ABSTRACT
La presente publicación describe las disposiciones técnicas y procedimientos para el cuidado y el autocuidado de la salud mental de gestantes y madres de niñas y niños menores de 5 años, con la finalidad de contribuir a la respuesta del sistema de salud de atención integral de la salud mental de la población, pacientes y sus familiares, así como de la población en situación de vulnerabilidad y mejora de su calidad de vida.
Subject(s)
Humans , Female , Pregnancy , Child , Health Care Levels , Child , Neonatal Screening , Comprehensive Health Care , Diagnostic Techniques and Procedures , Vulnerable Populations , Pregnant Women , Psychosocial Intervention , Mothers , Mental HealthABSTRACT
La presente publicación describe las pautas y disposiciones para la atención integral de los pacientes con diagnóstico probable o confirmado de dengue, en los diferentes niveles de atención de salud, en el país, con la finalidad de contribuir con la reducción de la morbimortalidad por dengue en el Perú, a través de la atención integral de la salud, con enfoque multisectorial según escenario epidemiológico, a fin de garantizar el cuidado de la salud y la vida de la población, evitando la ocurrencia de formas graves de la enfermedad. Asimismo, Establece las acciones de promoción de la salud a través de la articulación intergubernamental, intersectorial, la participación ciudadana y educación para la salud para eliminar sistemáticamente los criaderos del vector que transmite el dengue
Subject(s)
Humans , Health Care Levels , Indicators of Morbidity and Mortality , Comprehensive Health Care , Aedes , Severe Dengue , Diagnostic Techniques and Procedures , Dengue , Patient Care , Health Facilities , Health PromotionABSTRACT
This paper examines how participants in genetic counseling sessions interactionally manage situations where the results of tests to investigate the causes of identified fetal malformations are inconclusive or missing. The dataset consists of 54 audio-recorded interactions at a unit specialized in moderate- and high-risk pregnancies at a Brazilian public hospital. Conversation analysis was used to examine the data, revealing that the participants deployed interactional actions that exhibited highly negative valence toward diagnostic inconclusiveness, demonstrating that when there is a motivation for a medical examination, insofar as its results will serve as a basis for subsequent decision-making (in this case about future pregnancies), there is a preference for bad diagnostic news over absent or inconclusive diagnostic news. These findings are consistent with prior interactional studies.
Este artigo examina como os participantes em sessões de aconselhamento genético gerenciam interacionalmente resultados de testes genéticos inconclusivos ou ausentes testes para investigar as causas das malformações fetais identificadas. O conjunto de dados consiste em 54 interações gravadas em áudio em uma unidade de gestação de médio e alto risco de um hospital público brasileiro. A abordagem da Análise da Conversa utilizada para examinar os dados revela que os participantes desenvolvem ações interacionais que exibem uma orientação de valência altamente negativa em relação à inconclusividade diagnóstica, demonstrando que quando há motivação para um exame médico, ou seja, usando o resultado do teste diagnóstico como base para tomada de decisão, tal como acontece com futuras gestações, haja uma preferência por más notícias diagnósticas em detrimento de notícias diagnósticas ausentes ou inconclusivas. Tais resultados são consistentes com estudos interacionais anteriores.
Este artículo examina cómo los participantes en las sesiones de asesoramiento genético gestionan de forma interactiva los resultados de pruebas genéticas no concluyentes o faltantes, pruebas para investigar las causas de las malformaciones fetales identificadas. El conjunto de datos consta de 54 interacciones grabadas en audio en una unidad de embarazo de riesgo medio y alto de un hospital público brasileño. El enfoque de Análisis de Conversación utilizado para examinar los datos revela que los participantes desarrollan acciones interaccionales que exhiben una orientación de valencia altamente negativa hacia la falta de conclusión del diagnóstico, lo que demuestra que cuando hay motivación para un examen médico, es decir, utilizar el diagnóstico del resultado de la prueba como base para la toma de decisiones, como ocurre con futuros embarazos, se prefieran las malas noticias diagnósticas a las noticias diagnósticas ausentes o no concluyentes. Estos resultados son consistentes con estudios interaccionales previos.
Subject(s)
Congenital Abnormalities , Genetic Testing , Decision Making , Observational Study , Genetic Counseling , Medical Examination , Diagnostic Techniques and Procedures , Counseling , MethodsABSTRACT
La presente publicación describe las normas y disposiciones legales para la atención integral de los pacientes con diagnóstico probable o confirmado de dengue, en los establecimientos de salud, según nivel de atención y capacidad resolutiva, en el país, a fin de contribuir con la reducción de la morbimortalidad por dengue en el Perú, con enfoque multisectorial según escenario epidemiológico, del cuidado de la salud y la vida de la población, evitando la ocurrencia de formas graves de la enfermedad. Asimismo, las pautas y acciones de promoción de la salud a través de la articulación intergubernamental, intersectorial, la participación ciudadana y educación para la salud para eliminar sistemáticamente los criaderos del vector que transmite el dengue
Subject(s)
Humans , Female , Child , Adolescent , Health Care Levels , Comprehensive Health Care , Aedes , Severe Dengue , Diagnostic Techniques and Procedures , Dengue , Patient CareABSTRACT
Este trabajo, que gira entorno a la consulta por una joven de 14 años, permite desplegar algunas ideas acerca del diagnóstico en psicoanálisis. Se sostiene en una palabra clave: la construcción. Construir un diagnóstico habla de un recorrido singular que lleva tiempo y en la especificidad de la clínica con adolescentes pone en juego múltiples transferencias. Por lo tanto, diagnosticar para un psicoanalista no consiste en subsumir un ejemplar a una clase nosológica sino delinear un trayecto: el trayecto de alguien frente a sus circunstancias AU
This work revolves around the consultation of a 14-year-old girl, allowing us to display some ideas about diagnosis in psychoanalysis. It is based on a key word: construction. Building a diagnosis speaks of a unique journey that takes time and in the specificity of the clinic with adolescents, multiple transfers come into play.Therefore, diagnosing for a psychoanalyst does not consist of subsuming a specimen to a nosological class but rather outlining a path: someone's path in the face of their circumstances AU
Ce travail, qui s'articule autour d'une consultationd'une jeune fille de 14 ans, permet de développer quelques idées sur le diagnosticen psychanalyse. Il repose sur un mot clé: construction. Construire un diagnostic parle d'un parcours unique qui prend du temps et dans la spécificité de la clinique auprès des adolescents, de multiples transferts entrent en jeu.Ainsi, diagnostiquer pour un psychanalyste ne consiste pas à subsumer un spécimen à une classe nosologique mais plutôt à tracer un chemin: le chemin de quelqu'un face à sa situation AU
Este trabalho, que gira em torno da consulta de uma menina de 14 anos, permite-nos desdobrar algumas ideias sobre o diagnóstico em psicanálise. Baseia-se numa palavra-chave: construção. Construir um diagnóstico fala de um percurso único que leva tempo e na especificidade da clínica com adolescentes coloca em jogo múltiplas transferências.Portanto, diagnosticar para um psicanalista não consiste em subsumir um exemplar a uma classe nosológica, mas sim delinear um caminho: o caminho de alguém diante de suas circunstancias AU
Subject(s)
Humans , Female , Adolescent , Psychoanalytic Therapy/methods , Diagnostic Techniques and Procedures/psychology , Transference, PsychologyABSTRACT
Mpox (formerly referred to as monkey pox), a viral infection known for its characteristic manifestations, presents with atypical symptoms, leading to diagnostic and management challenges. Recent outbreaks of the disease have also revealed changes in the epidemiologic patterns of the disease with many cases going unnoticed. These scenarios if not properly identified and addressed can led to increased healthcare burden created by the virus. To conduct the narrative review of the concerned literature, a comprehensive and well through search from PUBMED, Google scholar, EMBASE and African Journal Online Evaluating Studies was conducted from published works between 2003 to 2023. This narrative review aims at exploring the atypical manifestations of Mpox, by reviewing various manifestations of the disease, examining the overlying mechanisms and factors influencing these manifestations; and more so, assessing various clinical implications and challenges facing its management, with the hope of suggesting future directions in tackling the clinical implications and challenges. Regarding the atypical manifestations of Mpox, the review focused on the neurological, dermatological, and respiratory presentations, highlighting the diverse symptoms observed in each case. In addition, accurate diagnosis of atypical cases is crucial and requires a high index of suspicion, comprehensive differential diagnosis, and appropriate diagnostic testing. Tailored strategies for treatment are essential to address the specific manifestations observed. For future research, a focus on elucidating the pathogenesis, identifying risk factors, improving diagnostic approaches, and evaluating treatment strategies for atypical
Subject(s)
Humans , Male , Female , Signs and Symptoms , Skin Manifestations , Monkeypox virus , Diagnostic Techniques and Procedures , Delivery of Health CareABSTRACT
Introdução O estudo analisa o rol de procedimentos de diagnóstico laboratorial do SUS quanto ao interesse para a vigilância em saúde, considerando as séries temporais de casos confirmados de doenças/agravos de notificação compulsória (DNC). Métodos Estudo ecológico, transversal e retrospectivo, a partir de dados secundários disponibilizados pelo Ministério da Saúde. Foram obtidos dados referentes às quantidades aprovadas de exames laboratoriais de interesse para diagnóstico das DNC realizados nos serviços públicos de saúde, incluídos na tabela unificada de procedimentos do SUS, e dados referentes ao registro de casos notificados e confirmados das DNC. O acesso aos dados foi realizado por meio das funcionalidades dos Sistemas de Informação em Saúde, do Ministério da Saúde. A pesquisa abrangeu dados referentes ao estado de São Paulo, segundo o ano de ocorrência, de 2009 a 2020. As análises compreenderam a estimativa dos coeficientes de correlação e de dispersão em séries temporais e teste de associação com características intrínsecas dos agravos/doenças e dos procedimentos laboratoriais, utilizando-se as ferramentas do MS-Excel e do Epi-Info. Resultados - Observou-se existência de correlação (r2>3,0; p≤0,05) entre o número de casos confirmados de DNC e as respectivas quantidades aprovadas de procedimentos para diagnóstico laboratorial no âmbito do SUS, em 85/199 (42,7%) dos pares temporais analisados, correspondendo a 57,6% (19/33) dos agravos/doenças selecionados para o estudo. Do total de procedimentos laboratoriais de interesse para a vigilância em saúde elencados na pesquisa, 45% (55/123) estão classificados na estrutura da tabela do SUS, quanto ao tipo de área...(AU)
Introduction The study analyzes the list of laboratory diagnostic procedures of the Brazilian Unified Health System (SUS) regarding their interest for health surveillance purposes, considering the time series of data from reporting on notifiable diseases/conditions (ND). Methods - Ecological, cross-sectional and retrospective study, based on secondary data provided by the Ministry of Health. Data consisted in the approved quantities of laboratory tests of interest for the diagnosis of ND ordered by public health services, included in the standardized table of SUS procedures, and data regarding the records of notified and confirmed cases of ND. Data access occurred through the functionalities of the Health Information Systems of the Ministry of Health. The research covered data related to the state of São Paulo, according to the year of occurrence, from 2009 to 2020. The analyses included the estimation of correlation and dispersion coefficients in time series and association testing with intrinsic characteristics of the conditions/diseases and laboratory procedures, and were carried out by means of the MS-Excel and Epi-Info tools. Results The existence of correlation (r2>3.0; p≤0.05) was observed between the number of confirmed cases of ND and the respective approved quantities of procedures for laboratory diagnosis within the scope of SUS, in 85/199 (42.7%) of the time pairs analyzed, corresponding to 57.6% (19/33) of the ND selected for the study. Of the total laboratory procedures of interest for health surveillance purposes selected in the research...(AU)
Subject(s)
Disease Notification , Diagnostic Techniques and Procedures , Public Health Surveillance , Health Information Systems , Correlation of DataABSTRACT
A curva ROC é bastante utilizada na área biológica para mensurar o poder discriminativo de um marcador. Porém somente saber o poder discriminatório não é suficiente na tomada de decisão do diagnóstico. Por este motivo, dicotomizamos o marcador através de um ponto de corte. Há diversos critérios para a escolha do ponto de corte na literatura. Objetivo: Propor e avaliar o desempenho de dois novos critérios (Ji1 e Ji2) para a escolha para ponto de corte. Métodos: A avaliação dos critérios ocorreu através de estudos de simulação para os desenho: transversal e longitudinal. No estudo de simulação do desenho transversal, realizou-se 1.000 replicações para 3 cenários diferentes, variando o tamanho amostral e o poder discriminativo do biomarcador. Já no estudo de simulação do desenho longitudinal foi realizada 1.000 replicações para diferentes cenários variando o tamanho amostral, a fração da doença, o nível de censura e o poder discriminativo do biomarcador. Resultados: Foi observado que o critério de Youden possui a maior variabilidade do erro quadrático médio em relação aos demais critérios estudados, quando utilizado o mesmo tamanho amostral. Os critério da mínima distância para o ponto (0,1) e os propostos (Ji1 e Ji2) apresentaram variabilidades de erro pequenas em relação aos demais.Conclusões: Os achados deste trabalho indicam que os critério da mínima distância para o ponto (0,1), Ji1 e Ji2 tem bons resultados na simulação (menores variabilidades). Porém advoga-se a utilização do critério Ji2, por apresentar melhores resultados na maioria dos cenários estudados.
The ROC curve is widely used in the biological field to measure the discriminative power of a marker. However, merely knowing the discriminative power is not enough in making a diagnostic decision. For this reason, we dichotomize the marker through a cutoff point. There are several criteria for choosing the cutoff point. Objective: This study aims to evaluate the performance of two new indices for cutoff point selection. Methods: Evaluation was conducted through simulation studies in two types of studies: cross-sectional and longitudinal. In the simulation study of the cross-sectional type, 1,000 replications were performed for 3 different scenarios, varying the sample size and the discriminative power of the biomarker. In the simulation study of the longitudinal type, 1,000 replications were performed for different scenarios varying the sample size, disease fraction, censoring level, and discriminative power of the biomarker. Results: It was observed that the Youden criterion has the highest variability of mean squared error compared to other studied criteria, at the same sample size. The criteria of point closet-to-(0,1) and the proposed ones (Ji1 and Ji2) showed a small variability of errors compared to the others. Conclusions: The findings of this study indicate that the criteria of point closet-to-(0,1), Ji1, and Ji2 yield good results in simulation (lower variabilities), and therefore, these criteria should be preferred for use in cutoff point selection. However, the use of criterion Ji2 is advocated, as it presents better results in most of the scenarios studied.
Subject(s)
ROC Curve , Diagnostic Techniques and Procedures , CourtshipABSTRACT
Introducción: El posgrado en salud, en especial el desarrollo de los programas de maestrías, constituye fuente de investigación para la evaluación del impacto, por la importancia que reviste para la calidad académica y la mejora continua de los programas de formación. Objetivo: Evaluar el impacto que produce a nivel individual, institucional y social-comunitario el programa de la maestría Medios Diagnósticos de la Universidad de Ciencias Médicas de Matanzas. Métodos: Se realizó un proyecto de evaluación de impacto, analítico, longitudinal y prospectivo, durante el período comprendido entre 2019 y 2022, con la aplicación de un procedimiento seleccionado que permitió demostrar la calidad del programa de la maestría objeto de estudio. Se aplicaron métodos teóricos, empíricos y estadísticos para determinar la calidad del programa de formación y sus transformaciones. Resultados: La evaluación del impacto de la maestría permitió conocer elementos esenciales para el desarrollo del programa en la institución y los rasgos que caracterizan los procedimientos existentes para dicho fin; asimismo, se obtuvo información relevante sobre la influencia del programa y las transformaciones obtenidas a nivel personal, institucional y social-comunitario. Conclusiones: La evaluación del impacto de la maestría objeto de estudio, con la aplicación del procedimiento seleccionado, constituyó una vía pertinente para medir los resultados del programa y su influencia en el desarrollo personal, institucional y en lo social-comunitario, lo que permitió la retroalimentación para la mejora continua del programa de formación(AU)
Introduction: Health postgraduate studies, especially the development of master's degree programs, are sources of research for assessing impact, due to their importance for academic quality and the continuous improvement of training programs. Objective: To assess the impact at the individual, institutional and social-community level produced by the program of the master's degree in Diagnostic Means from the Universidad de Ciencias Médicas de Matanzas. Methods: An analytical, longitudinal and prospective project for assessing impact was carried out during the period from 2019 to 2022, with the application of a selected procedure that allowed demonstrating the quality of the master's degree program under study. Theoretical, empirical and statistical methods were applied to determine the quality of the training program and its transformations. Results: The assessment of the impact of the master's degree program made it possible to know essential elements for the development of the program at the institution and the features that characterize the existing procedures for that purpose; likewise, relevant information was obtained on the influence of the program and the transformations obtained at the personal, institutional and social-community levels. Conclusions: The assessment of the impact of the master's degree under study, with the application of the selected procedure, was a pertinent way to measure the outcomes of the program and its influence on personal, institutional and social-community development, which allowed feedback for the continuous improvement of the training program(AU)
Subject(s)
Humans , Program Evaluation/methods , Diagnostic Techniques and Procedures , Health Programs and Plans , Prospective Studies , Longitudinal Studies , Education, Graduate/methods , Health Postgraduate Programs , Program AccreditationABSTRACT
Introdução: O teste de provocação oral (TPO) com alimentos é o padrão ouro para avaliação diagnóstica e de aquisição de tolerância em pacientes com alergia alimentar (AA). Exige, no entanto, equipe especializada e local apropriado para execução, uma vez que reações alérgicas, incluindo anafilaxia, podem acontecer. Foi recém-incorporado como procedimento reconhecido pelo Sistema Único de Saúde e pela Agência Nacional de Saúde, mas apenas no contexto da alergia ao leite de vaca para pacientes com até 24 meses de vida. Pouco se sabe sobre sua disponibilidade/execução no território brasileiro. Objetivos: Explorar o perfil de realização de TPO com alimentos em âmbito nacional, bem como as limitações para a sua não realização. Métodos: Inquérito virtual foi disponibilizado por e-mail aos 2.500 sócios cadastrados na Associação Brasileira de Alergia e Imunologia questionando sobre a prática de TPO, formação do profissional, limitações para sua não realização e possíveis soluções para sua execução. Resultados: Foram obtidas 290 respostas (11,6% dos associados), sendo a maioria deles proveniente da Região Sudeste (56,1%). Realizam TPO 54,5% (158/290) dos associados, 62% destes mais de 5 TPOs/mês, principalmente para leite e ovo. A execução de TPO na atualidade, majoritariamente na rede privada, esteve associada à prática do procedimento durante a especialização. Falta de recurso e ambiente apropriados são as maiores limitações para a não realização do TPO. Conclusões: Apesar do viés de seleção inerente à metodologia empregada do estudo, este inquérito pioneiro em território nacional tem importância por esclarecer e discutir a realização do TPO no âmbito do Brasil. Certamente este procedimento ainda é insuficientemente realizado no Brasil.
Background: Oral food challenge (OFC), the gold standard for diagnosing food allergy and determining tolerance levels, requires specialized staff and appropriate conditions since anaphylaxis may occur. In 2022, OFC was officially recognized in Brazilian public and private health systems, although only for milk allergy in children up to 24 months of age. Little is known about OFC practices in Brazil. Objectives: To explore OFC practices, barriers, and solutions among Brazilian allergists and immunologists. Methods: A survey was e-mailed to 2500 associates of the Brazilian Association of Allergy and Immunology regarding OFC practices, training experiences, barriers to this procedure, and workable solutions. Results: A total of 290 associates responded (11.6%), more than a half of whom (56.15) practiced in the southeast region: 158 (54.5%) reported performing OFC, of whom 62% performed > 5 procedures each month, mostly for cow milk and hen egg. OFCs were mostly performed in private practice and were associated with specialized training. Lack of an appropriate setting was seen as the main barrier to performing the procedure. Conclusions: Although this study's methodology involves intrinsic biases, this is the first exploration of OFC practice in Brazil. OFCs are still underperformed nationwide.
Subject(s)
Humans , Societies, Medical , Brazil , Diagnostic Techniques and ProceduresABSTRACT
O desenvolvimento e a ampliação do uso das vacinas durante décadas contribuíram para o controle e erradicação de doenças infecciosas, causando um grande impacto na saúde pública no mundo. A análise de segurança das vacinas percorre criteriosos processos e fases dos estudos clínicos, um dos pilares essenciais para aprovação regulatória e utilização do produto na população. O evento supostamente atribuído à vacinação e imunização (ESAVI), terminologia atual, é definido como qualquer ocorrência médica indesejada após a vacinação que possui, ou não, uma relação causal com o uso de uma vacina ou outro imunobiológico. Cabe ressaltar que eventos adversos mais raros ou inesperados, incluindo os eventos de hipersensibilidade, poderão ocorrer na fase pós-comercialização, quando as vacinas são aplicadas em milhões de pessoas. Neste artigo, serão discutidos os principais aspectos relacionados aos eventos adversos de hipersensibilidade pós-vacinais de interesse do especialista, e os desafios frente ao reconhecimento do agente causal e conduta a ser adotada. Além disso, serão revisados os potenciais alérgenos presentes nas vacinas de uso rotineiro para auxiliar o profissional de saúde na identificação de pacientes com potencial de risco de ESAVI por tais componentes. A atualização do conhecimento acerca da segurança e dos benefícios das vacinas pelos profissionais de saúde, sobretudo em populações especiais, contribui para condutas em imunização mais apropriadas, reduzindo o risco de exposição a um possível alérgeno em pessoas comprovadamente alérgicas às vacinas ou a alguns dos seus componentes, além de evitar contraindicações desnecessárias em eventos coincidentes ou não graves.
The expansion of vaccine use and development in recent decades has contributed to the control and eradication of infectious diseases, causing a major impact on public health worldwide. Vaccine safety analysis, which involves careful processes and clinical study, is one of the essential pillars of regulatory approval and use in the population. In current terminology, events supposedly attributable to vaccination and immunization (ESAVI) are defined as any unwanted medical occurrence after vaccination that may or may not have a causal relationship with vaccines or other immunobiologicals. It is noteworthy that rare or unexpected adverse events, including hypersensitivity, can occur during the post-marketing phase, when vaccines are administered to millions of people. In this article, we will discuss the main aspects of post-vaccine hypersensitivity events of interest to specialists and challenges to recognizing the causal agent and appropriate clinical practice. Potential allergens in routine vaccines will also be reviewed to help health professionals identify patients with a potential risk of ESAVI due to such components. Updating health professionals' knowledge about the safety and benefits of vaccines, particularly in special populations, can contribute to more appropriate clinical practice regarding immunization, reducing the risk of exposure to possible allergens in people with allergies to vaccines or their components, avoiding unnecessary contraindications in coincidental or non-serious events.
Subject(s)
Humans , Influenza Vaccines , Diphtheria-Tetanus-Pertussis Vaccine , Chickenpox Vaccine , Diphtheria-Tetanus Vaccine , Pneumococcal Vaccines , Yellow Fever Vaccine , COVID-19 Vaccines , Polyethylene Glycols , Milk Hypersensitivity , Diagnostic Techniques and Procedures , Latex Hypersensitivity , Egg Hypersensitivity , Anti-Infective AgentsABSTRACT
Objetivo: Caracterizar as notificações de infecção por SARS-CoV-2 em gestantes em um município do sul de Santa Catarina. Métodos: Estudo transversal que avaliou as notificações de casos suspeitos de infecção por SARS-CoV-2 em gestantes no município de Tubarão, Santa Catarina, de março de 2020 a outubro de 2021. Coletaram-se os dados das fichas de notificação de infecção por SARS-CoV-2 da Fundação Municipal de Saúde e no Prontuário Eletrônico do Cidadão (PEC) das gestantes notificadas. A comparação da prevalência de confirmação segundo sintomas apresentados e características maternas foi realizada pela razão de prevalência (RP), com intervalo de confiança (IC) de 95%. Resultados: Foram registradas 555 notificações de gestantes suspeitas para a COVID-19, correspondentes a 487 mulheres. A prevalência de confirmação para a doença foi de 27,3%. O sintoma mais frequente no momento da notificação foi cefaleia (53,0%), entretanto o mais associado à confirmação foi a anosmia (RP: 2,28; IC 95%: 1,68-3,09). Das notificações registradas, 35,0% foram realizadas por gestantes que tiveram contato com casos suspeitos ou confirmados de COVID-19. O contato prévio foi mais relatado por gestantes assintomáticas, em comparação às gestantes que apresentaram sintomas (RP: 1,46; IC 95%: 1,12-1,91). Mulheres que relataram contato prévio com suspeitos ou confirmados para a COVID-19 apresentaram maior frequência de doença confirmada, quando comparadas às gestantes não expostas (RP: 1,80; IC 95%: 1,35-2,39). Conclusão: As gestantes, por terem maior susceptibilidade a surtos de doenças e gravidade do quadro, podem ter adotado com mais atenção medidas como a realização de testes diagnósticos quando em contato prévio com casos de COVID-19, mesmo assintomáticas.
Objective: To characterize the notifications of SARS-CoV-2 infection in pregnant women in a city in the South of Santa Catarina. Methods: Cross-sectional study that evaluated notifications of suspected cases of SARS-CoV-2 infection in pregnant women in the municipality of Tubarão, Santa Catarina, from March 2020 to October 2021. Data were collected from the SARS-CoV-2 infection notification forms from the Municipal Health Foundation, and from the Citizen's Electronic Health Record of the notified pregnant women. The comparison of the prevalence of confirmation according to symptoms and maternal characteristics was performed using the Prevalence Ratio (PR), with a confidence interval (CI) of 95%. Results: 555 notifications of suspected pregnant women for COVID-19 were registered, corresponding to 487 women. The prevalence of confirmation for the disease was 27.3%. The most frequent symptom at the time of notification was headache (53.0%), however, the most associated with confirmation was anosmia (PR: 2.28; 95% CI: 1.68-3.09). Of the notifications registered, 35.0% were made by pregnant women who had contact with suspected or confirmed cases of COVID-19. The previous contact was more frequently reported by asymptomatic pregnant women compared to pregnant women who had symptoms (PR: 1.46; 95% CI: 1.12-1.91). Women who reported previous contact with suspected or confirmed COVID-19 had a higher frequency of confirmed disease when compared to unexposed pregnant women (PR: 1.80; 95% CI: 1.35-2.39). Conclusion: Pregnant women, due to their greater susceptibility to disease outbreaks and disease severity, may have adopted more attentive measures such as diagnostic testing in the face of previous contact with cases of COVID-19, even if asymptomatic.
Subject(s)
Humans , Female , Pregnancy , Signs and Symptoms , Comorbidity , Diagnostic Techniques and Procedures/statistics & numerical data , Public Health Surveillance , Maternal Health , COVID-19ABSTRACT
Introduction: Ultrasound is very useful in the management of rheumatological pathology today. Despite this, in Colombia, progress towards its implementation is limited and entails great difficulties. This deficit is also related to the difficulties in training new human talent. In Colombia, there is no study that identifies the current status of ultrasound among rheumatologists in the country. Methods: This is a descriptive cross-sectional study where medical specialists in Rheumatology practising in Colombia were surveyed through an online form. They were asked about general aspects and for their opinion regarding ultrasound in rheumatology and, if they practiced it, they were asked about specific aspects of its application in clinical practice. Additionally, questions were asked of the rheumatologists who are part of the specialist training processes in the country. Closed multiple-choice or Likert scale assessment questions were presented as required. The main objective was to describe the current use and opinion of musculoskeletal ultrasound in Colombian rheumatologists, as well as the limitations for its implementation. Frequency measurements were performed of the categorical variables of nominal type and ordinal type. The intention was to survey all rheumatologists in the country, who according to Colombian Society of Rheumatology data for the end of 2019 totalled 186. Results: Taking into account the number of rheumatologists of the Colombian Association of Rheumatology (Asoreuma) for 2019 totalling 186, a participation of 139 specialists (74.7%) was obtained, of which 22 of the respondents performed ultrasound in their daily practice (15.8%) the majority in this group being trained in Colombian territory (80.6%). Of the 139 respondents, 64.7% have received some type of training in ultrasound, generally pre-congress courses (22.5%), EULAR courses (16.7%) and training included in their residency curriculum outside the rheumatology service (9.8%). The acceptance of ultrasound is high among rheumatologists practicing in Colombia, 75.5% consider it important or very important and 84.9% indicated that for a comprehensive rheumatology service it is important or very important to have ultrasound. From the responses, however, they consider that its use could change their behaviour frequently, and very frequently in less than half of the cases at 46.7%. Regarding the opinion on the use of ultrasound in specific pathologies, rheumatoid arthritis (77.7%) and crystal arthropathies (72.7%) were considered the highest and most important, as well as in the performance of procedures at 87%. For decision-making in the inflammatory pathology study, 60.4% would consider performing ultrasound compared to 28.8% who responded MRI. Regarding the limitations for implementation, the lack of training in the country (25.6%), followed by the lack of resources to procure equipment (17.9%) and ignorance and lack of interest on the part of the health entities (17.1%) were the most recognized. Conclusion: Musculoskeletal ultrasound is only practiced by a minority of rheumatologists practicing in Colombia, even though the majority consider it important. Its importance lies in its use to treat patients with rheumatoid arthritis, crystal arthropathies and psoriatic arthropathy, as well as for the performance of procedures. More than half of the rheumatologists have received some type of training in ultrasound, usually very few hours' education and without practical or informal training, this being the main problem for its implementation.
Introducción: En la actualidad, la ecografía es de gran utilidad en el manejo de la patología reumatológica. A pesar de esto, en Colombia, los avances para su implementación son escasos y han enfrentado grandes dificultades. Este déficit también se encuentra relacionado con las complicaciones para la formación del nuevo talento humano. En Colombia no se dispone de ningún estudio en el que se identifique el estado actual de la ecografía entre los reumatólogos del país. Métodos: Se trata de un estudio descriptivo de carácter transversal en el cual se encuestó, por medio de un formulario on-line, a médicos especialistas en reumatología que hacen su práctica en el territorio colombiano. Se les preguntó acerca de los aspectos generales y su opinión sobre la ecografía en la reumatología, si la practicaban, como también en torno a los aspectos específicos de su aplicación en la práctica clínica. De manera adicional, se formularon preguntas dirigidas a aquellos reumatólogos que hacen parte de los procesos de capacitación de especialistas en el país; se presentaron preguntas cerradas de opción múltiple o de valoración por escala de Likert según se requirió. El objetivo principal fue describir el uso y la opinión actual sobre la ecografía musculoesquelética en reumatólogos colombianos, así como las limitantes para su implementación. A las variables categóricas de tipo nominal y de tipo ordinal se les hicieron medidas de frecuencia. Se pretendía encuestar a la totalidad de los reumatólogos en el país, los cuales, según información de la Asociación Colombiana de Reumatología (Asoreuma) de finales del 2019, eran 186. Resultados: De acuerdo con el número de reumatólogos proporcionado por la Asoreuma, de 186 especialistas en el año 2019, se obtuvo una participación de 139 de estos (74,7%), de los cuales 22 realizaban ecografía en su práctica diaria (15,8%), siendo este grupo en su mayoría formado en Colombia (80,6%). De los 139 encuestados, el 64,7% había recibido algún tipo de estudios en ecografía, generalmente cursos precongreso (22,5%), cursos de la Liga Europea Contra el Reumatismo (EULAR) (16,7%) y formación incluida en el pensum de su residencia fuera del servicio de reumatología (9,8%). La aceptación de la ecografía es alta entre los reumatólogos que ejercen en Colombia, el 75,5% la consideraron importante o muy importante. Asimismo, el 84,9% indicó que para un servicio de reumatología integral es importante o muy importante contar con ecografía. Sin embargo, los encuestados consideraron que su uso podría llegar a cambiar su conducta de manera frecuente, y muy frecuentemente en menos de la mitad de los casos (46,7%). Con respecto a la opinión sobre el uso de la ecografía en patologías específicas, se consideró con importancia y mucha importancia en artritis reumatoide (77,7%) y artropatías por cristales (72,7%), que fueron las más altas, así como para la realizaron de procedimientos (87%). Para la toma de decisiones en estudio de patología inflamatoria, el 60,4% consideraría realizar ecografía, comparado con 28,8% que se inclina por la resonancia. En relación con las limitaciones para la implementación, la falta de entrenamiento en el país (25,6%), seguida de la carencia de recursos para la consecución del equipo (17,9%) y el desconocimiento y la falta de interés por parte de los entes de salud (17,1%) fueron las más reconocidas. Conclusiones: La ecografía musculoesquelética solamente es practicada por una minoría de los reumatólogos que ejercen en Colombia, a pesar de que la mayoría la considera importante. Su relevancia radica en su uso para tratar a los pacientes con artritis reumatoide, artropatías por cristales y por artropatía psoriásica, así como para la realización de procedimientos. Más de la mitad de los reumatólogos ha recibido algún tipo de formación en ecografía, la mayoría de las veces educación de muy pocas horas o sin entrenamiento práctico, o no formal, lo cual constituye el principal problema para su implementación.
Subject(s)
Humans , Rheumatology , Ultrasonography , Diagnostic Techniques and Procedures , Diagnosis , Health Occupations , MedicineABSTRACT
Introduction: Nailfold videocapillaroscopy is a non-invasive tool for the assessment of peripheral microcirculation, the main indication is the study of Raynaud's phenomenon, poorly standardized outside of this context. There is no clear information in real-life about the rea-sons for referral, the presence of clinical findings of autoimmune diseases, the frequency of patterns of autoantibodies, and specific capillaroscopic findings. Objective: The purpose of this survey is to describe the sociodemographic, clinical, paraclinical, and angioscopy findings of a cohort of subjects referred to a capillaroscopy service in North-western Colombia. Methods: A retrospective study was conducted, from 2015 to 2018. Categorical variables were expressed in frequency and percentage and quantitative variables in mean and standard deviation or median with interquartile range, depending on the distribution of the data. Results: A total of 318 capillaroscopies were performed for the first time. The main referral reason was Raynaud's phenomenon (n = 134; 42.1%). The most frequent baseline capillaroscopic pattern found was normal (n = 123; 38.7%). Of the 12 capillaroscopies that presented a non-specific pattern at a 6-month follow-up, only one (8.3%) progressed to a scleroderma pattern. In the subjects with systemic sclerosis, the most frequent clinical finding was sclerodactyly (n = 34; 37.8%), and 42/44 individuals (95.4%) had positive antinuclear antibodies; the most frequent pattern was centromere (n = 27; 64.3%) Conclusions: In a real-world setting, the main referral reason for capillaroscopy was Raynaud's phenomenon; more than a third of the subjects had normal capillaroscopic findings. Sclerodactyly was the most frequent clinical finding in patients with scleroderma capillaroscopic pattern.
Introducción: La videocapilaroscopia del lecho ungular es una herramienta no invasiva para la evaluación de la microcirculación periférica; la indicación principal es el estudio del fenómeno de Raynaud. Luego de una revisión de la literatura, no hay información clara sobre los motivos de remisión, presencia de hallazgos clínicos de enfermedades autoinmunes, frecuencia de patrones de autoanticuerpos y hallazgos capilaroscópicos específicos. Objetivo: Describir los hallazgos sociodemográficos, clínicos, paraclínicos y capilaroscópicos de sujetos remitidos a un servicio de capilaroscopia en el noroccidente colombiano. Métodos: Estudio retrospectivo de 2015 a 2018. Las variables categóricas se expresaron en frecuencias absolutas y porcentajes, y las variables cuantitativas en media y desviación estándar o mediana con rango intercuartílico, dependiendo de la distribución de los datos. Resultados: Se realizaron 318 capilaroscopias por primera vez. El principal motivo de remisión fue el fenómeno de Raynaud (n = 134; 42,1%). El patrón capilaroscópico basal más frecuente fue el normal (n = 123; 38,7%). De las 12 capilaroscopias que presentaron un patrón no específico en un seguimiento de seis meses, solo una (8,3%) progresó a un patrón de esclerodermia. En los sujetos con esclerosis sistémica, el hallazgo clínico más frecuente fue la esclerodactilia (n = 34; 37,8%), y 42/44 individuos (95,4%) tenían anticuerpos antinucleares positivos; el patrón más frecuente fue el centromérico (n = 27; 64,3%). Conclusiones: La razón principal de remisión para realizar una capilaroscopia fue el fenómeno de Raynaud; más de un tercio de los sujetos tenían hallazgos capilaroscópicos normales. La esclerodactilia fue el hallazgo clínico más frecuente en pacientes con patrón capilaroscópico de esclerodermia.
Subject(s)
Humans , Adolescent , Skin and Connective Tissue Diseases , Raynaud Disease , Scleroderma, Systemic , Thrombosis , Vascular Diseases , Cardiovascular Diseases , Connective Tissue Diseases , Diagnostic Techniques and Procedures , Microscopic Angioscopy , Diagnosis , MicroscopyABSTRACT
Introducción. Las armas de energía cinética son diseñadas para generar lesiones dolorosas y superficiales. Sin embargo, las lesiones asociadas causan confusión al ser abordadas como heridas por proyectil de arma de fuego, convirtiendo el enfoque y el manejo correcto en un desafío. El caso presentado describe un paciente herido en el cuello por arma traumática con el objetivo de analizar factores que permitan identificar este tipo de heridas y sus implicaciones en el manejo. Caso clínico. Paciente masculino de 31 años que ingresó con intubación orotraqueal, remitido de una institución de nivel 2, con herida por aparente proyectil de arma de fuego con trayectoria transcervical. Se encontró hemodinámicamente estable, pero con dificultad para la valoración clínica, por lo que se realizaron exámenes complementarios que descartaron lesión aerodigestiva. La tomografía de cuello reportó proyectil alojado en musculatura paravertebral izquierda, descartando trayectoria transcervical. Discusión. El comportamiento de las lesiones asociadas a los proyectiles de armas depende de varios factores, como el tipo de material del proyectil, su velocidad y las propiedades del tejido impactado. Se presentó un caso en que inicialmente se sospechaba una lesión transcervical, pero con la evaluación se identificó el proyectil cinético en la musculatura paravertebral. Conclusión. En el abordaje de un paciente con sospecha de herida por proyectil de arma de fuego se debe considerar ante todo la respuesta clínica y la correlación del supuesto vector del proyectil con las lesiones sospechadas. La evaluación imagenológica permite identificar oportunamente los proyectiles y evitar procedimientos o terapias innecesarias que forman parte del manejo convencional del paciente con trauma penetrante
Introduction. Kinetic energy weapons are designed to produce superficial and painful injuries. Nevertheless, the approach of these patients in the emergency department can be confusing as they can be managed as gunshot wounds. This case describes a patient with an injury in the neck caused by kinetic energy gun. In addition, we analyzed factors that might identify these wounds and their implications in the management. Clinical case. A 31-year-old male patient who presented to the emergency department referred from a second level hospital with gunshot wound with suspected trans-cervical trajectory. They performed orotracheal intubation and transferred to our institution. Due to the patient Ìs hemodynamic stability and impossibility for clinical evaluation, test and radiology tests were performed. These ruled out any aero-digestive injuries. The CT-scan reported a bullet hosted in the left paravertebral muscles, ruling out a trans-cervical trajectory. Discussion. Several factors contribute to the injuries produced by kinetic energy weapons. The injury patterns may vary according to the bullet material, muzzle velocity and impacted tissue characteristics. In this case, an initial trans-cervical injury was suspected and due to clinical evaluation we identified the bullet hosted in the paravertebral muscles. Conclusion. In the approach of a patient with suspicion of gunshot wound, as surgical team we must consider clinical manifestations and the correlation of the vector with suspected injuries. Evaluation of diagnostic imaging allows the identification of traumatic bullets, avoiding unnecessary procedures in the conventional management of patients with penetrating trauma
Subject(s)
Humans , Wounds, Penetrating , Soft Tissue Injuries , Neck Injuries , Wounds, Gunshot , Diagnostic Techniques and ProceduresABSTRACT
El cáncer pulmonar se establece como la segunda causa de muerte en países desarrollados y en algunos en vías de desarrollo. Su diagnóstico es tardío, sus opciones de resección y su curación aun con terapias adyuvantes son limitadas, lo que incide en la pobre sobrevida a 5 años, es por ello que se necesitan mayores esfuerzos para combatir el hábito del tabaco, principal agente etiológico. Material y Métodos: Se trata de un estudio descriptivo transversal en pacientes adultos atendidos de 01 de enero del 2011 al 31 de diciembre del 2021, ingresados al servicio de cirugía del Hospital San Vicente de Guatemala, con diagnósticos de cáncer pulmonar, masa pulmonar, derrame pleural o nódulo pulmonar solitario. Resultados: Se atendieron 202 pacientes con diagnósticos presuntivos de cáncer pulmonar, no encontrando diferencias significativas en relación al sexo. La edad mayormente afectada se estableció entre los 50 y 70 años. Prevalecieron los estadíos IIIA, IIIB y IV basados en los hallazgos clínicos, tomográficos y transoperatorios y solo al 10% se le sometió a una cirugía de resección pulmonar mayor. Los cánceres de células no pequeñas NSCLC fueron reportados en el 68.7% y el adenocarcinoma fue la variedad más frecuente con el 54.95% sobre el 7.29% del epidermoide. La mortalidad a los treinta días se estableció en 2.97%. Conclusión: El adenocarcinoma pulmonar ocupa el primer lugar en la incidencia de los cánceres pulmonares, desplazando así al carcinoma epidermoide popularizado desde la mitad del siglo pasado. Esta tendencia en el cambio histológico está firmemente asociado a las modificaciones en los hábitos del fumar (AU)
Lung cancer is established as the second cause of death in developed countries and in some developing ones. Its diagnosis is late, its resection options and its cure even with adjuvant therapies are limited, which affects the poor survival at 5 years, which is why greater efforts are needed to combat the tobacco habit, the main etiological agent. Material and Methods: This is a cross-sectional descriptive study in adult patients treated from January 1, 2011 to December 31, 2021, admitted to the surgery service of the Hospital San Vicente de Guatemala, with diagnoses of lung cancer, lung mass, effusion pleural or solitary pulmonary nodule. Results: 202 patients with presumptive diagnoses of lung cancer were treated, finding no significant differences in relation to sex and the most affected age was established between 50 and 70 years. Stages IIIA, IIIB, and IV prevailed based on clinical, tomographic, and intraoperative findings, and only 10% underwent major lung resection surgery. NSCLC non-small cell cancers were reported in 68.7% and adenocarcinoma was the most frequent variety with 54.95% over 7.29% of epidermoid. Thirty-day mortality was established at 2.97%. Conclusion: Pulmonary adenocarcinoma occupies the first place in the incidence of lung cancers, thus displacing squamous cell carcinoma popularized since the middle of the last century. This trend in histological change is strongly associated with changes in smoking habits.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Adenocarcinoma of Lung/epidemiology , Histology/classification , Lung Neoplasms/diagnosis , Pleural Effusion/complications , Bronchoscopy/instrumentation , Diagnostic Techniques and Procedures , Multiple Pulmonary Nodules/diagnostic imagingABSTRACT
Resumo Este trabalho objetiva demonstrar a dimensão política do diagnóstico das formas de sofrimento psíquico, a partir da crítica da racionalidade neoliberal. A metodologia utilizada foi o trabalho de um conceito através de revisão de bibliografias, principalmente da Psicopatologia e Teoria Social. Historicamente, o tratamento clínico e social dado aos sujeitos que apresentam algum tipo de sofrimento psíquico se relaciona com a cultura de cada época e com a forma vigente de se exercer o poder. Na modernidade, o paradigma psiquiátrico acerca das doenças mentais segue a lógica do dispositivo saber-poder biomédico, que, dentro da lógica neoliberal individualizante, responsabiliza cada sujeito por seu adoecimento e tem como máxima o autoaprimoramento, não a cura. Nesse sentido, as categorias diagnósticas de nossa época servem muito mais para capturar as formas hegemônicas de mal-estar e traduzir em uma gramática passível de normalização do que para expressar a natureza de uma doença mental. Tal hipótese tem imenso peso político, visto que uma razão diagnóstica totalizante corrobora para o esgotamento da capacidade de enfrentar conflitos, contradições e reinvenções, o que gera um cenário de dificuldades para lidar com a alteridade e com as contingências próprias da vida, que acabam sendo patologizadas.
Abstract This work aims to demonstrate the political dimension of the diagnosis of the forms of psychic suffering, from the critique of neoliberal rationality. The methodology used was the work of a concept with a review of bibliographies, mainly on psychopathology and social theory. Historically, the clinical and social treatment given to subjects who present some type of psychic suffering is related to the culture of each time and the current way of exercising power. In modernity, the psychiatric paradigm about mental illness follows the logic of the biomedical knowledge-power device, which, within the individualizing neoliberal logic, holds each subject responsible for their illness and has at its maximum the self-improvement and not the cure. In this sense, the diagnostic categories of our time serve much more to capture the hegemonic forms of malaise and translate them into a grammar that can be normalized than to express the nature of a mental illness. Such a hypothesis has immense political weight, since a totalizing diagnostic reason corroborates the exhaustion of the capacity to deal with conflicts, contradictions, and reinventions, which generates a scenario of difficulties in coping with alterity and with the contingencies of life, which end up being pathologized.