Chest x-ray findings of paediatric patients seen at a Teaching Hospital in North-western Nigeria

Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.

Lineamientos técnicos para la atención nutricional y manejo ambulatorio de las personas con malnutrición en el ciclo de vida / Technical guidelines for nutritional care and outpatient management of people with malnutrition in the life cycle

Para contribuir a reducir o mejorar la problemática, se hace necesario fortalecer la atención nutricional, la cual tiene presencia en los diferentes niveles de atención en salud, sin embargo, no se cuenta con una normativa que determine como llevar a cabo el proceso; así como el manejo integral de la malnutrición. Sumado a ello se encuentra la brecha de cobertura con nutricionistas en los establecimientos de salud que aborden y desarrollen este tipo de atención; dicha situación da lugar a que los profesionales en nutrición empleen técnicas de manejo para la malnutrición no estandarizadas en el nivel nacional, a nivel público y privado. El presente documento, "Lineamientos Técnicos para la atención nutricional y manejo ambulatorio de las personas con malnutrición en el ciclo de vida", contiene las disposiciones técnicas del proceso de atención nutricional, manejo integral de la malnutrición; y referencia, interconsulta y retorno

To help reduce or improve the problem, it is necessary to strengthen nutritional care, which is present at different levels of health care, however, there are no regulations that determine how to carry out the process; as well as the comprehensive management of malnutrition. Added to this is the coverage gap with nutritionists in health establishments that address and develop this type of care; This situation leads nutrition professionals to use management techniques for malnutrition that are not standardized at the national, public, and private levels. This document, "Technical Guidelines for nutritional care and outpatient management of people with malnutrition in the life cycle", contains the technical provisions of the nutritional care process, comprehensive management of malnutrition; and reference, interconsultation and return

Nivel de información sobre factores de riesgo de Infarto agudo de miocardio en pacientes ambulatorios, Corrientes año 2021 / Level of information on risk factors for acute myocardial infarction in outpatients, Corrientes year 2021

Determinar el nivel de información sobre factores de riesgo de Infarto agudo de miocardio en los pacientes ambulatorios que asisten a una institución de salud de la provincia de Corrientes año 2021. Metodología: Estudio cuantitativo descriptivo, transversal y observacional. Muestra obtenida mediante muestreo probabilístico aleatorio simple compuesta por 108 pacientes que asistieron a los consultorios de Diabetes, Presurometría y Hospital de Día. Se aplicó un cuestionario validado mediante una prueba piloto. Variables: edad, sexo, nivel de instrucción, Nivel de información sobre alimentación, hábitos nocivos, actividad física y preguntas generales. Los resultados fueron volcados a una matriz diseñada en programa Excel. Resultados: La población en estudio presento una mediana de edad de 43, moda 39 y predomino del sexo masculino 56%, sobre el femenino 44%, en el nivel de instrucción prevaleció el secundario completo 19% seguido de primario incompleto 15%. Abordando los niveles de información sobre factores de riesgo de Infarto agudo de miocardio predominaron los niveles altos en todas las variables trabajadas, obteniendo un nivel general de información alto del 82%, se apreció en la alimentación 65%, hábitos nocivos 70%, aspectos generales un 86% y actividad física 48%. Conclusión: Esta investigación remarca la importancia de la educación permanente y en etapas tempranas sobre los factores de riesgo de Infarto Agudo de Miocardio. La población en estudio presento un nivel alto de información. No obstante, la educación debe fomentarse para llegar al 37% restante que obtuvo niveles inferiores[AU]

To determine the level of information on risk factors for acute myocardial infarction in outpatients attending a health institution in the province of Corrientes in 2021. Methodology: Quantitative descriptive, cross-sectional and observational study. Sample obtained by simple random probabilistic sampling made up of 108 patients who attended the Diabetes, Blood Pressure and Day Hospital clinics. A validated questionnaire was applied by means of a pilot test. Variables: age, sex, level of education, level of information on food, harmful habits, physical activity and general questions. Te results were dumped into a matrix designed in Excel program. Results: Te population under study presented a median age of 43, mode 39 and a predominance of males 56%, over females 44%, on the level of education the complete secondary prevailed 19% followed by incomplete primary 15%. Addressing the levels of information on risk factors for acute myocardial infarction, high levels predominated in all the variables worked on, obtaining a high general level of information of 82%, disaggregating 65%, harmful habits 70%, aspects general 86% and physical activity 48%. Conclusion: Tis research highlights the importance of permanent education and in early stages about the risk factors of Acute Myocardial Infarction. Te study population presented a high level of information. However, education should be encouraged to reach the remaining 37% who obtained lower levels[AU]

: Determinar o nível de informação sobre fatores de risco para infarto agudo do miocárdio em pacientes ambulatoriais atendidos em uma instituição de saúde na província de Corrientes em 2021. Metodologia: Estudo quantitativo descritivo, transversal e observacional. Amostra obtida por amostragem probabilística aleatória simples composta por 108 pacientes atendidos nas clínicas de Diabetes, Pressão Arterial e Hospital Dia. Foi aplicado um questionário validado por meio de teste piloto. Variáveis: idade, sexo, escolaridade, nível de informação sobre alimentação, hábitos nocivos, atividade física e questões gerais. Os resultados foram despejados em uma matriz projetada no programa Excel. Resultados: A população em estudo apresentou mediana de idade de 43 anos, moda 39 e predominância do sexo masculino 56%, sobre o feminino 44%, no nível de escolaridade o ensino médio completo prevaleceu 19% seguido do ensino fundamental incompleto 15%. Abordando os níveis de informação sobre fatores de risco para infarto agudo do miocárdio, predominaram níveis elevados em todas as variáveis trabalhadas, obtendo um nível geral de informação elevado de 82%, desagregando 65%, hábitos nocivos 70%, aspectos gerais 86% e atividade física 48%. Conclusão: Esta pesquisa destaca a importância da educação permanente e precoce sobre os fatores de risco do Infarto Agudo do Miocárdio. A população do estudo apresentou um alto nível de informação. No entanto, a educação deve ser incentivada para atingir os 37% restantes que obtiveram níveis mais baixos[AU]

Pesquisa de virus respiratorios habituales en pacientes pediátricos ambulatorios, a dos años de la pandemia por COVID-19 / Screening for common respiratory viruses in pediatric outpatients 2 years after the onset of the COVID-19 pandemic

Introducción. Durante el 2020, la circulación de otros virus respiratorios fue inferior a lo acostumbrado. Es probable que, almodificarse las medidas de mitigación para la infección por el coronavirus 2019, dicha prevalencia haya aumentado en 2021. Objetivo. Estimar la prevalencia de virus respiratorioshabituales en pacientes de 0 a 5 años asistidos en Departamento de Urgencias de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Métodos. Estudio transversal con 348 pacientes que consultaronpor sospecha de enfermedad por el coronavirus 2019(COVID-19), en quienes se descartó dicha enfermedad y se realizó la pesquisa sistemática de virus respiratorios habitualesResultados. En el 40 % de los pacientes se identificó el virus sincicial respiratorio (VSR), un virus respiratorio habitual. La edad menor de 2 años se mostró como predictor independiente de VSR (razón de momios [OR]: 4,15; intervalos de confianza del 95 % [IC95 %]: 2,46-6,99). Conclusión. En la población estudiada, 40 % de los pacientes con sospecha de COVID-19 en quienes se descartó infección por SARS-CoV-2 presentaban infección por VSR.

Introduction. During 2020, circulation of other respiratory viruses was lower than usual. Most likely, as mitigation measures for coronavirus disease 2019 (COVID-19) were modified, their prevalence in 2021 may have increased. Objective. To estimate the prevalence of common respiratory viruses among patients aged 0­5 years seen at the Emergency Department of a children's hospital in the City of Buenos Aires. Methods. Cross-sectional study of 348 patients consulting for suspected COVID-19 in whom SARS-CoV-2 infection was ruled out and routine screening for common respiratory viruses was performed. Results. Respiratory syncytial virus (RSV), a common respiratory virus, was identified in 40% of patients. Age younger than 2 years was an independent predictor of RSV (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 2.46­6.99). Conclusion. In the study population, 40% of patients suspected of COVID-19 in whom SARS-CoV-2 infection was ruled out had RSV infection.

Tiempos de espera de pacientes programados en un servicio de ecografía de consulta externa / Scheduled patient waiting times in an outpatient ultrasound service

INTRODUCCIÓN: la seguridad social se encarga de la atención médica de los trabajadores asalariados. OBJETIVOS: determinar los tiempos de espera en las programaciones de ecografía y conocer el nivel de satisfacción de pacientes asegurados en el Policonsultorio 20 de octubre de la Caja Petrolera de Salud. MÉTODOS: estudio descriptivo de corte transversal y cuantitativo. Se seleccionaron 1110 solicitudes de las gestiones 2012 ­ 2014 y 1110 pacientes que tenían su solicitud de ecografía en programación actual. Se revisó los expedientes clínicos y archivos de ecografía y se realizó cuestionarios estandarizados con escala Likert a los pacientes para medir el nivel de satisfacción. RESULTADOS: el 26% de los pacientes esperaron de 4.1 a 5.1 semanas (29-35 días), existieron 2.2 solicitudes de ecografía por cada paciente, el 93% de los pacientes no está nada o poco satisfecho con los periodos de espera y el 58% considera aceptable esperar entre 1.1 a 2.0 semanas (2-14 días) para la realización del estudio. DISCUSIÓN: se deben realizar acciones que mejoren la calidad de atención y satisfacción del paciente, una de ellas es disminuir los periodos de espera en las programaciones de ecografía.

INTRODUCTION: social security provides medical care for salaried workers. OBJECTIVES: to determine waiting times for scheduled ultrasound appointments and the level of satisfaction of insured patients at Policonsultorio 20 octubre, Caja Petrolera the Salud. METHODS: this is a descriptive, cross sectional, quantitative study. One thousand one hundred and ten ultrasounds orders from the 2012 ­ 2014 administration and 1110 patients who had ultrasounds orders currently scheduled were selected for review. Clinical records and ultrasounds files were reviewed and patients answers using a standardized questionnaire using the Likert scale were used to measure their level of satisfaction. RESULTS: twenty-six percent of the patients waited 4.1 to 5.1 weeks (29-35 days), there were 2.2 ultrasounds orders per patient, 93% of the patients are somewhat or completely dissatisfied with the waiting times, and 58% consider it acceptable to wait from 1.1 to 2.0 weeks (2-14 days) to undergo the study. DISCUSSION: Actions are needed to improve the quality of care and patient satisfaction, one of which is to shorten waiting times for scheduled ultrasound.

Conocimientos sobre donación de sangre en pacientes de un hospital de Amazonas, Perú / Knowledge about blood donation in patients of a hospital in Amazonas, Peru

RESUMEN El objetivo del estudio fue determinar el nivel de conocimientos sobre donación de sangre que tienen los pacientes externos que acuden a un hospital en Bagua Grande. Se realizó un estudio descriptivo transversal durante mayo a julio del 2019. Se elaboró y aplicó un cuestionario estructurado. Se captó a 244 personas que acudieron a consultorios externos mediante un muestreo sistemático. Los participantes obtuvieron una media de respuestas correctas de 8,90 (DE: 3,25) puntos de un total de 21. Se encontró que la edad y el grado de instrucción estaban correlacionados con el puntaje (rho = -0,21; p < 0,001 y rho = 0,38; p < 0,001, respectivamente). La procedencia y ocupación afectaron al puntaje (p < 0,001). Los conocimientos hallados en la población estudiada son bajos, pero esto no estaría relacionado con el antecedente de donación. Las intervenciones que se elaboren para mejorar la donación de sangre no solo se deben enfocar en brindar conocimientos, ya que otros factores estarían más relacionados con este resultado.

ABSTRACT This study aimed to determine the level of knowledge about blood donation among outpatients from a hospital in Bagua Grande. A descriptive cross-sectional study was conducted from May to July 2019. We developed and applied a structured questionnaire. A total of 244 outpatients were recruited through systematic sampling. Participants obtained a mean number of correct answers of 8.90 (SD: 3.25) points out of 21. Age and educational level were found to be correlated with the score (rho = -0.21; p < 0.001 and rho = 0.38; p < 0.001, respectively). Place of origin and occupation affected the score (p < 0.001). We found a low level of knowledge in the studied population, but this would not be related to previous history of donation. Interventions to improve blood donation should not only focus on providing knowledge, since other factors would be more related to this result.

Frontoplastia endoscópica para tratamiento del envejecimiento facial / Endoscopic Frontoplasty for Treating Facial Aging

Introducción: En el concepto moderno de rejuvenecimiento facial, lo principal es conseguir un resultado natural sin marcas quirúrgicas. El lifting endoscópico fronto-témporo-orbitario es en la actualidad, el mejor método para conseguirlo. Objetivo: Determinar la efectividad de la técnica de frontoplastia endoscópica para el tratamiento del envejecimiento facial. Métodos: Se realizó un estudio observacional descriptivo de una serie de 28 casos con diagnóstico de envejecimiento facial atendidos en el Centro Nacional de Cirugía de Mínimo Acceso en el período comprendido entre enero de 2014 hasta enero de 2017. Se estudiaron las variables de: sexo, edad, estado civil, escolaridad, raza, tiempo quirúrgico y complicaciones transoperatorias. Resultados: La edad media fue de 54,4 (40-73) años. Predominó el sexo femenino (89,3 por ciento). El nivel medio de escolaridad 61,5 por ciento, estado civil casado 52,0 por ciento. La ptosis de las cejas con presencia de arrugas frontales y glabelares fue el diagnóstico más frecuente 13; 46,4 por ciento. El tiempo quirúrgico medio fue 80,9 (40-120) minutos. No existieron complicaciones intraoperatorias, conversiones, ni reintervenciones. En 27 pacientes (96,4 por ciento) hubo permanencia de los resultados en el tiempo. Se presentaron complicaciones en 4 pacientes (14,3 por ciento). Hubo 19 pacientes atendidos de manera ambulatoria (67,9 por ciento), con estancia hospitalaria de un día (32,1 por ciento). La totalidad mostró satisfacción con los resultados obtenidos. Conclusiones: La frontoplastia endoscópica es un método poco invasivo y muy efectivo para reposicionar las cejas descendidas además tratar las arrugas frontales y glabelares(AU)

Introduction: In the modern concept of facial rejuvenation, the main thing is to achieve a natural result without surgical marks. The endoscopic fronto-temporo-orbital lifting is currently the best method to achieve this. Objective: To determine the effectiveness of the endoscopic frontoplasty technique for the treatment of facial aging. Methods: A descriptive observational study of a series of 28 cases with a diagnosis of facial aging treated at the National Center for Minimal Access Surgery in the period from January 2014 to January 2017 was carried out. The variables of: sex, age, marital status, schooling, race, surgical time and intraoperative complications. Results: The mean age was 54.4 (40-73) years. The female sex prevailed (89.3 percent). The average level of schooling 61.5 percent, married marital status 52.0 percent. Ptosis of the eyebrows with the presence of frontal and glabellar wrinkles was the most frequent diagnosis 13; 46.4 percent. The mean surgical time was 80.9 (40-120) minutes. There were no intraoperative complications, conversions, or reinterventions. In 27 patients (96.4 percent) there was permanence of the results over time. Complications occurred in 4 patients (14.3 percent). There were 19 patients treated as outpatients (67.9 percent), with a hospital stay of one day (32.1 percent). All showed satisfaction with the results obtained. Conclusions: Endoscopic foreheadoplasty is a minimally invasive and very effective method for repositioning lowered eyebrows, as well as treating frontal and glabellar wrinkles(AU)

Experiencia en un programa de rehabilitación cardíaca extrahospitalario usando cardiotacómetros: seguridad y eficacia / Experience in an outpatient cardiac rehabilitation program using cardiotachometers: safety and effectiveness / Experiência em programa de reabilitação cardíaca extra-hospitalar com uso de cardiotacômetros: segurança e eficácia

Introducción: El ejercicio físico, integrando la rehabilitación cardíaca (RC), tiene un efecto positivo demostrado en el pronóstico de los pacientes con enfermedad cardiovascular, optimizando el rendimiento cardíaco en términos de capacidad funcional. Mediante los programas de RC se pretende obtener los máximos beneficios clínicos del ejercicio físico con un mínimo riesgo para el paciente. Objetivos: Evaluar la seguridad y eficacia de un programa de RC extrahospitalario en pacientes de todos los niveles de riesgo, monitorizando con cardiotacómetros (instrumento de pulsera que detecta frecuencia cardíaca y permite programar alarmas) a pacientes de moderado y alto riesgo, con base en la ausencia de complicaciones cardíacas graves y la mejoría funcional de los participantes. Material y métodos: Estudio de cohorte retrospectiva, sometida a un plan de RC durante 12 semanas en el período comprendido entre enero de 2014 y marzo de 2020. Se evaluaron parámetros clínicos y funcionales al inicio y al final del plan de rehabilitación, controlando la tolerancia al esfuerzo, la presión arterial y la frecuencia cardíaca mediante el uso de cardiotacómetros. Resultados: Se incluyeron 181 pacientes, con edad promedio de 58,7 ± 9,7 años, 87,8% del sexo masculino, mayoritariamente portadores de cardiopatía isquémica (90,1%). Según la clasificación de la Asociación Americana de Rehabilitación Cardiovascular y Pulmonar, 54 pacientes (29,8%) eran de alto riesgo, 29 (16,0%) de moderado riesgo y 98 (54,1%) de bajo riesgo. En más de 10.000 horas de actividad física realizadas, un paciente requirió el implante de un marcapaso definitivo por bloqueo auriculoventricular completo, sin observarse otras complicaciones graves. Se obtuvo una mejoría significativa (p = 0,001) de la capacidad funcional, que aumentó de 7,34 ± 2,68 a 10,20 ± 2,35 METs (incremento relativo individual promedio 28,1%). Conclusiones: La RC es un tratamiento seguro y efectivo en los pacientes cardiópatas, aún en aquellos de moderado y alto riesgo. El uso de cardiotacómetros permite una adecuada monitorización del ejercicio y una oportuna detección de complicaciones.

Introduction: physical exercise, integrating cardiac rehabilitation (CR), has a proven positive effect on the prognosis of patients with cardiovascular disease, optimizing cardiac performance in terms of functional capacity. CR programs aim to obtain maximum clinical benefits with minimal risks to the patient. Objectives: assess the safety and efficacy of a cardiotachometer-monitored out-of-hospital CR program in high- and moderate-risk patients, based on the absence of major cardiac complications and improvement in participant's functional capacity. Materials and methods: retrospective cohort study, submitted to a CR plan for 12 weeks in the period between January 2014 and March 2020. Clinical and functional parameters were evaluated at the beginning and at the end of the rehabilitation plan, controlling effort tolerance, blood pressure and heart rate using cardiotachometers. Results: 181 patients were included, aged 58.7 ± 9.7 years and 87.8% female, of whom 90% were carriers of ischemic heart disease. According to the classification of the American Association of Cardiovascular and Pulmonary Rehabilitation, the patients were distributed as follows: 54 (29.8%) at high risk, 29 (16.0%) at intermediate risk, and 98 (54.1%) low risk. In more than ten thousand hours of physical activity performed, one patient required implantation of a permanent pacemaker due to complete atrioventricular block. A significant improvement (p = 0.001) of the functional capacity, from 7.34 ± 2.68 to 10.2 ± 2.35 (mean relative improvement: 28.1%.) was obtained. Conclusions: the CR is a safe and effective procedure for cardiac patients, even in moderate or high-risk subjects. The use of cardiotachometers allows adequate exercise monitoring and timely detection of complications.

Introdução: o exercício físico, integrando a reabilitação cardíaca (RC), tem comprovado efeito positivo no prognóstico de pacientes com doença cardiovascular, otimizando o desempenho cardíaco em termos de capacidade funcional. Os programas de RC visam obter o máximo de benefícios clínicos com riscos mínimos para o paciente. Objetivos: avaliar a segurança e eficácia de um programa de RC fora do hospital monitorado por cardiotacômetro em pacientes de alto e moderado risco, com base na ausência de complicações cardíacas maiores e na melhora da capacidade funcional dos participantes. Materiais e métodos: trata-se de um estudo descritivo, de um plano de RC de 12 semanas, em um período entre janeiro de 2014 a março de 2020. Os parâmetros clínicos e funcionais foram avaliados no início e no final do plano de reabilitação, a tolerância ao esforço, pressão arterial e frequência cardíaca utilizando cardiotacômetros. Resultados: foram incluídos 181 pacientes, com média de idade de 58,7 ± 9,7 anos e 87,8% do sexo masculino, dos quais 90% eram portadores de cardiopatia isquêmica. De acordo com a classificação da Associação Americana de Reabilitação Cardiovascular e Pulmonar, os pacientes foram distribuídos da seguinte forma: 54 (29,8%) de alto risco, 29 (16,0%) de risco intermediário e 98 (54,1%) de baixo risco. Em mais de dez mil horas de atividade física realizada, um paciente necessitou de implante de marcapasso definitivo por bloqueio atrioventricular total. A avaliação final mostrou melhora significativa (p = 0,001) na capacidade funcional medida em METs; este passou de 7,34 ± 2,68 para 10,2 ± 2,35 (melhora relativa média: 28,1%). Conclusões: este trabalho demonstra que a RC é um tratamento seguro e eficaz para pacientes com doenças cardíacas, mesmo em indivíduos de risco moderado e alto. O uso de cardiotacômetros permite o monitoramento adequado do exercício e a detecção oportuna de complicações.

Patients and physician's self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study / Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

OBJECTIVE: This study explores the relationship between patients' self-assessment and physicians' evaluation regarding clinical stability. METHODS: This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient's physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician's global clinical impression over the six previous months. The patients' self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients' self-evaluation was considered as our standard. RESULTS: The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians' evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. CONCLUSION: The data analysis confirms our hypothesis that the self- -assessment made by patients with SMD was accurate regarding their health condition, and that the self- -assessment made by patients who considered themselves stable agree with the physicians' evaluation.

OBJETIVO: Este estudo explora a relação entre a autoavaliação dos pacientes e a avaliação dos médicos quanto à estabilidade clínica. MÉTODOS: Trata-se de um estudo transversal realizado no ambulatório do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) em uma ampla amostra de pacientes (1.447), dos quais 67,9% eram portadores de transtornos mentais graves (TMG). Coletamos informações por meio de um questionário estruturado desenvolvido para esse fim, preenchido pelo médico assistente. A estabilidade clínica foi avaliada por meio de cinco critérios de instabilidade psiquiátrica e pela impressão clínica global do médico, nos seis meses anteriores. A autoavaliação dos pacientes baseou-se em uma pergunta sobre como eles avaliavam seu estado de saúde: estável/melhor, pior, não sabe. Para as análises, a autoavaliação dos pacientes foi considerada como nosso padrão. RESULTADOS: A amostra foi composta por 824 (57%) mulheres, com idade média de 49 anos. Os diagnósticos mais prevalentes na categoria TMG corresponderam a 937 pacientes, dos quais 846 (90,3%) se avaliaram como estáveis/melhores. As avaliações dos médicos concordaram mais com pacientes portadores de transtorno bipolar e menos com esquizofrênicos em relação à estabilidade. Quanto aos pacientes com transtorno depressivo, os médicos concordaram mais com eles em relação à instabilidade. CONCLUSÃO: A análise dos dados confirma nossa hipótese de que a autoavaliação feita por pacientes com TMG foi precisa quanto à sua condição de saúde e que a autoavaliação feita por pacientes que se consideravam estáveis concorda com a avaliação dos médicos.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Lineamientos técnicos para el seguimiento del aislamiento domiciliar y atención ambulatoria de casos sospechosos y confirmados por COVID-19 (Tercera Edición) / Technical guidelines for monitoring home isolation and outpatient care for suspected and confirmed cases of COVID-19 (Third Edition)

Los presentes Lineamientos pretenden establecer las disposiciones para el seguimiento del aislamiento domiciliar, manejo ambulatorio de casos sospechosos y confirmados COVID-19, para reducir la transmisibilidad y contribuir a garantizar la protección de los familiares, convivientes, trabajadores de la salud y de toda la población

These Guidelines aim to establish the provisions for monitoring home isolation, outpatient management of suspected and confirmed COVID-19 cases, to reduce transmissibility and help ensure the protection of family members, cohabitants, health workers and the entire population

Manejo ambulatorio de la diarrea aguda infantil: encuesta a pediatras de un hospital pediátrico de la Ciudad de Buenos Aires / Outpatient management of childhood acute diarrhea: survey among pediatricians from a children's hospital in the Autonomous City of Buenos Aires

Introducción. El tratamiento de la diarrea aguda se basa en prevenir la deshidratación, reducir la duración y gravedad de la enfermedad. El objetivo fue conocer los patrones de tratamiento ambulatorio de la diarrea aguda en <5 años. Métodos. Estudio observacional, analítico, mediante encuestas autoadministradas a pediatras de un hospital de niños de la Ciudad Autónoma de Buenos Aires. Se indagó: edad, sexo, lugar de trabajo, fuentes bibliográficas, indicación de tratamientos farmacológicos, no farmacológicos y medidas de prevención e higiene. Se evaluó la asociación entre prescripciones farmacológicas y características de los encuestados. Resultados. Respondieron 182/216 pediatras; la edad media fue 42,4 ± 10,24 años (el 78,6 %, mujeres); el 59,2 %, del sector público; el 22,4 %, de servicios de guardia. El 91,2 % consultaba guías/consensos. El 92,9 % prescribió fórmulas de rehidratación oral; el 46,2 %, antieméticos; el 43,4 %, antiácidos y/o protectores gástricos; el 35,7 %, probióticos, y el 30,7 %, cinc. El 91,7 % indicó realimentación precoz; el 96,7 %, lactancia materna y el 96-100 %, medidas de prevención e higiene. En el análisis multivariado, tener >40 años se asoció con prescribir antiácidos/protectores gástricos (odds ratio [OR] 2,6; 1,22-5,61), probióticos (OR 3,03; 1,34-6,83) y cinc (OR 0,39; 0,17-0,87); trabajar en el sector privado con prescribir probióticos (OR 3,05; 1,56-5,94) y en servicios de guardia, con prescribir antiácidos/ protectores gástricos (OR 2,60; 1,22-5,54). Conclusiones. El tratamiento se basó principalmente en hidratación, alimentación precoz y lactancia. La edad y el lugar de desempeño de los pediatras modifican el patrón de prescripción.

Introduction. The management of acute diarrhea is based on preventing dehydration and reducing disease duration and severity. The study objective was to establish the patterns for the outpatient management of acute diarrhea in children younger than 5 years. Methods. Observational, analytical study using a self-administered survey among pediatricians from a children's hospital in the Autonomous City of Buenos Aires. Age, sex, place of work, bibliographic sources, indication of drug and non-drug therapies, and preventive and hygiene measures were recorded. The association between drug prescription and the characteristics of surveyed pediatricians was assessed. Results. In total, 182/216 pediatricians completed the survey. Their mean age was 42.4 ± 10.24 years; 78.6% were females; 59.2% worked in the public sector; 22.4% worked in the emergency department; and 91.2% consulted guidelines and/or consensuses. Also, 92.9% prescribed oral rehydration solutions; 46.2%, antiemetics; 43.4%, antacids and/or gastric protectors; 35.7%, probiotics; and 30.7%, zinc. Early food reintroduction was indicated by 91.7%; breastfeeding, by 96.7%; and preventive and hygiene measures, by 96-100%. The multivariate analysis showed an association between age > 40 years and prescribing antacids/ gastric protectors (odds ratio [OR]: 2.6; 1.22-5.61), probiotics (OR: 3.03; 1.34-6.83), and zinc (OR: 0.39; 0.17-0.87); between working in the private sector and prescribing probiotics (OR: 3.05; 1.565.94); and between working in the emergency department and prescribing antacids/gastric protectors (OR: 2.60; 1.22-5.54). Conclusions. Treatment was mainly based on hydration, early food reintroduction, and breastfeeding. Age and work sector affected the prescription pattern.

Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

Influência da autoavaliação para melhoria do acesso e da qualidade no quantitativo de procedimentos dos Centros de Especialidades Odontológicas / Influence of self-assessment for improving access and quality in the outpatient procedures in the Dental Specialties Centers

Resumo Estudou-se a influência da Autoavaliação para Melhoria do Acesso e Qualidade (AMAQ) na produção de procedimentos especializados nos Centros de Especialidades Odontológicas (CEO). Utilizou-se dados da avaliação externa de 900 CEO do primeiro ciclo do Programa para Melhoria do Acesso e Qualidade (PMAQ/CEO) e Sistema de Informação Ambulatorial (SIA/SUS). A variável dependente foi a média mensal de procedimentos (proc/mês) dos CEO entre os três períodos: 1) outubro de 2012 a setembro de 2013; 2) outubro de 2013 a setembro de 2014; e 3) outubro de 2014 a setembro 2015. A principal variável independente foi o uso da AMAQ/CEO no segundo período. Tipo de CEO, média de cirurgiões-dentistas com carga-horária de 20h, estratégias contra absenteísmo, apoio matricial, protocolos clínicos e cobertura de cadastrados na Estratégia de Saúde Bucal das Família foram covariáveis. Utilizou-se modelos de regressão linear múltipla para análises ajustadas. Equipes que utilizaram a AMAQ-CEO apresentaram média de 515,0 proc/mês, 575,5 proc/mês, e 519,9 proc/mês no primeiro, segundo e terceiro períodos, respectivamente. As equipes que utilizaram AMAQ-CEO tiveram uma maior média de produção do que aquelas que não utilizaram, com diferença ajustada de 32,7 proc/mês, 64,7 proc/mês e 27,7 proc/mês no primeiro, segundo e terceiro períodos, respectivamente.

Abstract We studied the influence of Self-Assessment for Improving Access and Quality (AMAQ) in the production of specialized procedures in the of Dental Specialties Centers (DSC). Data were obtained from the 900 DSC submitted to the external evaluation of the Program for Improving Access and Quality (PMAQ-CEO) and the Outpatient Information System (SIA-SUS). The dependent variable was the monthly average of dental procedures (proc/mon) in the DSC performed in three periods: 1) October 2012 to September 2013; 2) October 2013 to September 2014; and 3) October 2014 to September 2015. The main independent variable was the use of AMAQ/CEO, which occurred during the second period. Type of DSC, average number of dentists with a 20-hour workload, strategies to reduce missing appointments, referral support, clinical protocols and coverage of PHC registered users were used as covariates. Multiple linear regression models were run to estimate adjusted differences. Teams that used AMAQ-CEO had a mean of 515.0 proc/mon, 575.5 proc/mon, and 519.9 proc/mon in the first, second and third periods, respectively. The DSC that used AMAQ-CEO had a higher mean than those that did not, with an adjusted difference of 32.7 proc/mon, 64.7 proc/mon and 27.7 proc/mon for the first, second and third periods, respectively.

Características clínicas de pacientes diabéticos manejados ambulatoriamente en el Instituto Salvadoreño del Seguro Social / Clinical characteristics of diabetic patients managed on an outpatient basis at the Salvadoran Institute of Social Security

La diabetes mellitus es una de las enfermedades crónicas endémicas no transmisibles que debido a su alta frecuencia se ha llegado a posicionar entre las principales enfermedades que afectan a cientos de millones de personas en todo el mundo, con incidencia, morbilidad y mortalidad en aumento. La información sobre atenciones ambulatorias, disponible en el Departamento de Actuariado y Estadística del Instituto Salvadoreño del Seguro Social (ISSS), indica que en 2019 se brindaron 4 871 908 consultas y 170 230 fueron por diabetes mellitus (3,5 %). El 60,7 % de las atenciones (103 429) se brindaron a mujeres. Debido a la magnitud y proporciones de la diabetes en esta población, se hace necesario realizar en el ISSS investigaciones para actualizar la situación de su condición y que al mismo tiempo permita saber el origen de estas personas. El objetivo principal del estudio consiste en definir las características epidemiológicas y clínicas de pacientes diabéticos manejados de manera ambulatoria.

Diabetes mellitus is one of the chronic endemic noncommunicable diseases that, due to its high frequency, has come to position itself among the main diseases that affect hundreds of millions of people worldwide, with increasing incidence, morbidity and mortality. The information on outpatient care, available at the Department of Actuarial Science and Statistics of the Salvadoran Social Security Institute (ISSS), indicates that in 2019, 4,871,908 consultations were provided and 170,230 were for diabetes mellitus (3.5%). 60.7% of the services (103,429) were provided to women. Due to the magnitude and proportions of diabetes in this population, it is necessary to carry out research at the ISSS to update the situation of their condition and at the same time allow knowing the origin of these people. The main objective of the study is to define the epidemiological and clinical characteristics of diabetic patients managed on an outpatient basis

A tropical tertiary neurosurgical center response to COVID-19 pandemic and its effect on neurosurgical practices

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic, but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics

Short-term effects and seasonal variation of ozone on daily hospital outpatient visits for childhood asthma in Lanzhou / 北京大学学报(医学版)

OBJECTIVE@#To analyze the effects of ozone (O3) concentrations measured with different approaches across different seasons on the total number of childhood asthma-related clinical visits, as well as the differentiation of such effects across different groups of patients.@*METHODS@#The outpatient data of three grade A tertiary hospitals in Lanzhou City spanning from 1 January 2014 to 31 December 2017, as well as air pollution and meteorological data during the same period were collected. Considering the nonlinear relationship between O3 concentrations and the total number of childhood asthma-related clinical visits and meteorological factors, a generalized additive temporal sequence model was employed to analyze the short-term association between changes in O3 concentrations and the total number of childhood asthma-related clinical visits. Taking into account of the variations in O3 concentrations within 1 day, this study adopted different measurement approaches to address the three types of O3 exposures, namely, the maximum 1 h daily concentration (O3max1h), the maximum 8 h daily concentration (O38h) and the mean 24 h daily concentration (O324h) as the short term exposure indicators to O3, followed by a model-based analysis.@*RESULTS@#The increase in short-term exposure levels to O3 in summer had a significant effect on the increase in the total number of childhood asthma-related clinical visits. With lag0 for the current day, every 10 μg/m3 increase in atmospheric concentration of O3max1h was associated with an increase in the total number of childhood asthma-related clinical visits by 3.351% (95%CI: 1.231%-5.516%); for every 10 μg/m3 increase in O38h concentration, the total number of childhood asthma-related clinical visits increased by 3.320% (95%CI: 0.197%-3.829%); for every 10 μg/m3increase in O324h concentration, the total number of childhood asthma-related clinical visits in summer increased by 6.600% (95%CI: 0.914%-12.607%); moreover, an increase in exposure to O3max1h also led to a significant rise in the total number of childhood asthma-related clinical visits among the males.@*CONCLUSION@#The increase in short-term exposure levels to O3 in summer in Lanzhou City has a significant effect on the increase in the total number of childhood asthma-related clinical visits; O3max1h is more closely correlated with the increase in the total number of childhood asthma-related clinical visits.

HIV infection status in male outpatients in sexually transmitted disease clinics in Tianjin, 2016-2020 / 中华流行病学杂志

Objective: To understand the HIV infection status in male outpatients in sexually transmitted disease (STD) clinics in Tianjin from 2016 to 2020. Methods: According to the sentinel surveillance protocol, continuous cross-sectional studies were conducted between April and June during 2016-2020 to collect the information about the awareness of AIDS related knowledge, related sex behaviors, HIV infection, syphilis prevalence and HCV infection of male STD outpatients in Tianjin with a sample seize of 400 in each sentinel clinic. Results: From 2016 to 2020, a total of 4 000 male STD outpatients were surveyed. The HIV positive rate increased from 1.13% (9/800) to 2.25% (18/800) (trend χ2=14.22, P<0.001), the positive rate of syphilis increased from 9.38% (75/800) to 13.00% (104/800) (trend χ2=7.30, P=0.007) in this population during this period. The overall HCV positive rate was 0.45% (18/4 000). Multivariate logistic regression analysis showed that compared with those who were unmarried, had registered residence in Tianjin, had no temporary sexual behavior in the past 3 months, had no anal sex and had negative syphilis test result, the risk factors of HIV infection in the male STD outpatients included cohabitation (aOR=7.53, 95%CI:2.13-26.62), being from other provinces (aOR=3.64,95%CI:1.58-8.38), having temporary sexual behavior in the past 3 months (aOR=2.24,95%CI:1.03-4.89), having homosexual anal sex (aOR=85.99,95%CI:38.76-190.74) and suffering from syphilis (aOR=6.06,95%CI:3.18-11.56). Conclusion: The detection rates of HIV infection and syphilis in male STD outpatients in Tianjin showed upward trends from 2016 to 2020. Having temporary sexual behavior and anal sex, and suffering from syphilis were the main risk factors of HIV infection in male STD outpatients.

Guideline of nitrous oxide-oxygen inhalation sedation technique in dental outpatient / 中华口腔医学杂志

The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.