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1.
Esc. Anna Nery Rev. Enferm ; 26: e20210203, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1339876

ABSTRACT

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.


RESUMEN Objetivo analizar las características individuales, clínicas y los factores asociados a la mortalidad en pacientes con COVID-19 en un hospital público del estado de Paraná. Métodos estudio transversal, retrospectivo, documental (n = 86), con pacientes adultos hospitalizados, de marzo a junio de 2020. Resultados la mortalidad fue del 12,8%, grupo de mayor riesgo para los ancianos con comorbilidades, especialmente enfermedades cardiovasculares. La probabilidad de muerte fue 58 veces mayor en los ancianos en comparación con los adultos y ocho veces mayor en aquellos con comorbilidades en comparación con los sanos. La mayoría de los pacientes presentaban síntomas respiratorios, fiebre y mialgia. Tratamiento a base de antibióticos, anticoagulantes y antivirales, asociado al soporte ventilatorio. Las principales complicaciones fueron hipoxia, insuficiencia renal aguda e infección secundaria. Conclusión e implicaciones para la práctica los ancianos con comorbilidades cardiovasculares que requirieron cuidados intensivos tenían una mayor probabilidad de muerte. Los resultados de uno de los centros de referencia pandémica permiten discutir las medidas epidemiológicas adoptadas, con énfasis en conceptos restrictivos en los primeros meses.


ABSTRACT Objective to analyze the individual and clinical characteristics and the factors associated with mortality in patients with COVID-19, in a public hospital in the state of Paraná, Brazil. Methods a cross-sectional, retrospective, documentary study (n= 86), with adult inpatients, from March to June 2020. Results mortality was 12.8%, the highest risk group was the elderly with comorbidities, especially cardiovascular ones. The chance of death was 58 times higher in the elderly compared to adults, and eight times higher in those with comorbidities compared to the healthy ones. Most patients presented with respiratory symptoms, fever, and myalgia. Treatment was based on antibiotics, anticoagulants and antivirals, associated with ventilatory support. The main complications were hypoxia, acute renal failure, and secondary infection. Conclusion and implications for practice elderly people with cardiovascular comorbidities who required intensive care had a higher chance of death. The results from one of the reference centers in the pandemic make it possible to discuss epidemiological measures adopted, with emphasis on restrictive concepts in the first months.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Health Profile , Death , SARS-CoV-2 , COVID-19/mortality , Respiration, Artificial , Cardiovascular Diseases , Comorbidity , Medical Records , Retrospective Studies , Risk Factors , Azithromycin/therapeutic use , COVID-19/drug therapy , Intensive Care Units , Length of Stay
2.
Infectio ; 25(4): 262-269, oct.-dic. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1286720

ABSTRACT

Abstract Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection by COVID-19 in 5 Colombian institutions. Materials and methods: Is a retrospective observational study of consecutive hospitalized patients with a diagnosis of COVID-19 confirmed from March 01 to May 30, 2020 in Colombia. Results: A total of 44 patients were included. The median age was 62 years. 43.2% had a history of smoking, while 69.8% were overweight or obese. 88.6% had at least one comorbidity and 52.3% had three or more comorbidities. Hypertension and dyslipidaemia were the most frequent comorbidities (40.9% and 34.1%, respectively). The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome occurred in the 36.4%. The biomarkers associated with mor tality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Conclusions: The clinical course of SARS-CoV-2 infection in hospitalized Colombian was characterised by a more advanced stage of the infection.


Resumen Objetivo: Analizar las características, clínicas, factores de riesgo, y la evolución de pacientes hospitalizados con infección confirmada por COVID-19 en 5 Institu ciones de Colombia. Material y método: Es un estudio observacional retrospectivo de pacientes consecutivos hospitalizados con diagnóstico de COVID-19 confirmado entre 01 de Febrero de 2020 y 30 de Mayo de 2020 en Colombia. Resultados: Un total de 44 pacientes fueron incluidos. La mediana de edad fue de 62 años y la mayoría del sexo masculino. El 43.2% tenían historia de tabaquismo, mientras que el 69.8% tenían sobrepeso u obesidad. El 88.6% tenían al menos una comorbilidad y el 52.3% tenían tres o más comorbilidades. La hipertensión arterial fue la comorbilidad más frecuente (40.9%), seguido de la dislipidemia (34.1%). La tasa de letalidad a 30 días fue de 47.7% y ocurrió con una mediana de 11 días. El 36.4% presentó el desenlace compuesto. Los biomarcadores asociados con el riesgo de muerte fue troponina > 14 ng/mL (RR:5.25, IC95% 1.37-20.1, p=0.004) y dímero D mayor a 1000 mg/dL (RR: 3.0, IC95% 1.4-6.3, p=0.008). Conclusiones: El curso clínico de la infección por SARS-CoV-2 en colombianos hospitalizados fue un estadio más avanzado de la infección.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Biomarkers , COVID-19 , Patients , Tobacco Use Disorder , Comorbidity , Risk , Risk Factors , Mortality , Colombia , Overweight , Courses , Infections , Obesity
4.
Rev. cuba. med ; 60(3): e1641, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347518

ABSTRACT

Introducción: La anemia drepanocítica es una enfermedad pleiotrópica sistémica. Con su padecimiento, casi todos los órganos se afectan. Las formas de presentación de esta enfermedad varían entre los pacientes. Objetivo: Describir las características principales de las complicaciones y comorbilidades más frecuentes en la anemia drepanocítica. Método: Se realizó una revisión de la literatura, de artículos publicados en los últimos 10 años sobre complicaciones y comorbilidades más frecuentes en la anemia drepanocítica. Conclusión: El conocimiento y diferenciación de las complicaciones y comorbilidades en la anemia drepanocítica permite administrar las terapias adecuadas(AU)


Introduction: Sickle cell anemia is a systemic pleiotropic disease. Almost all organs are affected with his condition. The forms of presentation of this disease vary. Objective: To describe the main characteristics of the most frequent complications and comorbidities in sickle cell anemia. Method: A literature review of articles published in the last 10 years on the most frequent complications and comorbidities in sickle cell anemia was carried out. Conclusion: The knowledge and differentiation of complications and comorbidities in sickle cell anemia allows the administration of appropriate therapiesAU)


Subject(s)
Humans , Comorbidity , Anemia, Sickle Cell/complications , Anemia, Sickle Cell/therapy
5.
Rev. cuba. med ; 60(3): e2059, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347514

ABSTRACT

Introducción: La insuficiencia cardíaca constituye un problema a nivel mundial y aumentará en los próximos años a consecuencia del envejecimiento poblacional. Se asocia a múltiples comorbilidades que pueden estar implicadas en su desarrollo, contribuir a la progresión de la enfermedad o empeorar el pronóstico. Objetivo: Evaluar la influencia de comorbilidades en la mortalidad de pacientes con insuficiencia cardíaca crónica. Métodos: Se realizó un estudio de cohorte retrospectivo en 242 pacientes, con diagnóstico de insuficiencia cardíaca crónica y una media de seguimiento de 5 años en la consulta de protocolo de insuficiencia cardíaca del Hospital Clínico Quirúrgico Hermanos Ameijeiras. Se determinó la magnitud de la asociación de la presencia de comorbilidades y la mortalidad a través del empleo de regresión logística. Resultados: El promedio de la edad fue mayor en los pacientes fallecidos 72,12 ± 12,088 años (p = 0,003). La presencia aislada de comorbilidades no mostró asociación con la mortalidad pero sí cuando coexistían más de dos comorbilidades. (OR: 2,91. IC: .991-8,61). Se encontró asociación lineal entre el número de comorbilidades y la mortalidad (p = 0,044). Conclusión: Las comorbilidades estudiadas no presentaron una asociación independiente con la mortalidad, pero la suma de ellas sí aumentó el riesgo de muerte en los pacientes con insuficiencia cardiaca(AU)


Introduction: Heart failure is a worldwide problem and will increase in the coming years as a result of population aging. It is associated with multiple comorbidities that may be involved in its development, contribute to the progression of the disease, or worsen the prognosis. Objective: To assess the influence of comorbidities on the mortality of patients with chronic heart failure. Methods: A retrospective cohort study was carried out in 242 patients with a diagnosis of chronic heart failure and a mean follow-up of 5 years in the heart failure protocol consultation at Hermanos Ameijeiras Surgical Clinical Hospital. The magnitude of the association between the presence of comorbidities and mortality was determined through the use of logistic regression. Results: The mean age was higher in deceased patients 72.12 ± 12.088 years (p = 0.003). The isolated presence of comorbidities did not show an association with mortality, but it did when more than two comorbidities coexisted. (OR: 2.91. CI: .991-8.61). A linear association was found between the number of comorbidities and mortality (p = 0.044). Conclusion: The studied comorbidities did not show an independent association with mortality, but the sum of them did increase the risk of death in patients with heart failure(AU)


Subject(s)
Humans , Comorbidity , Heart Failure/mortality , Retrospective Studies
6.
Mali méd. (En ligne) ; 36(2): 23-26, 20210812.
Article in French | AIM | ID: biblio-1283662

ABSTRACT

Le Burkina Faso a enregistré son premier cas de Covid-19 le 09 mars 2020 mais c'est au premier avril 2020 que le service de chirurgie générale et viscérale du Centre Hospitalier Universitaire Sourô SANOU (CHUSS) de Bobo-Dioulasso a enregistré son premier cas de COVID-19 et pathologie chirurgicale. En six mois, soit entre avril et septembre 2020, notre service a enregistré quatre cas, tous des malades de sexe masculin et testés positifs à la maladie de la Covid-19 après un prélèvement oropharyngé techniqué à l'aide de la trousse de RT-PCR Detection kit for 2019-n COV RNA (Da An Gene Co) et la Plate forme AriaMx (Real-Time PCR System).Les quatre malades étaient âgés respectivement de 63 ans, 70 ans, 60 ans et 66 ans et étaient pris en charge pour un traumatisme fermé du thorax, une gangrène de jambe, une tumeur vésicale et un adénocarcinome gastrique. Deux patients étaient décédés dans le service. Les deux autres avaient été transférés dans le centre régional spécialisé dans la prise en charge de la maladie COVID-19 avec une évolution favorable. L'impact de la Covid-19 en 2020 constaté dans le service de chirurgie générale et viscérale du CHUSS, a été une diminution de 82% des activités chirurgicales.


Burkina Faso recorded its first case of Covid-19 on March 09, 2020 but it was on April 1, 2020 that the general and visceral surgery department of the Center Hospitalier Universitaire Sourô SANOU (CHUSS) in Bobo-Dioulasso recorded its first case of COVID-19 and surgical pathology. From April to September 2020, our service recorded four cases, all male patients and tested positive for Covid-19 disease after an oropharyngeal sample performed using the RT- kit. PCR Detection kit for 2019-n COV RNA (Da An Gene Co) and the AriaMx (Real-Time PCR System) platform. The four patients were aged 63, 70, 60 and 66, respectively, and were being treated for blunt chest trauma, leg gangrene, bladder tumor and gastric adenocarcinoma. Two patients died in the ward. The other two had been transferred to the regional center specializing in the management of the COVID-19 with a favorable outcome. The impact of Covid-19 in 2020, observed in the general and visceral surgery department of the CHUSS, was a 82% decrease in surgical activities.


Subject(s)
Comorbidity , COVID-19 , General Surgery , Surgical Procedures, Operative
8.
Arq. ciências saúde UNIPAR ; 25(2): 95-103, maio-ago. 2021.
Article in Portuguese | LILACS | ID: biblio-1252352

ABSTRACT

Objetivo: Averiguar a eficácia da Escala de Braden como instrumento norteador na assistência para prevenção de lesão por pressão em indivíduos acamados no âmbito domiciliar. Método: Trata-se de um estudo descritivo com abordagem quantitativa com coleta de dados realizada em domicílio por meio de entrevista e inspeção da pele de 41 participantes. Resultados: A incidência de lesão por pressão foi de 7%. Constatou-se que os indivíduos acamados em domicílio com alto risco, na escala de Braden, não mostraram incidência de lesão por pressão, enquanto os que apresentaram risco moderado houve incidência. Conclusão: Apesar de ser um instrumento bastante utilizado pelos profissionais da área da saúde, o presente trabalho demonstrou que a alta sensibilidade e especificidade da Escala de Braden é questionável. Os cuidados foram essênciais para essa baixa incidência de lesão por pressão, diminuindo sua associação com a idade e tempo de acamado.


Objective: investigate the effectiveness of the Braden Scale as a guiding instrument in assisting in the prevention of pressure injury in bedridden individuals at home. Method: This is a descriptive study with a quantitative approach, with data collected at home through interviews and skin inspection of 41 participants. Results: There was an incidence of 7% of pressure injuries. It was found that individuals at high risk at home, according to the Braden scale, did not show incidence of pressure injuries, while those with moderate risk presented such incidence. Conclusion: Despite being widely used by health professionals, this study demonstrated that the high sensitivity and specificity of the Braden Scale is questionable. Care was essential for this low incidence of pressure injuries, reducing its association with age and bedridden time.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pressure Ulcer/prevention & control , Bedridden Persons , Primary Health Care/methods , Skin , Comorbidity , Caregivers , Home Nursing/methods
9.
Semina cienc. biol. saude ; 42(2): 115-126, jun./dez. 2021. Tab
Article in Portuguese | LILACS | ID: biblio-1292778

ABSTRACT

Objetivo: descrever as principais comorbidades e os procedimentos assistenciais correlatos ao desenvolvimento de retinopatia da prematuridade em recém-nascidos prematuros hospitalizados em Unidade de Terapia Intensiva Neonatal. Material e Método: estudo observacional quantitativo, com coleta de dados documental, obtida de 181 prontuários hospitalares de recém-nascidos prematuros, referente ao período de janeiro de 2014 a junho de 2016, em município de médio porte no Paraná. A análise estatística foi descritiva e inferencial. O estudo foi aprovado por comitê de ética em pesquisa. Resultados: prevaleceu o diagnóstico doenças respiratórias (41,99%; p-valor < 0,109), seguido da comorbidade sepse (63,54%; p-valor < 0,357). Necessitaram de transfusão de sangue 80 bebês (44,20%; p-valor < 0,001), e 152 (83,98%; p-valor < 0,001) fizeram uso de oxigenioterapia. A retinopatia da prematuridade prevaleceu nos prematuros moderados (44%), sendo o grau 3 o mais grave encontrado. Conclusão: doenças respiratórias, sepse e procedimentos como a transfusão de sangue, a oxigenioterapia e a cateterização intravenosa influenciaram na presença do agravo, com maior incidência em prematuros moderados.


Objective: to describe the main comorbidities and care procedures related with the development of retinopathy of prematurity in premature newborns hospitalized in a Neonatal Intensive Care Unit. Material and Method: quantitative observational study, with documentary data collection, obtained from 181 hospital records of premature newborns, referring to the period from January 2014 to June 2016, in a medium-sized municipality in Paraná. Statistical analysis was descriptive and inferential. The study was approved in Ethical Research Committee. Results: respiratory diseases (41.99%; p-value < 0.109) prevailed, followed by comorbidity sepsis (63.54%; p-value < 0.357). Eighty babies (44.20%; p-value < 0.001) required blood transfusion, and 152 (83.98%; p-value < 0.001) used oxygen therapy. Retinopathy of prematurity prevailed in moderate preterm infants (44%), with grade 3 being the most severe found. Conclusion: respiratory diseases, sepsis and procedures such as blood transfusion, oxygen therapy and intravenous catheterization influenced the presence of the disease, with a higher incidence in moderate preterm infants.


Subject(s)
Infant, Newborn , Retinopathy of Prematurity , Comorbidity , Neonatal Nursing , Infant, Newborn
10.
Rev. cuba. med ; 60(2): e2117, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280340

ABSTRACT

Introducción: Las comorbilidades se han relacionado con mayor riesgo de contraer COVID-19, de tener mala evolución y de mortalidad. Objetivo: Identificar factores de riesgo asociados a la mortalidad al final de la estadía hospitalaria de los pacientes con diagnóstico de COVID-19 en Cuba. Métodos: Investigación retrospectiva, de la totalidad de pacientes confirmados con COVID-19 en Cuba, con 18 años o más, diagnosticados entre el 11 de marzo al 15 de octubre de 2020. La fuente de información fue la base de datos nacional del Ministerio de Salud Pública. Se recopilaron edad, sexo y comorbilidades. Clasificados en recuperados y fallecidos. Estudio analítico de factores y comorbilidades asociadas a la mortalidad. Resultados: Se analizaron 5 490 pacientes (97,7 por ciento recuperados vs 2,3 por ciento fallecidos). Los fallecidos tenían significativamente más edad (72,8 vs 44,5 años). Las comorbilidades más frecuentes en fallecidos fueron hipertensión (47,6 por ciento vs 7,8 por ciento), diabetes (27,4 por ciento vs 2,6 por ciento), cardiopatía isquémica (14,5 por ciento vs 0,9 por ciento), enfermedad renal crónica (11,3 por ciento vs 0,3 por ciento) y EPOC (11,3 por ciento vs 0,5 por ciento). Se encontró riesgo independiente de mortalidad a la edad de 60 años o más (OR:10,090, IC 95 por ciento : 6,247-16,299), enfermedad renal crónica (OR:8,434, IC 95 por ciento: 3,400-20,919), cáncer (OR:7,169, IC 95 por ciento: 2,920-17,601), enfermedad pulmonar obstructiva crónica (OR:5,300, IC95 por ciento: 2,376-11,822), obesidad (OR:4,230, IC 95 por ciento: 1,362-13,139), insuficiencia cardiaca (OR:4,197, IC 95 por ciento: 1,085-16,244), diabetes (OR:2,360, IC 95 por ciento: 1,339-4,159), hipertensión (OR:2,264, IC 95 por ciento: 1,398-3,668) y cardiopatía isquémica (OR:2,321, IC 95 por ciento: 1,168-4,610). Se encontró asociación significativa de comorbilidades, con dos, tres y más de tres (OR: 22,9, IC 95 por ciento: 13,4-39.2), (OR:72,5, IC 95 por ciento: 39,8-132,1) y (OR:88,9, IC 95 por ciento: 36,2-217,8), respectivamente. La combinación de comorbilidades más frecuente entre los fallecidos fue: hipertensión con diabetes (17,7 por ciento vs 1,9 por ciento) e hipertensión con enfermedad renal crónica (8,1 por ciento vs 0,2 por ciento). Conclusiones: La edad avanzada, la enfermedad renal crónica, cardiopatía isquémica, insuficiencia cardiaca, hipertensión, diabetes, cáncer, enfermedad pulmonar obstructiva crónica, obesidad y el número de comorbilidades se relacionaron significativamente con la mortalidad y podrían ayudar a identificar a los pacientes con mayor riesgo(AU)


Introduction: Comorbidities have been related to highrisk of contracting COVID-19, and of having poor evolution and mortality. Objective: To identify risk factors associated with mortality at the end of the hospital stay in patients diagnosed with COVID-19 in Cuba. Methods: A retrospective cohort of all patients confirmed COVID-19 in Cuba, aged 18 years or older, diagnosed from March 11 to October 15, 2020. The source of information was the national database of the Ministry of Public health. Age, sex and comorbidities were collected, and classified as recovered and deceased. This is an analytical study of factors and comorbidities associated with mortality. Results: This study analyzed 5,490 patients (97.7 percent recovered vs 2.3 percent deceased). The deceased were significantly older (72.8 vs 44.5 years). The most frequent comorbidities in the deceased were hypertension (47.6 percent vs 7.8 percent), diabetes (27.4 percent vs 2.6 percent), ischemic heart disease (14.5 percent vs 0.9 percent), chronic kidney disease (11.3 percent vs 0.3 percent) and COPD (11.3 percent vs 0.5 percent). An independent risk of mortality was found at the age of 60 years or more (OR: 10,090, 95 percent CI: 6,247-16,299), chronic kidney disease (OR: 8,434, 95 percent CI: 3,400-20,919), cancer (OR: 7,169 , 95 percent CI: 2,920-17,601), chronic obstructive pulmonary disease (OR: 5,300, 95 percent CI: 2,376-11,822), obesity (OR: 4,230, 95 percent CI: 1,362-13,139), heart failure (OR: 4,197, CI 95 percent: 1,085-16,244), diabetes (OR: 2,360, 95 percent CI: 1,339-4,159), hypertension (OR: 2,264, 95 percent CI: 1,398-3,668) and ischemic heart disease (OR: 2,321, 95 percent CI: 1,168 -4,610). A significant association of comorbidities was found, with two, three and more than three (OR: 22.9, 95 percent CI: 13.4-39.2), (OR: 72.5, 95 percent CI: 39.8-132, 1) and (OR: 88.9, 95 percent CI: 36.2-217.8) respectively. The most frequent combination of comorbidities among the deceased subjects was hypertension with diabetes (17.7 percent vs 1.9 percent) and hypertension with chronic kidney disease (8.1 percent vs 0.2 percent). Conclusions: Advanced age, chronic kidney disease, ischemic heart disease, heart failure, hypertension, diabetes, cancer, chronic obstructive pulmonary disease, obesity and the number of comorbidities were significantly related to mortality and could help to identify patients with higher risk(AU)


Subject(s)
Humans , Comorbidity , COVID-19/mortality , Retrospective Studies , Cuba
11.
Medicina (B.Aires) ; 81(3): 401-407, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346476

ABSTRACT

Resumen La pandemia por COVID-19 significó una crisis mundial sin precedentes, que implicó la reorganización de los sistemas de salud y la racionalización de los recursos diagnósticos y terapéuticos disponibles. El objetivo de este estudio observacional y retrospectivo fue analizar características clínicas y evo lución de los pacientes internados en guardia, sala general y terapia intensiva en un hospital privado de alta complejidad de la Ciudad de Buenos Aires, durante los primeros siete meses de circulación viral. Se incluyeron 1005 pacientes con COVID-19 confirmado por laboratorio. La mediana de edad fue de 45 años; 73.7% eran varones. La mitad de los pacientes presentaba al menos una comorbilidad. La mediana de leucocitos totales fue 6300 células/mm3 y de linfocitos 818 células/mm3. El 82.3% presentó alteraciones en la tomografía de tórax; y el patrón radiológico observado con mayor frecuencia fue opacidad tipo vidrio esmerilado (33%). El 82.4% recibió antibioticoterapia empírica dirigida a foco respiratorio y, además, el 18.7% fu e tratado con dexametasona. Respecto de la gravedad, el 14.7% presentó enfermedad no complicada, el 55.2% neumonía leve, el 20.8% neumonía moderada y el 9.2% neumonía grave. Asimismo, el 8.7% fue transferido a terapia intensiva. Se registró una mortalidad hospitalaria del 2.3% y del 20.5% en terapia intensiva. Se encontró asociación estadísticamente significativa entre mortalidad y edad, con una diferencia de edad de 9.6 años, siendo mayor entre los fallecidos (p = 0.0004; IC 95% 4-14). Sin embargo, no hubo asociación entre presencia de comorbilidades y sexo vs. mortalidad y gravedad de la enfermedad.


Abstract Coronavirus disease 2019 (COVID-19) meant an unprecedented global crisis, which involved the reorganization of health systems and the rationalization of available diagnostic and therapeutic resources. The objective of this observational and retrospective study was to analyze the clinical characteristics and evolution of patients admitted to general ward, intensive care unit and emergency department of a high complexity hospital in Buenos Aires city, during the first seven months of viral circulation. A total of 1005 patients with laboratory-confirmed COVID-19 were included. The median age was 45 years, and 73.7% were men. Half of the patients had at least one comorbidity. Among the laboratory findings, the median of total leukocytes was 6300 cells/mm3 and that of lymphocytes 818 cells/mm3; 82.3% of the patients presented alterations in the chest tomography, and the most frequently observed radiological pattern was ground-glass opacity (33%); 82.4% of them received empirical antibiotic therapy directed to the respiratory focus and, in addition, 18.7% were treated with dexamethasone. Regarding severity, 14.7% of the patients presented uncomplicated disease, 55.2% mild pneumonia, 20.8% moderate pneumonia, and 9.2% severe pneumonia. Likewise, 8.7% of them were transferred to intensive care. In-hospital mortality was 2.3%, and 20.5% among critically ill patients. A statistically significant association was found between mortality and age, with an age difference of 9.6 years, being greater among the deceased (p = 0.0004; 95% CI 4-14). However, there was no association between the presence of comorbidities and sex vs. mortality and severity of the disease.


Subject(s)
Humans , Male , Female , Child , Middle Aged , SARS-CoV-2 , COVID-19 , Comorbidity , Retrospective Studies , Critical Illness , Intensive Care Units
12.
Alerta (San Salvador) ; 4(2): 28-37, may. 26, 2021. ilus
Article in Spanish | LILACS, BISSAL | ID: biblio-1224721

ABSTRACT

La infección respiratoria por coronavirus ha generado gran cantidad de muertes desde su inicio en China en diciembre 2019. Debido a que es una enfermedad desconocida, son necesarios estudios para mejorar el abordaje, especialmente a personas en riesgo. Las personas menores de 60 años sin comorbilidades tienen menor riesgo de muerte comparadas con las que tienen comorbilidades como diabetes, hipertensión y cáncer que presentaron un riesgo 3 veces mayor de muerte intrahospitalaria por COVID-19 y menor supervivencia a 15 días


The respiratory coronavirus infection has caused a large number of deaths since its onset in China in December 2019. Because it is an unknown disease, studies are needed to improve the approach, especially to people at risk. People under 60 years of age without comorbidities have a lower risk of death compared to those with comorbidities such as diabetes, hypertension and cancer, who had a 3 times higher risk of in-hospital death from COVID-19 and lower 15-day survival


Subject(s)
Humans , Patients , Comorbidity , Morbidity , Coronavirus Infections
13.
Medisan ; 25(2)mar.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1250345

ABSTRACT

Introducción: El consumo excesivo y prolongado de alcohol se asocia a una morbilidad elevada por afecciones hepáticas y de otros órganos. Objetivo: Precisar las lesiones hepáticas y su relación con otras enfermedades asociadas al alcohol y el estado nutricional en pacientes con enfermedad hepática alcohólica. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de 270 pacientes con enfermedad hepática alcohólica, atendidos en el Servicio de Medicina Interna y la consulta especializada de Hepatología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de Santiago de Cuba, quienes fueron examinados clínicamente para detectar síntomas y signos de enfermedades hepática y asociadas al alcohol en diferentes sistemas, durante el decenio 2010-2019. Resultados: Predominaron los hombres (234), de los cuales 117 estuvieron en el grupo de 25 - 44 años de edad. La forma clínica preponderante fue la cirrosis hepática en 109 pacie2ntes, de ellos una proporción importante eran bebedores con más de 20 años de exposición al hábito. La enfermedad por reflujo gastroesofágico junto a las formas de gastropatía y la polineuropatía en 89 y 96 afectados, respectivamente, fueron las comorbilidades más asociadas a la lesión hepática. Se observaron diferentes grados de desnutrición en 167 afectados (61,8 %), de los cuales primaron aquellos con cirrosis hepática, de estos 51 (49,0 %) presentaron desnutrición moderada y 31 (49,2 %) grave. Conclusiones: Resulta elevada la presencia de comorbilidades en pacientes con enfermedad hepática alcohólica, lo cual se asocia al deterioro nutricional y a una exposición prolongada al hábito nocivo.


Introduction: The excessive and prolonged consumption of alcohol is associated with a high morbidity due to hepatic disorders and affections of other organs. Objective: To specify the hepatic lesions and their relationship with other diseases associated with alcohol and the nutritional state in patients with alcoholic hepatic disease. Methods: An observational, descriptive and cross-sectional study of 270 patients with alcoholic hepatic disease was carried out. They were assisted in the Internal Medicine Service and in the specialized visit of Hepatology from Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba who were clinically examined to detect symptoms and signs of hepatic disease and those associated with alcohol in different systems, during the decade 2010-2019. Results: There was a prevalence of men (234), of which 117 were in the group of 25 - 44 years of age. The preponderant clinical form was the hepatic cirrhosis in 109 patients, an important proportion of them were drinkers with more than 20 years of exhibition to the habit. The disease due to gastroesophagic reflux along with the forms of gastropathy and polyneuropathy in 89 and 96 affected patients, respectively, were the comorbidities more associated with the hepatic lesion. Different degrees of malnutrition were observed in 167 affected patients (61.8 %), of which those with hepatic cirrhosis prevailed, of these 51 (49.0 %) presented moderate malnutrition and 31 (49.2 %) a serious one. Conclusions: The presence of comorbidities in patients with alcoholic hepatic disease is high, which is associated to the nutritional deterioration and a prolong exposure to the harmful habit.


Subject(s)
Comorbidity , Liver Cirrhosis , Liver Diseases, Alcoholic/epidemiology , Nutritional Status
15.
Fisioter. Bras ; 22(1): 49-60, Mar 19, 2021.
Article in Portuguese | LILACS | ID: biblio-1284029

ABSTRACT

Introdução: Queda é o acidente que ocorre com maior frequência no idoso, sendo a principal causa de morte naqueles com mais de 65 anos. As fraturas do quadril ocupam um papel de grande importância, gerando grande problema de ordem clínica envolvendo pacientes e familiares e de ordem econômica para a sociedade. Objetivo: Coletar dados de questionário da admissão e correlacionar a presença de comorbidades prévias a mortalidade em 30 dias do pós-cirurgia. Métodos: Estudo retrospectivo observacional não randomizado com 216 pacientes com fraturas cirúrgicas do quadril com 61 anos ou mais de idade atendidos no setor de emergência do Centro Hospitalar São Lucas na cidade de Niterói, RJ, no período de 30/03/2016 a 20/03/2018. Resultados: A incidência de óbito após a cirurgia do quadril é igual a 6,9% no primeiro mês. O paciente com fratura no quadril tem comorbidades cardiovasculares (75,9%). O óbito está associado à comorbidade hepática em 13,3% e ao baixo peso em 33,3%. O fato de ter duas ou mais comorbidades não está significativamente associado ao óbito. Conclusão: As comorbidades hepáticas, o baixo peso e a presença de disfunções cardiovasculares são importantes preditores prognósticos na mortalidade do paciente com mais de 61 anos após cirurgia de fratura do fêmur no primeiro mês. (AU)


Introduction: Falls are the leading cause of accidents and death in those aged 65 and above. The high incidence of these injuries impact patients, their families and it represents an economic problem for society. Objective: Collect data from the admission survey and correlate previous comorbidities to mortality in 30 days after surgery. Methods: Retrospective observational non-randomized study. 216 patients were included, aged 61 years or older, who were admitted at the emergency department of the Centro Hospitalar São Lucas in Niterói city, Rio de Janeiro. All the participants were candidates of hip fracture surgery between 03/30/2016 and 03/20/2018. Results: The mortality after hip surgery was 6.9% in the first month. Patients who underwent hip surgery had, previously, cardiovascular diseases (75.9%). Death was associated with liver comorbidity in 13.3% and low weight in 33.3%. The fact of having two or more comorbidities was not associated with death. Conclusion: Liver and cardiovascular diseases and low weight are important prognostic predictors in mortality of patients over 61 years of age after femoral fracture surgery in the first month. (AU)


Subject(s)
Humans , Aged , Aged, 80 and over , Postoperative Period , Aged , Comorbidity , Mortality , Femoral Fractures , Cardiovascular Diseases , Hepatic Insufficiency
16.
Rev. colomb. psiquiatr ; 50(1): 52-56, Jan.-Mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251634

ABSTRACT

RESUMEN El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.


ABSTRACT Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.


Subject(s)
Humans , Male , Aged , Substance Withdrawal Syndrome , Precipitating Factors , Delirium , Psychotropic Drugs , Therapeutics , Benzodiazepines , Comorbidity , Dehydration , Alcoholism , Hypnotics and Sedatives , Liver Cirrhosis, Alcoholic , Liver Diseases, Alcoholic
17.
Ciênc. Saúde Colet ; 26(3): 1023-1033, mar. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1153816

ABSTRACT

Resumo A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (β=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (β=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (β=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.


Abstract Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (β=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (β=1.40), and maximum per capita household income of the poorest fifth (β=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.


Subject(s)
Humans , Male , Female , Adult , Coronavirus Infections/epidemiology , Vulnerable Populations , Spatio-Temporal Analysis , Socioeconomic Factors , Brazil/epidemiology , Poverty Areas , Comorbidity , Incidence , Bayes Theorem , Age Factors , Population Density , Cities/epidemiology , Suburban Health/statistics & numerical data , Educational Status , Employment/statistics & numerical data , Housing/standards , Income , Middle Aged
18.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.1): 157-165, Feb. 2021. tab
Article in English | LILACS | ID: biblio-1155301

ABSTRACT

Abstract Objectives: to analyze the lethality and clinical characteristics in Pernambuco women with neoplasia that were infected by SARS-CoV-2. Methods: a cross-sectional, retrospective study with female patients with neoplasm sin the state of Pernambuco registered and made available by the Secretariat of Planning and Management of the State of Pernambuco (SEPLAG PE). Secondary data from public domain notifications and the independent factors associated with death were analyzed through logistic regression. The value ofp<0.25 was considered significant in the bivariate analysis and for a multivariate analysis, the value ofp<0.05 was considered significant. Results: forty-nine women died. The mean age and standard deviation were 58.75 ± 20.93 years. 55.86% of the patients were 60 years old or more. The overall lethality rate was 72.06% (CI95%=59.8 - 82.2). The most prevalent symptoms were fever (70.59%), cough (58.82%), dyspnea (57.35%) and O2 saturation less than 95% (48.53%). Conclusions: female patients, with cancer and infected by SARS-CoV-2 are particularly susceptible to death, regardless of the presence of comorbidities or age, with peripheral O2 saturation <95% being the only independent factor associated with death in this group.


Resumo Objetivos: analisar a letalidade e características clínicas em mulheres pernambucanas portadoras de neoplasia que apresentaram infecção por SARS-CoV-2. Métodos: estudo de corte transversal, retrospectivo com pacientes do sexo feminino, portadoras de neoplasias no estado de Pernambuco com registros disponibilizados pela Secretaria de Planejamento e Gestão do Estado de Pernambuco. Analisou-se dados secundários de notificações de domínio público e os fatores independentes associados ao óbito através de regressão logística. Foi considerado significativo o valor de p<0,25 na análise bivariada e para a análise multivariada foi considerado significativo o valor de p<0,05. Resultados: quarenta e nove mulheres vieram a óbito. A média da idade e desvio padrão foram 58, 75 ± 20,93 anos. 55,86% das pacientes tinham 60 anos ou mais. A taxa de letalidade global foi de 72,06% (IC95%= 59,8 - 82,2). Os sintomas mais prevalentes foram febre (70,59%), tosse (58,82%), dispneia (57,35%) e saturação de O2 <95% (48,53%). Conclusão: pacientes do sexo feminino, com câncer e infectadas pelo SARS-CoV-2 são particularmente suscetíveis a óbito, independentemente da presença de comorbidades ou da idade, sendo a saturação periférica de O2 <95% o único fator independente associado ao óbito nesse grupo.


Subject(s)
Humans , Female , Comorbidity , Risk Factors , SARS-CoV-2 , COVID-19/epidemiology , Neoplasms/diagnosis , Neoplasms/mortality , Brazil/epidemiology , Logistic Models , Indicators of Morbidity and Mortality , Multivariate Analysis , Mortality
19.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(supl.1): 177-186, Feb. 2021. tab
Article in English | LILACS | ID: biblio-1155307

ABSTRACT

Abstract Objectives: to determine the frequency and factors associated with severe / extreme signs and symptoms of stress, anxiety and depression in diabetic patients during the COVID-19 pandemic. Methods: cross-sectional study conducted in April /May 2020, which included 162 individuals with diabetes mellitus and over 18 years old. An online questionnaire was applied on social networks, composed of biological, sociodemographic, clinical characteristics and the Stress, Anxiety and Depression Scale (DASS-21). For statistical analysis, a multivariate logistic regression model was applied with a 5% significance level. Results: frequency of 37.7%, 43.3% and 45.1% were found for some symptom of stress, anxiety and depression, respectively. The factors associated with sign and symptoms of severe / extreme psychic disorders were: not having religion (stress, anxiety and depression); be at graduation (stress and anxiety); history of anxiety and depression (anxiety and depression); not practicing or decreasing physical exercises and starting, increased or continue taking sleeping medications (stress); history of contact with a suspected case of COVID-19, absence or decreased leisure (anxiety); female gender, absence of a partner, decreased family income and work or study (depression). Conclusion: the frequency of psychological disorders was higher than described in the literature on diabetic patients, being associated with biological, sociodemographic, clinical factors and aspects related to COVID-19 during the pandemic


Resumo Objetivos: determinar a frequência e os fatores associados aos sinais e sintomas de estresse, ansiedade e depressão grave/extremos em pacientes diabéticos durante a pandemia pela COVID-19. Métodos: realizou-se estudo de corte transversal em abril/maio de 2020 que incluiu 162 indivíduos com diabetes mellitus e maiores de 18 anos. Aplicou-se um questionário online divulgado nas mídias sociais, sendo composto por características biológicas, sociodemográ-ficas, clínicas e a Escala de Estresse, Ansiedade e Depressão (DASS-21). Para análise estatística foi aplicado modelo de regressão logística multivariado com nível de significância de 5%. Resultados: encontrou-se frequência de 37,7%, 43,3% e 45,1% para qualquer sinal e sintoma de estresse, ansiedade e depressão, respectivamente. Os fatores associados a sinais e sintomas psíquicos graves/extremos foram: não ter religião (estresse, ansiedade e depressão); estar na graduação (estresse e ansiedade);antecedente de ansiedade e/ou depressão (ansiedade e depressão); não realizar ou ter diminuído exercícios físicos, iniciado, aumentado ou mantido medicações para dormir (estresse); história de contato com caso suspeito da COVID-19; ausência ou diminuição de lazer (ansiedade) e sexo feminino, ausência de companheiro, diminuição da renda familiar e do trabalho ou estudo (depressão). Conclusão: a frequência de transtornos psíquicos foi maior que a descrita na literatura em pacientes diabéticos, sendo associada a fatores biológicos, sociodemográficos, clínicos e aspectos relacionados à COVID-19 durante a pandemia.


Subject(s)
Humans , Diabetes Mellitus/psychology , Physical Distancing , COVID-19/epidemiology , Mental Disorders/epidemiology , Anxiety , Patients , Brazil/epidemiology , Comorbidity , Cross-Sectional Studies , Risk Factors , Depression , Psychological Distress , SARS-CoV-2
20.
Rev. argent. salud publica ; 13: 1-8, 5/02/2021.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1343832

ABSTRACT

INTRODUCCIÓN: El objetivo principal fue evaluar el riesgo de defunción en pacientes con diagnóstico confirmado de COVID-19 según la presencia de uno o más factores de riesgo. MÉTODOS: Estudio transversal, descriptivo y correlacional de personas mayores de 18 años, residentes de la provincia de Buenos Aires, con diagnóstico de COVID-19 confirmado por laboratorio o criterio clínico-epidemiológico que hayan iniciado síntomas entre marzo y diciembre de 2020 (n = 622 084). Se utilizó información de fuente secundaria. Se consideraron cuatro escenarios de análisis con base en la calidad del dato y la condición del paciente. RESULTADOS: Se notificaron 21 706 casos fallecidos (letalidad 3,5%). La mayoría de los fallecidos tenía edad avanzada (72,8 ± 13,8 años en los fallecidos versus 41,2 ± 15,2 años en los no fallecidos) y eran de sexo masculino (56% versus 44%, p<0,05). Según el modelo multivariado, la edad de 60 años o más resultó ser el factor de mayor riesgo (razón de momios [OR, por su sigla en inglés]: 8,1), seguida por la hepatopatía crónica (OR: 2,3). DISCUSIÓN: Los resultados muestran que la mayoría de los casos sintomáticos tuvieron una evolución favorable. La tasa de letalidad provincial es similar a la tasa nacional. Los factores de riesgo que resultaron relevantes se condicen con estudios realizados tanto en Argentina como en otros países. Si bien tener 60 años o más fue el mayor factor de riesgo, la presencia concomitante de enfermedades crónicas no transmisibles también contribuyó al agravamiento de la infección por COVID-19. Esta información es relevante para pensar políticas de salud en dicha población.


Subject(s)
Comorbidity , Risk Factors , Death , Health Surveillance System , COVID-19 , Argentina
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