Comparación entre el tratamiento con dexametasona y metilprednisolona en pacientes hospitalizados por COVID-19

RESUMEN Introducción: la dexametasona es un medicamento que demostró una disminución de la mortalidad en la neumonía por SARS-CoV-2. Se desconoce la utilidad de otros corticoides, dosis y su duración para mejorar este resultado clínico. Objetivo: comparar la mortalidad de los pacientes adultos con neumonía por SARS-CoV-2 tratados con dexametasona versus metilprednisolona en el Hospital Nacional, Itauguá, Paraguay. Materiales y métodos: estudio ambispectivo. Se incluyeron 97 pacientes, 52 recibieron dexametasona y 45 metilprednisolona. Se utilizó un muestreo no probabilístico de casos consecutivos. Las variables fueron sometidas a estadística descriptiva y analítica. El protocolo fue aprobado por el Comité de Ética del Hospital Nacional. Los autores no presentan conflictos de interés. Resultados: todos los pacientes ingresaron con neumonía con valoración de 4 (OMS). No se encontraron diferencias significativas en la mortalidad entre ambos grupos. Al aplicar un análisis estratificado por edad, en los pacientes <65 años la mortalidad en los que recibieron dexametasona fue 15,8% mientras que los que recibieron metilprednisolona no fallecieron (p 0,03). En el grupo de ≥65 años la mortalidad n los recibieron dexametasona fue 29,4% vs. 21,4% en los que recibieron metilprednisolona (p 0,7). Conclusiones: en los pacientes <65 años tratados con dexametasona la mortalidad fue mucho más alta que en los que recibieron metilprednisolona, ya que en este último grupo no se registraron fallecimientos.

ABSTRACT Introduction: Dexamethasone is a medication that demonstrated a decrease in mortality in SARS-CoV-2 pneumonia. The usefulness of other corticosteroids, dose and their duration to improve this clinical result is unknown. Objective: To compare the mortality of adult patients with SARS-CoV-2 pneumonia treated with dexamethasone versus methylprednisolone at the Hospital Nacional of Itauguá, Paraguay. Materials and Methods: Ambispective study. Ninety seven patients were included, 52 received dexamethasone and 45 methylprednisolone. A non-probabilistic sampling of consecutive cases was used. The variables were subjected to descriptive and analytical statistics. The protocol was approved by the Ethics Committee of the Hospital Nacional. The authors do not present conflicts of interest. Results: All patients entered with 4 (WHO) vaulting pneumonia. No significant differences were found in mortality between both groups. When applying an age stratified analysis, in patients <65 years who received dexamethasone the mortality was 15.8% while those who received methylprednisolone did not die (p 0.03). In the ≥65 years group, mortality in those who received dexamethasone was 29.4% vs. 21.4% in those who received methylprednisolone (p 0.7). Conclusions: In patients <65 years treated with dexamethasone, mortality was much higher than in those who received methylprednisolone, since in the latter group no deaths were recorded.

Asociación del umbral de ciclos (Ct) en prueba RT-PCR para SARS-CoV-2 y severidad de la COVID-19 en pacientes de un hospital de referencia en Paraguay

RESUMEN Algunos estudios han encontrado que la severidad de la COVID-19 se asocia con una alta carga viral determinada por los números de ciclos (Ct) de amplificación de ADN de SARS-CoV-2. El objetivo fue determinar la relación entre el umbral de ciclos de PCR de SARS-CoV-2 y la severidad de la infección por el virus SARS-COV-2 en pacientes internados y ambulatorios en un hospital de referencia entre marzo a junio del 2021. Estudio retrospectivo observacional analítico de corte trasverso de pacientes adultos con COVID-19, ambulatorios e internados en el Hospital Nacional. Se incluyeron los pacientes cuya infección fue confirmada por RT-PCR para SARS-CoV-2, se consideró un punto de corte para Ct60 años (36,6%), estuvieron hospitalizados (69,8%), internados en sala (57,1%), y admitidos en cuidados intensivos (12,8%), tiempo medio de enfermedad 8,48 ± 4,2 días. La mortalidad fue de 22,2%. Se encontró mayor riesgo de fallecer para los pacientes con Ct 60 años (OR: 3,69; IC95%: 2,39-5,68). Estos dos factores permanecieron asociados con el óbito en el análisis multivariado. Hubo mayor riesgo de hospitalizarse y fallecer en los pacientes con Ct<25. El valor Ct podría ser útil para la predicción del curso clínico y el pronóstico de los pacientes con COVID-19.

ABSTRACT Some studies have found that severity of COVID-19 is associated with a high viral load determined by the number of cycles (Ct) of SARS-CoV-2 DNA amplification. The objective was to determine the relationship between the Ct value and the severity of the SARS-COV-2 virus infection in inpatients and outpatients at a reference hospital in Paraguay between March and June 2021. Cross-sectional retrospective study of adult patients with COVID-19, ambulatory and hospitalized admitted to the National Hospital. Patients whose infection was confirmed by RT-PCR for SARS-CoV-2 were included, a cut off point of Ct 60 years (36.6%), hospitalized (69.8%), admitted to ward (57.1%), and admitted to intensive care (12.8%), mean time of illness 8.48 ± 4.2 days and mortality was 22.2%. A higher risk of death was found for patients with Ct 60 years (OR: 3.69; 95% CI: 2.39-5.68). These two factors remained associated with death in the multivariate analysis. There was a higher risk of hospitalization and death in patients with TC <25. Ct value could be useful for predicting clinical course and prognosis of COVID-19 patients.

Simultaneidade de comportamentos de risco para doenças crônicas não transmissíveis em universitários de baixa renda de uma cidade do Sul do Brasil / Simultaneity of behavioral risk factors for chronic non-communicable disease among low-income undergraduate students from a city in southern Brazil

Resumo Introdução Poucos estudos avaliaram a prevalência e os fatores associados a comportamentos de risco para doenças crônicas não transmissíveis (DCNT) em universitários de baixa renda no Brasil. Objetivo Investigar a prevalência simultânea de comportamentos de risco para DCNT (inatividade física, consumo infrequente de frutas e vegetais, consumo excessivo de álcool e tabagismo) nessa população. Método Estudo transversal, conduzido em 2013, com 766 estudantes residentes em moradia estudantil da Universidade Federal de Santa Maria, no Rio Grande do Sul, Brasil. A prevalência simultânea de comportamentos de risco foi avaliada a partir do somatório dos comportamentos avaliados. Regressão de Poisson foi utilizada para avaliar fatores associados com 3 ou mais comportamentos de risco simultaneamente. Resultados Observou-se que 1,8% dos estudantes não apresentou comportamentos de risco, enquanto 19,5%, 49,3%, 24,9% e 4,5% apresentaram um, dois, três ou quatro comportamentos de risco, respectivamente. Sexo masculino (RP = 1,35; IC95%: 1,08-1,69), excesso de peso no geral (RP = 1,37; IC95%: 1,08-1,73) e histórico de morbidade apenas nos homens (RP = 2,09; IC95%: 1,52-2,87) foram associados à simultaneidade de comportamentos de risco. A combinação envolvendo todos os fatores de risco teve prevalência acima do esperado (O/E = 1,76; IC95%: 1,24-2,50). Conclusão A prevalência simultânea de comportamentos de risco em universitários de baixa renda é elevada, conhecimento que pode auxiliar na formulação de programas de prevenção e intervenções.

Abstract Background Few studies have investigated the prevalence and correlates of risk factors for non-communicable diseases (NCDs) among low-income undergraduate students in Brazil. Objective To investigate the co-occurrence of the main behavioral risk factors for NCDs (physical inactivity, low fruit and vegetables intake, binge drinking and smoking) in this population. Method Cross-sectional study was carried out during 2013, with 766 undergraduate students living in student housing at the Universidade Federal de Santa Maria, RS, Brazil. The simultaneous prevalence of risk factors was evaluated by a score created from the sum of individual behaviors. Poisson regression was applied for evaluating the associated factors with ≥3 risk factors, simultaneously. Results It was observed that 1.8% of students show no risk factor, while 19.5%, 49.3%, 24.9% and 4.5% presented one, two, three and four risk factors, respectively. Male (PR=1.35; 95%CI: 1.08-1.69), overweight/obesity (PR=1.37; 95%CI: 1.08-1.73) and morbidity history (PR=2.09; 95%CI: 1.52-2.87), only in males, were associated with the co-occurrence of risk factors. The combination involving all four risk factors showed a higher prevalence than the expected (O/E=1.76: 95%CI: 1.24-2.50). Conclusion The simultaneous prevalence of risk factors in low-income college students was high, this finding that may help in the formulation of prevention programs and interventions.

Inserción laboral de los egresados de la Carrera de Medicina y Cirugía de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, cohortes 2010-2012 / Labor insertion of Medicine and Surgery graduates of the School of Medical Sciences of the National University of Asunción, cohorts 2010-2012

Introducción: Una manera de evaluar el resultado y la pertinencia de un plan de estudios es a través del seguimiento de egresados, siendo esta una tarea fundamental en la gestión de una institución de educación superior. Objetivo: El objetivo del presente informe de seguimiento fue conocer la inserción laboral de los egresados de la Carrera de Medicina y Cirugía de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Metodología: Se solicitó al Departamento de Informática Académica la lista de egresados de la Carrera de Medicina y Cirugía de las cohortes 2010-212. A fin de obtener datos de aquellos egresados que se encontraban trabajando en el sector público se recurrió a la página Web Portal Paraguay. A los profesionales no ubicados en el sector público se les contactó vía telefónica. Resultados: Durante los años 2010-2012, egresaron 355 profesionales (172 mujeres y 183 varones). La mayoría de los egresados se encuentra trabajando en el sector público, esto es: 64% de los egresados de la cohorte de 2010; 63% de la cohorte 2011; y 74% de la cohorte 2012. 11% (año 2010), 5% (año 2011) y 3% (año 2012) de los egresados se encuentran en el extranjero. Discusión: Es recomendable crear la Unidad de Seguimiento a Egresados, que podría depender de la Dirección de Aseguramiento de la Calidad Académica y trabajar en estrecha colaboración con la Dirección de Postgrado, la Dirección Académica y la Dirección del Hospital de Clínicas. Esta Unidad podría dar continuidad a los programas de seguimiento de egresados y de valoración del impacto que tienen los mismos en la salud, la ciencia y la enseñanza de la ciencia médica a nivel local y regional.

Introduction: One way to assess the result and the relevance of a curriculum is through the follow-up of graduates. This is a fundamental task in the management of a higher education institution. Objective: The objective of the present follow-up report was to know and monitor the labor insertion of graduates of the Medicine and Surgery Career of the School of Medical Sciences, National University of Asunción. Methodology: The Department of Academic Informatics was asked for the list of graduates of the Medicine and Surgery Career of the 2010-212 cohorts. In order to obtain data from those graduates who were working in the public sector, the Paraguay Portal website was used. Professionals not located in the public sector were contacted by telephone. Results: During the years 2010-2012, 355 professionals (172 women and 183 men) graduated. The majority of the graduates are working in the public sector, that is: 64% of the graduates of the 2010 cohort; 63% of the 2011 cohort; and 74% of the cohort 2012. 11% (year 2010), 5% (year 2011) and 3% (year 2012) of the graduates are abroad. Discussion: It is advisable to create the Unit for the Follow-up of graduates, which could depend on the Academic Quality Assurance Department and work in close collaboration with the Postgraduate Department, the Academic Department and with the Hospital of Clínicas Management Department. This Unit could give continuity to graduate follow-up programs and to assess the impact graduates have on health, science and medical science education at the local and regional level.

De 2006 à 2014: a trajetória dos brasileiros no ICPAPH / From 2006 to 2014: the trajectory of Brazilians in the ICPAPH

A participação em eventos científicos é uma oportunidade para muitos pesquisadores trocarem experiências, ideias e criarem parcerias. Com o objetivo de ampliar a discussão sobre questões relacionadas à atividade física e saúde pública, foi criado o International Congress on Physical Activity and Public Health (ICPAPH). A pesquisa epidemiológica em atividade física e saúde cresce no Brasil, assim como a participação de brasileiros em sociedades e eventos internacionais. O objetivo deste estudo é descrever a participação de brasileiros em todas as edições do ICPAPH realizadas até 2014, ano em que o evento foi realizado no Brasil. Através da análise dos anais dos congressos, assim como informações obtidas através dos presidentes de cada edição e relatos de brasileiros, observou-se que a participação do Brasil ocorre desde a primeira edição em 2006. Cerca de 2% da participação geral de palestrantes tem sido de brasileiros, assim como 5% das apresentações de trabalhos, com aumento dessas participações na edição realizada no Rio de Janeiro (14% e 40%, respectivamente), o que se esperava devido à grande participação de congressistas locais em todas as edições do evento (2006=68%, 2008=14%, 2010=48%, 2012=60% e 2014=32%). Sendo assim, apesar do crescimento na participação de brasileiros neste evento internacional, estratégias de incentivo à participação de pesquisadores brasileiros em outros eventos de discussão internacional e de fomento à pesquisa na área de atividade física e saúde pública devem ser elaboradas.

The participation in scientific events is an opportunity for many researchers to exchange experience, ideas and create partnerships. In order to broaden the discussion on issues related to physical activity and public health, the International Congress on Physical Activity and Public Health (ICPAPH) was created. Epidemiological research in physical activity and health is growing in Brazil, as well as the participation of Brazilians on international events. The aim of this study was to describe the participation of Brazilians in every edition of the ICPAPH until 2014, when the event was held in Brazil. Through the analysis of programs of previous conferences, as well as the contact with the presidents of each edition and participants from Brazil, we noticed a participation from Brazilians since the very first edition, in 2006. Close to 2% of speakers and 5% of abstracts have been presented by Brazilian, with more participation in the event in Rio de Janeiro (14% and 40%, respectively), what was expected due to a large participation of locals in every edition of the event (2006=68%, 2008=14%, 2010=48%, 2012=60% and 2014=32%). Therefore, even though the participation of Brazilians has been growing, it is necessary to create strategies to increase Brazilian participation in international debates and financing for research in the field of physical activity and public health.

Autopercepção de saúde em adolescentes: prevalência e associação com fatores de risco cardiovascular / Self-rated health in adolescents: prevalence and association with cardiovascular risk factors

Verificar a prevalência de autopercepção de saúde negativa e sua associação com fatores sociodemográficas e de risco cardiovascular em adolescentes. Estudo transversal, com amostra de 1.134 escolares, idades entre 14-19 anos, da cidade de Santa Maria, RS, Brasil. Os fatores de risco cardiovascular pesquisadas foram: inatividade física, alimentação inadequada, tabagismo, consumo excessivo de álcool, excesso de peso e pressão arterial elevada. A variável dependente investigada foi autopercepção de saúde negativa (regular/ruim). Para análise dos fatores associados foi utilizada regressão de Poisson. A prevalência de autopercepção de saúde negativa foi de 25,7% (IC95% 20,8-31,1), superior nas meninas (30,8% vs 19,9%; p<0,001). Adolescentes com uma alimentação inadequada (RP=1,48; IC95% 1,04-2,11), inativos fisicamente (RP=1,33; IC95% 1,13-1,58), fumantes (RP=1,57; IC95% 1,13-2,19) ou com excesso de peso (RP=1,76; IC95% 1,49-2,08) apresentaram risco para autopercepção de saúde negativa. Também foi observada uma associação linear entre o número de fatores de risco cardiovasculares e autopercepção de saúde negativa; adolescentes com quatro ou mais fatores de risco apresentaram uma razão de prevalência para autopercepção de saúde negativa de 2,73 (IC95% 2,07-3,61) se comparado com aqueles sem fatores de risco combinados. Foi encontrada uma elevada prevalência de autopercepção de saúde negativa entre os adolescentes pesquisados. Ser do sexo feminino e apresentar fatores de risco para doenças cardiovasculares foram fatores associados à autopercepção de saúde negativa. Além disso, há uma forte associação entre o número de fatores de risco simultâneos e autopercepção de saúde negativa...

To determine the prevalence of negative self-rated health and the association with sociodemographic variables and cardiovascular risk factors in adolescents. Cross sectional study, with 1,134 high school adolescents, aged between 14-19 years old, from the city of Santa Maria, RS, Brazil. Cardiovascular risk factors studied were: physical inactivity, unhealthy diet, smoking, excessive alcohol consumption, overweight and high blood pressure. The dependent variable investigated was negative self-rated health. Correlates were investigated using Poisson regression. The prevalence of poorer self-rated health was 25.7% and it was higher among girls (30.8% vs 19.9%, p <0.001). Adolescents with an inadequate diet (PR=1.48; 95%CI 1.04-2.11), physically inactive (PR=1.33; 95%CI 1.13-1.58), that smoked (PR=1.57; 95%CI 1.13-2.19) or were overweight (PR=1.76; 95%CI 1.49-2.08) presented a risk of negative self-rated health. A linear association was observed between the number of risk factors and poorer self-rated health. Adolescents with four or more simultaneous risk factors had a prevalence ratio for negative self-perceived health of 2.73 (95%CI 2.07-3.61). A high prevalence of poorer self-rated health among the surveyed adolescents was found and female sex as well as the presence of cardiovascular risk factors, were factors associated with that condition. Furthermore, there is a linear relationship between the numbers of risk factors in cluster and negative self-perceived health...

Sobrepeso/obesidade em adolescentes de Santa Maria-RS: prevalência e fatores associados / Overweight/obesity in adolescents from Santa Maria, Brazil: prevalence and associated factors

A obesidade é uma epidemia mundial e continua a aumentar entre crianças e adolescentes de diversos países. O estudo teve como objetivo verificar a prevalência e fatores associados ao sobrepeso/obesidade em adolescentes matriculados no 1º ano do ensino médio da cidade de Santa Maria-RS. Estudo transversal, de base escolar, realizado durante o segundo semestre letivo de 2008. Adolescentes de 14 a 18 anos responderam a um questionário e tiveram a massa corporal e a estatura mensuradas. As prevalências de sobrepeso e obesidade foram definidas de acordo com o referencial do índice de massa corporal para jovens brasileiros. Os fatores associados ao sobrepeso/obesidade foram determinados por regressão de Poisson. A amostra compreendeu 424 adolescentes (54,7% meninos), com média de idade de 15,7 anos (±0,89). A prevalência de sobrepeso/obesidade foi de 23,8% (IC95% 19,75-27,85). Estiveram associadas a esse desfecho, após ajuste para possíveis fatores de confusão, as variáveis: sexo masculino (RP=2,45; IC95% 1,63-3,68), ser dispensado das aulas de educação física (RP=2,73; IC95% 1,88-3,95) e ter uma boa relação com os colegas (RP=1,57; IC95% 1,12-2,19). Pode-se concluir que a prevalência de sobrepeso/obesidade na amostra estudada foi elevada, alertando para a necessidade de programas de prevenção ao excesso de peso nessa faixa etária.

Obesity is a worldwide epidemic that keeps on rising among children and adolescents from several countries. The purpose of this study was to verify the prevalence of overweight/obesity and its correlates in adolescents enrolled in the 1st year of high school in the municipality of Santa Maria, state of Rio Grande do Sul, Brazil. A cross-sectional, school-based, study was performed during the second semester of 2008. Adolescents aged 14 to 18 years old responded to a questionnaire and had their body mass and stature measured. The prevalence of overweight and obesity was defined according to the Brazilian reference for body mass index in adolescents. Correlates of overweight/obesity were determined by Poisson regression. The sample included 424 adolescents (54.7% boys) with mean age of 15.7 years (±0.89). The prevalence of overweight/obesity was 23.8% (95%CI; 19.75-27.85). After adjusting for potential confounding factors, the following variables were associated with overweight/obesity: sex (PR=2.45; 95%CI 1.63-3.68), having been dismissed from physical education classes (PR=2.73; 95%CI 1.88-3.95) and having a good relationship with classmates (PR=1.57; 95%CI 1.12-2.19). It was concluded that the prevalence of overweight/obesity in this sample was high, prompting the need for preventive programs of excessive weight in this age group.