Experiencia sobre el proceso de salud-enfermedad-atención en pacientes con artritis reumatoidea pertenecientes a la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta / Experience on the health-disease-care process in patients with rheumatoid arthritis belonging to the Wichí community of Mission Chaqueña "El Algarrobal", Salta

Introducción: se ha reportado que la prevalencia de artritis reumatoidea (AR) en la comunidad Wichí representa la más alta informada por el Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). El objetivo de este estudio fue describir la experiencia sobre el proceso de salud-enfermedad-atención de pacientes con AR de la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta. Materiales y métodos: estudio narrativo. Diseño de corte etnográfico. Se realizaron entrevistas semi-estructuradas y observaciones registradas. Se utilizaron guías de entrevistas y observación. Los aspectos incluidos fueron: concepción del proceso salud-enfermedad, percepción de la AR en la vida diaria, el acceso al sistema de salud, utilización de recursos tradicionales y de medicina tradicional. Resultados: se realizaron 10 entrevistas. Los aspectos más relevantes fueron la concepción del proceso salud-enfermedad asociado al trauma social pasado y al concepto de voluntad Wichí. Se evidenció la combinación de estrategias para mejorar el dolor (biomedicina, medicina tradicional y acompañamiento religioso). Además, se observó una relación unidireccional con el sistema de salud. Conclusiones: la AR es una enfermedad con un impacto negativo en la comunidad Wichí. Se requieren otras actividades, desde otras disciplinas, para mejorar el acceso al sistema de salud y la continuidad de los tratamientos.

Introduction: the prevalence of rheumatoid arthritis (RA) in the Wichí community has already been published, representing the highest reported by the Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). The objective was to describe the experience of the health-disease-care process of patients with RA from the Wichí community of Misión Chaqueña "El Algarrobal", Salta. Materials and methods: study with ethnographic design. Semi-structured interviews and recorded observations were conducted. Interview and observation guides were used. The aspects included were: conception of the health-disease process; perception of RA in daily life, access to the health system, use of traditional resources and traditional medicine. Results: ten interviews were conducted. The most relevant aspects were the conception of the health-disease process, associated with past social trauma and the concept of "Wichí good will". The combination of strategies to improve pain (biomedicine, traditional medicine and religious accompaniment) was evidenced. In addition, a unidirectional relationship with the health system was observed. Conclusions: RA is a disease with a negative impact on the Wichí community. Other activities from other disciplines are necessary to improve access to the health system and continuity of treatment.

Systemic lupus erythematosus diagnosed during hospitalization: Greater baseline disease activity, short-term damage, and death / Lupus eritematoso sistémico diagnosticado durante una internación: mayor actividad basal de la enfermedad, daño y muerte a corto plazo

ABSTRACT Objectives: To analyze initial and follow-up features of patients with systemic lupus erythematosus (SLE) diagnosed during hospitalization. Methods: Retrospective analysis of medical records: two groups were studied, a) SLE diagnosed during hospitalization (SLEin), b) SLE diagnosed on an outpatient basis (SLEout). Results: 123 patients were assessed, 87% female, mean age at diagnosis was 34 years and 45 (37%) of them were SLEin. Patients in the SLEin group had a median of 144 days from the onset of symptoms to diagnosis of SLE vs. 287 days in the SLEout group (p = 0.04). Initially, SLEin had an average SLEDAI of 10 vs. 8 in SLEout (p = 0.004) and anti-dsDNA was positive in 71% vs. 53% in SLEout (p = 0.07). Within the first 6 months, the average cumulative glucocorticoid dose was 6493 mg in SLEin patients vs. 3563 mg in SLEout (p < 0.001) and immunosuppressant usage was higher in SLEin: 62% vs. 26% in SLEout (p<0.001). Within the first year, SLEin's kidney biopsies showed lupus nephritis III or IV in 31% vs. 12% in SLEout (p = 0.003, log-rank test). Within the first 2 years, 6 SLEin patients died vs. 1 SLEout patient (p = 0.02) and SLEin patients had more damage as measured by SLICC/ACR Damage Index (median 0, range 25%-75% 0-1 vs. median 0, range 25%-75% 0-0 in SLEout; p = 0.04). Conclusions: SLEin are initially more active, require higher doses of glucocorticoids and immunosuppressants, have more significant kidney involvement, and present more damage and greater mortality in the short term.

RESUMEN Objetivo: Analizar las características de los pacientes con lupus eritematoso sistêmico (LES) diagnosticados durante una hospitalización. Métodos: Análisis retrospectivo de historias clínicas. Se estudiaron dos grupos: a) LES diagnosticado durante la hospitalización (SLEin) y b) LES diagnosticado de forma ambulatoria (SLEout). Resultados: Se evaluaron 123 pacientes (87% mujeres); edad promedio al diagnóstico 34 arios; el 37% de ellos era SLEin. Los pacientes del grupo SLEin tuvieron una mediana de 144 días desde el inicio de los síntomas hasta el diagnóstico, vs. 287 días en SLEout (p = 0,04). Inicialmente, los pacientes SLEin tenían un SLEDAI promedio de 10, vs. 8 en SLEout (p = 0,004) y anti-dsDNA positivo en el 71%, vs. el 53% en SLEout (p = 0,07). A los 6 meses, la dosis acumulada de glucocorticoides (promedio) fue de 6.493 mg en SLEin vs. 3.563 mg en SLEout (p<0,001), y el uso de inmunosupresores fue mayor en SLEin: 62% vs. 26% en SLEout (p< 0,001). Al año se halló nefritis lúpica clase III o IV en el 31% de SLEin vs. el 12% en SLEout (Log Rank Test: p = 0,003). A los 2 años, 6 pacientes de SLEin murieron, vs. un paciente de SLEout (p = 0,02). Los pacientes con SLEin tuvieron más daño (índice de daño SLICC/ACR: mediana 0, rango 25-75%: 0-1, vs. mediana 0, rango 25-75%: 0-0 en SLEout; p = 0,04). Conclusiones: Los pacientes SLEin fueron inicialmente más activos, requirieron mayores dosis de glucocorticoides e inmunosupresores, tuvieron una afectación renal más significativa y presentaron más daño y mayor mortalidad a corto plazo.

The correlation of population, population density, age, and sex to the number of confirmed cases of COVID-19 among local government units in the National Capital Region / The Health Sciences Journal

INTRODUCTION@#The NCR had amassed 752,668 cases of COVID-19 as of September 2021, the highest among the regions in the Philippines. This study aimed to determine the correlation between population, population density, age, and sex with the number of cases among local government units (LGU) in the National Capital Region (NCR).@*METHODS@#The data for population, population density, age, and sex distribution of the LGUs of NCR were retrieved from the 2015 Philippine census while the data for cases were from DOH’s COVID-19 Tracker. Pearson correlation coefficient was computed to determine the correlation between population, population density and cases. Phi and Cramer’s V statistic were computed to determine associations between sex, age groups, and cases.@*RESULTS@#There was little or no correlation between population density and number of cases (r = 0.236) but was good (r = 0.905) when Quezon City was excluded for being an outlier. There was good correlation between population and number of cases (r = 964, p < 0.001). There was very weak to no association between sex and number of COVID-19 cases. There was a statistically significant moderate association between age and COVID-19 cases (f = 0.145, p < 0.001).@*CONCLUSION@#The study has shown that population density and population have a good correlation with the number of COVID-19 after Quezon City was removed as a data point. There is a moderate association between age and number of COVID-19 cases. There is a very weak to no association between sex and COVID-19 cases.