Epidemiología de la apendicitis aguda en Colombia: Un análisis de las bases de datos administrativas del Ministerio de Salud / Epidemiology of acute appendicitis in Colombia: An Analysis of the Ministry of Health administrative databases

Introducción. La apendicitis aguda es una afección común, con un pico de incidencia entre los 10 y 20 años. La cirugía es el tratamiento preferido y la apendicectomía por laparotomía sigue siendo el estándar, aunque el abordaje laparoscópico ha mostrado menos complicaciones. El objetivo de este artículo fue caracterizar tanto la enfermedad como el tratamiento quirúrgico en Colombia, usando datos de bases oficiales. Métodos. Se accedió a la base de datos del Sistema Integrado de Información para la Protección Social (SISPRO) del Ministerio de Salud de Colombia en febrero de 2023. Se recogieron datos de los pacientes con diagnóstico de apendicitis y con procedimiento de apendicectomía entre 2017 y 2021, y se analizaron por edad, sexo y ubicación geográfica. Resultados. Entre 2017 y 2021 se diagnosticaron 345.618 casos de apendicitis (51,8 % mujeres), con pico de incidencia a los 15-20 años. Se realizaron 248.133 apendicectomías, el 16,7 % por laparoscopia. Los hospitales con más procedimientos reportados estaban en Bogotá, Yopal, Popayán y Florencia. La mortalidad fue de 0,56 % en hombres y 0,51 % en mujeres. Conclusión. La apendicitis es común, con pico a los 10-19 años. Las mujeres tienen mayor probabilidad de apendicectomía, debido a otras afecciones ginecológicas. El acceso a la apendicectomía disminuye la mortalidad; en estos pacientes, el 16 % fue laparoscópica, lo que sugiere que se necesita más entrenamiento y acceso a esta técnica. Este estudio aporta a la comprensión de la epidemiología de la apendicitis y apendicectomías en Colombia.

Introduction. Acute appendicitis is a common condition, with a peak incidence between 10 and 20 years of age. Surgery is the preferred treatment and laparotomy appendectomy remains the standard, although the laparoscopic approach has shown fewer complications. The objective of this article was to characterize both the disease and the surgical treatment in Colombia, using data from official databases. Methods. The Integrated Information System for Social Protection (SISPRO) database of the Ministry of Health was accessed in February 2023. Data with diagnosis of apendicitis and with appendectomy between 2017 and 2021 were collected. Analysis was done by age, gender, and geographic location. Results. Between 2017 and 2021, 345,618 cases of appendicitis were diagnosed (51.8% females), with peak incidence at 15-20 years of age. A total of 248,133 appendectomies were performed, 16.7% by laparoscopy. The hospitals with most reported procedures were located in Bogotá, Yopal, Popayán, and Florencia. Mortality was 0.56% in men and 0.51% in women. Conclusion. Appendicitis is common, peaking at ages 10-19. Women are more likely undergo appendectomy due to other gynecological conditions. Access to appendectomy improves mortality. In these patients, 16% were laparoscopic, suggesting that more training and access to this technique is needed. This study contributes to the understanding of the epidemiology of appendicitis and appendectomies in Colombia.

Inserção de profissionais de educação física no Sistema Único de Saúde: análise temporal (2007-2021) / Insertion of physical education professionals in the Unified Health System: temporal analysis (2007-2021)

O objetivo desta pesquisa foi descrever e analisar a série temporal da inserção de profissionais de educação física (PEF) no Sistema Único de Saúde (SUS) no período de 2007 a 2021, bem como apresentar a distribuição por regiões e estados de profissionais no território brasileiro. Trata-se de um estudo descritivo e de série temporal que utilizou dados secundários oriundos do sistema de consultas do Cadastro Nacional dos Estabelecimentos de Saúde (CNES). Analisou-se o quantitativo de PEF no SUS nas cinco regiões e nos vinte e seis estados e no Distrito Federal entre 2007 e 2021 e reali-zou-se a análise temporal para verificar a distribuição dos PEF nas regiões brasileiras. Os resultados apontam para um crescimento no número de PEF entre 2007 (n = 22) e 2020 (n = 7.560) em todo o país. Em 2021 observa-se uma redução de 2,8% no quantitativo de PEF. Entre as regiões, os maio-res quantitativos foram observados nas regiões Nordeste e Sudeste, enquanto nos estados a maior concentração foi em Minas Gerais, seguido de São Paulo, Pernambuco, Bahia e Rio Grande do Sul. Observou-se uma tendência crescente de PEF nas regiões Norte e Sul. Conclui-se que o quantitativo de PEF atuantes no SUS teve um crescimento expressivo durante o período analisado, sendo fruto das políticas públicas e programas voltados à promoção da atividade física constituídos ao longo do tempo. Apesar disso, há importantes disparidades geográficas que não devem ser desconsideradas, reforçando a necessidade de estratégias coletivas e investimentos em políticas públicas que fomentem a inserção dos PEF na rede assistencial e de fortalecimento do SUS

The aim of this study was to describe and analyze the time series of physical education professionals (PEF in Portuguese) in the Unified Health System (SUS in Portuguese) from 2007 to 2021, as well as to present their distribution by Brazilian regions and states. This is a time series study which used secondary data from the Consultation System of the National Registry of Health Establishments (CNES in Portuguese). We analyzed the number of PEF in the country, in the five Regions and in the twenty-six States and the Fed-eral District between 2007 and 2021 and the temporal analysis was carried out to verify the distribution of PEF in the Brazilian regions. The results point to an increase in the number of PEF between 2007 (n = 22) and 2020 (n = 7560). In 2021, there is a 2.8% reduction in the amount of PEF. Among the regions, the highest numbers were observed in the Northeast and Southeast regions, while in the states the highest con-centration was in Minas Gerais, followed by São Paulo, Pernambuco, Bahia and Rio Grande do Sul. There was an increasing trend in the distribution of PEF in the North and South regions. The number of PEF working in the SUS had an expressive growth during the analyzed period, being the result of public policies and programs aimed at promoting physical activity constituted over time. Despite this, there are important geographic disparities that should not be disregarded, reinforcing the need for collective strategies and financ-ing in public policies that encourage the insertion of PEFs in the care network and the strengthening of SUS

Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China: a CR-HepB-based real-world study / 中华肝脏病杂志

Objective: To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data / 中华创伤杂志(英文版)

PURPOSE@#To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).@*METHODS@#Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).@*RESULTS@#Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance.@*CONCLUSIONS@#These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Comparing epidemiologic features, outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran / 中华创伤杂志(英文版)

PURPOSE@#To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.@*METHODS@#This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX).@*RESULTS@#Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p < 0.001). In the ≤ 15 years and ≥ 65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.022. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001).@*CONCLUSION@#The pandemic affected the epidemiology of traumatic patients in terms of gender, age, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Cancer statistics in China, 2016 / 中华肿瘤杂志

Objective: Data for 2016 from cancer registries were used to estimate cancer incidence and mortality in China in 2016. Methods: According to the quality control process of the National Central Cancer Registry, the data from 683 cancer registries submitted by each province were evaluated, and the data of 487 cancer registries were qualified and included in the final analysis. Age-specific incidence and mortality rates were calculated by area (urban/rural), sex, age and cancer site, combined with national population data to estimate cancer incidence and mortality in China in 2016. Chinese population census in 2000 and Segi's population were used for age-standardized incidence and mortality rates. Results: Total population covered by 487 cancer registries was 381 565 422 (192 628 370 in urban and 188 937 052 in rural areas). The percentages of morphologically verified (MV%) and death certificate-only cases (DCO%) accounted for 68.31% and 1.40%, respectively, and the mortality to incidence ratio was 0.61. It was estimated about 4 064 000 new cases occurred in China in 2016, with the crude incidence rate being 293.91/100 000 (the rates of males and females were 315.52/100 000 and 271.23/100 000), age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 190.76/100 000 and 186.46/100 000, with the cumulative incidence rate (0-74 years old) being 21.42%. The crude incidence and ASIRC were 314.74/100 000 and 196.38/100 000 in urban areas, whereas in rural areas, they were 265.90/100 000 and 182.21/100 000, respectively. It was estimated about 2 413 500 cancer deaths occurred in China in 2016, the crude mortality rate was 174.55/100 000 (216.16/100 000 in males and 130.88/100 000 in females), the age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 106.00/100 000 and 105.19/100 000, and the cumulative mortality rate (0-74 years old) was 11.85%. The crude mortality and ASMRC were 180.31/100 000 and 104.44/100 000 in urban areas, whereas in rural areas, they were 166.81/100 000 and 108.01/100 000, respectively. The most common cancer cases include lung, colorectal, stomach, liver and female breast cancers. The top five cancers accounted for about 57.27% of all cancer cases. The most common cancer deaths included lung, liver, stomach, colorectal and esophageal cancers. The top five cancers accounted for about 69.25% of all cancer deaths. Conclusions: The burden of cancer shows a continuous increasing trend in China. Regional and gender differences in cancer burden are obvious. The cancer patterns still show the coexistence of cancer patterns in developed countries and developing countries. The situation of cancer prevention and control is still serious in China.

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR) / 中华医学杂志(英文版)

BACKGROUND@#The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.@*METHODS@#Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.@*RESULTS@#In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.@*CONCLUSIONS@#Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

Incidence and survival of neuroendocrine neoplasms in China with comparison to the United States / 中华医学杂志(英文版)

BACKGROUND@#Neuroendocrine neoplasms (NENs) are rare tumors characterized by variable biology and delayed diagnosis. However, the nationwide epidemiology of NENs has never been reported in China. We aimed to estimate the incidence and survival statistics of NENs in China, in comparison to those in the United States during the same period.@*METHODS@#Based on the data from 246 population-based cancer registries covering 272.5 million people of China, we calculated age-specific incidence on NENs in 2017 and multiplied by corresponding national population to estimate the nationwide incidence in China. The data of 22 population-based cancer registries were used to estimate the trends of NENs incidence from 2000 to 2017 through the Joinpoint regression model. We used the cohort approach to analyze the 5-year age-standardized relative survival by sex, age group, and urban-rural area between 2008 and 2013, based on data from 176 high-quality cancer registries. We used data from the Surveillance, Epidemiology, and End Results (SEER) 18 program to estimate the comparable incidence and survival of NENs in the United States.@*RESULTS@#The overall age-standardized rate (ASR) of NENs incidence was lower in China (1.14 per 100,000) than in the United States (6.26 per 100,000). The most common primary sites were lungs, pancreas, stomach, and rectum in China. The ASRs of NENs incidence increased by 9.8% and 3.6% per year in China and the United States, respectively. The overall 5-year relative survival in China (36.2%) was lower than in the United States (63.9%). The 5-year relative survival was higher for female patients than male patients, and was higher in urban areas than in rural areas.@*CONCLUSIONS@#The disparities in burden of NENs persist across sex, area, age group, and site in China and the United States. These findings may provide a scientific basis on prevention and control of NENs in the two countries.

Estimación de la frecuencia del parto vaginal instrumentado en Colombia en los años 2015 - 2019. Estudio transversal de registros poblacionales / Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study

Objetivos: evaluar la frecuencia del parto instrumentado en Colombia y por regiones entre el 2015 y 2019. Materiales y métodos: estudio de corte transversal a partir de registros poblacionales. Se incluyeron los registros de mujeres con edad gestacional mayor a 28 semanas y parto vaginal. Muestreo consecutivo. La información se obtuvo a partir del certificado de nacido vivo del Departamento Administrativo Nacional de Estadística (DANE). Se realizó la descripción de las variables sociodemográficas y clínicas. La frecuencia del parto instrumentado fue calculada y descrita por año y departamento. Resultados: se incluyeron 3.224.218 registros de recién nacidos vivos. De estos, 1.719.405 (53,33 %) correspondieron a partos vaginales, y 1.468.726 (45,55 %) a partos por vía cesárea. La frecuencia nacional del parto instrumentado entre el 2015 y 2019 fue de 36.087 nacimientos (1,11 %); Antioquia y Bogotá, D.C. fueron los lugares con mayor ocurrencia, 16.201 (4,5 %) y 13.686 (2,52 %), respectivamente. Conclusiones: el parto vaginal instrumentado es la vía de parto con menor ocurrencia en Colombia con tendencia a la disminución. La formación en este recurso para el uso durante el trabajo de parto no debe perderse en la formación del profesional de salud, especialmente en los programas de Ginecología y Obstetricia. Se debe evaluar si el aumento en el adecuado uso de esta técnica puede disminuir la tasa de cesáreas observadas actualmente, así como describir los escenarios clínicos donde su uso es seguro para la madre y el feto. Se requieren estudios prospectivos, pues pueden permitir establecer las causas del descenso en el uso de esta herramienta obstétrica, los resultados maternos y perinatales en términos de su riesgo/beneficio.

Objectives: To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Materials and methods: Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results: Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions: The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.

Registro prospectivo de pacientes que presentan paro cardiorrespiratorio extrahospitalario en Santiago, Chile / A registry of out-of-hospital cardiac arrest in Chile

BACKGROUND: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). AIM: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. MATERIAL AND METHODS: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. RESULTS: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. CONCLUSIONS: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.

Uma visão da imprensa sobre o desmonte do Mais Médicos / Press coverage on the dismantling of the Mais Médicos Program / La mirada de la prensa sobre el desmantelamiento del Programa Más Médicos

Este relato descreve as principais etapas da investigação jornalística que culminaram na reportagem "Os pequenos que se foram", publicada pela revista piauí. A reportagem revelou que em municípios pobres a desorganização do sistema de Atenção Básica, provocada pelo desmonte do Programa Mais Médicos, gerou um aumento de 58% nas mortes por causas evitáveis de crianças menores de cinco anos. O relato mostra que a reportagem é resultado da reunião de documentos, parte deles obtida pela Lei de Acesso à Informação (LAI) e por cruzamentos feitos no Sistema de Informação de Mortalidade (SIM), um banco de dados abertos do Ministério da Saúde. São descritas também pesquisas em cartórios e a busca pelas famílias que perderam crianças em 2019. Por fim, o relato mostra como a reportagem se insere no processo de oferta de informações para deliberação pública.

This paper describes the main steps of the journalistic investigation that culminated in the report "The little children who are gone," published by piauí magazine. According to article, the disorganization of the Primary Care system in poor municipalities, caused by the dismantling of the More Doctors Program, led to a 58% increase in deaths from preventable causes in children under the age of five. The report is the result documents obtained by the Access to Information Law (LAI), and by cross-references made in the Mortality Information System (SIM), an open database of the Ministry of Health. Registry office research and the search for families who lost children in 2019 are also described. In short, the article takes part in the process of providing information for public deliberation.

Este informe describe las principales etapas de la investigación periodística que culminó con el reportaje "Los niños pequeños que murieron", publicado por la revista piauí. El reportaje reveló que en los municipios pobres la desorganización del sistema de Atención Primaria, provocada por el desmantelamiento del Programa Más Médicos, generó un aumento del 58% en las muertes por causas evitables de niños menores de cinco años. El informe muestra que el reportaje es el resultado de la recopilación de documentos, parte de ellos obtenidos por la Ley de Acceso a la Información (LAI) y por cruces realizados en el Sistema de Información de Mortalidad (SIM), una base de datos abierta del Ministerio de Salud. También se describen las investigaciones en los registros de muertes y la búsqueda de familias que perdieron a sus hijos en 2019. Finalmente, el informe muestra cómo el reportaje contribuye con el proceso de proporcionar información para la deliberación pública.

Impacto de la pandemia por COVID-19 en la incidencia de artroplastías de rodilla en Chile: estudio transversal basado en registro nacional / Impact of COVID-19 outbreak in knee arthroplasty in Chile: a cross-sectional, national registry-based analysis

Introducción Debido a la respuesta de los servicios de salud a la pandemia por COVID- 19, se han suspendido cirugías electivas como la artroplastía de rodilla. El objetivo de este estudio es determinar la incidencia de artroplastías de rodilla en 2020 reflejando el efecto de la pandemia, y estimar el tiempo y el costo para recuperar la situación de lista de espera previa a marzo de 2020. Métodos Estudio transversal. Se analizaron las bases de datos del Departamento de Estadística e Información en Salud de Chile de 2019 y 2020, identificando pacientes asociados a códigos de artroplastía de rodilla. Se calculó el número mensual de artroplastias realizadas durante 2019 para estimar el tiempo que tomará recuperar las cirugías no realizadas en 2020. El costo asociado a artroplastía de rodilla se hizo según el método de pago utilizado por el Fondo Nacional de Salud estimado por grupos relacionados por diagnóstico. Resultados En 2020 la tasa de incidencia de artroplastía de rodilla por 100 000 habitantes disminuyó 64% comparado con 2019. El impacto fue mayor en el sistema público (68%) y en beneficiarios del Fondo Nacional de Salud (63%). Un aumento en la productividad en 30% respecto a 2019 haría que en 27 meses se recuperen las cirugías no realizadas en 2020, significando un costo adicional mensual en el sistema público de 318 262 530 pesos chilenos (equivalentes a 378 mil dólares americanos, USD). Conclusiones Hubo una importante disminución de la tasa de artroplastías de rodilla en 2020, estimándose una caída del 64% en la incidencia por 100 000 habitantes. Esto muestra un incremento importante de personas que esperan la resolución a la artrosis de rodilla. Un aumento entre 20 y 40% respecto de 2019 permitiría recuperar las cirugías no realizadas en un plazo entre 20 y 41 meses, a un costo mensual en el sistema público que varía entre 210 y 425 millones pesos chilenos (de 250 a 506 mil dólares americanos, USD).

Introducción Debido a la respuesta de los servicios de salud a la pandemia por COVID- 19, se han suspendido cirugías electivas como la artroplastía de rodilla. El objetivo de este estudio es determinar la incidencia de artroplastías de rodilla en 2020 reflejando el efecto de la pandemia, y estimar el tiempo y el costo para recuperar la situación de lista de espera previa a marzo de 2020. Métodos Estudio transversal. Se analizaron las bases de datos del Departamento de Estadística e Información en Salud de Chile de 2019 y 2020, identificando pacientes asociados a códigos de artroplastía de rodilla. Se calculó el número mensual de artroplastias realizadas durante 2019 para estimar el tiempo que tomará recuperar las cirugías no realizadas en 2020. El costo asociado a artroplastía de rodilla se hizo según el método de pago utilizado por el Fondo Nacional de Salud estimado por grupos relacionados por diagnóstico. Resultados En 2020 la tasa de incidencia de artroplastía de rodilla por 100 000 habitantes disminuyó 64% comparado con 2019. El impacto fue mayor en el sistema público (68%) y en beneficiarios del Fondo Nacional de Salud (63%). Un aumento en la productividad en 30% respecto a 2019 haría que en 27 meses se recuperen las cirugías no realizadas en 2020, significando un costo adicional mensual en el sistema público de 318 262 530 pesos chilenos (equivalentes a 378 mil dólares americanos, USD). Conclusiones Hubo una importante disminución de la tasa de artroplastías de rodilla en 2020, estimándose una caída del 64% en la incidencia por 100 000 habitantes. Esto muestra un incremento importante de personas que esperan la resolución a la artrosis de rodilla. Un aumento entre 20 y 40% respecto de 2019 permitiría recuperar las cirugías no realizadas en un plazo entre 20 y 41 meses, a un costo mensual en el sistema público que varía entre 210 y 425 millones pesos chilenos (de 250 a 506 mil dólares americanos, USD).

Manual de registro y codificación de la atención en salud bucal 2022 / Manual of registration and coding of oral health care 2022

La publicación describe y homogeniza los criterios en la recopilación y codificación de diagnósticos CIE 10 y Catálogo de Procedimientos médicos y estomatológicos del Ministerio de Salud. Asimismo, la metodología de registros estadísticos sanitarios en salud bucal, el cual se convierte en un sistema de información necesaria para la toma de decisiones en la solución de los problemas sanitarios en el marco del sistema de coordinación

O impacto da gestão EBSERH na produção dos hospitais universitários do Brasil / The impact of EBSERH management on the production of Brazilian university hospitals

Resumo Este estudo analisa a evolução de resultados relacionados à produção de hospitais universitários (HUs) pertencentes à Empresa Brasileira de Serviços Hospitalares (EBSERH), enfatizando resultados alcançados antes e depois da adesão à EBSERH. Foram analisados dados mensais de 16 HUs, obtidos no Sistema de Informações Hospitalares (SIH/SUS) e no Cadastro Nacional de Estabelecimentos de Saúde (CNES), referentes ao número de internações hospitalares, número de profissionais, número de leitos, tempo médio de permanência, taxa média de mortalidade, valor total aprovado de autorizações de internação hospitalar (AIHs) e valor médio da AIH. O estudo utiliza a análise simples de séries temporais interrompidas (STI) para analisar os efeitos da gestão EBSERH nos HUs, avaliando comparativamente o nível e a tendência dos resultados dos HUs antes e após a adesão à gestão da EBSERH. Os hospitais, de modo geral, apresentaram melhores resultados após a adesão à EBSERH, com redução de tempo médio de permanência, aumento do número total de internações, crescimento no efetivo de pessoal e aumento do valor total aprovado pelo SUS. Entre os HUs analisados, os que apresentaram destaque positivo no aprimoramento de performance foram o HU/UFS, HULW/UFPB, o HUOL/UFRN e o HU/UFMA.

Abstract This study analyzes the evolution of results related to the production of university hospitals (HUs) in Brazil belonging to the Brazilian Hospital Services Company (EBSERH), emphasizing results achieved before and after joining EBSERH. Monthly data of 16 HUs, obtained from the Hospital Information System (SIH/SUS) and from the National Registry of Health Facilities (CNES), were analyzed, referring to the number of hospital admissions, number of professionals, number of beds, average length of stay, average mortality rate, total approved value of Hospitalization Authorizations (AIHs) and average AIH value. The study uses the simple analysis of interrupted time series (ITS) to analyze the effects of EBSERH management on HUs, assessing the level and trend of HU results before and after joining the EBSERH management. Hospitals, in general, had better results after joining the EBSERH, with a reduction in the average length of stay, an increase in the total number of hospitalizations, increase in work force, and an increase in the total amount approved by SUS. Among the analyzed HUs, the ones that showed the greatest performance improvement were HU/UFS, HULW/UFPB, HUOL/UFRN and HU/UFMA.

Detección de cardiopatías congénitas críticas en recién nacidos en Argentina a través del sistema nacional de vigilancia de anomalías congénitas (RENAC) / Detection of critical congenital heart disease among newborns in Argentina through the national surveillance system of congenital heart disease (RENAC)

Introducción. Las cardiopatías congénitas críticas (CCC) son las anomalías estructurales del corazón ductus-dependientes, que pueden llevar a la muerte o requieren tratamiento invasivo en el primer mes de vida. Objetivo. Conocer la prevalencia y distribución de CCC en recién nacidos de Argentina, en comparación con otros países, y la proporción de detección prenatal y de mortalidad perinatal. Material y métodos. Se utilizó material de la Red Nacional de Anomalías Congénitas de Argentina (RENAC) del período 2009-2018, y de otros sistemas de vigilancia de Estados Unidos (EE. UU.), Europa y Colombia. Para Argentina se analizó la proporción de detección prenatal, mortalidad perinatal y prevalencia de recién nacidos con CCC según jurisdicción y subsector de salud. Resultados. Prevalencia de CCC de 11,46 (IC95 %: 11,02-11,92) cada 10 000 nacimientos. El 43,93 % tuvo detección prenatal y la mortalidad perinatal fue del 25 %. La tetralogía de Fallot fue el defecto específico más frecuente. La prevalencia de CCC y el porcentaje de detección prenatal fue significativamente menor en el subsector público, mientras que la mortalidad perinatal fue mayor en este subsector. La prevalencia de CCC observada fue menor que en los registros de EE. UU. (NBDPN) y Europa (EUROCAT). El registro de Bogotá mostró prevalencias específicas diferentes. Conclusión. La prevalencia de CCC es más baja que la observada en otros países, y aún menor en el sector público de Argentina. Se enfatiza la necesidad de mejorar la detección prenatal e implementar la oximetría de pulso en recién nacidos como prueba de tamizaje obligatorio y universal.

Introduction. Critical congenital heart disease (CCHD) is a term that refers to ductus-dependent structural anomalies of the heart that may be fatal or require invasive management in the first month of life. Objective. To know the prevalence and distribution of CCHD among newborns in Argentina, compared to other countries, and the proportion of prenatal detection and perinatal mortality. Material and methods. Data provided by the National Network of Congenital Anomalies (Red Nacional de Anomalías Congénitas de Argentina, RENAC) for the 2009-2018 period and by other surveillance systems in the United States, Europe, and Colombia were used. For Argentina, the proportion of prenatal detection, perinatal mortality, and CCHD prevalence in newborns by jurisdiction and health system subsector were analyzed. Results. The prevalence of CCHD was 11.46 (95% confidence interval: 11.02-11.92) every 10 000 births. Prenatal detection was possible in 43.93% of cases, and perinatal mortality was 25%. Tetralogy of Fallot was the most frequent specific defect. The prevalence of CCHD and percentage of prenatal detection was significantly lower in the public subsector, whereas perinatal mortality was higher in this subsector. The prevalence of CCHD was lower than in the United States (NBDPN) and European (EUROCAT) registries. The Bogotá Registry showed different specific prevalence values. Conclusion. The prevalence of CCHD is lower than what has been observed in other countries, and even lower in the public sector of Argentina. The need to improve prenatal detection and implement pulse oximetry among newborns as a mandatory and universal screening is emphasized.

Lineamientos técnicos para el Registro Nacional de Diálisis y Trasplante Renal / Technical guidelines for the National Registry of Dialysis and Kidney Transplantation

En los presentes lineamientos técnicos se describen los conceptos y procedimientos a realizar en la implementación del registro, además se presentan entre otros aspectos, los componentes relacionados con la obligatoriedad en el reporte, definición de caso registrable, las variables a registrar, las fuentes de información, metodología de la recolección, los centros de diálisis y trasplante, así como el reporte de resultados y la hoja de recolección de la información

These technical guidelines describe the concepts and procedures to be carried out in the implementation of the registry, in addition to presenting, among other aspects, the components related to the obligatory nature of the report, the definition of the registrable case, the variables to be registered, the sources of information, collection methodology, dialysis and transplant centers, as well as the results report and the information collection sheet

A Philippine Tertiary Hospital cross-sectional and registry feasibility study: Gout clinical case scenario

Background@#Gout is one of the most common arthritides affecting Filipinos; yet, there is a lack of updated local data and Clinical Practice Guidelines. @*Objective@#To describe Clinical Case Scenario (CCS) of Filipino patients with gout in a tertiary referral hospital seen over a year. @*Design@#Cross-sectional study. @*Methods@#Patients’ characteristics, risk factors, disease course, management, and CCS were obtained by a rheumatologist using a questionnaire. Descriptive statistics were used. @*Results@#One hundred eight patients were included with a median age of 58 (range 26–80) years. 106 were male (98%); and, 2 were female (2%) who were menopause and had chronic kidney disease (CKD). Most prevalent CCS were stages 9 (29%), 1 (16%), and 2 (15%). The majority of cases had tophi and belonged to CCS 4-9 (62%). This signifies that most patients had advanced gout. Consistent with international and local data: almost half had hypertension (46%), a third had CKD (36%). Most were ethanol drinkers (65%) and smokers (57%). Unexpectedly, not many were obese (10%) or had metabolic syndrome (2%). The initial joint involved was the ankle (52%) rather than the first metatarsophalangeal joint (40%). Almost half of the patients presented with two or more joint involvement (46%) than monoarthritis (54%). Patients with acute flare were most commonly prescribed NSAIDs (77%), followed by colchicine (62%). Most were prescribed allopurinol (44%) compared with febuxostat (37%) for urate-lowering therapy. Only 16% received patient education. Medication compliance was 65%, but follow-up compliance was less than 18%. Comparing the Filipino clinical profile to historical data suggests an increased incidence of gout in the young and an increase in comorbidity prevalence. @*Conclusion@#This study reports a cohort of Filipino gout patients. Comorbidities are similar to world figures but differ in the low incidence of obesity and metabolic syndrome. It also differs from literature in having the ankle as the most common initial joint presentation. Management and compliance were also described. As a pilot study for a registry, this study can be implemented at different institutions to broaden and monitor the ever-changing Filipino gout profile. @*Recommendation@#A larger sample size and a more extended observation period are recommended to estimate gout CCS prevalence, flare risk factors, and treatment response more accurately. Other outcomes that can be measured are mortality rates and etiologies for each CCS.

SARS-CoV-2 Infection in Filipino Children: An interim report from the SALVACION registry

Background@#The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. @*Methods@#This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. @*Results@#As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. @*Conclusion@#Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.