Association of high ambient temperature with daily hospitalization for cardiorespiratory diseases in Brazil: A national time-series study between 2008 and 2018.

Further research is needed to examine the nationwide impact of temperature on health in Brazil, a region with particular challenges related to climate conditions, environmental characteristics, and health equity. To address this gap, in this study, we looked at the relationship between high ambient temperature and hospital admissions for circulatory and respiratory diseases in 5572 Brazilian municipalities between 2008 and 2018. We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by PM2.5, O3, relative humidity, and time-varying confounders. We estimated relative risks (RRs) of the association of heat (percentile 99th) with hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. In the second stage, we applied meta-analysis with random effects to estimate the national RR. Our study population includes 23,791,093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. The robustness of the RR and the effect size varied significantly by region, sex, age group, and health outcome. Overall, our findings suggest that i) respiratory admissions had the highest RR, while circulatory admissions had inconsistent or null RR in several subgroup analyses; ii) there was a large difference in the cumulative risk ratio across regions; and iii) overall, women and the elderly population experienced the greatest impact from heat exposure. The pooled national results for the whole population (all ages and sex) suggest a relative risk of 1.29 (95% CI: 1.26; 1.32) associated with respiratory admissions. In contrast, national meta-analysis for circulatory admissions suggested robust positive associations only for people aged 15-45, 46-65, >65 years old; for men aged 15-45 years old; and women aged 15-45 and 46-65 years old. Our findings are essential for the body of scientific evidence that has assisted policymakers to promote health equity and to create adaptive measures and mitigations.

Low ambient temperature and hospitalization for cardiorespiratory diseases in Brazil.

Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15-45, 46-65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature.

Short-term air pollution exposure and hospital admissions for cardiorespiratory diseases in Brazil: A nationwide time-series study between 2008 and 2018.

The established evidence associating air pollution with health is limited to populations from specific regions. Further large-scale studies in several regions worldwide are needed to support the literature to date and encourage national governments to act. Brazil is an example of these regions where little research has been performed on a large scale. To address this gap, we conducted a study looking at the relationship between daily PM2.5, NO2, and O3, and hospital admissions for circulatory and respiratory diseases across Brazil between 2008 and 2018. A time-series analytic approach was applied with a distributed lag modeling framework. We used a generalized conditional quasi-Poisson regression model to estimate relative risks (RRs) of the association of each air pollutant with the hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. Our study population includes 23, 791, 093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. Our findings suggest significant associations of ambient air pollution (PM2.5, NO2, and O3) with respiratory and circulatory hospital admissions in Brazil. The national meta-analysis for the whole population showed that for every increase of PM2.5 by 10 µg/m3, there is a 3.28% (95%CI: 2.61; 3.94) increase in the risk of hospital admission for respiratory diseases. For O3, we found positive associations only for some sub-group analyses by age and sex. For NO2, our findings suggest that a 10 ppb increase in this pollutant, there was a 35.26% (95%CI: 24.07; 46.44) increase in the risk of hospital admission for respiratory diseases. This study may better support policymakers to improve the air quality and public health in Brazil.

Mola invasiva en adolescente de 13 años. Aspectos fundamentales del diagnóstico y tratamiento / Invasive mola in 13-year-old girl. Fundamental aspects in diagnosis and treatment

Resumen ANTECEDENTES: La neoplasia gestacional trofoblástica es un tumor raro, derivado de la gestación que procede de un desarrollo anormal del tejido trofoblástico. Incluye cuatro variedades, entre las que se encuentra la mola invasiva y el coriocarcinoma. Puede tener diferentes grados de proliferación; el diagnóstico diferencial es decisivo porque influye directamente en el tratamiento. Las molas premalignas suelen tratarse con legrado uterino, las malignas requieren tratamiento sistémico con mono o poliquimioterapia. CASO CLÍNICO: Paciente de 13 años, hospitalizada debido a un cuadro de vómitos y dolor abdominal. Durante el internamiento se le practicaron estudios complementarios: determinación de la fracción β de la gonadotropina coriónica humana (β-hCG) y tomografía axial computada para plantear el diagnóstico diferencial. El diagnóstico definitivo lo aportó la biopsia obtenida mediante legrado. El tratamiento se basó en la poliquimioterapia. En la actualidad está en remisión completa de la enfermedad. CONCLUSIONES: Resulta imprescindible detectar lo más temprano posible la gestación anómala, entender perfectamente su evolución e importancia de la anticoncepción mientras se trata y la enfermedad desaparece y minimizar la cantidad de pacientes que deben recibir quimioterapia.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is a rare tumor that originates from pregnancy and it develop from anormal proliferation of trophoblastic tissue. It includes four varieties, including invasive mole and choriocarcinoma. They can present different degrees of proliferation, being essential differential diagnosis since it directly influences the treatment. Premalignant moles are usually treated by suction curettage while malignant forms require systemic therapy with mono or polychemotherapy. OBJECTIVE: Report the case, paying special attention to the differential diagnosis and treatment used, analyzing the reasons why polychemotherapy is established and describing the different possible options, based on current scientific evidence. CLINICAL CASE: We present the case of an invasive mola in a 13-year-old patient hospitalized by vomiting and abdominal pain. During this period, complementary techniques such as the determination of the β fraction of the human chorionic gonadotropin (β-hCG) or computed tomography (CT) are required to establish the differential diagnosis. Finally, the definitive diagnosis is provided by the biopsy obtained by curettage. Treatment is instituted with the pattern of polychemotherapy being, currently, with complete remission of the disease. CONCLUSIONS: Thus, it is essential to detect anomalous gestation early, to understand perfectly the evolution of this entity, the importance of contraception during its resolution, and to minimize patients susceptible to chemotherapy.

[Implementation of respiratory rehabilitation in the municipalities of Valparaíso, Viña del Mar, Quilpué and Villa Alemana in 2013]. / Implementación de la rehabilitación respiratoria en las comunas de Valparaíso, Viña del Mar, Quilpué y Villa Alemana durante el año 2013.

INTRODUCTION: Pulmonary rehabilitation is a keystone in the treatment of patients with Chronic Obstructive Pulmonary Disease. Significantly reduces the costs to the health system, the use of health resources by reducing hospital stay and consultations to emergency services. OBJECTIVE: Describe the current condition of respiratory rehabilitation in primary care centers located in the region of Valparaíso. METHOD: A closed survey in the respiratory centers of primary health care was applied. The sample consisted of 32 health centers corresponding to the communes of Valparaíso, Viña del Mar, Quilpué and Villa Alemana. RESULTS: 9 centers (28%) of the total sample performed pulmonary rehabilitation and the same number have a structured rehabilitation program. In 15 (47%) of the centers there is a Nutritionist in the health team. In 100% of hospitals patients assessed by spirometry and dyspnea scales. Most centers (89%) training upper and lower extremities. Among the factors that limit the performance of respiratory rehabilitation, 20 (63%) report that the schedule are one of the most limiting factors, while 23 (72%) report that centers do not have adequate space and 22 (69%) centers relate not have the minimum equipment necessary. DISCUSSION: Our findings suggest that most respiratory rehabilitation center did not performed as part of the treatment of patients with chronic obstructive pulmonary disease, mainly due to problems of human, material and infrastructure.

Introducción: La rehabilitación respiratoria es un pilar fundamental en el tratamiento del paciente con Enfermedad Pulmonar Obstructiva Crónica. Reduce importantemente los costos para el sistema de salud, el uso de recursos sanitarios, disminuyendo la estadía hospitalaria y las consultas a servicios de urgencia. Objetivo: Describir la condición actual de la rehabilitación respiratoria en los centros de atención primaria ubicados en la región de Valparaíso. Método: Se aplicó una encuesta cerrada a cada profesional a cargo del área respiratoria en los centros de atención primaria de salud. La muestra estuvo conformada por 32 centros de salud correspondientes a las comunas de Valparaíso, Viña del Mar, Quilpué y Villa Alemana. Resultados: 9 centros (28%) del total de la muestra realizan rehabilitación respiratoria y el mismo número tiene un programa de rehabilitación estructurado. En 15 (47%) de los centros existe un Nutricionista dentro del equipo de salud. En el 100% de los centros se evalúa a los pacientes mediante espirometría y escalas de disnea. La mayoría de los centros (89%) realiza entrenamiento de extremidades superiores e inferiores. Dentro de los factores que limitan la realización de la rehabilitación respiratoria, 20 (63%) centros refieren que el horario de atención es uno de los factores más limitantes, mientras que 23 (72%) centros refieren que no cuentan con espacio físico adecuado y 22 (69%) centros relatan no contar con los implementos mínimos necesarios. Discusión: Los datos obtenidos indican que en la mayoría de los centros encuestados no se realiza rehabilitación respiratoria como parte del tratamiento del paciente con Enfermedad Pulmonar Obstructiva Crónica, principalmente por problemas de recursos humanos, materiales e infraestructura.

Incidence of influenza-associated mortality and hospitalizations in Argentina during 2002-2009.

BACKGROUND: We estimated rates of influenza-associated deaths and hospitalizations in Argentina, a country that recommends annual influenza vaccination for persons at high risk of complications from influenza illness. METHODS: We identified hospitalized persons and deaths in persons diagnosed with pneumonia and influenza (P&I, ICD-10 codes J10-J18) and respiratory and circulatory illness (R&C, codes I00-I99 and J00-J99). We defined the influenza season as the months when the proportion of samples that tested positive for influenza exceeded the annual median. We used hospitalizations and deaths during the influenza off-season to estimate, using linear regression, the number of excess deaths that occurred during the influenza season. To explore whether excess mortality varied by sex and whether people were age <65 or ≥ 65 years, we used Poisson regression of the influenza-associated rates. RESULTS: During 2002-2009, 2411 P&I and 8527 R&C mean excess deaths occurred annually from May to October. If all of these excess deaths were associated with influenza, the influenza-associated mortality rate was 6/100,000 person-years (95% CI 4-8/100,000 person-years for P&I and 21/100,000 person-years (95% CI 12-31/100,000 person-years) for R&C. During 2005-2008, we identified an average of 7868 P&I excess hospitalizations and 22,994 R&C hospitalizations per year, resulting in an influenza-associated hospitalization rate of 2/10,000 person-years (95% CI 1-3/10,000 person-years) for P&I and 6/10,000 person-years (95% CI 3-8/10,000 person-years) for R&C. CONCLUSION: Our findings suggest that annual rates of influenza-associated hospitalizations and death in Argentina were substantial and similar to neighboring Brazil.

Mortality, severe acute respiratory infection, and influenza-like illness associated with influenza A(H1N1)pdm09 in Argentina, 2009.

INTRODUCTION: While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America. METHODS: During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event. RESULTS: We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5-44 years to 5.6 among persons aged ≥ 65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged <5 years to 41.8 among persons aged ≥ 65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged <5 to 17.1 among persons aged 45-64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p ≤ 0.001). CONCLUSION: Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations.

Proyecto de introducción de las Tecnología informáticas en apoyo a la enseñanza y aprendizaje del Test Muscular / Computer technologies introduction project in support to the teaching and learning of the muscular test

Dentro del currículo del perfil Terapia Física y Rehabilitación se encuentra la asignatura Evaluación Funcional del Discapacitado que se imparte en el primer año de la carrera proporcionándole al estudiante los conocimientos más trascendentes que se realizan en los procesos de rehabilitación de las diferentes especialidades y enfermedades discapacitantes a las que la especialidad presta sus servicios. Este programa se abarca nueve unidades entre ellas la de Test muscular, encontrándose con el problema de no contar con la bibliografía actualizada y necesaria para el desarrollo de los contenidos para profesores y estudiantes. Teniendo en cuenta el aprendizaje colaborativo apoyado en computadoras, que se han convertido en herramientas mediadoras en los procesos de enseñanza aprendizaje por lo que el siguiente trabajo consiste en una propuesta de introducción de las nuevas tecnologías informáticas en apoyo a la enseñanza del test muscular para dar respuesta a esta necesidad, proponiéndonos como objetivo analizar las potencialidades de la aplicación de la computación a la temática del test muscular. Nos proponemos la realización de un WEB CD mediante la utilización de un paquete macromedia (Dreamweaver MX) contentivo de un compendio informativo sobre los temas referidos a la mencionada unidad con el que se beneficiaran alrededor de 200 estudiantes de 5 municipios y 5 profesores ya que actualmente se cuenta con un solo libro que posee el profesor principal de la asignatura. El trabajo se encuentra en la primera fase de confección. La utilización del sofware educativo será novedosa, atractiva y práctico que facilitará la enseñanza del test muscular(AU)

La rehabilitacion oral como instrumento para la disminucion de la prevalencia de caries dental en niños de 6 a 9 años en el policlinico El Alto de la Caja Nacional de Salud / The oral rehabilitation as instrument for the reduction of the prevalence of caries in children from 6 to 9 years in the polyclinic He High of the national health Fund

Uno de los problemas de salud oral que se observa con mayor frecuencia entre niños de 6 a 9 años en la ciudad de El Alto es la caries dental. La prevalencia de este mal, que afecta a la mayoria de los niños de esta ciudad ees preocupantemente alta aproximadamente de cada 10 niños que acuden a la consulta odontologica 8 tienen caries en diferente estadios lo que convierte a eta patologia en la principal. Los sistemas de salud oral tanto publicos como privados, no cuentan con programas desarrollados para enfrentar de manera sistematica y permanente este problema, pese a que se cuenta, en ambos, con la capacidad técnica, de infraestructura, equipamiento y recursos humanos. La atención odontologica se rige a la atención de casos especificos requeridos por los pacientes, siendo la mayoria demendadas de extracciones y curaciones. El personal odontologico carece de la actitud profesional para desarrollar tratamientos curativos integrales y, menos aun, preventivos. Asi mismo, el paciente odontologico rehuye los tramientos prolongados y no comprende la importancia de la salud oral. Por lo propuesto el presente trabajo pretende demostrar, a traves de un estudio de casos y controles, la necesidad, pertinencia y factibilidad de disminuir la prevalencia de las caries dental en pacientes y niños entre los 6 y los 9 años en el Policlinico de la Ceja de El Alto, a traves de la rehabilitación oral. El objetivo general del trabajo es disminuir la prevalencia de caries dental en niños de 6 a 9 años, aplicando la rehabilitación oral, de acuerdo a las prestaciones a corto plazo que ofrece la Caja Nacional de Salud

Caracteres biológicos de Hemophilus influenzae aislado de diferentes poblaciones infantiles / Biological characteristics of Haemophilus influenzae isolated from different infantile populations

Las características biológicas de Hemophilus influenzae aisladas de áreas normalmente estériles o de la orofaringe de niños, no han sido descritas en el Uruguay. Esta información tiene importante implicancia en la comprensión de la patogenia de esas infecciones y en los requisitos para lograr una vacuna adecuada. Con tal fin se determinaron los serotipos y biotipos en 54.3 por ciento de las cepas aisladas entre 1986 y 1992. Además en la totalidad de las cepas conservadas (n=311) se investigó la producción de ß lactamasas. Se demostró que la resistecia a los ß lactámicos era poco frecuente (5.9 por ciento ). Las cepas invasivas, recuperadas de la sangre, derrame pleural o LCR, pertenecían en su mayoría, al serotipo b y al biotipo I (83.4 por ciento ). En las infecciones del oído medio predominaron los H. influenzae no tipificables, así como entre las cepas que colonizaban la orofaringe de pacientes y niños sanos, pero en estos casos los biotipos fueron diversos, con 38 por ciento correspondiendo al biotipo II. Las vacunas conjugadas conteniendo polisacárido capsular del serotipo b, prevendrían los cuadros invasivos, pero no se lograría el control de infecciones por otros serotipos y por cepas no tipificables

Recidiva de pterigio según técnica quirúrgica. Frecuencia y factores asociados. Fundación Oftalmológica Colombiana. 1986–1988 / Pterygium relapse according to surgical technique. Frequency and associated factors. Fundación Oftalmológica Colombiana. 1986-1988

En la Fundación Oftalmológica Colombiana de Medellín (Colombia) en el periodo 1986-1988 se diagnosticaron 1980 pterigios en 1341 pacientes, siendo 47.6 por ciento bilaterales. El 36.7 por ciento se presentaron en hombres y 63.2 por ciento en mujeres. El 95.7 por ciento de los casos se presentaron en mayores de 20 años. El 83.8 por ciento se manejaron médicamente y sólo se intervinieron quirúrgicamente el 16.1 por ciento de los casos. Las técnicas quirúrgicas más usadas fueron: Plastia Rotacional con 69.9 por ciento de los casos y Esclera Libre con el 15.9 por ciento. Al57.3 por ciento de los Pterigios operados, se les hizo un seguimiento adecuado. En el 50. 2 por ciento de los mismos no se evidenció recidiva. Se presentaron 91 recidivas (49 por ciento), el mayor número de las mismas se presentó con la técnica Esclera Libre con un 50.9 por ciento, seguida por la técnica de Plastia Rotacional con un 25.4 por ciento. El mejor resultado se obtuvo con la técnica de Injerto Libre con un 38.8 por ciento de pacientes libre de recidiva...