ABSTRACT
Resumen Objetivo: Identificar el nivel de conocimiento sobre bioética en el personal salud que labora en un hospital de tercer nivel de atención, para que los dilemas bioéticos se turnen al Comité Hospitalario de Bioética. Materiales y Métodos: Se realizó un estudio descriptivo, transversal y prospectivo. Mediante un muestreo probabilístico por estratos, se calculó el tamaño de muestra para una población finita n=302 con un 95% de nivel de confianza, se realizó una visita a las áreas por turnos, se aplicó un cuestionario obtenido de 2 cuestionarios validados por Lynch y cols, y Hernández y cols. Dentro de las consideraciones éticas se aplicó un consentimiento informado previo a contestar el cuestionario. Se realizó un análisis estadístico descriptivo. Resultados: Los principios bioéticos que revisa el cuestionario son: Autonomía la cual fue identificada de manera correcta en 17.2%, Justicia en 10.3% y Los principios bioéticos que revisa el cuestionario son: Autonomía la cual fue identificada de manera correcta en 17.2%, Justicia en 10.3% y Beneficencia en 14.6%. Con respecto al nivel de conocimiento se encontró un2% de conocimiento alto, 33% de conocimiento regular, 33% de conocimiento bajo y 32% de conocimiento nulo. Conclusiones: Todos los días se presentan dilemas éticos, el identificarse de manera adecuada por el personal de salud y canalizarlos al Comité Hospitalario de Bioética sería el ideal de todo hospital que permitiría coadyuvar de manera adecuada en una mejor toma de decisiones en la atención al paciente.
Abstract Objective: Identify the level of knowledge about Bioethics in the health care workers in a third level hospital, so that the bioethical dilemmas turn to the Hospital Committee of Bioethics. Materials and Methods A descriptive, cross-sectional and prospective study was conducted. By means of a probabilistic sampling by strata, the sample size was calculated for a finite population n = 302 with a 95% confidence level, a visit to the areas was made in shifts, a questionnaire obtained from 2 questionnaires validated by Lynch et al., and Hernández et al. was applied. Within the ethical considerations, a prior informed consent was applied to answer the questionnaire. A descriptive statistical analysis was performed. Results: The bioethical principles that the questionnaire reviews are autonomy which was correctly identified in 17.2%, justice in 10.3%and charity in 14.6%. With respect to the level of knowledge, a 2% high knowledge, 33% regular knowledge, 33% knowledge low and 32% of null knowledge was found. Conclusions: Ethical dilemmas are presented every day, identifying properly by health care workers and channeling them to the Bioethics Hospital Committee would be the ideal of every hospital that would allow us to properly contribute toa better decision -making in patient care.
ABSTRACT
Background: There is substantial variation in COVID-19 lethality across countries. In addition, in countries with populations with extreme economic inequalities, such as Mexico, there are regional and local differences in risk factors for COVID-19 death. The goal of this study was to test the hypothesis that the risk of death in Mexican COVID-19 patients was associated with the time between symptom onset and hospitalization and/or with the healthcare site. Also, death prognostic models were developed. Methods: The study included two COVID-19 inpatient cohorts, one prospective and one retrospective from Chiapas, Mexico. Demographic, clinical and laboratory variables were collected, and the diagnosis of SARS-CoV-2 infection was performed using RT-qPCR in samples collected seven days since symptom onset. The 30-day mortality, since symptom onset, was the outcome, and clinical variables at the first 48 hours of hospitalization were independent factors. Multivariate logistic regression analyses were conducted. Results: Of the 392 patients included, 233 died (59.4%). The time between symptom onset and hospitalization, the healthcare site and sex were not related to the 30-day mortality. Three death prognostic models were developed (AUC between 0.726 and 0.807). Age, LDH, AST, and lymphocyte count were included in all models, OSI-WHO Classification (Non-invasive ventilation or high-flow oxygen, and mechanical ventilation with or without organ support/ECMO) and leukocyte count in two models, and diabetes and diarrhea in one model. Conclusion: The population evaluated had underlying deteriorated health before COVID-19 compared with regional and country population. The factors that determine the COVID-19 mortality risk in a relatively healthy population are sex, age and comorbidities. However, as this study shows, when populations have underlying poor health, some of these factors lose their associations with mortality risk, and others become more important.
ABSTRACT
BACKGROUND: The emerging chikungunya virus (CHIKV), is an arbovirus causing intense outbreaks in North America. The situation in Mexico is alarming, and CHIKV threatens to spread further throughout North America. Clinical and biological features of CHIKF outbreaks in Mexico have not been well described; thus, we conducted a cross sectional study of a CHIKV outbreak in Chiapas, Southern Mexico to further characterize these features. METHODOLOGY/PRINCIPAL FINDINGS: We collected blood samples from patients suspected of having chikungunya fever (CHIKF) who presented to Clinical Hospital ISSSTE Dr. Roberto Nettel in Tapachula, Chiapas, Mexico. In addition to the clinical examination, real-time polymerase chain reaction (PCR) standardized for the Asian Chikungunya lineage and/or enzyme-linked immunosorbent assay for immunoglobulin M (IgM) were used to confirm CHIKV diagnosis. Of a total of 850 patients who presented with probably CHIKV at Hospital "Dr. Roberto Nettel", 112 probable CHIKF cases were enrolled in this study from November 2014- June 2015, of which 95 patients (84.8%) were CHIKV positive and 17 were negative (15.2%). Of these 95 CHIKV positive patients, 62 were positive by real-time reverse transcriptase PCR (+qRT-PCR); and 33 were seropositive to +IgM with a negative qRT-PCR. The most frequent symptoms reported were fever (100%), headache (82.3%), polyarthralgia (72.1%), and exanthem (82.3%). Biological abnormalities observed during CHIKV infection were lymphopenia (41.1%), leukopenia (51.6%), elevated transaminases (30.5%-46.3%) and high LDH (46.3%) and CRP (60.0%). CONCLUSION: Clinical and biological data obtained from this study is providing more useful information for benchmarking purposes with outbreaks from different parts of the world and would be helpful for better patient care and treatment.