ABSTRACT
Introducción: En diciembre de 2019, se detectó un brote de enfermedad por un nuevo coronavirus que evolucionó en pandemia con severa morbilidad respiratoria y mortali- dad. Los sistemas sanitarios debieron enfrentar una cantidad inesperada de pacientes con insuficiencia respiratoria. En Argentina, las medidas de cuarentena y control sani - tario retrasaron el primer pico de la pandemia y ofrecieron tiempo para preparar el sis- tema de salud con infraestructura, personal y protocolos basados en la mejor evidencia disponible en el momento. En una institución de tercer nivel de Neuquén, Argentina, se desarrolló un protocolo de atención para enfrentar la pandemia adaptado con la evo- lución de la mejor evidencia y evaluaciones periódicas de la mortalidad hospitalaria. Métodos: Estudio de cohorte observacional para evaluar la evolución de pacientes con COVID-19 con los protocolos asistenciales por la mortalidad hospitalaria global y al día 28 en la Clínica Pasteur de Neuquén en 2020. Resultados: Este informe describe los 501 pacientes diagnosticados hasta el 31 de di- ciembre de 2020. La mortalidad general fue del 16,6% (83/501) y del 12,2% (61/501) al día 28 de admisión. En los 139 (27,7%) pacientes con ventilación mecánica, la mortali- dad general y a los 28 días fue de 37,4% (52/139) y 28,1% (38/139) fallecieron, respec- tivamente. Los factores de riesgo identificados fueron edad, comorbilidades y altos re- querimientos de oxígeno al ingreso. Conclusión: La mortalidad observada en los pacientes hospitalizados en nuestra insti- tución en la primera ola de la pandemia COVID-19 fue similar a los informes internacio- nales y menor que la publicada en Argentina para el mismo período.
Introduction: In December 2019, an outbreak of disease due to a new coronavirus was detected that evolved into a pandemic with severe respiratory morbidity and mortality. Health systems had to face an unexpected number of patients with respiratory failure. In Argentina, quarantine and health control measures delayed the first peak of the pan - demic and offered time to prepare the health system with infrastructure, personnel and protocols based on the best evidence available at the time. In a third level institution of Neuquén, Argentina, a care protocol was developed to confront the pandemic adapted by evolving best evidence and periodic evaluations of hospital mortality. Methods: Observational cohort study to evaluate the evolution of patients hospitalized for COVID-19 with care protocols in terms of overall hospital mortality and at day 28 at the Pasteur Clinic in Neuquén in 2020. Results: This report describes the 501 patients diagnosed until December 31, 2020. Mortality was 16.6% (83/501) and 12.2% (61/501) on day 28 of admission. Among the 139 (27.7%) patients with mechanical ventilation, overall mortality and at 28 days it was 37.4% (52/139) and 28.1% (38/139), respectively. The risk factors identified were age, comorbidities and high oxygen requirements on admission. Conclusion: The mortality observed in patients hospitalized in our institution during the first wave of COVID-19 pandemic was similar to international reports and lower than other publications in Argentina for the same period.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiration, Artificial , SARS-CoV-2 , COVID-19/mortality , Oxygen Inhalation Therapy , Argentina/epidemiology , Tertiary Healthcare , Comorbidity , Risk Factors , Hospital Mortality , Pandemics/statistics & numerical dataABSTRACT
INTRODUCCIÓN. La quimioembolización transarterial ha demostrado mejorar la tasa de sobrevida en los pacientes con hepatocarcinoma, se ha descrito como tratamiento paliativo; es útil, efectivo y bien tolerado. Esta terapéutica tiene el objetivo de disminuir el volumen tumoral. OBJETIVO. Determinar las complicaciones que presentan los pacientes con diagnóstico de hepatocarcinoma, posterior a la realización de quimioembolización transarterial del servicio de Gastroenterología del Hospital de Especialidades Carlos Andrade Marín y Hospital de Especialidades Eugenio Espejo, durante el período enero 2015 - enero 2020. MATERIALES Y MÉTODOS. Es un estudio retrospectivo observacional transversal; se diseñó un formulario de recolección de información, utilizando media y desvío estándar para variables cuantitativas; frecuencia y porcentaje para cualitativas; en las variables con distribución no paramétrico se recurrió a la mediana, rango intercuartil y sus intervalos, además se utilizó Chi Cuadrado, Índice de Yates y test de U Mann Whitney. Se trabajó en el paquete estadístico SPSS versión 26. RESULTADOS. Se analizaron 97 pacientes, el 60,8% fue de sexo masculino de los cuales el 56.7% presentó alguna comorbilidad; la mayoría de los pacientes no tuvieron complicaciones, sin embargo, la hipertensión arterial se presentó como manifestación clínica post quimioembolización transarterial (10,3%); el choque, el síndrome ascítico edematoso y el dolor abdominal fueron las complicaciones de mayor frecuencia. Los datos estadísticamente significativos fueron los siguientes: los pacientes con hepatocarcinoma y cirrosis hepática con severidad Child Pugh B, tuvieron un porcentaje mayor de complicaciones valor p = 0,01; un tamaño más grande del tumor sobre el número de lesiones, se relacionó con presentar alguna complicación postquimioembolización transarterial valor p = 0,001, lo que significó un aumento en la estancia hospitalaria valor p = 0,006; los pacientes que presentaron complicaciones mayores y menores tuvieron un tiempo de hospitalización más prolongado valor p < 0,05; la asociación entre la mortalidad y las complicaciones post quimioembolización en hospitalización y en UCI tuvieron una tasa general de 3,2% valor p = 0,001. CONCLUSIÓN. Las complicaciones mayores como el síndrome ascítico edematoso y el estado de choque, se mantuvieron sobre la media general. Con una tasa de mortalidad esperada según la tendencia internacional.
INTRODUCTION: Transarterial chemoembolization has been shown to improve the survival rate in patients with hepatocarcinoma, it has been described as palliative treatment; it is useful, effective and well tolerated. This therapy aims to reduce tumor volume, due to its embolic, vascular and cytotoxic effects. OBJECTIVE: To determine the complications presented by patients diagnosed with hepatocarcinoma, after performing transarterial chemoembolization of the Gastroenterology service of the Carlos Andrade Marín Specialty Hospital and Eugenio Espejo Specialty Hospital, during the period January 2015 - January 2020. METHODOLOGY: This cross-sectional observational study was conducted in patients with hepatocarcinoma who underwent transarterial chemoembolization. A form was designed for the collection of information, through a pseudonymized database, which was analyzed using the statistical package SPSS version 26. RESULTS: 97 patients were analyzed, 60.8% were male, of which 56.7% presented some comorbidity; Most of the patients had no complications, however, arterial hypertension presented as a clinical manifestation after transarterial chemoembolization in 10.3%; shock, ascites edema decompensation and abdominal pain were the most frequent complications. The statistically significant data were the following: patients with hepatocellular carcinoma and liver cirrhosis with Child Pugh B severity had a higher percentage of complications valor p = 0,01; a larger tumor size compared to the number of lesions was related to presenting some post-transarterial chemoembolization complication valor p = 0,001, which meant an increase in hospital stay valor p = 0,006; patients who presented major and minor complications had a longer hospitalization time valor p < 0,05, the association between mortality and post chemoembolization complications in hospitalization and in the ICU had an overall rate of 3.2% valor p = 0,001. CONCLUSION. Major complications, such as edematous ascitic syndrome and shock, remained above the general average. With an expected mortality rate according to the international trend.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ascites , Shock , Survival , Sclerotherapy , Carcinoma, Hepatocellular , Hypertension , Tertiary Healthcare , Adenocarcinoma , Mortality , Adenoma, Liver Cell , Ecuador , Gastroenterology , Liver Cirrhosis , Liver Cirrhosis, AlcoholicABSTRACT
INTRODUCCIÓN. Las fístulas anales representan una gran afectación a la calidad de vida de los pacientes. Conocer su comportamiento clínico, epidemiológico y el manejo quirúrgico es de gran importancia para optimizar el tratamiento. OBJETIVO. Describir las características clínicas, quirúrgicas y de seguimiento en los pacientes con fístula anal intervenidos quirúrgicamente en la Unidad de Coloproctología del Hospital Carlos Andrade Marín, Quito-Ecuador, entre mayo del 2018 hasta abril de 2023. MATERIALES Y MÉTODOS. Investigación descriptiva y observacional. Población: historias clínicas de todos los pacientes adultos (edad ≥ 18 años) con fístula anal a los que se les realizó tratamiento quirúrgico. Muestra: 159 historias que cumplieron con los criterios de selección. Se utilizó la técnica de revisión documental. Se siguieron las pautas de STROBE para estudios observacionales. Se utilizaron estadísticos descriptivos e inferenciales. Las pruebas χ² se aplicó a los datos categóricos, además de porcentajes y frecuencias. Se consideró significación estadística cuando p<0,05. RESULTADOS. Características clínicas: edad promedio 49,6 años. Sexo masculino (90,6%). Tipo de fístula: Interesfinterica baja (64,8%), Transesfinterica alta (9,4%). Subcutánea (8,2%), Transesfinterica baja (6,2%). Síntomas: secreción (71,1%). Tratamiento: Fistulotomía (40,9%), Fistulectomía con esfinteroplastia (13,2%), Fistulotomia con esfinteroplastia (8,2%), Seton (7,5%). Evolución: complicaciones (15,7%), recidivas (1,3%). Seguimiento: sin incontinencia fecal (73,6%), calidad de vida ≥ 4 puntos (97,5%). Factores relacionados con complicaciones: fístula compleja y técnica quirúrgica utilizada (p<0,05). DISCUSIÓN. Se evidenció una similitud entre las características de este trabajo y la literatura especializada. El tratamiento quirúrgico de elección es la fistulotomía. CONCLUSIÓN. La descripción de las características clínicas, quirúrgicas y de seguimiento de los pacientes con fístula anal en el Hospital Carlos Andrade Marín no difiere de otros reportes consultados. Con este trabajo se sientan las bases para el estudio epidemiológico de las fístulas anales en el Ecuador y, el manejo quirúrgico.
INTRODUCTION. Anal fistulas represent a great impact on the quality of life of patients. Knowing its clinical and epidemiological behavior and surgical management is of great importance to optimize treatment. AIM. To describe the clinical, surgical, and follow-up characteristics of patients with anal fistula who underwent surgery at the Coloproctology Unit of the Carlos Andrade Marin Hospital, Quito, Ecuador, between May 2018 and April 2023. MATERIALS AND METHODS. Descriptive and observational research. Population: medical records of all adult patients (age ≥ 18 years) with anal fistula who underwent surgical treatment. Sample: 159 records that met the selection criteria. The documentary review technique was used. STROBE guidelines for observational studies were followed. Descriptive and inferential statistics were used. The χ² tests were applied to the categorical data, in addition to percentages and frequencies. Statistical significance was considered when p<0.05. RESULTS. Clinical characteristics: average age 49.6 years. Male sex (90.6%). Fistula type: Low intersphincteric (64,8%), High transsphincteric (9.4%), Subcutaneous (8.2%). Low transsphincteric (6.2%). Symptoms: secretion (71.1%). Treatment: fistulotomy (40.9%), fistulectomy with sphincteroplasty (13,2%), Fistulotomy with sphincteroplasty (8,2%), Seton (7,5%). Evolution: complications (15.7%), recurrences (1.3%). Follow-up: no fecal incontinence (73.6%), quality of life ≥ 4 points (97.5%). Factors related to complications: complex fistula and surgical technique used (p<0.05). DISCUSSION. A similarity was demonstrated between the characteristics of this research and the specialized literature. Fistulotomy is the surgical treatment of choice. CONCLUSION. The clinical, surgical, and follow- up characteristics of patients with anal fistula at the Carlos Andrade Marin Hospital do not differ from other consulted reports. This research lays the foundations for the epidemiological study of anal fistulas in Ecuador and their surgical management.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Quality of Life , Surgical Procedures, Operative , Digestive System Fistula , Rectal Fistula , Colorectal Surgery , Abscess , Tertiary Healthcare , EcuadorABSTRACT
Introdução: O componente hospitalar da Rede de Atenção Psicossocial preconiza o fechamento progressivo de hospitais psiquiátricos e a implementação de leitos de saúde mental em hospital geral, capazes de fornecer atendimento para os casos agudos que necessitem de internação de forma articulada com os demais pontos de atenção da rede. Objetivo: Diante disso, o objetivo do presente artigo foi analisar a distribuição do número de leitos de atenção hospitalar em saúde mental no Rio Grande do Norte entre 2012 e 2022 e apresentar uma proposta de planejamento e avaliação para fortalecer a Rede de Atenção Psicossocial do estado. Metodologia: Trata-se de um estudo ecológico realizado no estado do Rio Grande do Norte, Brasil, no período de 2012 a 2022, usando dados secundários sobre as internações, seguido de um estudo propositivo com base em referências de planejamento e avaliação em saúde. Resultados: Observa-se uma redução do número de leitos psiquiátricos ao longo do tempo, mas que não se mostra suficiente e não se traduz em um crescimento satisfatório de leitos de saúde mental em hospital geral. Foram propostas cinco ações com o intuito de fortalecer a Rede de Atenção Psicossocial através da implantação e qualificação de leitos de saúde mental em hospitais gerais. Conclusão: Conclui-se que o movimento de constituição do componente hospitalar da Rede de Atenção Psicossocial do Rio Grande do Norte tem se apresentado em movimento irregular e o número de leitos de saúde mental em hospital geral é insuficiente. Espera-se que as intervenções e avaliações sugeridas possam contribuir para subsidiar importantes encaminhamentos no âmbito das políticas públicas de saúde mental do Rio Grande do Norte, Brasil (AU).
Introduction: The hospital component of the Psychosocial Care Network (PCN) advocates the progressive closure of psychiatric hospitals and the implementation of mental health beds in general hospitals, capable of providing care for acute cases that require hospitalization in conjunction with other network attention points. Objective: In view of this, the objective of this article was to analyze the quantitative distribution of hospital mental health care beds in Rio Grande do Norte between 2012 and 2022 and present a planning and evaluation proposal to strengthen the state's PCN. Methodology: This is an ecological study carried out in the state of Rio Grande do Norte, Brazil, from 2012 to 2022 using secondary data on hospitalizations, followed by a proactive study based on health planning and evaluation references. Results:There has been a reduction in the number of psychiatric beds over time, but not sufficient andnot translated into a satisfactory growth in mental health beds in general hospitals. Five actions were proposed with the aim of strengthening the PCN through the implementation and qualification of mental health beds in general hospitals.Conclusion: It is concluded that the movement to establish the hospital component of PCN in Rio Grande do Norte has been irregular and the number of mental health beds in general hospitals is insufficient. It is expected that the suggested interventions and evaluations may contribute to supporting important developments within the scope of public mental health policies in Rio Grande do Norte, Brazil (AU).
Introducción: El componente hospitalario de la Red de Atención Psicosocial (RAPS) aboga por el cierre progresivo de los hospitales psiquiátricos y la implementación de camas de salud mental en los hospitales generales, capaces de brindar atención a casos agudos que requieran hospitalización en conjunto con otros puntos de atención de la red. Objetivo:Ante esto, el objetivo de este artículo fue analizar la distribución del número de camas hospitalarias de atención a la salud mental en Rio Grande do Norte entre 2012 y 2022 y presentar una propuesta de planificación y evaluación para fortalecer el RAPS del Estado. Metodología:Se trata de un estudio ecológico realizado en el Estado de Rio Grande do Norte, Brasil, de 2012 a 2022, utilizando datos secundarios sobre hospitalizaciones, seguido de un estudio propositivo basado en referencias de planificación y evaluación de la salud. Resultados:Hay una reducción en el número de camas psiquiátricas a lo largo del tiempo, pero esto no es suficiente y no se traduce en un crecimiento satisfactorio de camas de salud mental en los hospitales generales. Se propusieron cinco acciones con el objetivo de fortalecer el RAPS a través de la implementación y habilitación de camas de salud mental en hospitales generales. Conclusión:Se concluye que el movimiento para establecer el componente hospitalario del RAPS en Rio Grande do Norte ha sido irregular y el número de camas de salud mental en un hospital general es insuficiente. Se espera que las intervenciones y evaluaciones sugeridas puedan contribuir a apoyar derivaciones importantes dentro del alcance de las políticas públicas de salud mental en Rio Grande do Norte, Brasil (AU).
Subject(s)
Health Evaluation , Mental Health , Health Planning , Mental Health Services , Tertiary Healthcare , Brazil/epidemiology , Data Interpretation, Statistical , Ecological Studies , Secondary Data Analysis , Hospitals, PsychiatricABSTRACT
Justificativa: Desde o início da história, registra-se a presença da figura do palhaço na sociedade, designadamente nos cenários de saúde, onde buscavam levar a arte e a recreação ao processo de tratamento. Entretanto, no século XX, especificamente a partir dos anos 1970, surgiram propostas de trabalho para que essa relação no hospital fosse vinculada à promoção da saúde, de forma integrada e efetiva. Este projeto tem como objetivo avaliar como os palhaços de hospital interferem nas relações hospitalares. O estudo questiona: Como estabelecer relações hospitalares para ampliar a eficácia da intervenção do palhaço? De que forma as relações já existentes entre a organização de palhaços e os hospitais facilitam ou dificultam o acesso aos hospitais? Para responder a estes questionamentos foi utilizada a metodologia de pesquisa qualitativa para a produção de dados através de entrevistas semiestruturadas com integrantes de projetos de palhaços de hospital a nível internacional. Para análise dos dados, foi utilizada a técnica Análise de Conteúdo na modalidade temática de Bardin (2010). Como resultados desta pesquisa estão a compreensão de como são promovidas e mantidas as relações entre as organizações de palhaços e a administração hospitalar, de modo a assegurar a abertura, continuidade, eficácia e reconhecimento do trabalho dos palhaços nesse contexto. Além disso pontua-se a identificação, sistematização e disseminação de práticas, de modo a permitir a sua adoção por outras organizações de palhaços em escala mundial. Como conclusão, foi visualizado o potencial do palhaço de hospital no que diz respeito às relações de gênero e raciais e enquanto instrumento de enfrentamento à colonialidade, principalmente a nível nacional, com respaldo nas políticas do SUS. Mostra-se ainda primordial que o discurso para conhecimento da prática de cuidados dos palhaços promotores da saúde seja compartilhado com os gestores hospitalares, tendo como finalidade promover a qualidade das relações interinstitucionais.
Justification: Since the beginning of history, the presence of clowns in society has been recorded, particularly in healthcare settings, where they sought to bring art and recreation to the treatment process. However, in the 20th century, specifically from the 1970s onwards, proposals emerged to link this relationship in hospital to health promotion, in an integrated and effective way. This project aims to assess how hospital clowns interfere in hospital relationships. The study asks: How can hospital relationships be established to increase the effectiveness of the clown's intervention? How do existing relationships between clown organisations and hospitals facilitate or hinder access to hospitals? To answer these questions, a qualitative research methodology was used to produce data through semi-structured interviews with members of international hospital clown projects. Bardin's (2010) thematic content analysis technique was used to analyse the data. The results of this research include an understanding of how relationships between clown organisations and hospital administration are promoted and maintained in order to ensure the openness, continuity, effectiveness and recognition of clowns' work in this context. In addition, the identification, systematisation and dissemination of practices is highlighted, so that they can be adopted by other clown organisations worldwide. In conclusion, the potential of hospital clowns was visualised with regard to gender and race relations and as an instrument for confronting coloniality, especially at a national level, backed up by SUS policies. It is also essential that the discourse on the care practices of health-promoting clowns is shared with hospital managers, with the aim of promoting the quality of inter-institutional relations.
Justificación: Desde el comienzo de la historia, se ha registrado la presencia de payasos en la sociedad, en particular en el ámbito sanitario, donde buscaban aportar arte y recreación al proceso de tratamiento. Sin embargo, en el siglo XX, concretamente a partir de los años 70, surgieron propuestas para vincular esta relación en el hospital a la promoción de la salud, de forma integrada y eficaz. Este proyecto pretende evaluar cómo los payasos de hospital interfieren en las relaciones hospitalarias. El estudio se pregunta: ¿Cómo se pueden establecer relaciones hospitalarias para aumentar la eficacia de la intervención del payaso? ¿Cómo facilitan o dificultan el acceso a los hospitales las relaciones existentes entre las organizaciones de payasos y los hospitales? Para responder a estas preguntas, se utilizó una metodología de investigación cualitativa para producir datos a través de entrevistas semiestructuradas con miembros de proyectos internacionales de payasos de hospital. Para analizar los datos se utilizó la técnica de análisis de contenido temático de Bardin (2010). Los resultados de esta investigación incluyen la comprensión de cómo se promueven y mantienen las relaciones entre las organizaciones de payasos y la administración hospitalaria con el fin de garantizar la apertura, la continuidad, la eficacia y el reconocimiento del trabajo de los payasos en este contexto. Además, se destaca la identificación, sistematización y difusión de prácticas, para que puedan ser adoptadas por otras organizaciones de payasos en todo el mundo. En conclusión, se visualizó el potencial de los payasos de hospital en lo que se refiere a las relaciones de género y raza y como instrumento de enfrentamiento a la colonialidad, especialmente a nivel nacional, respaldado por las políticas del SUS. También es fundamental que el discurso sobre las prácticas asistenciales de los payasos promotores de salud sea compartido con los gestores hospitalarios, con el objetivo de promover la calidad de las relaciones interinstitucionales.
Subject(s)
Humans , Male , Female , Physician-Patient Relations , Tertiary Healthcare , Laughter Therapy , Health Promotion , Hospital Administration , Hospitals , Unified Health System , BrazilABSTRACT
Introducción. La muerte involucra, para los médicos, un análisis complejo que determina su actitud hacia el paciente, principalmente los comportamientos en situaciones de diagnóstico, tratamiento y la relación médico-paciente. Objetivos. 1) Describir las actitudes del personal médico de un hospital pediátrico ante la muerte. 2) Explorar si existen factores asociados a esas actitudes. Población y métodos. Estudio transversal, por encuesta. Se invitó a los médicos de un hospital pediátrico de tercer nivel de la Ciudad Autónoma de Buenos Aires, Argentina, a completar el Cuestionario de actitud ante la muerte (CAM). Se investigaron variables sociodemográficas, categoría profesional y área laboral, haber presenciado la muerte de pacientes, autopercepción de actitud positiva ante la muerte y actitud ante la muerte según CAM. Resultados. Entre el 01 de junio de 2021 y el 01 de junio de 2022 se incluyeron 362 participantes, con edad media de 39,88 (± 11,56) años y experiencia médica asistencial de 14,06 (± 11,97) años. Presentaron actitud positiva 35 (9,67 %). Encontramos significancia estadística para mayor probabilidad de actitud positiva en edad ≥ 40 años (p = 0,02, IC95 % 1,1-3,9), experiencia médica asistencial ≥ 14 años (p = 0,042, IC95 % 1-4,1), creencia religiosa (p = 0,003, IC95 % 1,4-10,5), práctica religiosa activa (p <0,001, IC95 % 1,6-6,9) y autopercepción positiva ante la muerte (p = 0,002, IC95 % 1,7-30,8). Conclusiones. El 9,67 % de los encuestados presentó actitud positiva ante la muerte. Los factores asociados a ella fueron edad ≥ 40 años, experiencia médica asistencial ≥ 14 años, creencia religiosa, práctica religiosa activa y la autopercepción personal de actitud positiva ante la muerte.
Introduction. For physicians, death involves an intricate analysis that determines their attitude towards the patient. Objectives. 1) To describe the attitudes towards death among medical staff working at a children's hospital. 2) To explore factors associated with such attitudes. Population and methods. Cross-sectional, survey study. The physicians working at a tertiary care children's hospital completed the Questionnaire of attitudes towards death (QAD). Sociodemographic variables, professional category, work setting, having witnessed the death of patients, self-perception of a positive attitude towards death, and attitude towards death according to the QAD were studied. Results. Between June 1st, 2021 and June 1st, 2022, 362 participants were included; mean age: 39.88 years (± 11.56), health care experience: 14.06 years (± 11.97). A positive attitude was observed in 35 (9.67%). A statistical significance was observed for a greater probability of a positive attitude among those who were ≥ 40 years old (p = 0.02, 95% CI: 1.13.9), had health care experience for ≥ 14 years (p = 0.042, 95% CI: 14.1), had a religious belief (p = 0.003, 95% CI: 1.410.5), actively practiced their religion (p < 0.001, 95% CI: 1.66.9), and had a positive self-perception in the face of death (p = 0.002, 95% CI: 1.730.8). Conclusions. A positive attitude towards death was observed in 9.67% of surveyed participants. Associated factors were age ≥ 40 years, health care experience for ≥ 14 years, religious belief, active religious practice, and self-perception of a positive attitude towards death.
Subject(s)
Humans , Physicians , Attitude of Health Personnel , Tertiary Healthcare , Cross-Sectional Studies , Surveys and Questionnaires , HospitalsABSTRACT
La Odontología Intrahospitalaria requiere un modelo de atención conformado por un conjunto de profesionales que contribuyan de manera coordinada y simbiótica, para devolver o mantener la salud bucodental del paciente, siendo el hospital es un ambiente acertado para alcanzar este objetivo, ya que permite realizar un tratamiento de manera coordinada y transdisciplinaria. Los pacientes con enfermedades sistémicas o crónicas, síndromes o discapacidades, requieren de un abordaje integral, en donde exista un trabajo en conjunto, entre las especialidades médico-quirúrgicas y odontológicas, teniendo siempre un apoyo en la historia clínica del paciente o en las interconsultas realizadas de manera apropiada. La implementación de la valoración odontológica en pacientes hospitalizados previa a una intervención quirúrgica, radioterapia, quimioterapia, trasplantes, entre otros, ha sido demostrado que producen una mejoría en la calidad de vida del paciente mientras cursa su enfermedad, favoreciendo también en el costo que representa al sistema de salud una complicación durante el trata-miento de su enfermedad de base.
In-hospital Dentistry requires a care model made up of a group of professionals who contribute in a coordinated and symbiotic manner, to restore or maintain the patient's oral health, with the hospital being a suitable environment to achieve this objective, since it allows for treatment. in a coordinated and transdiscipli-nary manner.Patients with systemic or chronic diseases, syndromes or disa-bilities require a comprehensive approach, where there is joint work between the medical-surgical and dental specialties, always having support in the patient's clinical history or in the interconsultations carried out appropriately.The implementation of dental assessment in hospitalized pa-tients prior to surgery, radiotherapy, chemotherapy, transplants, among others, has been shown to produce an improvement in the patient's quality of life while their illness is ongoing, also fa-voring the cost it represents. to the health system a complication during the treatment of their underlying disease.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Patient Care Team , Tertiary Healthcare , Dentistry , Disease Prevention , Integrative Dentistry , Health Promotion , Preventive Health Services , Referral and Consultation , Rare Diseases , Dental Health Services , Ecuador , Education, Dental , Mouth RehabilitationABSTRACT
La ventilación mecánica no invasiva (VMNI) se utiliza en pacientes con insuficiencia respiratoria aguda, para mejorar el in-tercambio de gases y reducir el trabajo respiratorio, sin la ne-cesidad de una vía aérea artificial1. Es una modalidad de asis-tencia ventilatoria que proporciona dos niveles de presión. Cabe destacar que la presión aumenta durante la fase inspiratoria de la respiración, aumentando el volumen corriente, mejorando así el intercambio de gases, aliviando los músculos respiratorios y esto regresa a una línea de base alta en la exhalación. El aumento de presión durante la fase inspiratoria IPAP (presión inspiratoria positiva en las vías respiratorias) es similar a la presión de so-porte de los ventiladores convencionales. Durante la espiración, el ajuste de la presión en los dispositivos diseñados principal-mente para VMNI se denomina presión espiratoria positiva en las vías respiratorias (EPAP). Se debe considerar que la EPAP es similar al PEEP en un ventilador convencional 2. El conoci-miento de su funcionalidad permite determinar en qué pacientes está indicado el uso de la ventilación no invasiva y establecer una estrategia de manejo inicial. Debe considerarse que, a mayor gravedad de la patología respiratoria, la ventilación no invasiva no redujo la necesidad de intubación ni la mortalidad 3,4. Estos resultados se relacionaron con estudios realizados en el con-texto de la pandemia de SARS COV 2 donde se encontró que, la ventilación no invasiva en pacientes con determinado grado de afectación respiratoria, redujo el uso de ventilación invasiva y la mortalidad 5-8.
Noninvasive mechanical ventilation (NIMV) is used in patients with acute respiratory failure to improve gas exchange and reduce the work of breathing, without the need for an artificial airway1. It is a modality of ventilatory assistance that provides two levels of pressure. It should be noted that the pressure in-creases during the inspiratory phase of breathing, increasing the tidal volume, thus improving gas exchange, relieving the respi-ratory muscles and this returns to a high baseline on exhalation. The pressure rise during the IPAP (inspiratory positive airway pressure) inspiratory phase is similar to pressure support venti-lation of conventional ventilators. During expiration, the pres-sure setting in devices designed primarily for NIMV is called expiratory positive airway pressure (EPAP). It should be consi-dered that EPAP is similar to PEEP on a conventional ventilator2. Knowledge of its functionality allows determining in which pa-tients the use of non-invasive ventilation is indicated and esta-blishing an initial management strategy. It should be considered that, with greater severity of the respiratory pathology, non-in-vasive ventilation did not reduce the need for intubation or mor-tality3,4. These results were related to studies carried out in the context of the SARS COV 2 pandemic where it was found that non-invasive ventilation in patients with a certain degree of res-piratory involvement reduced the use of invasive ventilation and mortality5-8.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Respiratory Insufficiency , Oxygenation , Critical Care , Noninvasive Ventilation , Tertiary Healthcare , Work of Breathing , Positive-Pressure Respiration , Pulmonary Ventilation , Ecuador , Intensive Care UnitsABSTRACT
La Enfermedad Cerebrovascular Isquémica (ECV-Isquémica) provoca alteraciones neurológicas agudas, causadas por la dis-función del flujo sanguíneo cerebral, lo que determina la pre-sencia de injuria neuronal.1Los factores de riesgo se clasifican en modificables y no modi-ficables entre estos últimos, los más frecuentes son: la hiperten-sión arterial, diabetes mellitus, obesidad, tabaco y sedentarismo, y su frecuencia es notablemente mayor después de los 65 años de edad (Anexo 1).1La Enfermedad Cerebrovascular Isquémica se caracteriza por ser la segunda causa de mortalidad a nivel mundial, y la ter-cera en causar discapacidad. En 2019, según el reporte del Ins-tituto Nacional de Estadísticas y Censos (INEC), se registraron 4577 fallecimientos producto de esta patología; y se reportó como la tercera causa de fallecimiento en hombres y mujeres en Ecuador.2El impacto económico que genera la ECV-Isquémica es con-siderable, puesto que se ha evidenciado que aproximadamente supone un gasto promedio de 4330 dólares en los primeros 3 meses posterior a presentar esta patología, sin considerar otras consecuencias como la pérdida laboral.3
Ischemic Cerebrovascular Disease (Ischemic-CVD) causes acute neurological alterations, caused by cerebral blood flow dysfunction, which determines the presence of neuronal injury.1Risk factors are classified as modifiable and non-modifiable, among the latter, the most frequent are: arterial hypertension, diabetes mellitus, obesity, smoking and sedentary lifestyle, and their frequency is notably higher after 65 years of age (Anexo 1).1Ischemic Cerebrovascular Disease is characterized as the second leading cause of mortality worldwide, and the third leading cause of disability. In 2019, according to the report of the National Ins-titute of Statistics and Census (INEC), 4577 deaths were regis-tered as a result of this pathology; and it was reported as the third leading cause of death in men and women in Ecuador.2The economic impact of CVD-ischemic stroke is considerable, since it has been shown that approximately US$ 4330 is spent on average in the first 3 months after the onset of this pathology, without considering other consequences such as loss of work.3
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tertiary Healthcare , Brain Ischemia , Brain Infarction , Critical Care , Ischemic Stroke , Neurology , Brain Diseases , Tissue Plasminogen Activator , Stroke , EcuadorABSTRACT
Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)
Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)
Subject(s)
Humans , Tertiary Healthcare/statistics & numerical data , Dental Service, Hospital/statistics & numerical data , Dentists/supply & distribution , Unified Health System , Brazil , Workload , Ecological Studies , Hospital Bed Capacity/statistics & numerical data , Intensive Care Units/statistics & numerical dataABSTRACT
INTRODUCCIÓN: Panamá ocupa la quinta posición en incidencia acumulada de países latinoamericanos y la cuarta posición de muertes en Centroamérica por COVID-19. Hay pocos datos en la población pediátrica panameña. Se describen las características de esta población, admitidos al Hospital Materno Infantil José Domingo De Obaldía, durante el primer año de pandemia. OBJETIVOS: Describir factores clínicos y epidemiológicos asociados al ingreso hospitalario a salas o Unidad Terapia Intensiva Pediátrica (UCIP). MÉTODOS: Estudio descriptivo, transversal, retrospectivo con componente analítico con edad de 1 mes a 13 años 11 meses, de pacientes hospitalizados entre 01 abril 2020 y 30 abril 2021 y diagnóstico de SARS-CoV2 mediante reacción de polimerasa en cadena, detección de antígeno o serología al ingreso o durante su hospitalización. Los datos fueron analizados con IBM SPSS versión 25.0. RESULTADOS: 84 pacientes fueron evaluados, 71 (85%) cumplieron los criterios de inclusión. Los factores de riesgo asociados a ingreso a UCIP: indígena 1,86 (3,08-1,13), referido de Bocas del Toro 9,33(43,43-2), desnutrición 5,6 (30,53-1,02), enfermedad neurológica 7,46 (36,94-1,5), radiografía de tórax con infiltrado intersticial y consolidación 14,93 (123,9-1,8), shock 1,32 (1,58-1,1), alteración del estado de alerta 22,4 (172-2,91), hipoxia 6,22 (23,13-1,67) y disnea 2,61 (5,7-1,19). La mortalidad fue 4%, asociada a compromiso respiratorio y comorbilidades. CONCLUSIONES: Ser indígena, tener comorbilidades, radiografía de tórax (infiltrados intersticiales y consolidados) predominaron en los ingresos a la UCIP.
BACKGROUND: Panama occupies the fifth position in cumulative incidence of Latin American countries and the fourth position in deaths in Central America from COVID-19. There are few data in the Panamanian pediatric population. The characteristics of this population, admitted to the José Domingo De Obaldia Maternal and Child Hospital, during the first year of the pandemic, are described. AIM: To describe clinical and epidemiological factors associated with hospital admission to wards or Pediatric Intensive Care Unit (PICU). METHODS: Descriptive, cross-sectional, retrospective study with an analytical component with an age range of 1 month to 13 years 11 months, patients hospitalized between April 1,2020 to April 30, 2021 and diagnosis of SARS-CoV2 by polymerase chain reaction, antigen detection, or serology. upon admission or during hospitalization. Data were analyzed with IBM SPSS version 25.0. RESULTS: 84 patients were included, 71 (85%) met the inclusion criteria. Risk factors associated with admission to the PICU: indigenous 1.86 (3.08-1.13), referred from Bocas del Toro 9.33 (43.43-2), malnutrition 5.6 (30.53-1.02), neurological disease 7.46 (36.94-1.5), chest X-ray with interstitial infiltrate and consolidation 14.93 (123.9-1.8), shock 1.32 (1.58-1.1), altered alertness 22.4 (172-2.91), hypoxia 6.22 (23.13-1.67) and dyspnea 2.61 (5.7-1.19). Mortality was 4%, associated with respiratory compromise and comorbidities. CONCLUSIONS: Being indigenous, having comorbidities, chest X-ray (interstitial and consolidated infiltrates) predominated in admissions to the PICU.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Panama , Tertiary Healthcare , Intensive Care Units, Pediatric/statistics & numerical data , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Pandemics , SARS-CoV-2ABSTRACT
INTRODUCCIÓN. La sepsis es un estado de disfunción multisistémica, que se produce por una respuesta desregulada del huésped a la infección. Diversos factores influyen en la gravedad, manifestaciones clínicas y progresión de la sepsis, tales como, heterogeneidad inmunológica y regulación dinámica de las vías de señalización celular. La evolución de los pacientes depende del tratamiento oportuno, las escalas de puntuación clínica permiten saber la mortalidad estimada. OBJETIVO. Evaluar la mortalidad en la unidad de cuidados intensivos; establecer el manejo y la utilidad de aplicar paquetes de medidas o "bundlers" para evitar la progresión a disfunción, fallo multiorgánico y muerte. METODOLOGÍA. Modalidad de investigación tipo revisión sistemática. Se realizó una búsqueda bibliográfica en bases de datos como Google académico, Mendeley, ScienceDirect, Pubmed, revistas como New England Journal Medicine, Critical Care, Journal of the American Medical Association, British Medical Journal. Se obtuvo las guías "Sobreviviendo a la sepsis" actualización 2021, 3 guías internacionales, 10 estudios observacionales, 2 estudios multicéntricos, 5 ensayos aleatorizados, 6 revisiones sistémicas, 5 metaanálisis, 1 reporte de caso clínico, 4 artículos con opiniones de expertos y actualizaciones con el tema mortalidad de la sepsis en UCI con un total de 36 artículos científicos. RESULTADOS. La mortalidad de la sepsis en la unidad de cuidados intensivos, fue menor en el hospital oncológico de Guayaquil, seguido de Australia, Alemania, Quito, Francia, Estados Unidos de Norteamérica y Vietnan, La mortalidad más alta se observa en pacientes con enfermedades del tejido conectivo. DISCUSIÓN. La aplicación de los paquetes de medidas o "bundlers" en la sepsis, se asocia con una mejor supervivencia y menores días de estancia hospitalaria. CONCLUSIÓN. Las escalas SOFA, APACHE II y SAPS II ayudan a predecir la mortalidad de forma eficiente, en la detección y el tratamiento temprano en pacientes con enfermedades agudas y de alto riesgo.
INTRODUCTION. Sepsis is a state of multisystem dysfunction, which is caused by a dysregulated host response to infection. Several factors influence the severity, clinical manifestations and progression of sepsis, such as immunological heterogeneity and dynamic regulation of cell signaling pathways. The evolution of patients depends on timely treatment, clinical scoring scales allow to know the estimated mortality. OBJECTIVE. To evaluate mortality in the intensive care unit; to establish the management and usefulness of applying bundlers to prevent progression to dysfunction, multiorgan failure and death. METHODOLOGY. Systematic review type research modality. A bibliographic search was carried out in databases such as Google Scholar, Mendeley, ScienceDirect, Pubmed, journals such as New England Journal Medicine, Critical Care, Journal of the American Medical Association, British Medical Journal. We obtained the guidelines "Surviving Sepsis" update 2021, 3 international guidelines, 10 observational studies, 2 multicenter studies, 5 randomized trials, 6 systemic reviews, 5 meta-analyses, 1 clinical case report, 4 articles with expert opinions and updates on the subject of sepsis mortality in ICU with a total of 36 scientific articles. RESULTS. The mortality of sepsis in the intensive care unit, was lower in the oncological hospital of Guayaquil, followed by Australia, Germany, Quito, France, United States of America and Vietnam, The highest mortality is observed in patients with connective tissue diseases. DISCUSSION. The application of bundlers in sepsis is associated with better survival and shorter days of hospital stay. CONCLUSIONS. The SOFA, APACHE II and SAPS II scales help to predict mortality efficiently in the early detection and treatment of patients with acute and high-risk disease.
Subject(s)
Humans , Male , Female , Tertiary Healthcare , Hospital Mortality , Systemic Inflammatory Response Syndrome , Sepsis , Organ Dysfunction Scores , Intensive Care Units , Vasodilator Agents , Drug Resistance, Multiple , Candida glabrata , Candida tropicalis , Ecuador , Hypotension , Immunosuppressive Agents , Multiple Organ FailureABSTRACT
de la deglución, los cuales representan todas las alteraciones del proceso fisiológico encargado de llevar el alimento desde la boca al esófago y después al estómago, salvaguardando siempre la protección de las vías respiratorias. OBJETIVO. Definir el manejo óptimo, de la disfagia en pacientes con antecedente de infección severa por COVID-19. METODOLOGÍA. Se realizó una revisión de la literatura científica en las bases de datos PubMed y Elsevier que relacionan el manejo de la disfagia y pacientes con antecedente de infección severa por SARS-CoV-2. Se obtuvo un universo de 134 artículos que cumplieron los criterios de búsqueda. Se seleccionaron 24 documentos, para ser considerados en este estudio. RESULTADOS. La incidencia de disfagia posterior a infección severa por SARS-CoV-2 fue del 23,14%, siendo la disfagia leve la más frecuente 48,0%. Los tratamientos clínicos más empleados en el manejo de la disfagia fueron rehabilitación oral y cambio de textura en la dieta en el 77,23% de los casos, mientras que el único tratamiento quirúrgico empleado fue la traqueotomía 37,31%. Un 12,68% de pacientes recuperó su función deglutoria sin un tratamiento específico. La eficacia de los tratamientos clínicos y quirúrgicos en los pacientes sobrevivientes de la infección severa por SARS-CoV-2 fue del 80,68%, con una media en el tiempo de resolución de 58 días. CONCLUSIÓN. La anamnesis es clave para el diagnóstico de disfagia post COVID-19. El tratamiento puede variar, desde un manejo conservador como cambios en la textura de la dieta hasta tratamientos más invasivos como traqueotomía para mejorar la función deglutoria.
INTRODUCTION. The difficulty to swallow or dysphagia is included within the problems of swallowing, which represent all the alterations of the physiological process in charge of carrying the food from the mouth to the esophagus, and then to the stomach, always taking into account the protection of the airways. OBJECTIVE. To define the optimal management, both clinical and surgical, for the adequate treatment of dysphagia produced as a consequence of severe SARS-CoV-2 infection. METHODOLOGY. A review of the scientific literature was carried out using both PubMed and Elsevier databases, which relate the management of dysphagia and patients with a history of severe SARS-CoV-2 infection. RESULTS. The incidence of dysphagia following severe SARS-CoV-2 infection was of 23,14%, with mild dysphagia being the most frequent 48,00%. The most frequently used clinical treatments for dysphagia management were oral rehabilitation and change in dietary texture in 77,23% of cases, while tracheotomy was the only surgical treatment used 37,31%. A total of 12,68% of patients recovered their swallowing function without specific treatment. The efficacy of clinical and surgical treatments in survivors of severe SARS-CoV-2 infection was 80,68%, with a mean resolution time of 58 days. CONCLUSION. An adequate medical history is key to the diagnosis of post-COVID-19 dysphagia. Treatment can range from conservative management such as changes in diet texture to more invasive treatments such as tracheotomy to improve swallowing function.
Subject(s)
Rehabilitation , Respiration, Artificial , Tracheotomy , Deglutition Disorders/therapy , Deglutition/physiology , COVID-19 , Otolaryngology , Rehabilitation of Speech and Language Disorders , Respiratory Tract Diseases , Speech , Tertiary Healthcare , Pulmonary Medicine , Deglutition Disorders , Respiratory Mechanics , Enteral Nutrition , Aerophagy , Dysgeusia , Ecuador , Exercise Therapy , Pathologists , Gastroenterology , Anosmia , Glossopharyngeal Nerve , Intensive Care Units , Intubation, IntratrachealABSTRACT
INTRODUCCIÓN. La paradoja de la obesidad propone que, en determinadas enfermedades, los enfermos con obesidad tienen menor mortalidad. OBJETIVO. Asociar el índice de masa corporal con la mortalidad a 30 días en adultos con choque séptico. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, multicéntrico. Se analizaron 673 pacientes con choque séptico, ingresados en terapia intensiva de dos hospitales de la ciudad de la ciudad de Quito Ecuador, durante enero 2017 - diciembre 2019. Criterios de inclusión: Mayores a 18 años, choque séptico, registro de peso, talla y condición vital al día 30. Criterios de exclusión: Orden de no reanimación, embarazadas, protocolo de donación de órganos, cuidados paliativos. Las variables se recolectaron a partir de las historias clínicas digitales y físicas de los centros participantes. Las estimaciones de riesgo calculadas se presentaron como OR (Odds Ratio) en el análisis bivariado y OR Adj (OR ajustado) para el análisis multivariado. Un valor de p <0.05 se consideró estadísticamente significativo. Todos los análisis estadísticos se realizaron usando el software estadístico R® (Versión 4.1.2). RESULTADOS. La edad promedio fue de 65 años, índice de masa corporal promedio 25,9 Kg/m2 (+4,9 Kg/m2). El 54,3% tuvo índice de masa corporal > 25 Kg/m2. La mortalidad general fue 49.2%. Sujetos con sobrepeso y obesidad tuvieron menor mortalidad, OR: 0,48 (IC 95%: 0.34, 0.68; p <0.0001) y OR 0.45 (IC 95 %: 0.28, 0.70; p =0.001) respectivamente, con similar tendencia en el análisis multivariado. Los sujetos con peso bajo tuvieron la mayor mortalidad (OR: 2.12. IC 95%: 0.91 - 5.54. p: 0.097). DISCUSIÓN. Los resultados obtenidos apoyan la teoría de paradoja de obesidad, sin embargo, no se realizó evaluación según los niveles de obesidad. CONCLUSIÓN. La mortalidad en choque séptico es menor en sujetos con sobrepeso y obesidad comparada con sujetos con peso normal o bajo peso.
The obesity paradox proposes that, in certain diseases, patients with obesity have lower mortality. OBJECTIVE. To associate body mass index with 30-day mortality in adults with septic shock. MATERIALS AND METHODS. Observational, analytical, retrospective, multicenter, retrospective study. We analyzed 673 patients with septic shock, admitted to intensive care in two hospitals in the city of Quito - Ecuador, during January 2017 - December 2019. Inclusion criteria: older than 18 years, septic shock, weight, height and vital condition at day 30. Exclusion criteria: Do not resuscitate order, pregnant women, organ donation protocol, palliative care. Variables were collected from the digital and physical medical records of the participating centers. Calculated risk estimates were presented as OR (Odds Ratio) in bivariate analysis and OR Adj (adjusted OR) for multivariate analysis. A p value <0.05 was considered statistically significant. All statistical analyses were performed using R® statistical software (Version 4.1.2). RESULTS. The mean age was 65 years, mean body mass index 25.9 kg/m2 (+4.9 kg/m2). Body mass index > 25 kg/m2 was 54.3%. Overall mortality was 49.2%. Overweight and obese subjects had lower mortality, OR: 0.48 (95% CI: 0.34, 0.68; p<0.0001) and OR 0.45 (95 % CI: 0.28, 0.70; p=0.001) respectively, with similar trend in multivariate analysis. Underweight subjects had the highest mortality (OR: 2.12. 95% CI: 0.91 - 5.54. p: 0.097). DISCUSSION. The results obtained support the obesity paradox theory, however, assessment according to obesity levels was not performed. CONCLUSIONS. Mortality in septic shock is lower in overweight and obese subjects compared to normal weight or underweight subjects.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Shock, Septic , Body Mass Index , Mortality , Critical Care , Focal Infection , Obesity , Bacterial Infections , Vasoconstrictor Agents , Tertiary Healthcare , APACHE , Ecuador , Overweight , Organ Dysfunction Scores , Protective Factors , Obesity Paradox , Intensive Care UnitsABSTRACT
BACKGROUND The knowledge about the epidemiological profile of patients admitted to the hospital for severe COVID infection, allows an adequate health care planning and resource allocation. AIM: To describe the epidemiology of patients with COVID-19 admitted to a public hospital between March 2020 and July 2021. Material and Methods: Demographic variables, comorbidities, ventilatory support requirements, and hospital resources were recorded from clinical records and hospital databases of diagnosis related groups. The primary outcomes were overall mortality and need of ventilatory support. RESULTS: In the study period, 4,474 patients (56% males) were hospitalized with a diagnosis of COVID-19. Overall mortality was 25.8% and in-hospital mortality was 18%. Invasive and non-invasive ventilatory support was required in 1349 (30.2%) and 2060 (46%) patients, respectively. The most common comorbidities in admitted patients were diabetes mellitus (29.2%), chronic kidney disease (11.1%), and chronic liver disease (10.4%). The readmission rate was 3.2%. CONCLUSIONS: Mortality associated with COVID-19 in this hospital was similar to the rates reported abroad. Local risk predictors for this infection should be identified.
Subject(s)
Humans , Male , Female , COVID-19 , Tertiary Healthcare , Retrospective Studies , Hospital Mortality , SARS-CoV-2 , Hospitalization , Hospitals, PublicABSTRACT
Introducción. En las unidades de cuidados intensivos pediátricos, se utiliza gran cantidad de medicamentos, muchos prescritos fuera de las condiciones establecidas en su ficha técnica (prescripciones off-label y unlicensed). El objetivo de este estudio fue describir el uso de medicamentos y estimar la prevalencia de fármacos off-label y unlicensed en una unidad de cuidados intensivos pediátricos de un hospital de tercer nivel español. Población y métodos. Estudio transversal, observacional, de una cohorte de niños ingresados en una unidad de cuidados intensivos pediátricos. El estudio se llevó a cabo en 2017. Se revisó cada fármaco prescrito, sus condiciones de uso y administración. Además, se analizaron las fichas técnicas de los fármacos implicados con la finalidad de identificar si el uso de los medicamentos se realizaba según sus condiciones de autorización, o bien se hacía fuera de prospecto (off-label) o como unlicensed. Resultados. La muestra fue de 97 pacientes. El 74,2 % (n = 72) de los pacientes recibieron algún fármaco off-label o unlicensed. El 23,8 % (n = 243) de las prescripciones fueron off-label y el 8,7 % (n = 89), unlicensed. El subanálisis realizado por grupos de edad mostró que el grupo de edad que recibió mayor número de prescripciones totales (n = 611) y el mayor porcentaje de fármacos prescritos en condiciones off-label y/o unlicensed (38,4 %) fue el de menores de 2 años. Conclusiones. La prescripción de fármacos off-label y/o unlicensed es una práctica habitual en la unidad de cuidados intensivos pediátricos. Este estudio permite documentar la complejidad de la terapéutica en niños.
Introduction. In pediatric intensive care units, a large number of drugs are used, many of which are prescribed for condition beyond those established in their summary of product characteristics (off-label and unlicensed drug prescriptions). The objective of this study was to describe drug use and estimate the prevalence of off-label and unlicensed drugs in a pediatric intensive care unit of a tertiary care Spanish hospital. Population and methods. Cross-sectional, observational study with a single cohort of children admitted to a pediatric intensive care unit. The study was conducted in 2017. Each drug prescription, its conditions of use and administration were reviewed. In addition, the summary of product characteristics of drugs used were analyzed in order to identify whether they were used according to their conditions of authorization, or whether they were used in an off-label or unlicensed manner. Results. The sample included 97 patients. At least one off-label or unlicensed drug was administered to 74.2% (n = 72) of patients; 23.8% (n = 243) corresponded to off-label prescriptions and 8.7% (n = 89), unlicensed prescriptions. A sub-analysis by age group showed that the age group that received a higher number of total prescriptions (n = 611) and a higher percentage of off-label and/or unlicensed drug prescriptions (38.4%) was under 2 years of age. Conclusions. Off-label and/or unlicensed drug prescription is a common practice in the pediatric intensive care unit. This study allowed us to document the complexity of therapeutics in children.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Off-Label Use , Tertiary Healthcare , Pharmaceutical Preparations , Cross-Sectional Studies , Prospective Studies , HospitalsABSTRACT
Introducción. Bartonella henselae es el agente etiológico de la enfermedad por arañazo de gato. Afecta a niños y a adultos jóvenes. El espectro clínico es amplio; la forma de presentación más frecuente es la linfadenopatía única. El objetivo de este estudio fue analizar epidemiología, características clínicas y evolución de esta enfermedad en un hospital de alta complejidad de Argentina. Población y métodos. Estudio retrospectivo, descriptivo y observacional realizado en un hospital pediátrico de tercer nivel, desde el 01 de enero de 2019 hasta el 30 de junio de 2021. Se incluyeron niños de 0 a 16 años con clínica compatible y serología positiva. Resultados. Se incluyeron 150 niños, con una media de edad de 7,9 años ± 3,68. El 68,7 % refirió tener contacto con gatos. El motivo de consulta más frecuente fueron las adenopatías únicas (84,7 %) localizadas en cabeza y cuello. El síndrome febril sin foco motivó la consulta en el 15,5 % de los casos, con ecografía abdominal patológica en el 85,7 %. Presentó IgM e IgG positivas el 88 %. Con el resultado de la serología positiva, el 44 % recibió tratamiento antibiótico. Las adenopatías prolongadas fueron la principal causa de su instauración; el más utilizado fue la azitromicina (42,4 %). El 14 % (n = 21) requirió internación. Conclusiones. El diagnóstico implica sospecha clínica, nexo epidemiológico y exámenes complementarios. Su forma típica son las adenomegalias únicas localizadas en cabeza y cuello. Debido a la alta frecuencia de compromiso hepatoesplénico, la realización de ecografía abdominal estaría indicada en niños con fiebre.
Introduction. Bartonella henselae is the etiologic agent in cat-scratch disease. It affects children and young adults. The clinical spectrum is wide; the most common clinical presentation is a solitary lymphadenopathy. The objective of this study was to analyze the epidemiology, clinical features, and course of this disease in a tertiary care hospital in Argentina. Population and methods. Retrospective, descriptive, and observational study conducted at a tertiary care pediatric hospital from January 1st, 2019 to June 30 th, 2021. Children aged 0 to 16 years with compatible clinical signs and symptoms and positive serology were included. Results. A total of 150 patients were included; their mean age was 7.9 years ± 3.68. Of them, 68.7% reported having contact with cats. The most common reason for consultation was the presence of solitary lymphadenopathies (84.7%) in the head and neck. Febrile syndrome without source was the reason for consultation in 15.5% of cases, with a pathological abdominal ultrasound scan in 85.7%. IgM and IgG were positive in 88%. With the result of a positive serology test, 44% received antibiotic treatment. Protracted lymphadenopathy was the main reason for antibiotic treatment; the agent most commonly used was azithromycin (42.4%). Fourteen percent (n = 21) required hospitalization. Conclusions. Diagnosis is based on clinical suspicion, epidemiological history, and complementary testing. Its typical presentation is a solitary enlarged lymph node in the head and neck. Due to the high frequency of hepatosplenic involvement, an abdominal ultrasound scan would be indicated in children with fever.
Subject(s)
Humans , Animals , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cat-Scratch Disease/diagnosis , Cat-Scratch Disease/epidemiology , Lymphadenopathy/diagnosis , Lymphadenopathy/etiology , Lymphadenopathy/epidemiology , Tertiary Healthcare , Cats , Retrospective Studies , Hospitals , Anti-Bacterial Agents/therapeutic useABSTRACT
Abstract Objective To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Method Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. Results A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale (p= 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale (p= 0.468 and p= 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 (p> 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence (p< 0.005). Conclusions The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.
Resumo Objetivo Avaliar o alinhamento espinopélvico em pacientes com fratura toracolombar do tipo explosão (FTE) sem déficit neurológico tratados de forma não operatória e operatória em um hospital terciário de referência em trauma. Método Estudo transversal retrospectivo de pacientes com FTE apenas da região toracolombar, de nível único, do tipo A3 e A4 AOSpine. Análise de dados clínicos, dor lombar (escala visual analógica [EVA]), Escala de Denis, qualidade de vida (SF-36), parâmetros radiográficos sagitais (cifose torácica [CT], cifose toracolombar [CTL], lordose lombar [LL] e eixo vertical sagital [EVS]) e espinopélvicos (incidência pélvica [IP], versão pélvica [VP], inclinação sacral [IS] e a discrepância entre incidência pélvica e lordose lombar [IP-LL]) de pacientes tratados de forma operatória e não operatória. Resultados O presente estudo avaliou um total de 50 indivíduos com uma média de 50 anos de idade com acompanhamento médio de 109 meses (mínimo de 19 e máximo de 306 meses). Houve diferença significativa entre os tratamentos para Denis trabalho (p= 0,046) a favor do tratamento não operatório. Não houve diferença significativa entre os tratamentos para EVA dor lombar e Denis dor (p= 0,468 e p= 0,623). Não houve diferença significante entre os tratamentos em nenhum dos domínios avaliados do SF-36 (p> 0,05). Parâmetros radiográficos não se mostraram diferentes entre os grupos analisados; contudo, todos os parâmetros radiográficos mostraram diferença significante entre a população considerada assintomática, com exceção da incidência pélvica (p< 0,005). Conclusões O alinhamento espinopélvico foi normal em pacientes com FTE sem déficit neurológico tratados de forma não operatória e operatória, após acompanhamento mínimo de 19 meses. Entretanto, estes pacientes apresentaram maior média de versão pélvica e de discrepância entre lordose lombar e incidência pélvica quando comparados com os valores de referência da população brasileira.
Subject(s)
Humans , Spinal Curvatures , Spinal Injuries , Tertiary Healthcare , Spinal FracturesABSTRACT
Human immunodeficiency virus (HIV) treatment program has grown exponentially in Nigeria largely due to improved Antiretroviral therapy (ART) regimen which has changed the course of HIV/AIDs by enabling patients to live longer, raising concern of the co-existence of HIV with other chronic illnesses, notably non communicable diseases (NCDs). This study determined the prevalence of hypertension and diabetes mellitus among HIV positive patients in a tertiary institution in Makurdi, North-central Nigeria.Methods: A cross-sectional study was conducted at the ART clinic among clients ≥ aged 21 years old living with HIV /or enrolled between October 2022, and March 30, 2023. The clients' information was extracted from the register using a Proforma and all the clients who had attended their follow up clinic visit within the study period were included in the study. Data was analyzed using SPSS version 21.0. Categorical data were presented as frequencies and percentages. Results: Among the 491 patients, 404 (82.3%) had HIV only and 87 (17.7%) had HIV and at least one comorbidity, namely DM and/or HTN. Hypertension was the most prevalent comorbidity affecting 15.5% of the patients while 1.0% of them were diabetic. The middle aged (30-49) patients, females (63.2%) had the highest prevalence of comorbidities and some of those with normal weight (35.6%) also had the highest prevalence of NCDs.Conclusion: Non-communicable diseases are common among people living with HIV. There is need to encourage early diagnosis and treatment of non-communicable diseases in HIV positive patients in Nigeria.
Subject(s)
Humans , Tertiary Healthcare , Antiretroviral Therapy, Highly Active , Diabetes Mellitus , Prevalence , HIV , Noncommunicable Diseases , HypertensionABSTRACT
La hipertrigliceridemia severa es una de las principales causas etiológicas de la pancreatitis aguda, donde la literatura internacional la posiciona como la tercera causa. Sus causas gatillantes, comorbilidades, severidad y evolución son importantes de conocer para evitar futuros episodios. En Chile, a nuestro entender, no tenemos literatura sobre esta asociación, por lo que presentamos datos de un hospital terciario, destacando 15 casos de pancreatitis aguda en 5 años de estudio, casi la mitad de ellos con antecedentes previos de hipertrigliceridemia, un porcentaje importante de los casos con cuadros graves y con complicaciones intrahospitalarias y que la diabetes mellitus tipo 2 fue la principal condición asociada a la hipertrigliceridemia severa.
Severe hypertriglyceridaemia is one of the main aetiological causes of acute pancreatitis, with international literature ranking it as the third leading cause. Its triggering causes, comorbidities, severity and evolution are important to know in order to avoid future episodes. In Chile, to our knowledge, we have no literature on this association, so we present data from a tertiary hospital, highlighting 15 cases of acute pancreatitis in 5 years of study, almost half of them with a previous history of hypertriglyceridaemia, a significant percentage of cases with severe symptoms and in-hospital complications, and that type 2 diabetes mellitus was the main condition associated with severe hypertriglyceridaemia.