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2.
Gastroenterol. latinoam ; 31(1): 21-27, mayo 2020. tab
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1103271

RESUMO

The new Coronavirus (SARS-CoV-2) appeared in China in December 2019. Since then and until April 2020 it spread worldwide affecting more than three million people. Its exponential rise is still growing all over the world, taking thousands of lives. SARS-CoV-2 is very contagious, person to person, by droplets which can generate a respiratory infection known as COVID-19. Some patients are at higher risk: Older people, those with cardiovascular disease, diabetes and hypertension are the most prone to an unfavorable outcome. Our Inflammatory Bowel Disease (IBD) patients are a special cluster, with many of them taking immunosuppressive treatment for long periods, which could pose an important risk. Scientifics societies all over the world have joined efforts to generate data, share experiences and make recommendations for good clinical management. This is a review of the available evidence, expert opinion, and proposed ways of working during the pandemic


El nuevo coronavirus (SARS-CoV-2) apareció en China en diciembre de 2019. Desde su inicio hasta abril de 2020 se ha expandido por todo el mundo, afectando a más de tres millones de personas. Su ascenso exponencial sigue creciendo, generando miles de muertes. Su contagiosidad es persona a persona por gotitas, pudiendo llegar a generar un cuadro clínico de infección respiratoria conocido como COVID-19. Algunos pacientes tienen más riesgos de tener un curso desfavorable; adultos mayores, pacientes con enfermedad cardiovascular, hipertensos y diabéticos. Nuestros pacientes con enfermedad inflamatoria intestinal son un grupo de pacientes con características particulares, muchos de ellos reciben tratamiento inmunosupresor por largos períodos, lo que pudiese suponer un riesgo específico. Las sociedades científicas de Europa y Norteamérica han realizado un esfuerzo conjunto para generar datos, compartir experiencias y dictar recomendaciones de buen manejo clínico. Esta es una revisión de la evidencia disponible, opiniones de expertos y formas de trabajo propuestos durante la pandemia.


Assuntos
Humanos , Pneumonia Viral/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Doenças Inflamatórias Intestinais/tratamento farmacológico , Fatores de Risco , Guias de Prática Clínica como Assunto , Medição de Risco , Pandemias
3.
Univ. salud ; 22(1): 58-69, ene.-abr. 2020.
Artigo em Espanhol | LILACS (Américas), COLNAL | ID: biblio-1094580

RESUMO

Introducción: Los adolescentes experimentan cambios físicos y psicosociales que los hacen vulnerables a múltiples comportamientos de riesgo, evidenciando la necesidad de generar políticas de prevención. Objetivo: Identificar los principales comportamientos de riesgo de los adolescentes, su prevalencia, factores predisponentes; así como las guías y escalas validadas que existen para su detección. Materiales y métodos: Se realizó una búsqueda bibliográfica en diferentes bases de datos y páginas oficiales de las principales organizaciones de salud. Se seleccionaron 45 artículos completos en español e inglés, publicados entre los años 2003 y 2017. Resultados: Se agruparon los comportamientos de riesgo en cinco dominios de los cuales se identificó su prevalencia se describieron las guías y escalas validadas existentes para su detección. Conclusiones: Al identificar los comportamientos de riesgo en los adolescentes se disminuye su morbimortalidad si se intervienen de forma precoz. Se recomienda a los profesionales de salud utilizar las mejores herramientas de tamizaje disponibles, que evalúan de manera rápida y simultánea múltiples comportamientos tales como las guías: Education/employment, peer Activities, Drugs, Sexuality and Suicide/depression, Rapid Assessment for Adolescent Preventive Services, Global school-based student health survey, de fácil aplicación en atención primaria y permiten realizar un adecuado abordaje y manejo de esta población.


Introduction: Adolescents experience physical and psychosocial changes that make them vulnerable to multiple risk behaviors, highlighting the need to generate prevention policies. Objective: To identify main risk behaviors of adolescents and their prevalence, as well as the validated guides and scales for their detection. Materials and methods: A bibliographic search was carried out in different databases and official pages of main health organizations. 45 complete articles published in Spanish and English from 2013 to 2017 were selected. Results: Risk behaviors were grouped into five domains, identifying their prevalence and describing the validated guides and scales that exist for their detection. Conclusions: The identification of risk behaviors and early intervention in adolescents decrease their morbidity and mortality. It is recommended that health professionals use the best available screening tools such as Home/environment, Education/employment, peer Activities, Drugs, Sexuality and Suicide/depression (HEADDS); Rapid Assessment for Adolescent Preventive Services (RAAPS); and Global school-based student health survey (GSHS). These guides quickly and simultaneously assess multiple behaviors, are easily applied in primary care, and facilitate the approach and management of this population.


Assuntos
Adolescente , Comportamentos de Risco à Saúde , Comportamento , Prevalência , Medição de Risco , Fatores de Proteção
4.
Pesqui. prát. psicossociais ; 15(1): 1-16, jan.-abr. 2020. tab
Artigo em Português | LILACS (Américas), INDEXPSI | ID: biblio-1098431

RESUMO

A literatura considera que existe um conjunto de valores, crenças e práticas familiares que constituem o referencial cultural da família e que interfere na participação dos familiares no tratamento dos consumidores de crack e outras drogas. O objetivo deste estudo foi investigar as crenças familiares sobre consumo de crack e sua relação com a participação familiar no tratamento de seus membros. Participaram desta pesquisa qualitativa 10 familiares de consumidores de crack que estavam em tratamento em uma Comunidade Terapêutica (CT) e um representante da instituição. Foram aplicados os seguintes instrumentos: uma escala para avaliar o nível socioeconômico; uma versão resumida do questionário Cebrid/Samsha, para avaliar a percepção de risco sobre o consumo de substâncias psicoativas; e dois roteiros de entrevista semiestruturada - versões família e representante da CT. Na avaliação de risco, os familiares consideraram que o consumo de crack, desde a primeira vez na vida, já apresentava um risco grave, em comparação com as outras substâncias. Foram investigadas crenças relacionadas ao consumo do crack, principalmente com relação à influência dos amigos, dependência química, influência do consumidor com o tráfico, entre outras. Os familiares acreditam na importância da participação familiar e consideram que contribuem nesse sentido. Os resultados puderam fornecer subsídios para uma melhor compreensão das crenças familiares sobre o consumo de crack, contribuindo para fomentar uma intervenção que favoreça a participação familiar no tratamento.


According to the literature, there is a set of values, beliefs, and family practices that form a family's cultural frame of reference and may even interfere in the participation of the family in the treatment of crack users - and users of other types of substances. The goal study is to explore family beliefs regarding the use of crack and its correlation with the family's involvement in the treatment of its members. Ten family members of crack users, all of whom were receiving treatment at one of the recovery centers known as Therapeutic Communities, and a representative of this institution took part in the study. The following tools were used: a scale to evaluate the socioeconomic status, a shortened version of the questionnaire developed by Cebrid (the "Brazilian Center of Information on Psychotropic Drugs") and Samsha (the Substance Abuse and Mental Health Services Administration), in order to evaluate the perception of the risks involved in the use of psychoactive substances, and two semi-structured interview scripts. Two versions of the script were elaborated: one for the family and another for the Therapeutic Community representative. The family members stated that using crack is dangerous from the very beginning, particularly when compared to using other substances. Beliefs related to the use of the drug were analyzed, especially concerning the influence of friends, substance abuse, the relationship between the drug user and the traffic, and other factors. The family members believe in the importance of their participation. The results provided a better understanding of family beliefs regarding the use of crack, which helped to create an intervention that may emphasize more the family's participation in the treatment.


La literatura tiene en cuenta que hay un conjunto de valores, creencias y prácticas familiares que constituyen el referencial cultural de la familia y que interfieren en su participación en el tratamiento de los consumidores del crack y de otras drogas. Esta investigación tuvo el objetivo de buscar las creencias familiares acerca del consumo del crack y su relación con la participación de la familia en tratamiento de sus miembros. Participaron de esta investigación cualitativa 10 familiares de consumidores del crack que recibían tratamiento en uno de los centros de recuperación conocidos como Comunidades Terapéuticas y un representante de la institución. Las siguientes herramientas fueron utilizadas: una escala para que se evaluara el nivel socioeconómico, una versión resumida del cuestionario desarrollado por Cebrid (el "Centro Brasileño de Informaciones sobre Drogas Psicotrópicas") y Samsha (la "Administración de Salud Mental y de Abuso de Sustancias", en los EE.UU.), para que se evaluara la percepción de riesgo acerca del consumo de sustancias psicoactivas, y dos guiones de entrevistas semiestructuradas - en las versiones "familia" y "representante de la Comunidad Terapéutica". En la evaluación de riesgos, los miembros de la familia afirmaron que el consumo del crack, desde el principio, representa un grave riesgo en comparación con otras sustancias. Se investigaron las creencias relacionadas al consumo del crack, sobre todo con respecto a la influencia de los amigos, a la dependencia química, a la relación del consumidor con el tráfico y otros factores. La familia cree en la importancia de su participación y en su contribución. Los resultados colaboraron con una mejor comprensión de las creencias de la familia acerca del consumo del crack, lo que ayudó a desarrollar un tipo de intervención que favoreciera la participación de la familia en el tratamiento.


Assuntos
Cocaína Crack , Usuários de Drogas , Psicotrópicos , Família , Medição de Risco , Transtornos Relacionados ao Uso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Serviços de Saúde Mental
5.
Arch. argent. pediatr ; 118(2): s59-s63, abr. 2020. ilus, tab
Artigo em Espanhol | LILACS (Américas), BINACIS | ID: biblio-1100502

RESUMO

El síndrome de lisis tumoral representa una complicación potencialmente letal provocada por la liberación masiva de ácidos nucleicos, potasio y fosfato hacia la circulación como resultado de la lisis de células neoplásicas, las cuales se caracterizan por una rápida capacidad de proliferación y alta sensibilidad a fármacos. Esto puede ocurrir de forma espontánea antes del inicio del tratamiento y agravarse luego de haberse iniciado la quimioterapia. Presenta una alta mortalidad. Su prevención continúa siendo la medida terapéutica más importante. El cuadro clínico se caracteriza por la existencia de trastornos del metabolismo hidroelectrolítico, en particular, hipercalemia, hiperfosfatemia e hiperuricemia y por la aparición de una lesión renal aguda. Una adecuada intervención terapéutica implica hidratación intravenosa y medidas para prevenir o corregir las alteraciones metabólicas. En este artículo, se proponen lineamientos para seguir tanto en la etapa diagnóstica como en el tratamiento de esta complicación.


The tumor lysis syndrome represents a potentially lethal complication caused by the massive release of nucleic acids, potassium and phosphate into the circulation as a result of the lysis of neoplastic cells, which are characterized by a rapid proliferation capacity and high sensitivity to drugs. This may occur spontaneously prior to the start of treatment, becoming worse after the initiation of chemotherapy. It presents a high mortality; its prevention continues being the most important therapeutic measure. The clinical picture is characterized by the existence of hydroelectrolytic metabolism disorders, in particular hyperkalemia, hyperphosphatemia and hyperuricemia and by the appearance of an acute renal lesion. Adequate therapeutic intervention involves intravenous hydration and measures to prevent or correct metabolic alterations. This article proposes guidelines to follow both in the diagnostic stage and in the treatment of this complication.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Síndrome de Lise Tumoral/diagnóstico , Síndrome de Lise Tumoral/prevenção & controle , Síndrome de Lise Tumoral/tratamento farmacológico , Medição de Risco , Hiperuricemia/tratamento farmacológico , Hiperfosfatemia/tratamento farmacológico , Hipercalcemia/tratamento farmacológico , Hipocalcemia/tratamento farmacológico
6.
Edumecentro ; 12(1): 61-81, ene.-mar. 2020. graf
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1089999

RESUMO

RESUMEN Fundamento: la hipertensión arterial y la obesidad en la edad pediátrica exhiben altos niveles de prevalencia a nivel mundial, incluyendo Cuba, lo cual fundamenta su diagnóstico precoz para disminuir sus efectos en estas edades y su impacto en la adultez. Objetivo: elaborar una estrategia educativa encaminada al perfeccionamiento de la labor docente para fomentar una adecuada cultura en salud entre los escolares. Métodos: se desarrolló un estudio epidemiológico descriptivo y prospectivo de carácter transversal, que incluyó el cálculo de la obesidad y otros factores de riesgo, en escolares de varias escuelas primarias. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción y sistémico-estructural; empíricos: análisis documental y encuestas a escolares, docentes y familiares y los matemático-estadístico para los valores analizados. Resultados: en el diagnóstico clínico se encontró elevada prevalencia de factores de riesgo cardiovascular, en cifras relacionadas con hipertensión arterial, obesidad, sobrepeso, sedentarismo y otros; mientras el diagnóstico educativo permitió conocer carencias en la preparación docente y en la familia de los escolares sobre temas de hábitos y estilos de vida saludable, por lo que se elaboró y aplicó una estrategia pedagógica para ofrecer solución a la problemática. Conclusiones: la estrategia permitió dotar a los docentes de los conocimientos y medios necesarios para promover estilos de vida saludables, desde lo curricular y extracurricular donde se fortaleció el trabajo metodológico integrando estos temas al proceso docente educativo, lo cual propició desarrollar una cultura de salud en los escolares.


ABSTRACT Background: high blood pressure and obesity in the pediatric age exhibit high levels of prevalence worldwide, including Cuba, which bases its early diagnosis to reduce its effects at these ages and its impact on adulthood. Objective: to develop an educational strategy aimed at improving the teaching work to promote an adequate health culture among schoolchildren. Methods: a cross-sectional descriptive and prospective epidemiological study was developed that included the calculation of obesity and the test of sustained weight in schoolchildren of several primary schools. Theoretical methods were used: analysis-synthesis, induction-deduction and systemic-structural; empirical ones: documentary analysis and surveys to schoolchildren, teachers and family; and the mathematical-statistic for the analyzed values. Results: in the clinical diagnosis a high prevalence of cardiovascular risk factors was found, in figures related to high blood pressure, body overweight, obesity, and cardiovascular hyperactivity; while the educational diagnosis allowed knowing deficiencies in the teaching preparation and in the family of schoolchildren on topics as healthy habits and lifestyles, so an educational strategy was developed and applied to offer a solution to the problem. Conclusions: the strategy allowed teachers to provide the necessary knowledge and means to promote healthy lifestyles, inside the curriculum and out of it where methodological work was strengthened by integrating these issues into the teaching-learning process, which led to the development of a necessary health culture in the students.


Assuntos
Projetos de Pesquisa , Serviços de Saúde Escolar , Fatores de Risco , Indicadores Básicos de Saúde , Estratégias , Medição de Risco , Promoção da Saúde
7.
Neumol. pediátr. (En línea) ; 15(1): 251-256, Mar. 2020. tab
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1088092

RESUMO

Home cardio-respiratory monitoring began over 40 years ago with the aim of preventing sudden infant death. Although it has been shown that monitoring does not meet this objective, its prescription has been maintained in various clinical situations and with very different criteria. Consensus on the subject has not been able to define precisely the type of monitoring or the time required for different diseases. Among the diseases that still consider the indication of cardio-respiratory monitoring at home are: persistent apnea of prematurity, high-risk BRUE (Brief Resolved Unexplained Events), neurological or metabolic diseases with compromise of the respiratory center, convulsive cough, pathologic gastroesophageal reflux and technology-dependent patients (high flow nasal cannula (CNAF), noninvasive ventilation (NIV), invasive mechanical ventilation (IMV) to tracheostomy, and others). A review is presented on the development of cardio-respiratory monitoring at home, highlighting the true usefulness of this technology with a general proposal, which must be evaluated on a case-by-case basis and always taking into account the conditions that must be met to perform adequate monitoring and useful.


La monitorización cardio-respiratoria en domicilio se inició hace más de 40 años con el objetivo de prevenir la muerte súbita del lactante. Aun cuando se ha demostrado que la monitorización no cumple este objetivo, se ha mantenido su prescripción en diversas situaciones clínicas y con criterios muy diversos. Consensos acerca del tema no han llegado a definir con precisión el tipo de monitorización ni el tiempo requerido para distintas enfermedades. Dentro de las enfermedades que todavía consideran la indicación de monitorización cardio-respiratoria en domicilio se encuentran: apnea persistente del prematuro, BRUE (episodio breve resuelto inexplicado) de alto riesgo, enfermedades neurológicas o metabólicas con compromiso del centro respiratorio, tos convulsiva, reflujo gastroesofágico patológico y pacientes dependientes de tecnología (cánula nasal de alto flujo (CNAF), ventilación no invasiva (VNI), ventilación mecánica invasiva (VMI) a traqueostomía, y otros). Se presenta una revisión sobre el desarrollo de la monitorización cardio-respiratoria en domicilio, resaltando la verdadera utilidad que tendría esta tecnología con una propuesta general, que debe evaluarse caso a caso y siempre teniendo en cuenta las condiciones que deben cumplirse para realizar una monitorización adecuada y útil.


Assuntos
Humanos , Lactente , Apneia/fisiopatologia , Taxa Respiratória/fisiologia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica/métodos , Medição de Risco , Seleção de Pacientes , Serviços de Assistência Domiciliar
8.
Int. j. morphol ; 38(1): 120-125, Feb. 2020. tab, graf
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1056408

RESUMO

En el mundo la obesidad es considerada una pandemia que provoca grandes cambios metabólicos, responsables de las llamadas enfermedades crónicas no transmisibles (ECNT), las cuales presentan un 60 % de mortalidad, según la Organización Mundial de la Salud (2016). En Chile el 75 % de la población adulta y el 50,9 % de la población estudiantil, muestran índices de masa corporal de sobrepeso y obesidad, con un nivel de sedentarismo general de 66,2 %. Los objetivos de este trabajo fueron determinar los perfiles antropométricos, riesgo metabólico y niveles de actividad física en profesores de enseñanza básica en un colegio particular subvencionado de Arica-Chile. El total de los profesores, 12 varones y 29 mujeres, fueron evaluados según: peso, talla, perímetro de cintura, índice cintura-talla (ICT), índice de masa corporal (IMC), masa grasa (MG), masa grasa visceral (MGV) y masa muscular (MM). A todos ellos se les calculó el riesgo metabólico según protocolos de Ashwell & Gibson (2016) y el IMC según fórmula de Quetelet. Para determinar los porcentajes de MG, MM y MGV, se utilizó instrumento de bioimpedancia eléctrica, Omron HBF-514C. Posteriormente se les aplicó una encuesta sobre nivel de actividad física (IPAQ). Los datos fueron analizados en estadístico IBM SPSS para tendencia central, dispersión, conteos y porcentajes. Para correlación se usó test de Pearson (r>0,5). Los resultados muestran que un 68,3 % de los profesores presenta sobrepeso y obesidad. El IMC y porcentaje de MGV son significativamente más alto en varones que en mujeres (30,6 ±7,0 / 26,9±4,6 y 11,2±5,6 / 7,6±2,5 respectivamente). El riesgo metabólico general de la población en estudio fue de 58,5 % (75 % y 51,7 % varones y mujeres respectivamente). Se observa una alta correlación entre IMC-MGV (0,84), IMC-ICT (0,84) y MM-MG (0,85). Respecto al nivel de actividad física, solo el 19,5 % de los profesores muestra un nivel de actividad física alto. Se concluye que los profesores presentan valores antropométricos alterados que indican altos índices de riesgos metabólicos y con bajos niveles de actividad física. Independientemente, las mujeres presentan mejores índices morfométricos en todos los parámetros en estudio respecto a los profesores varones. Existe una alta correlación (r) entre el índice de masa corporal y los porcentajes de masa de grasa visceral y el índice de de cintura talla. Se sugiere enfocar las intervenciones educativas según sello de vida saludable, incentivando la actividad física y mejorar los hábitos alimenticios en los profesores.


Obesity is considered a global pandemic that causes major metabolic changes. It is responsible for the so-called noncommunicable chronic diseases (NCDs), which report a 60 % mortality rate (WHO, 2017). In Chile, 63 % of the population shows body mass indexes (BMI) of overweight and obesity, with a sedentary level of 86.7 %. The objectives of this work were to determine the anthropometric profiles, metabolic risk, and physical activity levels in primary school teachers, in a subsidized school in Arica, Chile. The teachers (n=41), 12 men, and 29 women were evaluated according to weight, height, waist circumference (WC), waist-to-height index (WHI), BMI, Fat Mass (FM), Visceral Fat Mass (VFM) and Muscle Mass (MM). All of them were calculated for metabolic risk, according to Ashwell & Gibson protocols and BMI according to Quetelet's formula. To determine the percentages of FM, MM, and VFM, an electric bioimpedance instrument, Omron HBF-514C, was used. Subsequently, a survey of physical activity level (IPAQ) was applied. The data were analyzed in the IBM SPSS statistic for central tendency, dispersion, counts, and percentages. For correlation, Pearson's test (r> 0.5) was used. The results show that 68.3 % of teachers are overweight and obese. BMI and percentage of VFM are significantly higher in men than in women (30.6 ± 7.0 / 26.9 ± 4.6 and 11.2 ± 5.6 / 7.6 ± 2.5 respectively). The overall metabolic risk of the study population was 58.5 % (75 % and 51.7 % men and women, respectively). There is a high correlation between BMIVFM (0.84), BMI-WHI (0.84), MM-FM (0.85). Regarding the level of physical activity, only 19.5 % of teachers show a high level of physical activity. It is concluded that teachers have altered anthropometric values that indicate high rates of metabolic risks and low levels of physical activity. Regardless, women have better morphometric indexes in all parameters under study, compared to male teachers. There is a high correlation (r) between body mass index and percentages of visceral fat mass and waist height index. It is suggested to focus on educational interventions according to the healthy life seal, promoting physical activity, and improving eating habits in teachers.


Assuntos
Humanos , Masculino , Feminino , Adulto , Composição Corporal , Medição de Risco , Professores Escolares , Doenças Metabólicas/diagnóstico , Índice de Massa Corporal , Chile , Tecido Adiposo , Razão Cintura-Estatura
9.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-762474

RESUMO

BACKGROUND: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. METHODS: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. RESULTS: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. CONCLUSIONS: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The combination of biomarkers with hepcidin-25 may further improve diagnostic discrimination.


Assuntos
Lesão Renal Aguda , Biomarcadores , Proteínas do Sistema Complemento , Discriminação Psicológica , Hepcidinas , Humanos , Interleucina-6 , Rim , Lipocalinas , Projetos Piloto , Medição de Risco , Curva ROC , Cirurgia Torácica
10.
Korean Circulation Journal ; : 148-159, 2020.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-786223

RESUMO

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is associated with a higher long-term risk of major cardiovascular events. However, its clinical implications with respect to peri-operative cardiovascular outcomes in patients undergoing non-cardiac surgery is unclear. We tried to examine the association between pre-operative AF and peri-operative cardiovascular outcomes.METHODS: We retrospectively analyzed data from 26,501 consecutive patients who underwent comprehensive preoperative cardiac evaluations for risk stratification prior to receiving non-cardiac surgery at our center. Preoperative AF was diagnosed in 1,098 patients (4.1%), and their cardiovascular outcomes were compared with those of patients without AF. The primary outcome was the rate of major adverse cardiac and cerebrovascular events (MACCE) during immediate post-surgery period (<30 days).RESULTS: Patients with AF were older and had higher proportion of male sex, higher rate of extra-cardiac comorbidities, higher CHA₂DS₂-VASc score, and higher revised cardiac risk index (RCRI) compared with those without AF. The rate of MACCE was significantly higher in AF patients compared to non-AF patients (4.6% vs. 1.2%, p<0.001). Preoperative AF was associated with higher risk of MACCE, even after multivariable adjustment (odds ratio, 2.97; 95% confidence interval, 2.13–4.07, p<0.001). The relative contribution of AF to MACCE was larger in patients with lower RCRI (p for interaction=0.010). The discriminating performance of RCRI was significantly enhanced by addition of AF.CONCLUSIONS: In patients undergoing non-cardiac surgery, preoperative AF was associated with a higher risk of peri-operative cardiovascular outcomes.


Assuntos
Fibrilação Atrial , Comorbidade , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral
12.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-785435

RESUMO

PURPOSE: The risk of posthepatectomy liver failure (PHLF) after right hepatectomy remains substantial. Additional parameters such as computed tomography volumetry, liver stiffness measurement by FibroScan, indocyanine green retention rate at 15 minutes, and platelet count used to properly assess future liver remnant volume quality and quantity are of the utmost importance. Thus, we compared the usefulness of these modalities for predicting PHLF among patients with hepatocellular carcinoma after right hepatectomy.METHODS: We retrospectively reviewed patients who underwent right hepatectomy for hepatocellular carcinoma between 2007 and 2013. PHLF was determined according to International Study Group of Liver Surgery consensus definition and severity grading. Grades B and C were defined as clinically relevant posthepatectomy liver failure (CRPHLF). The results were internally validated using a cohort of 97 patients.RESULTS: Among the 90 included patients, 15 (16.7%) had CRPHLF. Multivariate analysis confirmed that platelet count < 140 (109/L) (hazard ratio [HR], 24.231; 95% confidence interval [CI], 3.623–161.693; P = 0.001) and remnant liver volume-to-body weight (RVL/BW) ratio < 0.55 (HR, 25.600; 95% CI, 4.185–156.590; P < 0.001) were independent predictors of CRPHLF. Among the 12 patients with a platelet count < 140 (109/L) and RLV/BW ratio < 0.55, 9 (75%) had CRPHLF. Likewise, 5 of 38 (13.2%) with only one risk factor developed CRPHL versus 1 of 40 (2.5%) with no risk factors. These findings were confirmed by the validation cohort.CONCLUSION: RLV/BW ratio and platelet count are more important than the conventional RLV/TFLV, indocyanine green retention rate at 15 minutes, and liver stiffness measurement in the preoperative risk assessment for CRPHLF.


Assuntos
Carcinoma Hepatocelular , Estudos de Coortes , Consenso , Hepatectomia , Humanos , Verde de Indocianina , Falência Hepática , Fígado , Análise Multivariada , Contagem de Plaquetas , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
13.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-811450

RESUMO

PURPOSE: The main purpose of this study was to compare the relationships between physical activity (measured using an accelerometer vs. self-reported) and cardiovascular disease risk factors. Differences in accelerometry physical activity between 10-minute bouts and total bouts were also compared.METHODS: Data originated from the Korea National Health and Nutrition Examination Survey. Logistic regression was used to predict cardiovascular disease risk from physical activity levels.RESULTS: Self-reported physical activity could not significantly predict the odds of having cardiovascular risk. However, the insufficiently active group classified according to the total-bout physical activity had significantly greater odds of having hypertension or prehypertension (odds ratio [OR], 1.35; 95% confidence interval [95% CI], 1.00–1.82), diabetes mellitus (OR, 1.77; 95% CI, 1.01–3.19), and dyslipidemia (OR, 1.65; 95% CI, 1.17–2.36) than the highly active group. Regarding the 10-minute bout physical activity, the inactive group had significantly greater odds of having only hypertension or prehypertension (OR, 1.67; 95% CI, 1.02–2.76) than the highly active group.CONCLUSION: Total-bout physical activity measured using an accelerometer could significantly predict the cardiovascular disease risk compared to 10-minute bout physical activity. However, self-reported physical activity could not significantly predict the cardiovascular disease risk.


Assuntos
Acelerometria , Doenças Cardiovasculares , Diabetes Mellitus , Dislipidemias , Hipertensão , Coreia (Geográfico) , Modelos Logísticos , Atividade Motora , Inquéritos Nutricionais , Pré-Hipertensão , Medição de Risco , Fatores de Risco , Autorrelato
14.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-810971

RESUMO

BACKGROUND: Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.METHODS: Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).RESULTS: During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).CONCLUSION: In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.


Assuntos
Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Desfibriladores Implantáveis , Filtração , Seguimentos , Coração , Insuficiência Cardíaca , Humanos , Coreia (Geográfico) , Mortalidade , Prevenção Primária , Medição de Risco , Prevenção Secundária , Choque
15.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wprim-816642

RESUMO

The 2019 novel coronavirus disease (COVID-19) outbreaks that emerged in Wuhan city, Hubei province, have led to a formidable number of confirmed cases that resulted in >5,700 deaths globally, including 143 countries in all 6 continents. The World Health Organization declared a Public Health Emergency of International Concern with a very high level of global risk assessment. Severe acute respiratory syndrome (SARS)-coronavirus-2 (SARS-CoV-2), the agent of COVID-19, has >79% nucleotide sequence homology to SARS-CoV; therefore, both belong to the genus betacoronavirus and subgenus sarbecovirus. The S1 domains of the two appeared to share the cellular receptor ACE2, but revealed a much higher S1-ACE2 binding affinity. As seen in many other human coronaviruses, SARS-CoV-2 also shows respiratory infection, but the basic reproductive number (R₀) in transmission and the clinical latency are quite dissimilar from those of SARS- or MERS-CoVs. Many scientists infer that the time point of cross-barrier transfer from bats to mediate animals or to humans should be a rather recent event based on the full-length genome analyses obtained from the very first patients. Copy-choice polymerization, which often leads to a significant genome recombination rate in most coronaviruses, predicts the continued emergence of novel coronaviruses.


Assuntos
Animais , Sequência de Bases , Quirópteros , Coronavirus , Surtos de Doenças , Emergências , Genoma , Humanos , Coronavírus da Síndrome Respiratória do Oriente Médio , Biologia Molecular , Polimerização , Polímeros , Saúde Pública , Recombinação Genética , Medição de Risco , Vírus da SARS , Síndrome Respiratória Aguda Grave , Organização Mundial da Saúde
16.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wprim-816629

RESUMO

Osteoporotic fracture (OF) is associated with high disability and morbidity rates. The burden of OF may be reduced by early identification of subjects who are vulnerable to fracture. Although the current fracture risk assessment model includes clinical risk factors (CRFs) and bone mineral density (BMD), its overall ability to identify individuals at high risk for fracture remains suboptimal. Efforts have therefore been made to identify potential biomarkers that can predict the risk of OF, independent of or combined with CRFs and BMD. This review highlights the emerging biomarkers of bone metabolism, including sphongosine-1-phosphate, leucine-rich repeat-containing 17, macrophage migration inhibitory factor, sclerostin, receptor activator of nuclear factor-κB ligand, and periostin, and the importance of biomarker risk score, generated by combining these markers, in enhancing the accuracy of fracture prediction.


Assuntos
Biomarcadores , Densidade Óssea , Macrófagos , Metabolismo , Fraturas por Osteoporose , Overall , Medição de Risco , Fatores de Risco
17.
Evid. actual. práct. ambul ; 23(2): e002053, 2020.
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1103669

RESUMO

En este artículo, el autor reflexiona sobre las expectativas de los profesionales de la salud acerca de la evidencia para recomendar tratamiento farmacológico a los pacientes con COVID-19. (AU)


In this article, the author reflects on the expectations of health professionals regarding the evidence to recommend pharmacological treatment to patients with COVID-19. (AU)


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Comunicação em Saúde , Inibidores de Proteases/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Azitromicina/uso terapêutico , Medição de Risco , Ritonavir/uso terapêutico , Medicina Baseada em Evidências/tendências , Coronaviridae/efeitos dos fármacos , Disseminação de Informação , Pandemias , Lopinavir/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Hidroxicloroquina/uso terapêutico
18.
Evid. actual. práct. ambul ; 23(2): e002057, 2020.
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1103663

RESUMO

La pandemia de COVID-19 está generando información epidemiológica y clínica en una escala sin precedentes para una enfermedad de reciente aparición. Aunque ya se han iniciado numerosos ensayos clínicos de fármacos antiguos y nuevos como potenciales antivirales específicos, la mayor parte de la información publicada hasta ahora carece de los controles básicos para la evaluación de la eficacia de un medicamento. Los medios de comunicación amplifican estos resultados preliminares y suman presión a los médicos asistenciales y a los decisores de políticas públicas. Este artículo revisa las pruebas disponibles sobre los cuatro tratamientos antivirales específicos más prometedores: hidroxicloroquina, lopinavir/ritonavir, remdesvir e interferones alfa y beta. Se comprueba en todos ellos que no hay demostración suficiente de eficacia como para recomendar su uso fuera de una investigación experimental adecuadamente controlada. En el uso individual de un medicamento no hay forma de saber si está beneficiando o perjudicando al paciente. Es erróneo asumir que la eventual curación se debe al fármaco y un mal desenlace debe atribuirse a la enfermedad. Sólo la comparación entre grupos de pacientes asignados al tratamiento experimental o a un control adecuado permite conocer la eficacia y seguridad de las intervenciones. El desafío es conciliar la urgencia de actuar con la generación de nuevos conocimientos.Aunque no resulta sencillo organizar ensayos clínicos en este contexto, las instituciones pueden sumarse a los proyectos en marcha a nivel nacional e internacional. El uso de estos fármacos debe considerarse experimental, por lo que es necesario obtener el consentimiento informado del paciente. (AU)


The COVID-19 pandemic is generating epidemiological and clinical information on an unprecedented scale for a newly emerging disease. Although numerous clinical trials of old and new drugs as potential specific antivirals have already been started, most of the information published so far lacks basic controls for evaluating drug efficacy. The media amplify these preliminary results and add pressure to doctors and policymakers. This article reviews the available evidence for the four most promising specific antiviral treatments: hydroxychloroquine, lopinavir / ritonavir, remdesvir, and alpha and beta interferons. The findings show that none of them has sufficient demonstration of efficacy to recommend its use outside ofthe adequately controlled experimental study. In the individual use of a drug there is no way of knowing if it is benefiting orharming the patient. It is wrong to assume that the eventual cure is due to the drug and a poor outcome must be attributed to the disease. Only the comparison between groups of patients assigned to the experimental treatment or to an adequate control can establish the efficacy and safety of the interventions. The challenge is to reconcile the urgency to act with the generation of new knowledge. Although it is not easy to organize clinical trials in this context, the institutions can join theongoing projects at the national and international levels. The use of these drugs should be considered experimental, so it is necessary to obtain the informed consent of the patient. (AU)


Assuntos
Humanos , Antivirais/farmacologia , Pneumonia Viral/tratamento farmacológico , Interferons/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Ritonavir/farmacologia , Lopinavir/farmacologia , Hidroxicloroquina/farmacologia , Antivirais/efeitos adversos , Resultado do Tratamento , Azitromicina/farmacologia , Medição de Risco , Ritonavir/administração & dosagem , Ritonavir/efeitos adversos , Medicina Baseada em Evidências/tendências , Disseminação de Informação , Uso Off-Label , Comunicação em Saúde , Pandemias , Lopinavir/administração & dosagem , Lopinavir/efeitos adversos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Consentimento Livre e Esclarecido
19.
Evid. actual. práct. ambul ; 23(2): e002058, 2020. tab
Artigo em Espanhol | LILACS (Américas) | ID: biblio-1103846

RESUMO

Ciertos hallazgos preclínicos generaron preocupación en la comunidad científica y en la población general sobre el uso de inhibidores de la enzima convertidora de angiotensina (IECA) y los antagonistas del receptor de la angiotensina II (ARAII), y los posibles desenlaces adversos asociados con relación a la infección por el nuevo Coronavirus (SARS-Cov-2).Por este motivo, nos planteamos como objetivo proveer de recomendaciones dinámicas (living recommendations) para el tratamiento con fármacos IECA o ARA II en pacientes con riesgo o documentación de infección por SARS-CoV-2 (en todo su espectro de gravedad). Se utilizó como metodología la adaptación/adopción de guías de práctica clínica bajo el enfoque GRADE, actualizando la evidencia al 7 de abril de 2020 mediante búsquedas en múltiples bases de datos y consultando a un panel multidisciplinario libre de conflictos de interés. Como resultado de este proceso se arribó a la siguiente afirmación: se recomienda, en contexto de la pandemia de COVID-19, en personas que se encuentran en tratamiento con IECA/ARAII, mantener el tratamiento sin cambios por sobre suspenderlo o reemplazarlo por otros fármacos (Recomendación fuerte a favor - calidad de evidencia baja). (AU)


Certain preclinical findings raised concerns in the scientific community and in the general population about the use ofangiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) and the possible adverse outcomes associated with the infection with the new Coronavirus (SARS-Cov-2). For this reason, our objective is to provide living recommendations for treatment with ACEI or ARA in patients with risk or documentation of SARS-CoV-2 infection (inall its severity spectrum). The adaptation/adoption of clinical practice guidelines under the GRADE approach was used as a methodology, updating the evidence as of April 7, 2020, by searching multiple databases and consulting a multidisciplinary panel free of conflicts of interest. As a result of this process, the following statement was reached: it is recommended, in the context of the COVID-19 pandemic, in people who are undergoing treatment with ACEI/ARA, to maintain the treatment unchanged instead of its suspension or replacement with other drugs (Strong recommendation in favor - low quality ofevidence). (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Pneumonia Viral/complicações , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Infecções por Coronavirus/complicações , Bloqueadores do Receptor Tipo 2 de Angiotensina II/farmacologia , Anti-Hipertensivos/farmacologia , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doenças Cardiovasculares/tratamento farmacológico , Inquéritos e Questionários , Guias de Prática Clínica como Assunto , Medição de Risco , Medicina Baseada em Evidências , Diabetes Mellitus/tratamento farmacológico , Insuficiência Renal Crônica/tratamento farmacológico , Bloqueadores do Receptor Tipo 2 de Angiotensina II/efeitos adversos , Pandemias , Tomada de Decisão Clínica , Betacoronavirus/efeitos dos fármacos , Abordagem GRADE , Anti-Hipertensivos/efeitos adversos
20.
Rev Rene (Online) ; 21: 42053, 2020. ilus
Artigo em Inglês, Português | LILACS (Américas), BDENF | ID: biblio-1087338

RESUMO

Objetivo: descrever os elementos constitutivos do cuidado de enfermagem presentes nas escalas de avaliação do risco de lesão por pressão usadas em unidades de terapia intensiva. Métodos: trata-se de uma revisão integrativa da literatura a partir do LILACS, MEDLINE, SCIELO e BDENF. Os descritores utilizados para a busca foram Pressure Ulcer; Decubitus Ulcer; Prevention and Control; Prevention; Intensive Care Units. A amostra final foi constituída por 13 artigos científicos. Resultados: a escala mais utilizada entre os estudos analisados foi Braden. Os elementos constitutivos evidenciados foram avaliação estruturada do risco, avaliação da pele e tecidos, cuidados preventivos com a pele, nutrição, reposicionamento no leito, superfícies de apoio e cuidados com dispositivos médicos. Conclusão: a prevenção de lesões relacionadas às incontinências, avaliação nutricional, intervenções nutricionais com o objetivo de prevenir lesões e os cuidados relacionados a dispositivos médicos são elementos constitutivos do cuidado de enfermagem pouco explorados ou ausentes nas escalas avaliadas


Objective: to describe the constituent elements of nursing care present in the pressure injury risk assessment scales used in intensive care units. Methods: this is an integrative literature review based on LILACS, MEDLINE, SCIELO and BDENF. The descriptors used for the search were Pressure Ulcer; Decubitus Ulcer; Prevention and control; Preven-tion; Intensive Care Units. The final sample consisted of 13 scientific articles. Results: the Braden scale was the most used scale among the analyzed studies. The constituent ele-ments highlighted were structured risk assessment, skin and tissue assessment, preventive skin care, nutrition, re-positioning in bed, support surfaces, and care with medical device. Conclusion: the prevention of incontinence-related injuries, nutritional assessment, nutritional interventions aimed at preventing injuries and care with medical devices are constituent elements of nursing care still poorly explo-red or absent in the evaluated scales


Assuntos
Humanos , Lesão por Pressão/prevenção & controle , Unidades de Terapia Intensiva , Avaliação Nutricional , Medição de Risco/métodos , Lesão por Pressão/enfermagem , Equipamentos e Provisões Hospitalares
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