Efectos de la rehabilitación pulmonar en pacientes con EPOC según la clasificación GOLD 2020 en Cali, Colombia / Pulmonary rehabilitation effects in patients with COPD according to GOLD 2020 classification in Cali, Colombia

Introducción: La enfermedad pulmonar obstructiva crónica dispone de una guía encargada de la prevención y tratamiento, denominada Global Initiative for Chronic Lung Disease, la cual anualmente se actualiza y cataloga la rehabilitación pulmonar, dentro de las opciones de tratamiento. Objetivo: Describir los efectos en variables clínicas, de capacidad funcional, de ansiedad/depresión y calidad de vida relacionada con la salud en pacientes con enfermedad pulmonar obstructiva crónica, después de un programa de rehabilitación pulmonar, de acuerdo con la clasificación GOLD 2020 en una clínica de Cali. Materiales y métodos: Estudio descriptivo, longitudinal donde se incluyeron 79 pacientes divididos en 3 grupos (B, C y D). Resultados: La edad media fue de 70 años; el 69% eran hombres. La cantidad de días hospitalizados fue mayor para el grupo C y D, con un promedio de 8 y 13 días, respectivamente (p≤0,000). La capacidad funcional evidenció una mayor distancia en el grupo C (421m) y la menor distancia para el grupo D (328m), p≤0,006. En la ansiedad y depresión, el grupo D logró obtener mejorías al igual que en el cuestionario de calidad de vida. Conclusión: El grupo C presentó mayor capacidad funcional y mejor calidad de vida, el grupo B tuvo mejores resultados en las variables clínicas, y el grupo D tuvo peor condición clínica, capacidad funcional y calidad de vida. Al finalizar la rehabilitación pulmonar el grupo D presentó mayores cambios en la capacidad funcional y calidad de vida.(AU)

Introduction: Chronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options. Objective: To describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic. Materials and methods: Descriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D). Results:The mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire. Conclusion: Group C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life.(AU)

Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism.

BACKGROUND: The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. METHODS: We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. RESULTS: Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. CONCLUSIONS: Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality.

[Pulmonary rehabilitation effects in patients with COPD according to GOLD 2020 classification in Cali, Colombia]. / Efectos de la rehabilitación pulmonar en pacientes con EPOC según la clasificación GOLD 2020 en Cali, Colombia.

INTRODUCTION: Chronic obstructive pulmonary disease has a guide in charge of prevention and treatment, called the Global Initiative for Chronic Lung Disease, which is annually updated and catalogs pulmonary rehabilitation, within the treatment options. OBJECTIVE: To describe the effects on clinical variables, functional capacity, anxiety/depression and health-related quality of life in patients with chronic obstructive pulmonary disease, after a pulmonary rehabilitation program, according to the GOLD 2020 classification in a Cali clinic. MATERIALS AND METHODS: Descriptive, longitudinal study where 79 patients divided into 3 groups were included (B, C and D). RESULTS: The mean age was 70 years, 69% men. The number of hospitalized days was greater for groups C and D with an average of 8 and 13 days, respectively (p≤0.000). The functional capacity showed a greater distance in group C (421m) and the shortest distance for group D (328m), p≤0.006. In anxiety and depression, group D managed to obtain improvements as well as in the quality of life questionnaire. CONCLUSION: Group C presented greater functional capacity and better quality of life, group B had better results in clinical variables, and group D had worse clinical condition, functional capacity and quality of life. At the end of pulmonary rehabilitation, group D presented greater changes in functional capacity and quality of life.

Reconfigurable frequency multipliers based on graphene field-effect transistors.

Run-time device-level reconfigurability has the potential to boost the performance and functionality of numerous circuits beyond the limits imposed by the integration density. The key ingredient for the implementation of reconfigurable electronics lies in ambipolarity, which is easily accessible in a substantial number of two-dimensional materials, either by contact engineering or architecture device-level design. In this work, we showcase graphene as an optimal solution to implement high-frequency reconfigurable electronics. We propose and analyze a split-gate graphene field-effect transistor, demonstrating its capability to perform as a dynamically tunable frequency multiplier. The study is based on a physically based numerical simulator validated and tested against experiments. The proposed architecture is evaluated in terms of its performance as a tunable frequency multiplier, able to switch between doubler, tripler or quadrupler operation modes. Different material and device parameters are analyzed, and their impact is assessed in terms of the reconfigurable graphene frequency multiplier performance.

Two predicted α-helices within the prion-like domain of TIAR-1 play a crucial role in its association with stress granules in Caenorhabditis elegans.

Stress granules (SGs) are sites for mRNA storage, protection, and translation repression. TIA1 and TIAR1 are two RNA-binding proteins that are key players in SGs formation in mammals. TIA1/TIAR have a prion-like domain (PrD) in their C-terminal that promotes liquid-phase separation. Lack of any TIA1/TIAR has severe consequences in mice. However, it is not clear whether the failure to form proper SGs is the cause of any of these problems. We disrupted two predicted α-helices within the prion-like domain of the Caenohabditis elegans TIA1/TIAR homolog, TIAR-1, to test whether its association with SGs is important for the nematode. We found that tiar-1 PrD mutant animals continued to form TIAR-1 condensates under stress in the C. elegans gonad. Nonetheless, TIAR-1 condensates appeared fragile and disassembled quickly after stress. Apparently, the SGs continued to associate regularly as observed with CGH-1, an SG marker. Like tiar-1-knockout nematodes, tiar-1 PrD mutant animals exhibited fertility problems and a shorter lifespan. Notwithstanding this, tiar-1 PrD mutant nematodes were no sensitive to stress. Our data demonstrate that the predicted prion-like domain of TIAR-1 is important for its association with stress granules. Moreover, this domain may also play a significant role in various TIAR-1 functions unrelated to stress, such as fertility, embryogenesis and lifespan.

Gravedad de los pacientes ingresados por EPOC agudizada en el ensayo clínico SLICE / Severity of patients admitted for acute COPDin the SLICE clinical trial

Introducción: Hay poca información actualizada sobre las características clínicas y la gravedad de los pacientes con EPOC que ingresan por una agudización. Nuestro objetivo fue caracterizar a los pacientes que ingresan por agudización de EPOC según la limitación al flujo aéreo: obstrucción leve (Volumen Espiratorio Forzado en el primer segundo [VEF1] ≥ 80%); moderada (VEF1 50 - 79%); grave (VEF1 30 - 49%); o muy grave (VEF1 <3 0%).Métodos: Realizamos un análisis post-hoc del ensayo clínico multicéntrico SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), que reclutó pacientes consecutivos con agudización de EPOC que requirieron ingreso en 18 hospitales españoles en el periodo comprendido entre septiembre de 2014 y julio de 2020.Resultados: Incluimos 737 pacientes, con una edad media (DE) de 70,2 ± 9,9 años, y un predominio de hombres (73,5%). La espirometría clasificó a los pacientes con obstrucción leve, moderada, grave o muy grave en el 8%, 31,5%, 45% y el 15,5%, respectivamente. Al comparar a los pacientes de acuerdo al grado de obstrucción, observamos que los pacientes con mayor obstrucción al flujo aéreo eran más jóvenes (leve: 71,7 ± 8,8, moderada: 72,4 ± 10, grave: 70,2 ± 9,8, muy grave: 66,6 ± 9,2; p < 0,001), presentaban más insuficiencia respiratoria crónica (37,3% vs. 30,2% vs. 44,9% vs. 64,3%; p < 0,001), presentaban más cianosis (5,8% vs. 5,9% vs. 8,5% vs. 15,3%; p < 0,001), presentaron mayor porcentaje de agudizaciones y estaban más taquicárdicos a su llegada al centro hospitalario (92 ± 16 latidos por minuto [lpm] vs. 94 ± 18 vs. 96 ± 18 lpm vs. 99 ± 18 lpm; p < 0,001). Además, la gasometría arterial al ingreso mostraba un pH menor y una pCO2 mayor cuanto más grave era la obstrucción al flujo aéreo (p < 0,001). Conclusión: La gravedad de la obstrucción al flujo aéreo se asocia con la forma de presentación y el resultado de la gasometría arterial del paciente con agudización de EPOC que requiere ingreso hospitalario. (AU)

Introduction: There is little up-to-date information on the clinical characteristics and severity of COPD patients admitted for an exacerbation. Our objective was to characterize patients admitted due to COPD exacerbation according to airflow limitation: mild obstruction (Forced Expiratory Volume in 1 second [FEV1] ≥ 80%); moderate (FEV1 50 - 79%); severe (FEV1 30 - 49%); or very severe (FEV1 <3 0%).Methods: We performed a post-hoc analysis of the multicenter clinical trial SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), which recruited consecutive patients with COPD exacerbation who required admission to 18 Spanish hospitals in the period between September 2014 and July 2020.Results: We included 737 patients, with a mean (SD) age of 70.2 ± 9.9 years, and a predominance of men (73.5%). Spirometry classified patients with mild, moderate, severe, or very severe obstruction in 8%, 31.5%, 45%, and 15.5%, respectively. When comparing the patients according to the degree of obstruction, we observed that the patients with greater airflow obstruction were younger (mild: 71.7 ± 8.8, moderate: 72.4 ± 10, severe: 70.2 ± 9.8, very severe: 66.6 ± 9.2; p < 0.001), had more chronic respiratory failure (37.3% vs. 30.2% vs. 44.9% vs. 64.3%; p < 0.001), had more cyanosis (5.8% vs. 5.9% vs. 8.5% vs. 15.3%; p < 0.001), had a higher percentage of exacerbations and were more tachycardic on arrival at the center hospital (92 ± 16 beats per minute [bpm] vs. 94 ± 18 vs. 96 ± 18 bpm vs. 99 ± 18 bpm; p < 0.001). In addition, arterial blood gases on admission showed a lower pH and a higher pCO2 the more severe the airflow obstruction was (p < 0.001).Conclusion: The severity of the airflow obstruction is associated with the form of presentation and the result of the arterial blood gases of the patient with COPD exacerbation who requires hospital admission. (AU)

Usefulness of bilateral mucoplasty plus reboot surgery in severe type-2 chronic rhinosinusitis with nasal polyps.

BACKGROUND: Although extended endoscopic sinus surgery (ESS) constitutes an alternative approach in patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP), the surgical techniques proposed so far do not allow for an optimal control of the disease. This study introduces bilateral mucoplasty as a complementary technique to extended ESS such as reboot surgery, analyzing its benefits in healing and quality of life (QoL). METHODS: Patients diagnosed with severe Type-2 CRSwNP were selected for a prospective cohort study in two surgery groups: reboot surgery plus bilateral mucoplasty versus reboot surgery only. In the first group, an autologous endonasal mucosal graft from the nostril floor was placed bilaterally onto the ethmoidal roof. Endoscopic, radiological and QoL outcomes were compared before and one year after surgery between the two groups using Modified Lund Kennedy (LKM), Meltzer and Lund Mackay (LM) scores, and the Sino-Nasal Outcome Test 22 (SNOT-22). RESULTS: 64 patients with homogeneous baseline characteristics were included: 17 patients underwent a reboot surgery plus a bilateral mucoplasty and 47 a reboot surgery only. LKM, Meltzer and SNOT-22 scores showed significant differences before and after surgery in both groups, with higher improvement in the mucoplasty group. A greater mean improvement of 20.5 ± 6.4 points in SNOT-22 change was associated with bilateral mucoplasty. CONCLUSION: Bilateral mucoplasty plus reboot surgery constitutes a useful surgical resource in Type-2 CRSwNP patients, showing improved endoscopic, radiological and QoL outcomes one year after surgery. Further studies are needed to determine their long-term benefits.

Effects of ergo-nutritional strategies on recovery in combat sports disciplines / Efectos de las estrategias ergo-nutricionales sobre la recuperación en las disciplinas de deportes de combate

In order to improve the recovery process in combat sports disciplines, ergo-nutritional strategies could be an effective option in training and competition. Some of these ergo-nutritional aids could improve performance but literature references are scarce, with controversial results regarding actual recovery effects. This systematic review aimed to examine which ergo-nutritional methods are most effective for assisting in the recovery process in combat sports, and to determine the appropriate training stimuli. This systematic review was carried out following the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. A computerized search was performed in PubMed, Web of Science, the Cochrane Collaboration Database, Evidence Database, Evidence Based Medicine Search review, National Guidelines, EM-BASE, Scopus and Google Scholar system (from 1995 to April 30, 2021). The PICOS model was used to define inclusion and exclusion criteria. Out of 123 studies initially found, 18 met the eligibility criteria and were included in the review. Data from 367 athletes from different disciplines were examined. The evidence was grouped in 4 areas: oxidative stress, muscle and energy recovery, muscle repair, and metabolic acidosis. Evidence showed that vitamins, minerals, and some natural ergo-nutritional products are effective as antioxidants. Carbohydrates and protein determine the recovery effect. Sodium bicarbonate has a role as primary acidosis metabolic delayer. Accordingly, ergo-nutritional aids can help in the recovery process. Considering the effects outlined in the literature, more studies are needed to provide firm evidence (AU)

Para mejorar el proceso de recuperación en las disciplinas deportivas de combate, las estrategias ergo-nutricionales son una opción eficaz en el entrenamiento y la competición. Algunas de estas alternativas mejoran el rendimiento, pero actualmente existe una escasa bibliografía con resultados controvertidos relacionados con el efecto de recuperación. Esta revisión sistemática tuvo como objetivo determinar qué estrategias ergo-nutricionales son más efectivas en los procesos de recuperación. Se llevó a cabo siguiendo las pautas Preferred Reporting Items for Systematic Review (PRISMA). Se realizó una búsqueda computarizada en PubMed, Web of Science, Cochrane Collaboration Database, Evidence Database, Evidence Based Medicine Search review, National Guidelines, EM-BASE, Scopus y el sistema Google Scholar (desde 1995 hasta el 30 de abril de 2021). Se utilizó el modelo PICOS para definir los criterios de inclusión y exclusión. De los 123 estudios encontrados inicialmente, 18 cumplieron los criterios de elegibilidad y fueron incluidos. Se examinaron datos de 367 atletas de diferentes disciplinas. La evidencia se agrupó en 4 áreas: estrés oxidativo, recuperación muscular y energética, reparación muscular y acidosis metabólica. La evidencia mostró que las vitaminas, los minerales y algunos productos ergo-nutricionales naturales son eficaces como antioxidantes, los hidratos de carbono y las proteínas determinan su efecto recuperador y el bicarbonato de sodio es el principal retardador metabólico de la acidosis. Se destaca la importancia de aceptar un plan ergo-nutricional para mejorar el proceso de recuperación. A pesar de ello, y teniendo en cuenta los efectos descritos en la literatura, se necesitan más estudios para reforzar la evidencia actual (AU)

An insight into an intriguing oxidative biotransformation pathway of 5-O-caffeoylquinic acid by a gut bacterium.

Microbiota is known to play a pivotal role in generating bioavailable and bioactive low-molecular-weight metabolites from dietary polyphenols. 5-O-caffeoylquinic acid (5-CQA), one of the main polyphenols found in human diet, was submitted to a resting cell biotransformation study using three gut bacteria species Lactobacillus reuteri, Bacteroides fragilis and Bifidobacterium longum. These bacteria were selected according to their belonging to the main phyla found in human gut microbiota. Our study highlighted the ability of only one of the strains studied, L. reuteri, to bioconverse 5-CQA into various metabolites due to the expression of the cinnamoyl esterase enzyme as the first step. Interestingly, one known natural compound, esculetin, was described for the first time as a 5-CQA-derived metabolite after conversion by a gut bacterium, the other metabolites had already been reported. This evidence highlighted an interesting oxidative pathway occurring in vivo by intestinal microbiota leading to esculetin. This molecule was also identified after electrochemical and enzymatic oxidations of caffeic acid. The oxidation capacity of L. reuteri led to less diverse metabolites in comparison to those obtained either electrochemically and enzymatically where dimers and trimers were reported. Thus, esculetin may have interesting and benefical biological effects on gut microbiota, which should be further evaluated. Novel synbiotics could be formulated from the association of L. reuteri with 5-CQA.

Changes in Body Composition in Older Adults after a Technology-Based Weight Loss Intervention.

We conducted a post-hoc analysis of a pre/post, single-arm, non-randomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (-3.4kg±6.8, p=0.19), appendicular lean mass (-0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.

Neoplasias en trabajadores expuestos a radiación cósmica: una revisión sistemática / Neoplasms in workers exposed to cosmic radiation: a systematic review

Introducción: La radiación cósmica, como tipo de radiación ionizante, se asocia con la inducción de cáncer en las personas expuestas. Dado que el nivel de exposición está relacionado con la altitud, los trabajadores expuestos a mayor radiación cósmica (pilotos de aerolínea, auxiliares de vuelo, astronautas) podrían estar expuestos a mayor riesgo de neoplasias. Objetivo: Identificar el riesgo de neoplasias en trabajadores expuestos a radiación cósmica. Método: Revisión sistemática de la literatura científica recogida en diferentes bases de datos hasta noviembre de 2021. Los términos utilizados como descriptores fueron: “Neoplasms”, “Occupational Exposure” y “Cosmic Radiation”. La búsqueda se completó con otros términos en texto libre y no se emplearon filtros (límites). Se incluyeron artículos originales de estudios observacionales y revisiones sistemáticas, cuya calidad fue evaluada a través de las guías STROBE y AMSTAR-2, respectivamente. Resultados: Se recuperaron 597 referencias, de las que se pudieron obtener a texto completo 10 artículos tras aplicar los criterios de inclusión y exclusión. En algunos de ellos se describe un aumento de riesgo de cáncer en trabajadores expuestos a la radiación cósmica, especialmente a cáncer de piel y a cáncer de mama, mientras que en otros no se evidenció una relación significativa entre la exposición a la radiación cósmica y el desarrollo de neoplasias. Conclusiones: No existe evidencia suficiente que demuestre el riesgo de neoplasias entre pilotos, auxiliares de vuelo y astronautas, por estar expuestos a la radiación cósmica (AU)

Introduction: Cosmic radiation, as a type of ionizing radiation, is associated with the induction of cancer in exposed people. Since the level of exposure is related to altitude, workers exposed to higher cosmic radiation (airline pilots, cabin crew, astronauts) could be exposed to a higher risk of neoplasms. Objective: To identify the risk of neoplasms in workers exposed to cosmic radiation. Method: Systematic review of scientific literature retrieved from different databases until November 2021. The terms used as descriptors were: “Neoplasms”, “Occupational Exposure” and “Cosmic Radiation”. The search was completed with other free-text terms and no filters (limits) were used. Original articles of observational studies and systematic reviews were included, whose quality was evaluated through the STROBE and AMSTAR-2 guidelines, respectively. Results: 597 references were retrieved. From these, 10 articles could be obtained in full text after applying the inclusion and exclusion criteria. Some of them describe an increased risk of cancer in workers exposed to cosmic radiation, especially skin cancer and breast cancer, while others did not show a significant relationship between exposure to cosmic radiation and the development of neoplasms. Conclusions: There is not enough evidence to demonstrate the risk of neoplasms among pilots, flight attendants and astronauts, due to being exposed to cosmic radiation (AU)

Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward.

OBJECTIVE: Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units. METHODS: A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected. RESULTS: A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p <0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]). CONCLUSIONS: Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

Understanding patient-reported knowledge of hernia surgery: a quantitative study.

PURPOSE: The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery. METHODS: A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit. RESULTS: The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient's perceived health status was "neither bad nor good" or "good" in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution. CONCLUSION: PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.

[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Análisis curricular de la carrera de enfermería en universidades chilenas / Curriculum analysis of the nursing career in Chilean universities

La Organización Mundial de la Salud en conjunto con la Organización Panamericana de la Salud, (2015), destacaron que el personal de enfermería conforma la mayor parte del trabajo sanitario, siendo su actual déficit una limitante a los derechos humanos en salud. Dentro del aspecto cantidad, históricamente en Chile existen limitantes en relación a este personal, además de su falta hay mala distribución, como es la relación médico 2: 1 enfermera, desde 1950 hasta la actualidad [Fragmento de texto] (AU)

Cambios en los hábitos de sedentarismo y actividad física de trabajadores que pasaron a teletrabajo durante la pandemia de Covid19 / Changes in sedentary and physical activity habits of workers who switched to teleworking during the Covid19 pandemic

Introducción: El confinamiento ha supuesto cambios en la modalidad de trabajo de algunos trabajadores que repercuten en hábitos como el de la actividad física. Objetivo: Analizar las diferencias en cuanto a tiempo de sedentarismo y actividad física antes (2018) y después de la pandemia (2021) en trabajadores sedentarios (N=44), diferenciados por sexo, que pasaron a la modalidad de teletrabajo. Material y Métodos: Estudio observacional retrospectivo antes-después de un solo grupo. Se recogieron las variables edad, sexo, tiempo de sedentarismo y gasto energético en equivalentes metabólicos. Se calcularon porcentajes, media, mediana y desviación estándar. Se aplicaron los test U de Mann-Whitney, prueba T para muestras independientes y relacionadas y el test de signos por ausencia de simetría. Resultados: El tiempo de sedentarismo disminuyó entre 2018 y 2021 (p=0,005). El gasto total y los gastos parciales por actividad física intensa y ligera aumentaron entre ambos años (p<0,001). Conclusión: El paso a teletrabajo disminuyó el sedentarismo y aumentó la actividad física intensa y ligera (AU)

Introduction: Confinement has led to changes in the work patterns of some workers that have an impact on habits such as physical activity. Objective: The aim was to analyse differences in sedentary time and physical activity before (2018) and after the pandemic (2021) in sedentary workers (N=44), differentiated by sex, who switched to teleworking. Material and Methods: Single-group retrospective observational before-after study. The variables age, sex, sedentary time and energy expenditure in metabolic equivalents were collected. Percentages, mean, median and standard deviation were calculated. Mann-Whitney U-test, t-test for independent and related samples and the sign test for absence of symmetry were applied. Results: Sedentary time decreased between 2018 and 2021 (p=0.005). Total expenditure and partial expenditure for heavy and light physical activity increased between the two years (p<0.001). Conclusion: Switching to telework decreased sedentary time and increased heavy and light physical activity (AU)

Prioritization criteria of patients on scheduled waiting lists for abdominal wall hernia surgery: a cross-sectional study.

PURPOSE: Long delays in waiting lists have a negative impact on the principles of equity and providing timely access to care. This study aimed to assess waiting lists for abdominal wall hernia repair (incisional ventral vs. inguinal hernia) to define explicit prioritization criteria. METHODS: A cross-sectional single-center study was designed. Patients in the waiting list for incisional/ventral hernia (n = 42) and inguinal hernia (n = 50) repair were interviewed by phone and completed health-related quality of life (HRQoL) questionnaires (EQ-5D, COMI-hernia, HerQLes) as a measure of severity. Priority was measured as hernia complexity, patient frailty using the modified frailty index (mFI-11), and the consumption of analgesics for hernia. RESULTS: The mean (SD) time on the waiting list was 5.5 (3.2) months (range 1-14). Complex hernia was present in 34.8% of the patients. HRQoL was moderately poor in patients with incisional/ventral hernia (mean HerQL score 66.1), whereas it was moderately good in patients with inguinal hernia (mean COMI-hernia score 3.40). The use of analgesics was higher in patients with incisional/ventral hernia as compared with those with inguinal hernia (1.48 [0.54] vs. 1.31 [0.51], P = 0.021). Worst values of mFI were associated with inguinal hernia as compared with incisional/ventral hernia (0.21 [0.14] vs. 0.12 [0.11]; P = 0.010). CONCLUSION: Explicit criteria for prioritization in the waiting lists may be the consumption of analgesics for patients with incisional/ventral hernia and frailty for patients with inguinal hernia. A reasonable approach seems to establish separate waiting lists for incisional/ventral hernia and inguinal hernia repair.