ABSTRACT
Purpose: The effect of high altitude ( ≥ 1500â m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
Subject(s)
COVID-19 , Adult , Aged , Altitude , Cohort Studies , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Respiration, Artificial , Retrospective StudiesABSTRACT
Analiza que la adolescencia es un período comprendido entre los 12 a 21 años, en la cual sucede una maduración física y psicológica. Al presentarse un embarazo en esta época, el riesgo para la madre y el niño serán mayores, influyendo además la inmadurez psicológica, como su instrucción deficiente. El presente es un estudio prospectivo, realizado por medio de una encuesta precodificada a las madres adolescentes que acudieron para el parto al Hospital Pablo Arturo Suárez de Quito, durante oct.-dic. 1996. Se estudiaron 73 madres, cuyo promedio fue 17,2, 0.99 años, en su mayoría de instrucción secundaria icnompleta (42,46 por ciento), y con trabajos de baja remuneración. La edad promedio de inicio de la vida sexual fue de 15,8, 3,07 años, desconocían de métodos anticonceptivos un 78,089 por ciento. Se observó que en este grupo en su mayoría los controles prenatales son inadecuados (54,79 por ciento), presentaron complicaciones durante el embarazo el 54,8 por ciento, las principales fueron: infección de vías urinarias, leucorrea, y anemia, mientras que el 62 por ciento de recién nacidos no presentaron complicaciones...
