Diferencias cliniconeurológicas en pacientes con enfermedad cerebrovascular isquémica de edades menores y mayores de 65 años

Introducción: La enfermedad cerebrovascular isquémica tiene una alta frecuencia debida, fundamentalmente, al envejecimiento poblacional. Objetivo: Comparar las características clínicas de pacientes con enfermedad cerebrovascular isquémica de dos grupos etarios. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo en 36 pacientes con enfermedad cerebrovascular isquémica correspondientes a dos grupos etarios (65 y menos años y mayores de 65), quienes fueron atendidos en el Instituto de Neurología y Neurocirugía, La Habana, de enero a diciembre del 2017. Al respecto, se analizaron variables demográficas y clínicas y se aplicaron diferentes pruebas estadísticas para comparar. Resultados: Se obtuvo un aumento significativo de pacientes hipertensos (88,9 %) en el grupo etario mayor de 65 años. La mediana de la escala de ictus del National Institute of Health fue superior en estos pacientes (mediana [10-90 percentil]: 9,5 (4-19]). Hubo incremento estadístico de los mayores de 65 años con parálisis parcial de la mirada y ataxia; en tanto, la monoparesia y la extinción visual predominaron en los de 65 y menos años. Dicha escala mostró un aumento estadístico en el ictus aterotrombótico y cardioembólico en comparación con otras causas en ambos grupos. Los pacientes mayores de 65 años con solo un factor de riesgo o ninguno y los que eran hipertensos tuvieron mayor puntuación de la escala. Conclusiones: El grado de afectación neurológica fue superior en los mayores de 65 años que tenían un factor de riesgo y en aquellos con hipertensión arterial. Puede sugerirse que los mecanismos moleculares y fisiopatológicos de estos pacientes varían según la edad.

Introduction: The ischemic cerebrovascular disease has a high frequency due to the population aging mainly. Objective: To compare clinical characteristics of patients with ischemic cerebrovascular of two age groups. Methods: A descriptive, cross-sectional, retrospective study was carried out in the Neurology and Neurosurgery Institute in Havana, from January to December, 2017 in patients with ischemic cerebrovascular disease; 36 individuals of both age groups. In this regard, demographic variables, risk factors, clinical manifestations, coma scale and neurological deficiency, etiology and localization of the ischemic ictus were analyzed. Results: The 65 years group had a significant increase of hypertensive patients (88.9%). The average of the National Institute of Health stroke scale was superior in these patients (median [10-90 percentile]: 9.5 [4-19]). There was statistical increment of over 65 years patients with partial paralysis of the look and ataxia, but monoparesis and visual extinction in the age under 65 years. Such a scale had a statistical increase in the atherothrombotic and cardioembolic ictus in comparison with other etiologies in both patient groups. The over 65 years patients with just one risk factor or and those with hypertension had a higher punctuation of the scale. Conclusions: The degree of neurological affectation was higher in over 65 years patients that had a risk factor and in those with hypertension. As a result it could be suggested that the molecular and pathophysiolologic mechanisms of these patients vary with the age.

Perfil de óbitos por dengue (2015-2023) em cidade paulista: desafios para a saúde pública / Dengue death profile (2015-2023) in a são paulo municipality: challenges for public health / Perfil de muertes por dengue (2015-2023) en una ciudad del interior del estado de são paulo: desafíos para la salud pública

O número de casos de dengue no continente americano, no primeiro semestre de 2023, superou o total de casos de 2022 e o Brasil lidera com 2,3 milhões de ocorrências da doença e 769 mortes. A dengue se expande no mundo e já é considerada endêmica em mais de 100 países. Este estudo objetiva caracterizar o perfil dos óbitos por dengue, no período de 2015 a 2023, em uma cidade do interior do estado de São Paulo. Este é um estudo transversal, retrospectivo e descritivo, com análise de dados secundários do Sistema Nacional de Notificação (Sinan), Sistema de Mortalidade (SIM) e banco de dados dos óbitos por dengue, do comitê de mortalidade da vigilância epidemiológica municipal. A capacidade das equipes de saúde em identificar os sinais e sintomas ocorreu em apenas 42,9% dos casos antes da internação e do óbito, seguida por no dia do óbito (11,7%) e após o óbito (8,8%). A mortalidade por dengue predominou em indivíduos do sexo masculino (51,4%), com idade mediana de 74 anos. A análise dos dados demonstrou que o manejo clínico da dengue ainda é desafiador para a equipe de saúde, que precisa se manter permanentemente capacitada para o reconhecimento dos sintomas, sinais de alarme e gravidade, para a correta condução de cada caso, visando a redução da mortalidade.

In the first half of 2023, the number of dengue cases in the Americas surpassed the total for 2022, with Brazil leading the list with 2.3 million disease occurrences and 769 deaths. Dengue is expanding globally and is already considered endemic in more than 100 countries. This study characterizes the profile of dengue deaths from 2015 to 2023 in a municipality of São Paulo. A cross-sectional, retrospective, and descriptive study was conducted with secondary data obtained from the National Notification System (SINAN), Mortality System (SIM), and dengue death database of the municipal epidemiological surveillance mortality committee. Only in 42.9% of cases were the health teams able to identify the signs and symptoms before hospitalization and death, followed by after death (8.8%) and on the day of death (11.7%). Dengue mortality predominated among male individuals (51.4%) with a median age of 74 years. Data analysis showed that the clinical management of dengue remains challenging for health teams, who needs continuous training to recognize the signs and symptoms, warning signs, and severity for correct management of each case, aiming to reduce mortality.

Los casos de dengue en las Américas superaron en el primer semestre de 2023 al total de casos de 2022, en el cual lidera Brasil con 2,3 millones de notificaciones de la enfermedad y 769 muertes. El dengue se expande por el mundo, y más de 100 países ya lo consideran una endemia. Este estudio tiene como objetivo caracterizar el perfil de las muertes por dengue en el período de 2015 a 2023, en una ciudad del interior del estado de São Paulo. Se trata de un estudio transversal, retrospectivo y descriptivo con análisis de datos secundarios del Sistema Nacional de Notificación (SINAN), del Sistema de Mortalidad (SIM) y de la Base de Datos de Muertes por Dengue del Comité de Mortalidad de la Vigilancia Epidemiológica Municipal. Los equipos de salud fueron capaces de identificar los signos y síntomas en solo el 42,9% de los casos antes de la hospitalización y de la muerte, seguida del día de la muerte (11,7%) y tras la muerte (8,8%). La mortalidad por dengue predominó en individuos del sexo masculino (51,4%) con una edad media de 74 años. El análisis de datos demostró que el manejo clínico del dengue sigue siendo un desafío para el equipo de salud, quien necesita mantenerse capacitado continuamente para detectar los signos y síntomas, señales de alarma y gravedad, para la correcta conducción de cada caso, con el objetivo de reducir la mortalidad.

Clinical features and serum lipidomic profile of patients with nonalcoholic fatty liver disease and healthy individuals in the overweight population / 临床肝胆病杂志

objectiveTo investigate the differences in clinical indices and lipid metabolism between the patients with nonalcoholic fatty liver disease （NAFLD） and healthy individuals in the overweight population. MethodsIn this study， body mass index （BMI）>23 kg/m2 was defined as overweight. A total of 62 overweight patients with NAFLD who were admitted to Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2020 to April 2021 were enrolled as overweight NAFLD group， and 50 overweight individuals who underwent physical examination during the same period of time were enrolled as control group. Clinical information and blood biochemical parameters were recorded for all subjects. Ultra-performance liquid chromatography-tandem mass spectrometry was used to analyze serum lipidomic profile， and principal component analysis and orthogonal partial least squares-discriminant analysis were used to perform the multivariate statistical analysis of lipidomic data. The chi-square test was used for comparison of categorical data between two groups， and the independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups. ResultsThe overweight NAFLD group had a significantly higher BMI than the overweight control group （Z=-2.365， P=0.018）. As for serological markers， compared with the overweight control group， the overweight NAFLD group had significantly higher levels of red blood cells， hemoglobin， hematocrit， uric acid， total protein， globulin， alkaline phosphatase， gamma-glutamyl transpeptidase， alanine aminotransferase， aspartate aminotransferase， cholinesterase， low-density lipoprotein， total cholesterol， triglyceride， apolipoprotein B， and blood glucose （all P<0.05）. The lipidomic analysis showed that there was a significant difference in lipid metabolism between the two groups， and a total of 493 differentially expressed lipids were identified （VIP value>1， P<0.05）， among which 143 lipids were significantly upregulated and 350 lipids were significantly downregulated in the overweight NAFLD group. The mean total fatty acid content in the overweight NAFLD group was 3.6 times that in the overweight control group. Compared with the overweight control group， the overweight NAFLD group had a significant reduction in the content of triglyceride with>3 unsaturated bonds （P<0.001） and a significant increase in the content of triglyceride with ≤3 unsaturated bonds （P<0.001）. ConclusionCompared with healthy overweight individuals， overweight NAFLD patients tend to have significant abnormalities in some biochemical parameters and lipid metabolites， with significant increases in the content of fatty acid in blood and the types of saturated fat chains in triglycerides.

Efficacy of repetitive transcranial magnetic stimulation in the treatment of negative symptoms in patients with schizophrenia / 中国基层医药

Objective:To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of negative symptoms in patients with schizophrenia and its effect on brain-derived neurotrophic factor (BDNF).Methods:A total of 130 patients with negative symptoms of schizophrenia who received treatment at The Third Hospital of Quzhou from March 2021 to March 2023 were included in this randomized controlled study. They were divided into a control group and a study group ( n = 65 per group). Both groups of patients were treated with antipsychotic drugs. Based on this, patients in the study group were treated with high-frequency rTMS, while those in the control group were treated with pseudo-rTMS. After 8 weeks of treatment, Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS), and Personal and Social Performance Scale (PSP) scores were evaluated in each group before and after treatment. Serum BDNF levels were compared between the two groups before and after treatment. Adverse reactions were observed during the treatment. Results:After 8 weeks of treatment, the PANSS negative subscale score and SANS score in the study group were (16.45 ± 3.98) points and (35.41 ± 6.29) points, respectively, which were significantly lower than (20.08 ± 4.16) points and (41.76 ± 7.36) points in the control group ( t = -7.46, -6.85, both P < 0.05). PSP score in the study group was (66.85 ± 8.93) points, which was significantly higher than (58.79 ± 8.28) points in the control group ( t = 5.62, P < 0.001). There were no significant differences in PANSS positive subscale score, general psychopathology scale score or total score between the two groups (all P > 0.05). After 8 weeks of treatment, the serum BDNF level in the study group was (12.05 ± 2.13) μg/L, which was significantly higher than (8.86 ± 1.94) μg/L in the control group ( t = 9.73, P < 0.001). There was no significant difference in the incidence of adverse reactions during the treatment period between the two groups ( P > 0.05). Serum BDNF level was negatively correlated with PANSS and SANS scores ( r = -0.81, -0.85, both P < 0.001), while it was positively correlated with PSP score ( r = 0.82, P < 0.001). Conclusion:High-frequency rTMS can effectively alleviate the negative symptoms of schizophrenia, increase the secretion of BDNF, and be highly safe.

Efectividad de la intervención de enfermería Prostactive para el automanejo de síntomas en hombres con cáncer de próstata en tratamiento / Effectiveness of the Prostactive nursing intervention for symptom self-management in men with prostate cancer

Introducción: El cáncer de próstata es el cáncer de mayor prevalencia en hombres. La enfermedad y el tratamiento generan síntomas urinarios, intestinales, sexuales, hormonales y emocionales que repercuten en el rendimiento funcional de los hombres quienes las padecen, el automanejo de los síntomas ha sido considerada desde la Organización Mundial de la Salud (OMS) como una estrategia para permitir que los hombres puedan conocer mejor su enfermedad y generar habilidades para manejarla desde un ámbito domiciliario. Objetivo: Determinar la efectividad de la Intervención Prostactive para el automanejo de síntomas y su repercusión en el rendimiento funcional, en personas con cáncer de próstata en tratamiento que asisten a la Unidad Oncológica de la Clínica Nogales entre 2022 y 2023. Materiales y métodos: Es un diseño experimental paralelo determinado por la conformación aleatoria de dos grupos con un tamaño de muestra de 100 participantes, 50 para el control (GC) que recibirá el cuidado habitual y 50 para el experimental (GI) al cual se implementó la intervención Prostactive que consta de 4 sesiones presenciales en las cuales se le explicará cómo manejar los síntomas que presenta debido al cáncer de próstata y el tratamiento. Posteriormente se realizó el seguimiento telefónico para conocer el estado de salud a la semana 8 después de las sesiones presenciales. Resultados: la Intervención Prostactive mejoró los niveles de autoeficacia en los participantes del GI, el rendimiento funcional (0,0001) además del automanejo de síntomas urinarios con diferencias estadísticamente significativas frente al GC. No se identificaron cambios en los síntomas obstructivos (valor P= 0.6), síntomas sexuales y síntomas hormonales. Conclusión: La Intervención Prostactive mejora el automanejo de síntomas en hombres con CP en tratamiento, además de la autoeficacia y el Rendimiento Funcional. (AU)

Introduction: Prostate cancer is more prevalent in men. The disease and treatment generate urinary, intestinal, sexual, hormonal and emotional symptoms that impact the functional performance of men who suffer from them. Self-management of symptoms has been considered since the World Health Organization (WHO) as a strategy to allow men to better understand their disease and generate skills to manage it from a home environment. Objective: Determine the effectiveness of the Prostactive Intervention for the selfmanagement of symptoms and its impact on functional performance, in people with prostate cancer undergoing treatment who attend the Oncology Unit of the Nogales Clinic between 2022 and 2023. Materials and methods: It is a parallel experimental design determined by the random formation of two groups with a sample size of 100 participants, 50 for the control (CG) who will receive the usual care and 50 for the experimental (GI) to which the Prostactive intervention was implemented, which It consists of 4 face-to-face sessions in which you will be explained how to manage the symptoms you present due to prostate cancer and the treatment. Subsequently, telephone follow-up was carried out to determine the health status at week 8 after the face-to-face sessions. Results: the Prostactive Intervention improved the levels of self-efficacy in the IG participants, functional performance (0.0001) in addition to the self-management of urinary symptoms with statistically significant differences compared to the CG. No changes were identified in obstructive symptoms (P value= 0.6), sexual symptoms, and hormonal symptoms. Conclusion: The Prostactive Intervention improves symptom self-management in men with CP undergoing treatment, in addition to self-efficacy and Functional Performance. (AU)

Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde / Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies / Panorama de la COVID larga en Brasil: un análisis preliminar de una encuesta para pensar en políticas de salud

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Analysis of signs and symptoms in confirmed cases of severe dengue among children aged 0 to 10 years old

ABSTRACT Objective: The prevalent symptoms of severe dengue in pediatric patients are divided into three subgroups: severe plasma leakage, severe bleeding, and severe organ damage. In addition, the seasonal patterns of the disease and the outcomes of cure or death from dengue were evaluated. Methods: An epidemiological, observational, analytical, cross-sectional study was conducted with data from the Notifiable Disease Information System (SINAN - Sistema de Informação de Agravos de Notificação and DATASUS - Departamento de Informática do Sistema Único de Saúde) of the Ministry of Health from 2019 to 2020. Results: During the study period, 1,857 cases of severe dengue were observed in the pediatric age group, with the most common symptoms being respiratory failure, melena, hematemesis, and altered level of consciousness. The total proportion of patients hospitalized for severe dengue was 89.6%, and 51.2% of these patients died, corroborating the importance of early detection of the disease. Conclusion: Severe dengue is more prevalent during the seasonal period, with hot and humid characteristics owing to the mechanism involved in the viral cycle. The most prevalent symptoms of severe dengue in pediatric patients were respiratory failure alone, gastrointestinal bleeding, and altered level of consciousness. It is important to identify signs of severity for early intervention and a better prognosis, considering that death is closely related to a delayed diagnosis.

Sleep duration and quality of Brazilian nursing staff who work in shifts / Duração e qualidade do sono da equipe de enfermagem brasileira que trabalha em turnos / Duración y calidad del sueño del personal de enfermería brasileño que trabaja por turnos

ABSTRACT Objective: to analyze sleep duration and sleep quality in nursing professionals who work in shifts. Method: this is a cross-sectional, analytical research, carried out between September 2017 and April 2018, at a public hospital in southern Brazil, with the nursing team. A socio-occupational and health symptoms questionnaire, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index were used. Data are presented as descriptive and inferential statistics, bivariate analysis, and binary logistic regression. Results: participants were 308 nursing professionals with a predominance of long-term sleep, absence of drowsiness, and poor sleep quality. Short-term sleep (<6h) was associated with day shift and poor sleep quality. Sleep quality was associated with presence excessive daytime sleepiness and work day shift. Conclusion: work shift, insomnia and headache were the main factors related short-term sleep for nursing professionals. The results may justify the development of intervention research for workers' health.

RESUMO Objetivo: analisar a duração e qualidade do sono em profissionais de enfermagem que trabalham em turnos. Método: pesquisa transversal, analítica, realizada entre setembro de 2017 e abril de 2018, em hospital público do Sul do Brasil, com equipe de enfermagem. Foram utilizados questionário sócio-ocupacional e de sintomas de saúde, Escala de Sonolência de Epworth e Índice de Qualidade do Sono de Pittsburgh. Os dados são apresentados como estatística descritiva e inferencial, análise bivariada e regressão logística binária. Resultados: participaram 308 profissionais de enfermagem com predomínio de sono prolongado, ausência de sonolência e má qualidade do sono. Sono de curta duração (<6h) foi associado a turno diurno e má qualidade do sono. Qualidade do sono esteve associada à presença de sonolência diurna excessiva e trabalho diurno. Conclusão: turno de trabalho, insônia e cefaleia foram os principais fatores relacionados ao sono de curta duração para profissionais de enfermagem. Os resultados podem justificar o desenvolvimento de pesquisas de intervenção para a saúde do trabalhador.

RESUMEN Objetivo: analizar la duración y calidad del sueño en profesionales de enfermería que trabajan por turnos. Método: investigación analítica, transversal, realizada entre septiembre de 2017 y abril de 2018, en un hospital público del sur de Brasil, con el equipo de enfermería. Se utilizó el cuestionario sociolaboral y de síntomas de salud, la Escala de Somnolencia de Epworth y el Índice de Calidad del Sueño de Pittsburgh. Los datos se presentan como estadística descriptiva e inferencial, análisis bivariado y regresión logística binaria. Resultados: participaron 308 profesionales de enfermería, con predominio de sueño prolongado, ausencia de somnolencia y mala calidad del sueño. La duración corta del sueño (<6 h) se asoció con turnos de día y mala calidad del sueño. La calidad del sueño se asoció con la presencia de somnolencia diurna excesiva y con el trabajo diurno. Conclusión: los turnos de trabajo, el insomnio y la cefalea fueron los principales factores relacionados con la falta de sueño de los profesionales de enfermería. Los resultados pueden justificar el desarrollo de investigaciones de intervención para la salud de los trabajadores.

Factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer

Introducción: La principal causa de demencia degenerativa es la enfermedad de Alzhéimer. En la población cubana, una de cada cuatro personas de 65 años y más fallece por esta enfermedad u otra forma de demencia. Objetivo : Identificar los factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer en el Hospital Psiquiátrico Universitario Rene Vallejo Ortiz entre enero de 2013 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo integrado por todos los pacientes ingresados en la mencionada institución asistencial y docente. La muestra no probabilística y a criterio de los autores la integraron 77 pacientes adultos con el diagnóstico de la enfermedad en el periodo de estudio señalado. Las historias clínicas fueron la fuente secundaria de información. Se utilizó estadística descriptiva e inferencial. La información se resumió en tablas y gráficos. Resultados: El 90,6 % presentaban más de 60 años y más de la mitad eran del sexo masculino (54,5 %). La mayoría de los pacientes presentaron diversos síntomas asociados. Lo trastornos de personalidad y orientación se constataron en el 75,3 % mientras que los de memoria en el 72,7 %. Conclusiones: El agravamiento clínico luego del ingreso hospitalario se acentuó en aquellos pacientes sin escolaridad, solteros, desocupados, con enfermedades cerebro vasculares y presencia de familias disfuncionales presentaron. Los pacientes anémicos o con signos de irritación cortical focal en región frontoparietal con generalización secundaria presentaron mayoritariamente un empeoramiento clínico.

Introduction: The main cause of degenerative dementia is Alzheimer's disease. In the Cuban population, one in four people aged 65 and over dies from this disease or another form of dementia. Objective: To identify the risk factors associated with the clinical worsening of patients admitted with Alzheimer's disease at the Rene Vallejo Ortiz University Psychiatric Hospital. Methods: An observational, descriptive and cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned healthcare and teaching institution. The non-probabilistic sample and at the discretion of the authors was made up of 77 adult patients with the diagnosis of the disease in the indicated study period between January 2013 and December 2022. Medical records were the secondary source of information. Descriptive and inferential statistics were used. The information was summarized in tables and graphics. Results: 90.6% were over 60 years old and more than half were male (54.5%). Most patients presented various associated symptoms. Personality and orientation disorders were found in 75.3%, while memory disorders were found in 72.7%. Conclusions: The clinical worsening after hospital admission was accentuated in those patients without schooling, single, unemployed, with cerebrovascular diseases and presence of dysfunctional families. Anemic patients or patients with signs of focal cortical irritation in the frontoparietal region with secondary generalization mostly presented clinical worsening.

Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha / Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project / Alteraciones respiratorias en niños expuestos al polvo de residuos de la minería en Brumadinho, Minas Gerais, Brasil: Proyecto Bruminha

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Velocidade da marcha associada aos fatores clínicos em idosos na atenção primária à saúde: revisão integrativa / Gait speed associated with clinical factors in the elderly in primary health care: integrative review / Velocidad de la marcha asociada a factores clínicos en ancianos en atención primaria: una revisión integradora

RESUMO Objetivo: analisar a produção científica nacional e internacional sobre a velocidade da marcha associada aos sinais, sintomas e fatores clínicos em pessoas idosas da atenção primária à saúde. Método: revisão integrativa de literatura realizada em cinco fontes de dados (Biblioteca Virtual em Saúde, Embase, Web of Science, Cumulative Index To Nursing And Allied Health Literature (CINAHL) e PubMed) com publicações do período de janeiro de 2017 até junho de 2023. Resultados: 13 publicações que atenderam aos critérios de elegibilidade, com predomínio de estudos no idioma inglês. Estudos evidenciaram que a velocidade da marcha reduzida está associada com fraturas (p<0,05), demência (p<0,01), doenças cardiovasculares (p<0,001) e neuropsiquiátricas (p<0,01), quedas (p<0,05) e polifarmácia (p<0,001). Conclusão: alteração no padrão da velocidade de marcha em pessoas idosas está relacionada a diversos fatores clínicos, reforçando a necessidade de novos estudos e o papel norteador da equipe de enfermagem geriátrica na saúde da pessoa idosa.

ABSTRACT Objective: to analyze national and international scientific production on gait speed associated with signs, symptoms, and clinical factors in elderly people in primary health care. Method: integrative literature review carried out in five data sources (Virtual Health Library, Embase, Web of Science, Cumulative Index To Nursing And Allied Health Literature (CINAHL), and PubMed) with publications from January 2017 to June 2023. Results: 13 publications met the eligibility criteria, with a predominance of studies in English. Studies indicated that reduced gait speed is associated with fractures (p<0.05), dementia (p<0.01), cardiovascular (p<0.001) and neuropsychiatric (p<0.01) diseases, falls (p<0.05) and polypharmacy (p<0.001). Conclusion: altered gait speed patterns in the older people are related to various clinical factors, reinforcing the need for further studies and the guiding role of the geriatric nursing team in the health of the older person.

RESUMEN Objetivo: analizar la producción científica nacional e internacional sobre la velocidad de la marcha asociada a signos, síntomas y factores clínicos en personas mayores en atención primaria de salud. Método: revisión bibliográfica integradora realizada en cinco fuentes de datos (Virtual Health Library, Embase, Web of Science, Cumulative Index To Nursing And Allied Health Literature (CINAHL) y PubMed) con publicaciones desde enero de 2017 hasta junio de 2023. Resultados: 13 publicaciones que cumplían los criterios de elegibilidad, con predominio de estudios en inglés. Los estudios han demostrado que la reducción de la velocidad de la marcha se asocia con fracturas (p<0,05), demencia (p<0,01), enfermedades cardiovasculares (p<0,001) y neuropsiquiátricas (p<0,01), caídas (p<0,05) y polifarmacia (p<0,001). Conclusión: la alteración de los patrones de velocidad de la marcha en ancianos está relacionada con diversos factores clínicos, lo que refuerza la necesidad de nuevos estudios y el papel orientador del equipo de enfermería geriátrica en la salud de los ancianos.

Validation and cultural translation for the Brazilian Portuguese version of the Estro-Androgenic- Symptom Questionnaire in Women

Abstract Objective This study aimed to translate and validate the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese language, as we hypothesized that this tool would be consistent for addressing the specific context of hormonal symptoms in menopause. Methods In a cross-sectional study, a total of 119 women with Genitourinary Syndrome of Menopause (GSM) and 119 climacteric women without GSM were included. The EASQ-W was translated, and its psychometric properties were rigorously examined. Participants completed questionnaires covering sociodemographic details, the EASQ-W, and the Menopause Rating Scale (MRS). A subgroup of 173 women was re-invited after 4 weeks for test-retest analysis of the EASQ-W. Additionally, the responsiveness of the questionnaire was evaluated in 30 women who underwent oral hormonal treatment. Results The internal consistency of the EASQ-W was found to be satisfactory in both GSM and control groups (Cronbach's alpha ≥ 0.70). Notably, a floor effect was observed in both groups; however, a ceiling effect was only evident in the sexual domain of the GSM group. Construct validity was established by comparing the EASQ-W with the MRS, yielding statistically significant correlations (0.33831-0.64580, p < 0.001). The test-retest reliability over a 4-week period was demonstrated to be satisfactory in both the GSM and control groups (ICC 0.787-0.977). Furthermore, the EASQ-W exhibited appropriate responsiveness to oral hormonal treatment (p < 0.001). Conclusion This study successfully translated and validated the Estro-Androgenic-Symptom Questionnaire in Women (EASQ-W) into Brazilian Portuguese, with satisfactory internal consistency, test-retest reliability, and construct validity.

Colitis eosinofílica: una entidad aparte / Eosinophilic colitis: a separate entity

Eosinophilic colitis (EoC), a rare immune-mediated disease that is part of the eosinophilic gastrointestinal diseases, is characterized by the presence of an eosinophilic infiltrate in the colonic wall in symptomatic patients. Before considering the diagnosis of EoC, other diseases associated with colonic eosinophilia should be ruled out, such as parasitic infections, drugs, chronic immune-mediated diseases, and neoplasms. The symptoms of EoC are variable and non-specific, being abdominal pain and diarrhea the most common. Although systemic corticosteroids and budesonide have demonstrated their efficacy, these drugs have only been evaluated in case series studies and cli- nical case reports. Herein, we discuss the clinical strategy for diagnosis, therapy selection, and follow-up of EoC

La colitis eosinofílica (CEo), una enfermedad inmunomediada que forma parte de las enfermedades gastrointes- tinales eosinofílicas, se caracteriza por la presencia de infiltrado eosinofílico en la pared del colon en pacientes sintomáticos. Antes de plantear el diagnóstico de una CEo, otras enfermedades asociadas a una eosinofilia coló- nica, incluyendo infecciones parasitarias, fármacos, enfermedades crónicas inmunomediadas y neoplasias, deben ser descartadas. Los síntomas de la CEo son variables e inespecíficos, siendo el dolor abdominal y la diarrea los más frecuentes. Aunque los corticoides sistémicos y la budesonida han demostrado su eficacia, estos fármacos han sido evaluados solo en estudios de serie de casos y reportes de casos clínicos. En este artículo, discutimos la estrategia clínica para el diagnóstico, selección del tratamiento y el seguimiento de la CEo.

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Conhecimento de equipes de enfermagem quanto às manifestações clínicas e grupo de risco para COVID-19 / Knowledge of nursing teams regarding clinical manifestations and risk group for COVID-19 / Conocimiento de los equipos de enfermería sobre manifestaciones clínicas y grupos de riesgo para COVID-19

Objetivo: comparar o conhecimento de enfermeiros e técnicos de enfermagem atutentes em Unidades de Pronto Atendimento quanto ao reconhecimento de manifestações clínicas e grupos de risco para o desenvolvimento da forma grave da COVID-19. Método: estudo descritivo, realizado com 53 profissionais de três unidades de pronto atendimento, com coleta de dados realizada por meio de questionário autorrespondido. Dados analisados por meio de estatística descritiva e inferencial (testes t-student e qui-quadrado). Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa da instituição. Resultados: destaca-se uma associação entre a citação de manifestações clínicas como náuseas e vômitos, grupos de risco e a função, enfermeiros ou técnicos de enfermagem (p<0,05) e o nível de formação, ou seja, os enfermeiros relataram com maior frequência a presença desses sintomas que os técnicos de enfermagem. Conclusão: os profissionais de enfermagem apresentam conhecimento quanto a sintomatologia e grupos de risco, ainda que haja diferença entre o nível profissional(AU)

Objective: to compare the knowledge of nurses and nursing technicians working in Emergency Care Units regarding the recognition of clinical manifestations and risk groups for the development of the severe form of COVID-19. Method: descriptive study, carried out with 53 professionals from three emergency care units, with data collection carried out through a self-answered questionnaire. Data analyzed using descriptive and inferential statistics (t-student and chi-square tests). Research protocol approved by the institution's Research Ethics Committee. Results: an association stands out between the mention of clinical manifestations such as nausea and vomiting, risk groups and the role, nurses or nursing technicians (p<0.05) and the level of training, that is, nurses reported with the presence of these symptoms was more frequent than nursing technicians. Conclusion: nursing professionals have knowledge regarding symptoms and risk groups, even if there is a difference between the professional level(AU)

Objetivo: comparar los conocimientos de enfermeros y técnicos de enfermería que trabajan en Unidades de Atención de Emergencia sobre el reconocimiento de manifestaciones clínicas y grupos de riesgo para el desarrollo de la forma grave de COVID-19. Método: estudio descriptivo, realizado con 53 profesionales de tres unidades de atención de emergencia, con recolección de datos realizada a través de un cuestionario auto respondido. Datos analizados mediante estadística descriptiva e inferencial (pruebas t de Student y chi-cuadrado). Protocolo de investigación aprobado por el Comité de Ética en Investigación de la institución. Resultados: se destaca asociación entre la mención de manifestaciones clínicas como náuseas y vómitos, grupos de riesgo y el rol, enfermeros o técnicos de enfermería (p<0,05) y el nivel de formación, es decir, los enfermeros reportaron la presencia de estos síntomas. fue más frecuente que los técnicos de enfermería. Conclusión: los profesionales de enfermería tienen conocimientos sobre síntomas y grupos de riesgo, aunque exista diferencia entre el nivel profesional(AU)

Percepción temporal de síntomas de disfagia en una cohorte de pacientes con disfagia orofaríngea neurogénica

Introducción: La disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo: Conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: Estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: Un total de 90 personas con evaluación basal, de las cuales el 56,7 % (51/90) lograron seguimiento al tercer mes y 25,6 % (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: Las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: El reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Introduction: Dysphagia results from several pathophysiological mechanisms where its symptoms are not static or homogeneous in people, especially when there is neurogenic oropharyngeal dysphagia. Objective: To know the perception and behavior over time of symptoms of dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients with neurogenic oropharyngeal dysphagia to visualize the clinical dynamics of this form of dysphagia. Methodology: Observational cohort study in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes with, follow-up at three and six months, and completion of the EAT-10 at baseline, third and sixth month. Results: A total of 90 people with baseline evaluation were included, of whom 56.7% (51/90) achieved follow-up at the third month and 25.6% (23/90) at the sixth month. Symptoms of dysphagia with greater self-perception at all three moments were difficulty swallowing solids, sensation of food stuck in the throat and coughing when eating. Odynophagia was not a commonly perceived symptom. The total score of the EAT-10 was between 16.61±9 and 18.1±9.5 points in general. In patients with complete follow-up, variation in self-perception of swallowing liquids and pills was observed. Variation of the score when adjusting for the reception of therapies. Discussion: Neurological and neuromuscular diseases directly impact swallowing with mild to profound severity, where self-perception of swallowing symptoms is dynamic, but with cardinal symptoms of oropharyngeal dysphagia over time. Conclusions: The recognition and monitoring of dysphagia symptoms should be usual aspects in the care of patients with neurological and neuromuscular diseases.

Prevalencia de síntomas persistentes en pacientes con COVID-19 seguidos por el área de telemedicina del Hospital de Clínicas San Lorenzo

Introducción: con la evolución de la pandemia de COVID-19 se observó que esta infección se comporta como un iceberg: en el vértice se ubican las complicaciones en el contexto de la infección aguda y en la base se van acumulando aquellos síntomas que persisten en el tiempo e impiden al paciente su recuperación total. Objetivo: determinar la prevalencia de síntomas persistentes en pacientes diagnosticados con COVID-19 seguidos por el área de telemedicina del Departamento de Control de Infecciones del Hospital de Clínicas, San Lorenzo, Paraguay, durante el periodo agosto 2020- abril 2021. Metodología: se aplicó un diseño estudio observacional, descriptivo, retrospectivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Se incluyeron 236 cuestionarios digitales de pacientes seguidos por el área de telemedicina entre agosto 2020 y abril 2021. Resultados: la edad media fue 36± 10 años, 71,2% fue del sexo femenino. El 61% de los pacientes provenía del Departamento Central y 58,9% fue personal de blanco. El 29,7% padecía de obesidad. El 86,9% presentó un cuadro leve. Presentaron síntomas persistentes el 66,9% siendo la fatiga la más común (66,5%) y los síntomas duraron menos de tres meses en 55%. Conclusiones: la edad promedio muestra mayoría de población joven, sobre todo mujeres y procedentes del Departamento Central. Más de la mitad califican como personal de blanco, la mayoría fueron obesos, casi todos presentaron un cuadro de COVID-19 leve y el síntoma persistente más frecuente fue la fatiga con una duración de menos que 3 meses.

Introduction: With the evolution of the COVID-19 pandemic, it was observed that this infection behaves like an iceberg: at the apex there are the complications in the context of acute infection and at the base there are those symptoms that persist in the time and prevent the patient from full recovery. Objective: To determine the prevalence of persistent symptoms in patients diagnosed with COVID-19 followed by the telemedicine area of ​​the Infection Control Department of the Hospital de Clínicas, San Lorenzo, Paraguay, during the period August, 2020-April, 2021. Methodology: An observational, descriptive, retrospective cross-sectional study design was applied, with non-probabilistic sampling of consecutive cases. Two hundred thirty-six digital questionnaires from patients followed by the telemedicine area between August, 2020 and April, 2021 were included. Results: The mean age was 36 ± 10 years, 71.2% was female, 61% of the patients came from the Central Department and 58.9% was health professionals. Twenty-nine-point seven percent suffered from obesity while 86.9% presented a mild condition. Sixty-six-point nine percent presented persistent symptoms, fatigue being the most common (66.5%) and the symptoms lasted less than three months in 55%. Conclusions: The mean age showed a majority of the young population, especially women from the Central Department. More than half qualified as health professionals, most were obese, almost all had mild COVID-19, and the most frequent persistent symptom was fatigue lasting less than 3 months.

Elaboração de um protocolo de classificação de risco para pacientes oncológicos em Cuidados Paliativos Domiciliares / Development of a risk classification protocol for cancer patients in Home-based Palliative Care

RESUMO Os serviços de Cuidados Paliativos Domiciliares especializados no tratamento de pacientes oncológicos têm como objetivo identificar e controlar sintomas físicos, psicossociais e espirituais em domicílio. Alguns desafios encontrados são a complexidade de sintomas, a sobrevida reduzida dos pacientes com câncer avançado e limitações do sistema de saúde. Para estratificar a prioridade de atendimento dos pacientes com câncer avançado em Cuidados Paliativos Domiciliares, foi elaborado um protocolo de classificação de risco. Este artigo é um relato de experiência sobre o processo de elaboração de um protocolo de classificação de risco para pacientes com câncer avançado atendidos em um serviço de Cuidados Paliativos Domiciliares no Rio de Janeiro. A etapa inicial envolveu reuniões da equipe da Assistência Domiciliar de um hospital oncológico e buscas estruturadas na literatura. Depois, foram listadas as situações clínicas de manejo mais complexo no domicílio, chamadas de sinais e sintomas de alerta: dor, falta de ar, náuseas/ vômitos, sangramento e confusão mental aguda. Elaborou-se um protocolo de avaliação e classificação de risco com cinco categorias/cores, para determinar a prioridade de atendimento dos pacientes. O sistema de triagem desenvolvido possui fácil aplicabilidade e requer um treinamento breve do profissional de saúde para que possa ser utilizado durante os atendimentos domiciliares.

ABSTRACT Home-based Palliative Care services specialized in the treatment of cancer patients aim to identify and control physical, psychosocial, and spiritual symptoms at home. Some challenges encountered are the complexity of symptoms, reduced survival of patients with advanced cancer, and limitations of the health care system. To stratify the priority of care for patients with advanced cancer in home Palliative Care, a risk classification protocol was developed. This article is an experience report on the process of creating a risk classification protocol for patients with advanced cancer treated at a home Palliative Care service in Rio de Janeiro. The initial stage involved meetings of the home care team at an oncology hospital and structured searches in the literature. Afterwards, the clinical situations of more complex management at home were listed and named as warning signs and symptoms: pain, shortness of breath, nausea/ vomiting, bleeding, and acute mental confusion. An assessment and triage protocol was developed with five categories/colors to determine the priority of patient care. The developed triage system has easy applicability and requires a brief training of the health professional so that it can be used during home visits.

Mpox: Aspectos epidemiológicos, imunopatogênicos e manejo pré e pós-infecção / Mpox: Epidemiological, immunopathogenic aspects and pre- and post-infection management

Mpoxou Varíola M é uma zoonose causada por vírus do gênero Orthopoxvirus, causadores também da varíola comum. É uma doença considerada rara e autolimitada, sendo endêmica em países africanos. Entretanto, no ano de 2022 ganhou destaque devido ao surto global que se iniciou, quando o mundo ainda se recuperava da pandemia da COVID-19. Dessa forma, por se tratar de uma doença emergente, a presente revisão visa pontuar aspectos gerais do que se sabe até o momento sobre a Mpox, desde sua imunopatogenia até as formas atuais de prevenção e cuidados pós-infecção

Mpox or Variola M is a zoonosis caused by viruses of the genus Orthopoxvirus, which also cause smallpox. It is a disease considered rare and self-limiting, being endemic in African countries. However, in 2022, it gained prominence due to the global outbreak that began when the world was still recovering from the COVID-19 pandemic. Thus, as it is an emerging disease, this review aims to point out general aspects of what is known so far about Mpox, from its immunopathogenesis to current forms of prevention and post-infection care

Características clínico-epidemiológicas de pacientes post-COVID-19 en Baracoa, Guantánamo

Fundamento un elevado porcentaje de personas que han padecido COVID-19, refieren tras la recuperación de la fase aguda, manifestaciones que se prolongan por más de tres semanas, e incluso, durante tres meses después del cuadro clínico original. Objetivo caracterizar desde el punto clínico y epidemiológico a pacientes confirmados al SARS-CoV-2 en la etapa post-COVID-19. Métodos se realizó un estudio descriptivo transversal, en pacientes confirmados al SARS-CoV-2 en etapa post-COVID-19, pertenecientes al Policlínico Hermanos Martínez Tamayo, en el periodo octubre-noviembre de 2021. Se estudiaron todos los pacientes (N=400) atendidos en consulta post-COVID-19 en el periodo declarado. La información se obtuvo mediante encuestas epidemiológicas realizadas. Resultados predominaron los pacientes con edades entre 50 y 59 años, del sexo femenino. Las manifestaciones clínicas más frecuente fueron tos, pérdida del gusto y del olfato. El esquema de vacunación incompleto fue el más frecuente. El lugar de ingreso más utilizado fueron los centros de aislamiento, así como el uso del Nasalferon como tratamiento. Las complicaciones predominaron en pacientes no vacunados, y con edad de 60 años y más. Conclusiones un elevado porcentaje de pacientes presentó manifestaciones clínicas tras el periodo agudo de la enfermedad. La COVID-19, a mediano plazo, tuvo mayores implicaciones en el sistema respiratorio, nervioso y osteomioarticular. Las campañas de vacunación ayudan a prevenir los síntomas graves del virus y a contrarrestar las complicaciones.

Background a high percentage of people who have suffered from COVID-19 report, after recovery from the acute phase, manifestations that last for more than three weeks, and even for three months after the original clinical picture. Objective to characterize, from the clinical and epidemiological point of view, patients confirmed to SARS-CoV-2 in the post-COVID-19 stage. Methods a descriptive cross-sectional study was carried out in patients confirmed to SARS-CoV-2 in the post-COVID-19 stage, belonging to the Hermanos Martínez Tamayo Polyclinic, from October to November 2021. All patients were studied (N= 400) attended in post-COVID-19 consultation in the declared period. The information was obtained through epidemiological surveys carried out. Results there was a predominance of patients aged between 50 and 59 years old, female. The most frequent clinical manifestations were cough, loss of taste and smell. The incomplete vaccination scheme was the most frequent. The most used place of admission were isolation centers, as well as the use of Nasalferon as a treatment. Complications predominated in unvaccinated patients, and aged 60 years and over. Conclusions a high percentage of patients presented clinical manifestations after the acute period of the disease. COVID-19, in the medium term, had greater implications in the respiratory, nervous and osteomyoarticular systems. Vaccination campaigns help prevent serious symptoms of the virus and counteract complications.