incidence of sever acute malnutrition and moderate acute malnutrition and mild malnutrition and its relation to some sociodemographic factors (paternal job, birth weight, type of feeding, age, sex). Results: the incidence of severe acute Malnutrition is 1%, the incidence of moderate acute malnutrition is 10% and mild malnutrition 27% from the sample of patients taken 469 patients there is a strong relationship of all degree of malnutrition to paternal age and low birth weight with some relation to type of feeding. Conclusions: while the incidence of severe acute malnutrition has been decreased last years In Karbala teaching hospital, there is marked increase in incidence of moderate acute malnutrition and mild malnutrition with their impact on general pediatric health regarding morbidity and mortality efforts should be taken to manage the moderate acute malnutrition and mild malnutrition by offering nutritional advice and support especially in people who are not governmental Employer.

Estudio clínico del eritrasma en pacientes diabéticos / Clinical study of Erythrasma in diabetic patients

Este estudio se realizó para caracterizar la frecuencia de aparición, extensión, edad y sexo de la incidencia del eritrasma en pacientes diabéticos según el tipo, la duración y el estado. Estudio transversal y combinado de casos y controles de 200 pacientes diabéticos y 160 grupos no diabéticos que visitaron la consulta externa del Hospital Docente Al-Saddar, Departamento de Medicina y Dermatología, desde el período de diciembre de 2019 a julio de 2020. Dentro del grupo con Diabetes las edades oscilan entre los 12 y los 60 años con una edad media de 37,6 años. 148 pacientes padecían diabetes mellitus tipo no insulinodependiente (NIDDM) y 52 pacientes padecían IDDM. Entre todos los pacientes diabéticos examinados con la lámpara de Wood, para detectar infección por eritrasma, 34 (17%) resultaron afectados, de 26 hombres (76,5% de los afectados) y 8 mujeres (23,5%) se vieron afectados. Entre los 52 pacientes con DMID, 15 (28,8%) se vieron afectados y sólo 19 (12,8%) del resto con DMID se vieron afectados. Se encontró que la incidencia máxima de edad se encuentra en la cuarta década (30-40 años). El sitio de mayor propensión de las lesiones parecía ser la ingle en un 100%. La forma extensa o generalizada se encontró solo en 3 (8,8%) pacientes y el sitio menos afectado fue la membrana de los dedos solo en 2 (5,9%). La presentación de los pacientes fue asintomática en 22 (64,7%) y el cambio de color (marrón rojizo) se encontró en todos los pacientes. En conclusión, la aparición de eritrasma en pacientes diabéticos es más frecuente que su aparición en pacientes no diabéticos. Existe una asociación significativa entre la aparición de eritrasma y la IDDM. La frecuencia de aparición de eritrasma aumenta con la larga duración de la DM y más con la DM incontrolada

This study was conducted to characterize the frequency of occurrence, extent, age, and sex incidence of Erythrasma in diabetic patients according to the type, duration, and state. A cross-sectional and case-control combined study of 200 diabetic patients and 160 non-diabetic groups visiting the outpatient clinic of Al-Saddar Teaching Hospital, Department of Medicine and Dermatology, from the period of December 2019 to July 2020. Among the diabetic group, their ages range from 12-60 years with a mean age of 37.6 years. 148 patients were non-insulin-dependent diabetes mellitus type (NIDDM) and 52 patients were IDDM. Among all the diabetic patients examined by wood's light to detected Erythrasma infection 34(17%) were found to be affected, from 26 males (76.5% of the affected) and 8 females (23.5%) were affected. Among the 52 patients with IDDM, 15(28.8%) were affected and only 19(12.8%) from the remainder with NIDDM affected. The peak age incidence was found to be in the fourth decade (30-40 y). The site of greatest propensity of the lesions appeared to be the groin was 100%. The extensive or generalized form was found only in 3(8.8%) patients and the least affected site was the toe webs only in 2(5.9%). The presentation of the patients was found to be asymptomatic in 22(64.7%), and the color change (red brown) was found in all of the patients. In the conclusion, the occurrence of Erythrasma in diabetic patients is more frequent than its occurrence in non-diabetic patients. There is a significant association between the occurrence of Erythrasma and the IDDM. The frequency of occurrence of Erythrasma increase with the long duration of DM and more with the uncontrolled DM.

Estudio cadavérico de anteversión de cuello femoral en Población de Indonesia / Cadaveric Study Of Femoral Neck Anteversion In Indonesian Population

Objective: The normal morphology of femoral anteversion is an essential factor which determines the clinical results of hip replacement to achieve the normal activity and the length of the replaced joint. No previous study has been documented regarding normal value of femoral anteversion in Indonesian population and how they are different with Western, India and African population. This study aimed on measurement of normal femoral anteversion values of Indonesian population and compare it with existing data of Western, African and India values. Method: This cross-sectional study by measuring the femoral neck anteversion angle in 120 samples of Indonesians's cadaveric femur. Comparisons were made between Western, African and India. Result: The result showed that the average values of femoral neck anteversion angle in men were 11.60 ± 4.83 and 12.96 ± 5.1 in the right and left parts respectively, while in women, the results were 14.83+-5.14 and 13.37+-5.66 in right and left parts. The p value of ≤ 0.05 was considered to be significant. Conclusion: The mean femoral anteversion values of Indonesian population is 13.22. It is significantly different in comparison with Western, African, and Indian population.

Características epidemiológicas y clínicas de pacientes internados con COVID-19 en la Ciudad de Buenos Aires / Epidemiological and clinical characteristics of patients hospitalized with COVID-19 in Buenos Aires cityEsta obra está bajo una licencia de CreativeCommons Reconocimiento-NoComercial 4.0Internacionalhttps://creativecommons.org/licenses/by-nc/4.0/i

Introducción: La pandemia de COVID-19 representa un desafío para la salud mundial y continúa en investigación. Objetivo: Describir las características epidemiológicas, demográficas, clínicas y la mortalidad por todas las causas de pacientes internados con COVID-19 en un establecimiento de salud privado de la Ciudad de Buenos Aires. Materiales y métodos: Se realizó un estudio retrospectivo, de corte transversal y descriptivo entre el 3 de marzo y el 8 de julio de 2020. Se incluyeron pacientes adultos con diagnóstico confirmado de COVID-19 por RT-PCR de hisopado nasofaríngeo internados en sala general y unidad de terapia intensiva (UTI) del Sanatorio San José. Se analizaron las características epidemiológicas, demográficas (edad, sexo, ocupación, procedencia, residencia), clínicas y mortalidad por todas las causas. Las variables continuas fueron descriptas con mediana y rango intercuartilo (RIC) y las variables categóricas con número y porcentaje. Se utilizó el programa STATA v 13.0.Resultados: Se incluyeron 118 pacientes. La mediana de edad fue de 50 años, 51% varones. Las comorbilidades más prevalentes fueron hipertensión arterial 31,4%, enfermedad neurológica crónica 27,1%, enfermedad cardiovascular 14,4% y diabetes 13,6%. Los signos y síntomas más frecuentes: fiebre 68,6% y tos 51,7%. Según la severidad inicial: 33,9% neumonía moderada y 27,1% grave. El 75% de las tomografías de tórax reveló vidrio esmerilado; linfopenia presentó el 30%. No se detectó coinfección viral. La mortalidad por todas las causas fue del 20%, y del 57% en UTI con ventilación mecánica. Conclusiones: Nuestro trabajo describe las características y mortalidad de pacientes internados con COVID-19. Es necesario aumentar la evidencia para desarrollar modelos de predicción clínica relacionados con COVID-19.Palabras clave: infecciones por coronavirus, pandemias, epidemiología, COVID-19.

ntroduction: The COVID-19 pandemic represents a global health challenge and continues to be investigated.Objective: To describe the epidemiological, demographic, clinical characteristics and all-cause mortality of patients hospitalized with COVID-19, in a private health care facility in Buenos Aires city.Materials and methods: A retrospective, cross-sectional, and descriptive study was conducted between March 3 and July 8, 2020. Adult patients with a confirmed diagnosis of COVID-19 by nasopharyngeal swab RT-PCR, admitted to the general ward and intensive care unit (ICU) at the San José Sanatorium were included. Epidemiological, demographic (age, sex, occupation, origin, residence), clinical characteristics, and all-cause mortality were analyzed. Continuous variables were described with median and interquartile range (IQR) and categorical variables with number and percentage. The STATA v 13.0 program was used. Results: 118 patients were included. The median age was 50 years, 51% were men. The most prevalent comorbidities: arterial hypertension 31.4%, chronic neurological disease 27.1%, cardiovascular disease 14.4% and diabetes 13.6%. The most frequent signs and symptoms: fever 68.6% and cough 51.7%. According to the initial severity: 33.9% moderate pneumonia and 27.1% severe. Ground glass was reported in 75% of chest scans; lymphopenia presented 30%. Viral coinfection was not detected. Mortality from all causes was 20%, and 57% in ICU with mechanical ventilation.Conclusions: Our work describes the characteristics and mortality of hospitalized patients with COVID-19. Increased evidence is needed to develop clinical predictive models related to COVID-19

Internações compulsórias por processos judiciais para usuários de um Centro de Atenção Psicossocial álcool e drogas / Compulsory hospitalization by legal proceedings for users of a psychosocial Care Center - alcohol and drugs

O estudo teve por objetivo avaliar as características sociodemográficos e clínicas de 218 usuários de substâncias psicoativas, em um Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-ad), de Ribeirão Preto, que chegaram por mandado judicial para avaliação médica e internação compulsória. Trata-se de um estudo retrospectivo, baseado em dados secundários do tipo transversal da abordagem quantitativa. O período avaliado se deu entre os anos de 2008 e 2019. Foram avaliadas as informações sociodemográficas, tipos de internações, diagnósticos, tipos de substâncias psicoativas usadas, requerentes no processo judicial e motivações para a abertura do processo judicial. Os resultados demonstraram que os usuários encaminhados por demanda judicial se caracterizam por serem adultos, com média de idade de 30,5 anos, variando entre 15 e 69 anos, do sexo masculino 182 (83,5%), raça/ etnia branca 146 (67,0%), viviam sem um companheiro 177 (81,2%), possuíam baixo nível de escolaridade 146 (66,1%), desempregados 140 (64,2%) e eram residentes de Ribeirão Preto 215 (98,6%). Quanto aos tipos de internações: 126 (58%) foram Internações Compulsórias, 66 (30,3%) internações voluntárias em Comunidades Terapêuticas, 69 (31,7%) internações voluntárias em hospital e 36 (16,6%) internações involuntárias. Considerando que o estudo se deu a partir da análise dos prontuários ao longo de um período de tempo, o mesmo paciente pode ter tido mais de uma internação em qualquer uma das modalidades. Em relação aos tipos de substâncias psicoativas as mais usadas foram: crack 104 (48,4%), cocaína 59 (27,4%), álcool 33 (15,3%) e a maconha 19 (8,8%). Um pouco mais da metade, 113 (54,6%) dos usuários, possuía outro transtorno mental associado ao uso de substâncias, dentre eles, a Esquizofrenia 40 (18,1%) e o Transtorno de Personalidade 25 (11,5%) foram os mais prevalecentes, seguidos de Outros Transtornos Psicóticos 20 (9,2%) e Transtorno Afetivo Bipolar 18 (8,3%). Não apresentaram outro transtorno mental associado ao uso de substâncias 99 (45,4%). O estudo aponta principalmente a dificuldade das famílias dos usuários de álcool ou de outras drogas para lidar com situações de conflito, bem como a necessidade de políticas públicas de saúde que entendam a realidade na qual esses indivíduos estão inseridos

The study aimed to evaluate the sociodemographic and clinical characteristics of 218 users of psychoactive substances, in a Psychosocial Care Center for Alcohol and Drugs (CAPS-ad) in Ribeirão Preto who arrived by court order for medical evaluation and compulsory hospitalization. This is a retrospective study based on secondary data of the transversal type of the quantitative approach. The evaluated period took place between the years 2008 to 2019. Sociodemographic information, type of hospitalizations, diagnosis, type of psychoactive substances used; applicant in the judicial process and reasons for opening the judicial process. The results showed that the users referred by judicial demand were characterized by being adults, with an average age of 30.5 years, ranging from 15 to 69 years old, male 182 (83.5%), white race / ethnicity 146 (67.0%), lived without a partner 177 (81.2%), had a low level of education 146 (66.1%), unemployed 140 (64.2%) and were residents of Ribeirão Preto 215 (98, 6%). Regarding the types of hospitalizations: 126 (58%) were Compulsory Hospitalizations, 66 (30.3%) voluntary hospitalizations in Therapeutic Communities, 69 (31.7%) voluntary hospitalizations and 36 (16.6%) involuntary hospitalizations. Considering that the study was based on the analysis of medical records over a period of time, the same patient may have had more than one hospitalization in any of the modalities. Regarding the type of psychoactive substance most used were: crack 104 (48.4%), cocaine 59 (27.4%), alcohol 33 (15.3%) and marijuana 19 (8.8%). A little more than half, 113 (54.6%) of users had another mental disorder associated with substance use; among them, Schizophrenia 40 (18.1%) and Personality Disorder 25 (11.5%) were the most prevalent, followed by Other Psychotic Disorders 20 (9.2%) and Bipolar Affective Disorder 18 (8.3%). There was no other mental disorder associated with substance use 99 (45.4%). The study mainly points out the difficulty of the family of users of alcohol or other drugs to deal with conflict situations, as well as the need for public health policies that understand the reality in which these individuals are inserted

Seroprevalencia de COVID 19 en personas viviendo con VIH en el Area Metropolitana / COVID-19 Seroprevalence and PLHIV

Se desconoce si las personas que viven con el VIH (PVV) tienen un mayor riesgo de contraer la infección por SARS-CoV-2. Los estudios serológicos prospectivos pueden permitir análisis de seroincidencia. Este estudio prospectivo incluyó a PVV sin antecedentes de vacunación contra SARS-CoV-2 de la Ciudad Autónoma de Buenos Aires (CABA) y Gran Buenos Aires (GBA) que concurrieron entre marzo y junio de 2021 a realizar sus controles al instituto INBIRS. La tasa de seroprevalencia de anticuerpos contra la proteína espiga del SARS-CoV-2 fue del 33,3% (IC 24,9-42,5%) para la población estudiada. Esta prevalencia fue significativamente mayor a la reportada previamente para la población general de la misma región geográfica. No se observó una asociación entre el recuento de linfocitos T CD4+ con los niveles de IgG específica. En conclusión, el hallazgo de una alta seroprevalencia de anticuerpos contra SARS-CoV-2 entre las PVV en CABA y GBA puede sugerir una mayor susceptibilidad a la infección por este virus; sin embargo, puede ser también un marcador subrogante que indica la tasa de seroprevalencia en población general se encuentra subestimada

It is not known whether people living with HIV (PLHIV) are at increased risk of acquiring SARS-CoV-2 infection. Prospective serological studies can allow seroincidence analysis. This prospective study included PLHIV, without a history of vaccination against SARS-CoV-2, from the Autonomous City of Buenos Aires (CABA) and Buenos Aires surroundings (GBA), who attended INBIRS Institute between March and June 2021 to carry out their controls. The seroprevalence rate of antibodies against the SARS-CoV-2 spike protein was 33.3% (CI 24.9-42.5%) for the study population. This prevalence was significantly higher than that previously reported for the general population of the same geographic region. No association was found between CD4+ T-cell counts with levels of SARS-CoV-2 specific IgG. In conclusion, the finding of a high seroprevalence of antibodies against SARS-CoV-2 among PLHIV in CABA and GBA may suggest a greater susceptibility to infection; however, it can also be a surrogate marker that the seroprevalence rate in the general population is underestimated.

Prevalência de parto vaginal após cesárea em uma maternidade de alto risco / Prevalence of vaginal delivery after cesarean in a high-risk maternity / Prevalencia de entrega vaginal después de cesárea en una maternidad de alto riesgo

Objetivo: estimar a prevalência de parto vaginal após cesárea em uma maternidade de alto risco e identificar as complicações maternas e neonatais. Método: trata-se de um estudo transversal, quantitativo e retrospectivo, realizado com 44 mulheres que tiveram parto normal com cesárea prévia, por meio da análise dos prontuários realizou-se a análise descritiva com frequências absolutas e simples. Resultados: a prevalência de parto vaginal após cesárea foi de 13%. Ocorreu complicação em 13,6% das mulheres, porém não houve rotura uterina e em 4,5% dos neonatos. Conclusões: os desfechos favoráveis comprovam a segurança deste procedimento para a mãe e para neonato e servem de estímulo para que os profissionais incentivem as gestantes com cesárea anterior a considerarem a via vaginal como uma possibilidade segura para o próximo parto

Objective: to estimate the prevalence of vaginal delivery after cesarean section in a high-risk maternity and to identify maternal and neonatal complications. Method: this is a cross-sectional, quantitative and retrospective study, carried out with 44 women who had a normal delivery with previous cesarean section, through the analysis of medical records, descriptive analysis was carried out with absolute and simple frequencies. Results: the prevalence of vaginal delivery after cesarean section was 13%. Complication occurred in 13.6% of women, but there was no uterine rupture and in 4.5% of neonates. Conclusions: the favorable outcomes prove the safety of this procedure for the mother and the newborn and serve as a stimulus for professionals to encourage pregnant women with a previous cesarean to consider the vaginal route as a safe possibility for the next delivery

Objetivo: estimar la prevalencia del parto vaginal después de una cesárea en una maternidad de alto riesgo e identificar complicaciones maternas y neonatales. Método: se trata de un estudio transversal, cuantitativo y retrospectivo, realizado con 44 mujeres que tuvieron un parto normal con cesárea previa, a través del análisis de registros médicos, se realizó un análisis descriptivo con frecuencias absolutas y simples. Resultados:la prevalencia del parto vaginal después de una cesárea fue del 13%. La complicación ocurrió en el 13.6% de las mujeres, pero no hubo ruptura uterina y en el 4.5% de los recién nacidos. Conclusiones: los resultados favorables demuestran la seguridad de este procedimiento para la madre y el recién nacido y sirven de estímulo para que los profesionales alienten a las mujeres embarazadas con una cesárea previa a considerar la vía vaginal como una posibilidad segura para el próximo parto

Aislamiento social en adultos mayores semi-institucionalizados del litoral ecuatoriano / Social isolation in semi-instutionalized older adults on the ecuadorian coast

El aislamiento social es una realidad evidente durante la tercera edad, propiciado por el debilitamiento en las redes de soporte de amigos y familiares del adulto mayor, lo cual repercute en la incidencia de trastornos orgánicos que alteran el bienestar holístico del mismo. La investigación tuvo como objetivo determinar la presencia de aislamiento social de los usuarios en adultos mayores semi-institucionalizados del litoral ecuatoriano; se empleó una metodología cuantitativa, observacional, descriptiva, transversal durante los meses de Mayo a Octubre del año 2018, usando como técnica la encuesta, mediante el instrumento denominado Escala de Redes Sociales de Lubben - LSNS-6. El universo estuvo conformado por 395 adultos de la provincia de Santa Elena; mediante muestreo aleatorio estratificado proporcional se priorizaron 248 usuarios divididos en tres estratos; los datos se procesaron mediante el programa SPSS v23 generando análisis estadísticos univariado y bivariados. Como resultados la media de edad de la población fue de 73,44 ± 7,1 en mayoría mujeres con estado civil casado; Se evidencian que el 46.8% población percibe aislamiento social y alteración en la dimensión amistades (54.4%). Existió relación estadística con la variable sexo (p=0,044). Se concluyó que, cerca de la mitad de la población percibe el aislamiento social y que dicho aislamiento posee una relación estadística con el sexo, destacando una mayor ocurrencia en el sexo femenino.

Social isolation is an evident reality during the elderly, caused by the weakening of the support networks of friends and relatives of the elderly, which affects the incidence of organic disorders that alter their holistic well-being. The objective of the research was to determine the presence of social isolation of users in semi-institutionalized older adults of the Ecuadorian coast; A quantitative, observational, descriptive, cross-sectional methodology was used during the months of May to October 2018, using the survey as a technique, through the instrument called the Lubben Social Network Scale - LSNS-6. The universe was made up of 395 adults from the province of Santa Elena; Through proportional stratified random sampling, 248 users were prioritized, divided into three strata; The data were processed using the SPSS v23 program, generating univariate and bivariate statistical analyzes. As results, the mean age of the population was 73.44 ± 7.1, mostly women with married marital status; It is evident that 46.8% of the population perceives social isolation and alteration in the friendships dimension (54.4%). There was a statistical relationship with the sex variable (p = 0.044). It was concluded that about half of the population perceives social isolation and that such isolation has a statistical relationship with sex, highlighting a higher occurrence in females.

Factores relacionados con la higiene personal de la calle niños en el sitio de disposición final de residuos en Distrito de Mangagala, ciudad de Makassar, Indonesia / Factors related to personal hygiene of street children in the final waste disposal site in Manggala district, Makassar city, Indonesia

Background. Street children are a real phenomenon in everyday life that cause complex social and health problems, dirty appearance, come from poor families, slum settlements or even street children do not have a place to live. The number of homeless people, beggars and street children has decreased, there were 990 street children and homeless people with beggars in Makassar City in 2012. There were 798 street children in Makassar City in 2016 who were recorded by Social Service officers from a number of points. Makassar road with various problems. This number includes 257 street children, 249 homeless and beggars, 58 buskers, 41 prostitutes, 5 transgender women, 63 drug users, and 125 mental disorders. The results of the observations of street children were found with traffic light and garbage disposal sites. These places are often found with dirty, dirty appearance, dirty clothes, smelly, unkempt hair, dirty hands, not wearing sandals and sometimes they eat without washing their hands, which can cause health problems for street children. Based on this background, the researcher is interested in examining the factors related to the personal hygiene of street children in the final waste disposal site in Manggala District, Makassar City. Material and Methods. The research is analytic observation using the Cross-Sectional study. The study was conducted in 21 October 2019 - 31 December 2019. The population was the patients with street children numbered 88 people, a purposive sampling technique was applied through chic square, uji continuity correction and multiple logistic regression analysis. Results. The results showed that the variables age, gender, education and knowledge had a relationship with personal hygiene (pvalue 0.035), the R-square value was 0.897, which means that the ability of the independent variable to explain the dependent variable was 89.7% and 10.3% explained. by factors other than variables. Conclusion. Knowledge variable has a significant effect on personal hygiene (pvalue <0.001), the magnitude of the influence is indicated by the value of Exp (B) 26.6, which means that street children who are knowledgeable are at least 26.6 times less likely to have personal hygiene than street children with good knowledge

Lípidos anormales e inmunidad adquirida Síndrome de Deficiencia: Asociación de Suero Lípidos con estatus de VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and posthoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls.

INVESTIGACIÓN DE LA INCIDENCIA Y COMPLICACIONES DEL PERIPARTO DE EMERGENCIA HISTERECTOMÍA / 9 INVESTIGATION OF INCIDENCE AND COMPLICATIONS OF EMERGENCY PERIPARTUM HYSTERECTOMY

Introduction: The emergency peripartum hysterectomy is a high-risk surgery, which is mostly performed after vaginal delivery or Cesarean section. Given the importance of complications and mortality of pregnant mothers for the health system, the present study aimed to investigate the incidence and complications of emergency peripartum hysterectomy in general and teaching hospitals of Zahedan University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive-analytic study, after obtaining the Ethics Committee approval, the medical record of patients with emergency peripartum hysterectomy admitted to Ali ibn Abitaleb hospital of Zahedan for pregnancy termination during 2017-2018 were investigated. were studied. After evaluating demographic characteristics, including age, education, and occupation, causes, and complications of emergency hysterectomy were investigated. Finally, data were analyzed by SPSS software. Results: Out of 2438 cases, 50 cases of hysterectomy were investigated. The mean age of mothers and the average number of pregnancies was 31.06±5.21 and 5.72±2.31, respectively. In this study, 35 cesarean sections (70%) and 15 normal vaginal delivery (30%) were recorded, with only 2% leading to emergency hysterectomy. The most common causes of emergency hysterectomy included placenta accreta (28%), uterine atony (24%), and uterine rupture (20%). The complications also included fever (24%), coagulopathy (14%), and wound infection (12%). Conclusion: Placenta accreta and uterine atony are the most important causes of hysterectomy. The most common complications of emergency hysterectomy are fever, coagulopathy, and wound infections. A decrease in elective caesarean delivery and further encouraging to natural vaginal delivery could significantly reduce the incidence of peripartum hysterectomy and maternal mortality.

Evaluación del impacto de la apnea obstructiva del sueño (OSA) Gestión de la calidad de vida (QoL) en pacientes pediátricos: un estudio transversal / Assessing the Impact of Obstructive Sleep Apnea (OSA) Management on Quality of Life (QoL) in Pediatric Patients: A Cross-Sectional Study

Objective: The study aims to assess the impact of obstructive sleep apnea on quality of life in pediatric patients along with their management approaches. Methodology: The study has applied a cross-sectional design to recruit children, visiting ENT clinics with the suggestion of obstructive sleep apnea. History and OSA assessment were collected for these children from the hospital. Besides this, OSA-18 questionnaire was used to collect the data, translated into Arabic language for respondents' feasibility. Results: A total of 24 patients (40%) were able to cure with medical treatment, whereas 36 patients (60%) were provided with surgical treatment. There were significant association between medical management and parental smoking (p-value=0.011), OSA score (p-value-0.003) and the size of adenoid (p-value=0.008). A significant association was also shown between size of adenoid and severity of OSA18 (p-value=0.031). No significant difference was shown between parental smoking, allergic rhinitis and severity of OSA. Conclusion: Although the surgical management is still the main modality in treating OSA, medical treatment plays an important role especially in cases with mild OSA, small adenoids and indoor smoking.

Factors associated with the consumption of fruits and vegetables by schoolchildren: a comparative analysis between 2007 and 2012 / Fatores associados ao consumo de frutas e de vegetais por escolares: uma análise comparativa entre 2007 e 2012

ABSTRACT Objective Perform comparative analysis of adequate consumption of fruits and vegetables and their associated factors in schoolchildren. Methods Probabilistic samples representative of students of both sexes, 7 to 14 years old, from public and private schools in Florianópolis, SC were investigated in cross-sectional studies in 2007 (n=2,836) and 2012 (n=2,506). The exposure variables were: sex, age, family income per capita, mother's education and school system. The outcome variable (fruit and vegetable consumption) was collected using the third validated version of the previous day's food questionnaire. Using the Chi-Square test, exposure variables with a p-value <0.20 were eligible for analysis using crude and adjusted multiple logistic regression models. Exposure variables with p<0.05 were considered to be associated with the consumption of fruits and vegetables. Results There were no significant differences in the adequate consumption between 2007 and 2012. While in 2007 the per capita family income was the only exposure variable associated, in 2012 only a mother with complete higher education was a protective factor for the adequate consumption of fruits and vegetables Conclusion Despite governmental strategies to stimulate the consumption of fruits and vegetables in Brazil, their results are still not perceptible, requiring more time for an evaluation of effectiveness

RESUMO Objetivo Realizar análise comparativa do consumo adequado de frutas e de vegetais e seus fatores associados em escolares. Métodos Em estudos transversais de 2007 (n=2.836) e de 2012 (n=2.506), foram investigadas amostras probabilísticas representativas de escolares de ambos os sexos, com idade entre 7 e 14 anos, pertencentes a escolas públicas e privadas de Florianópolis, SC. As variáveis de exposição foram: sexo, idade, renda familiar per capita, escolaridade da mãe e sistema escolar. A variável de desfecho (consumo de frutas e de vegetais) foi coletada por meio da terceira versão validada do questionário alimentar do dia anterior. A partir do teste de chi-quadrado, as variáveis de exposição com valor de p<0,20 foram elegíveis para análise por meio de modelos bruto e ajustado de regressão logística múltipla. Enquanto isso, as que apresentaram valor de p<0,05 foram consideradas associadasao consumo de frutas e de vegetais. Resultados Não houve diferenças significativas no consumo adequado entre 2007 e 2012. Enquanto em 2007 a renda familiar per capita era a única variável de exposição associada, em 2012 apenas a escolaridade da mãe, com ensino superior completo, foi fator protetor para o consumo adequado de frutas e de vegetais. Conclusão Apesar das estratégias governamentais para estimular o consumo de frutas e de vegetais no Brasil, seus resultados ainda não são perceptíveis, exigindo mais tempo para uma avaliação de eficácia.

Conhecimento, atitude e prática de enfermeiros na detecção do câncer de mama / Conocimiento, actitud y práctica de enfermeros en la detección del cáncer de mama / Knowledge, attitude and practice of nurses in the detection of breast cancer

RESUMO Objetivo Analisar o conhecimento, as práticas e atitudes sobre a constatação de câncer de mama por profissionais enfermeiros da atenção primária à saúde de municípios do interior do estado do Ceará, Brasil. Método Estudo descritivo, de corte transversal, inferencial com abordagem quantitativa e utilização do Inquérito Conhecimento, Atitude e Prática, realizado com 62 enfermeiros. A coleta ocorreu com a aplicação de um questionário com 27 itens. Resultados No que se refere ao conhecimento dos enfermeiros, 6,4% tiveram conhecimento adequado necessitando do aprimoramento do mesmo. Concernente à atitude, 85,4% tiveram resultado adequado, e atinente à prática, 50% tiveram resultado regular. Conclusão e Implicações para a Prática Há necessidade de educação permanente sobre a detecção e o controle do câncer de mama, tornando a prática clínica da enfermagem efetiva e resolutiva. O estudo contribuiu para detectar lacunas no conhecimento, atitude e prática da enfermagem na detecção precoce e rastreio do câncer de mama e na efetivação do serviço de saúde para o sucesso das políticas públicas de saúde.

RESUMEN Objetivo Analizar los conocimientos, las prácticas y las actitudes sobre la detección del cáncer de mama por parte de enfermeros profesionales de atención primaria de salud en municipios del interior del estado de Ceará, Brasil. Método Estudio descriptivo, de corte transversal, e inferencial con abordaje cuantitativo y utilización de la Encuesta de Conocimiento, Actitud y Práctica (CAP), realizado con 62 enfermeros. La recolección de datos se hizo aplicando un cuestionario semiestructurado con 27 ítems. Resultados En lo que se refiere al conocimiento de los enfermeros, el 6,4% tuvo un conocimiento adecuado con necesidad de perfeccionarlo. En cuanto a la actitud, el 85,4% obtuvo un resultado adecuado, y en la práctica, el 50% obtuvo un resultado regular. Conclusión e implicaciones para la práctica Se requiere educación permanente sobre la detección y el control del cáncer de mama, para hacer que la práctica clínica de la enfermería sea efectiva y resolutiva. Implicaciones para la práctica: el estudio contribuyó a detectar lagunas en el conocimiento, la actitud y la práctica de la enfermería en la detección precoz y el seguimiento del cáncer de mama y en la efectividad del servicio de salud para el buen resultado de las políticas públicas de salud.

ABSTRACT Objective To analyze the knowledge, practices, and attitudes about the detection of breast cancer by professional nurses of primary health care in municipalities in the inland of the state of Ceará, Brazil. Method A descriptive, cross-sectional and inferential study with a quantitative approach and use of the Knowledge, Attitude, and Practice Survey, conducted with 62 nurses. The collection took place with the application of a semi-structured questionnaire with 27 items. Results With regard to the nurses' knowledge, 6.4% had an adequate knowledge, requiring improvement. Concerning the attitude, 85.4% had an adequate result, and regarding practice, 50% had a regular result. Conclusion and implications for practice There is a need for permanent education on the detection and control of breast cancer, making the nursing clinical practice effective and resolutive. Implications for practice: the study has contributed to detect gaps in nursing knowledge, attitude and practice in the early detection and screening of breast cancer and the implementation of the health service for the success of public health policies.

Fatores sociodemográficos e diagnósticos de enfermagem em pacientes submetidos às cirurgias ortopédicas / Factores sociodemográficos y diagnósticos de enfermería en pacientes sometidos a cirugías ortopédicas / Sociodemographic factors and nursing diagnoses in patients undergoing orthopedic surgeries

RESUMO Objetivo Identificar os diagnósticos de enfermagem mais frequentes e verificar suas associações com fatores sociodemográficos em pacientes submetidos às cirurgias ortopédicas. Método Estudo observacional, analítico e transversal, desenvolvido na unidade de ortopedia de um hospital escola. Para coleta de dados utilizou-se instrumentos estruturados, anamnese e exame físico. Os dados foram analisados pelo programa Statistical Package for Social Sciences. Resultados Dos 201 pacientes avaliados, 68,2% eram homens. Os diagnósticos de enfermagem mais frequentes foram: risco de infecção (100%), integridade da pele prejudicada (100%), integridade tissular prejudicada (97,5%), déficit no autocuidado para banho (90,5%), dor aguda (80,6%), risco de quedas (76,6%) e ansiedade (70%). Constatou-se associações entre a dor aguda e participação na renda familiar e entre o déficit no autocuidado para banho e estado civil. Conclusão e implicações para a prática A análise do perfil sociodemográfico de uma população favorece o planejamento de uma assistência segura e a tomada de decisões pautada em evidências científicas. Minimizar possíveis complicações, promover a apropriação de diagnósticos de enfermagem, bem como melhorar a qualidade da assistência, reduzir custos operacionais para as instituições de saúde e promover a segurança do paciente.

RESUMEN Objetivo identificar los diagnósticos de enfermería más frecuentes y verificar sus asociaciones con factores sociodemográficos en pacientes sometidos a cirugías ortopédicas. Método Estudio observacional, analítico y transversal, desarrollado en la unidad de ortopedia de un hospital docente. Para la recolección de datos utilizamos instrumentos estructurados, anamnesis y examen físico. Los datos se analizaron mediante el programa Paquete estadístico para ciencias sociales. Resultados De los 201 pacientes evaluados, el 68,2% eran hombres. Los diagnósticos de enfermería más frecuentes fueron: riesgo de infección (100%), integridad de la piel deteriorada (100%), integridad del tejido deteriorada (97.5%), déficit de autocuidado en el baño (90.5%), dolor agudo (80,6%), riesgo de caídas (76,6%) y ansiedad (70%). Se encontraron asociaciones entre el dolor agudo y la participación en el ingreso familiar y entre el déficit de autocuidado para bañarse y el estado civil. Conclusión e implicaciones para la práctica El análisis del perfil sociodemográfico de una población favorece la planificación de la atención segura y la toma de decisiones basadas en evidencia científica. Minimice las posibles complicaciones, promueva la apropiación de los diagnósticos de enfermería, mejore la calidad de la atención, reduzca los costos operativos para las instalaciones de atención médica y promueva la seguridad del paciente.

ABSTRACT Objective To identify the most frequent nursing diagnoses and verify their associations with sociodemographic factors in patients undergoing orthopedic surgeries. Method Observational, analytical and cross-sectional study, developed in the orthopedics unit of a teaching hospital. For data collection we used structured instruments, anamnesis and physical examination. Data were analyzed using the Statistical Package for Social Sciences program. Results Of the 201 patients evaluated, 68.2% were men. The most frequent nursing diagnoses were: risk of infection (100%), impaired skin integrity (100%), impaired tissue integrity (97.5%), bathing self-care deficit (90.5%), acute pain (80.6%), risk of falls (76.6%) and anxiety (70%). Associations were found between acute pain and participation in family income and between self-care deficit for bathing and marital status. Conclusion and Implications for practice The analysis of the sociodemographic profile of a population favors the planning of safe care and decision making based on scientific evidence. Minimize potential complications, promote the appropriation of nursing diagnoses, improve the quality of care, reduce operating costs for healthcare institutions, and promote patient safety.

Chemsex y uso de sustancias durante las relaciones sexuales: resultados de una encuesta realizada en Argentina / Chemsex and use of substances during sexual intercourse: results of a survey conducted in Argentina

Introducción: Chemsex está relacionado con el uso de ciertas drogas que facilitan la excitación y el prolongar la duración de los encuentros sexuales.Objetivo: Describir el perfil de consumo de los usuarios de sustancias durante las relaciones sexuales (SRS) y su relación con variables demográficas, de estilo de vida y de salud.Métodos: Estudio descriptivo y transversal realizado a través de una encuesta autoadministrada y anónima en el marco de la plataforma Google Forms® que se transmitió en diferentes redes sociales. Objetivo: describir los aspectos demográficos y de estilo de vida de los encuestados y del subgrupo de usuarios de SRS y chemsex.Resultados: Se recibieron 2924 encuestas; 421 personas (16,9%) refirieron haber consumido al menos una vez uno o más de los siguientes: mefedrona, metanfetamina, crystal meth, GHB/GBL, cocaína, LSD, poppers, ketamina y éxtasis. Chemsex se definió como el consumo de los tres primeros y su prevalencia fue del 1,1%. El perfil de usuario de SRS y chemsex en nuestro estudio fue un hombre de entre 26 y 35 años, HSH y habitante de la Ciudad de Buenos Aires. Hubo mayor proporción de personas con VIH y diagnósticos de ITS en el último año dentro de los usuarios de SRS y chemsex.Conclusiones: Esta es la primera encuesta que trata este tema en nuestro país y en América Latina. Teniendo en cuenta la tendencia a un menor uso de los condones RESUMENARTÍCULO ORIGINALISSN 2314-3193. Actualizaciones en sida e infectología. Buenos Aires. noviembre 2020. volumen 28. número 103: 40-50y a presentar más diagnósticos de ITS y VIH en la población de usuarios de SRS, consideramos de interés conocer la epidemiología en nuestra población

Introduction: Chemsex is related to the use of certain drugs to facilitate sustained arousal and induce a feeling of instant rapport with sexual partners.Aim: To describe the consumption profile of users of substances during sexual intercourse (SSI) and its relationship with demographic, lifestyle and health variables.Methods: Descriptive and cross-sectional study conducted through a self-administered and anonymous survey under the Google Forms platform ® which was broadcasted on different social networks. Main outcome measures: Description on demographic and lifestyle aspects of the respondents and in the subgroup of SSI and chemsex users.Results: 2924 surveys were received; 421 people (16.9%) referred to having consumed at least once one or more of the following: mephedrone, crystal meth, GHB/GBL, cocaine, LSD, poppers, ketamine and ecstasy. Chemsex was defined as the consumption of the first three and its prevalence was 1.1%. A SSI and chemsex user profile in our study was a man between 26 and 35 years, MSM and inhabitant of the city of Buenos Aires. SSI and chemsex users were more likely to and STI in the last year and to have HIV diagnosis.Conclusions: This is the first survey that deals with this issue in our country and in Latin America. Accounting for the tendency to less use of condoms and to present more diagnoses of STIs and HIV in the population of SSI users, we consider it necessary to study this subject in our country as the rising reports in world literature show a boost in substance use.Keywords: Chemsex, Drugs, HIV, VIH, STI, ITS.Chemsex and use of substances during sexual intercourse: results of a survey conducted in Argentina

Conhecimento dos enfermeiros da atenção primária à saúde sobre fatores de risco para Lesão Renal Aguda / Conocimiento de las enfermeras de atención primaria de salud sobre los factores de riesgo de lesión renal aguda / Knowledge of primary health care nurses about risk factors of acute kidney injury

RESUMO Objetivo Descrever o conhecimento dos enfermeiros sobre a identificação, medidas de prevenção e de autocuidado direcionadas à lesão renal aguda (LRA) em hipertensos e/ou diabéticos na atenção primária à saúde (APS). Método Estudo transversal e quantitativo. Amostra constituída de 57 enfermeiros atuantes na APS. Adotou-se questionário semiestruturado para coleta de dados. Realizou-se análise descritiva e inferencial. Considerou-se significativo resultado com p≤0,05. Resultados O perfil dos enfermeiros era jovem (idade 42± 9 anos) e tempo de exercício profissional de 9±6 anos. O conhecimento sobre aspectos gerais relacionados a LRA mostrou-se abaixo da média (48±19 pontos), embora, uma maioria, tenha descrito o conceito corretamente 41 (71,9%). Os fatores de risco relacionados à LRA foram majoritariamente: exposição às drogas 56 (98,2%) e diabetes mellitus 49 (86%). O tempo de atuação na APS aliado ao conhecimento insuficiente sobre alteração do valor da creatinina sérica implicou na decisão sobre a necessidade de encaminhamento ao nefrologista (p=0,004). Conclusões e implicações para a prática O conhecimento dos enfermeiros mostrou-se insuficiente para reconhecimento dos fatores de risco, prevenção e autocuidado da doença renal. Evidencia-se, portanto, a necessidade de capacitação dos enfermeiros da APS para otimizar a identificação precoce da LRA, evitando progressão e cronificação dessa doença.

RESUMEN Objetivo Describir el conocimiento de las enfermeras en materia de medidas de identificación, prevención y autocuidado, dirigidas a la lesión renal aguda (LRA) en pacientes hipertensos y / o diabéticos en atención primaria de salud (APS). Método estudio transversal y cuantitativo. Muestra compuesta por 57 enfermeras que trabajan en atención primaria de salud (APS). Se adoptó un cuestionario semiestructurado para la recopilación de datos. Se realizó un análisis descriptivo e inferencial. El resultado con p≤0.05 se consideró significativo. Resultados El perfil de las enfermeras se circunscribió a personas jóvenes (edad 42 ± 9 años) con tiempo de práctica profesional de 9 ± 6 años. Sin embargo, el conocimiento sobre los aspectos generales vinculados con la LRA se consideró por debajo del promedio (48±19 puntos), aunque el concepto se describió de manera adecuada por la mayoría (41, equivalente a 71.9%). Los factores de riesgo reconocidos como determinantes para la LRA fueron principalmente la exposición a medicamentos (56, equivalente a 98.2%) y la diabetes mellitus 49 (86%). La duración de la práctica en APS se asoció con un conocimiento reducido sobre la necesidad de derivación al nefrólogo basado en el valor de creatinina sérica (p=0,004). Conclusiones e implicaciones para la práctica El conocimiento de las enfermeras era insuficiente para el reconocimiento de los factores de riesgo, prevención y autocuidado de la enfermedad renal. Por lo tanto, se advierte la necesidad de capacitación permanente de enfermeras en APS para optimizar la identificación temprana de LRA, y evitar la progresión, la cronificación y las complicaciones de la enfermedad.

ABSTRACT Objective To describe nurses' knowledge about the identification, prevention and self-care measures directed to Acute Kidney Injury (AKI) in hypertensive and / or diabetic patients in Primary Health Care (PHC). Method Cross-sectional and quantitative study. Sample consisting of 57 nurses working in primary health care (PHC). The semi-structured questionnaire was adopted for data collection. A descriptive and inferential analysis was performed. The result with p≤0.05 was considered significant. Results The nurses' profile was young (age 42 ± 9 years old) and professional practice time being 9 ± 6 years. Knowledge about general aspects related to AKI was identified as below average (48±19 points), however, although the concept was correctly described by a majority 41 (71.9%). Risk factors recognized as determinant for AKI were mostly drug exposure 56 (98.2%) and diabetes mellitus 49 (86%). The length of practice in PHC was associated with reduced knowledge about the need for referral to the nephrologist based on serum creatinine value (p=0.004). Conclusion and implications for the practice Nurses' knowledge was insufficient for recognition of risk factors, prevention and self-care activities of kidney disease. Thus, there is a need for permanent training of nurses in PHC to optimize the early identification of AKI, avoiding progression, and chronification and complications of this disease.

Relación entre niveles de vitamina D y perfil lipídico en embarazadas de alto riesgo / Relationship between level of vitamin D and lipid profile in high risk pregnant women

En la Argentina, las embarazadas presentan alta prevalencia (80%) de hipovitaminosis D y de sobrepeso u obesidad (27,4%). Ambas condiciones pueden aumentar la morbimortalidad materno-fetal. Bajos niveles de vitamina D se han relacionado con aumento del colesterol total, LDL, triglicéridos (Tg) y descenso de HDL. Objetivo: evaluar los niveles de 25-hidroxivitamina D (25OHD) y su relación con el perfil lipídico en pacientes embarazadas de alto riesgo. Materiales y métodos: estudio de corte transversal entre septiembre de 2016 y abril de 2017. Se excluyeron pacientes que recibieron suplementos de vitamina D, con disfunción tiroidea no compensada, malabsorción, insuficiencia cardíaca, renal o hepática y dislipidemia familiar. Niveles circulantes de 25OHD < 30 ng/ml se consideraron hipovitaminosis. Resultados: se evaluaron 86 embarazadas de 29,3 ± 7,1 años durante la semana 28 ± 6,5. El IMC pregestacional fue 28,3 ± 6,5 kg/m2 y la ganancia de peso 7 ± 4,3 kg. Perfil lipídico: colesterol total 240 ± 54 mg/dl; LDL 156 ± 54 mg/dl; HDL 66 ± 15 mg/dl; Tg 204 ± 80 mg/dl. La media de 25OHD fue de 23,8 ± 9 ng/ml, con una prevalencia de hipovitaminosis D de 77,9 %. Las pacientes con hipovitaminosis D presentaron mayores valores de colesterol total y LDL (p < 0,05), con tendencia no significativa a presentar mayores valores de Tg. Conclusión: en embarazadas de alto riesgo se observó una alta prevalencia de hipovitaminosis D, asociada con mayores concentraciones de colesterol total y LDL. (AU)

In Argentina, pregnant women have a high prevalence (80 %) of hypovitaminosis D and verweight/obesity (27.4%), conditions that can increase maternal-fetal morbidity and mortality. Low levels of 25-hydroxyvitamin D (25OHD) have been linked to an increase in total cholesterol, LDL cholesterol, triglycerides (TG) and a decrease in HDL cholesterol. Objective: to evaluate the levels of vitamin D and its relationship with the lipid profile in high risk pregnant patients. Materials and methods: cross-sectional study between September 2016 and April 2017. Patients who received vitamin D supplements or had non-compensated thyroid dysfunction, malabsorption, heart failure, renal or hepatic failure, or familial dyslipidemia were excluded. Hypovitaminosis D was defined as a circulating level of 25OHD < 30 ng/ml. Results: We assessed 86 women of 29.3 ± 7.1 years during pregnancy week 28 ± 6.5. Pre-gestational BMI was 28.3 ± 6.5 kg/m2. Their weight gain was 7 ± 4.3 kg. Lipid profile: total cholesterol 240 ± 54 mg/dl; LDL cholesterol 156 ± 54 mg/dl; HDL cholesterol 66 ± 15 mg/dL; TG 204 ± 80 mg/dl. The mean 25OHD level was 23.8 ± 9 ng/ml, with a 77.9 % prevalence of hypovitaminosis D. Patients with hypovitaminosis D had higher values of total cholesterol and LDL cholesterol (p<0.05), and a non-significant trend toward higher triglyceridemia. Conclusion: A high prevalence of hypovitaminosis D, associated with high total and LDL cholesterol was found in high risk pregnant women. (AU)