Factores relacionados con la adherencia al tratamiento de tuberculosis en el Departamento de Boyacá / Factors related with adherence to treatment of tuberculosis in the Department of Boyacá

Resumen Introducción: la tuberculosis es una enfermedad infecciosa crónica causada por Mycobacterium tuberculosis, capaz de afectar cualquier órgano o tejido siendo la forma más común la enfermedad pulmonar. Objetivo: identificar los factores que afectan la adherencia al tratamiento antituberculoso en pacientes del Departamento de Boyacá durante los años 2017-2019. Metodología: estudio descriptivo retrospectivo que utilizó como fuentes de información datos registrados en la base del programa departamental de Tuberculosis y SIVIGILA. Se realizó análisis univariado, determinando la distribución de las variables y análisis bivariado en el que se exploró la asociación entre la adherencia al tratamiento de tuberculosis y las variables independientes, se utilizó la prueba de Chi cuadrado. Resultados: se incluyeron 402 pacientes, la adherencia al tratamiento antituberculoso fue 96,5% y la no adherencia de 3,5%. El 66,7% eran de sexo femenino; 55,7% vivián en zona urbana; 66,5% pertenecían al régimen subsidiado; 89,7% mestizos; 91,2% correspondían a otros grupos poblacionales, seguido del 7,5% de población privada de la libertad y 1,3% habitantes de calle. Dentro de las comorbilidades la coinfección con VIH con 4,2% fue la de mayor presencia. Entre las causas de no adherencia al tratamiento fueron desinterés, cambio frecuente de domicilio, contrato finalizado con la EPS y suspensión del tratamiento por toxicidad hepática. El paciente con mayor probabilidad de abandonar el tratamiento pertenece al sexo masculino, al grupo poblacional de migrantes o habitantes de calle y se encuentra afiliado al régimen subsidiado, ​​​​se encontró una relación estadísticamente significativa entre estas variables y el resultado con la adherencia al tratamiento. Conclusiones: si bien el resultado obtenido en el presente trabajo no es elevado, es importante realizar vigilancia de la adherencia al tratamiento antituberculoso para disminuir el riesgo de complicaciones derivadas de su abandono como mayor mortalidad, desarrollo de resistencia bacteriana y un período de contagiosidad más prolongado.

Abstract Introduction: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, capable of affecting any organ or tissue, the most common form being lung disease. Objective: Identify the factors that affect adherence to tuberculosis treatment in patients from the Department of Boyacá during the years 2017-2019. Methodology: Retrospective descriptive study that used as information sources data registered in the database of the departmental Tuberculosis program and SIVIGILA. A univariate analysis was carried out, determining the distribution of the variables and a bivariate analysis in which the association between adherence to tuberculosis treatment and the independent variables was explored, using the Chi-square test. Results: 402 patients were included, adherence to anti-tuberculosis treatment was 96.5% and non-adherence 3.5%. 66.7% were female; 55.7% lived in an urban area; 66.5% belonged to the subsidized regime; 89.7% mestizo; 91.2% corresponded to other population groups, followed by 7.5% of the population deprived of liberty and 1.3% homeless. Within the comorbidities, coinfection with HIV 4.2% was the one with the greatest presence. Among the causes of non-adherence to treatment were lack of interest; frequent change of address; Terminated contract with the EPS and suspension of treatment due to liver toxicity. The patient with the highest probability of abandoning treatment belongs to the male sex, to the population group of migrants or street dwellers and is affiliated with the subsidized regime, a statistically significant relationship was found between these variables and the result with adherence to treatment. Conclusions: Although the result obtained in this study is not high, it is important to monitor adherence to tuberculosis treatment to reduce the risk of complications derived from its abandonment, such as increased mortality, development of bacterial resistance, and a longer period of contagiousness.

Complete Blood Count in Children With COVID-19: A Predictor of Disease Severity.

Blood count abnormalities are frequent in patients with severe COVID-19 disease and there is still a lack of information in pediatric complete blood count (CBC) results. Thus, this study aims to correlate the CBC in the emergency room of children with COVID-19 between 0 and 10 years old and the clinical severity of the disease. A retrospective cohort study was performed in children with COVID-19 who collected at the emergency room CBC, C-reactive protein (CRP), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), lymphocyte to neutrophil ratio (LNR), lymphocyte to monocyte ratio (LMR), monocyte to neutrophil ratio (MNR) and monocyte to lymphocyte ratio (MLR). In total, demographic data from 93 children with median age of 19 months (0.3-126), 60.2% males, were included. The main changes in the CBC were atypical lymphocytes (51.6%) and eosinopenia (49.5%). From 69 hospitalized children, 21 were considered severe. There was no association between age, gender, and CRP value with clinical severity. The presence of underlying disease was five times higher (odds ratio [OR] = 5.08) in patients who required hospitalization and a higher NLR value was 54% (OR = 1.54) more likely to occur. Eosinopenia was three times more frequent in inpatients with disease severity criteria (OR = 3.05). In conclusion, children younger than 10 years of age with COVID-19 have changes in the CBC collected in the emergency room, mainly atypical lymphocytes and eosinopenia. The presence of a comorbidity or a higher NLR increases the chance of hospitalization. In addition, eosinopenia was a predictor of severity in inpatient children due to COVID-19.

Intraoperative hypotension and postoperative delirium in elderly male patients undergoing laryngectomy: a single-center retrospective cohort study.

BACKGROUND: Postoperative delirium (POD) is a common, transient postoperative cognitive dysfunction in elderly patients. The relationship between POD and intraoperative hypotension remains unclear. This study aims to determine if intraoperative hypotension predicts POD in elderly male patients undergoing laryngectomy. METHODS: This study included male patients over 65 years old who underwent laryngectomy between April 2018 and January 2022. The Confusion Assessment Method (CAM) was used to diagnose delirium. Intraoperative hypotension was defined as a Mean Arterial Pressure (MAP) during surgery that was less than 30% of the preoperative level for at least 30 minutes. The relationship between intraoperative hypotension and POD incidence was adjusted for patient demographics and surgery-related factors. RESULTS: Out of 428 male patients, 77 (18.0%) developed POD, and 166 (38.8%) experienced intraoperative hypotension. Surgery duration ≥ 300 minutes (OR = 1.873, 95% CI 1.041-3.241, p = 0.036), intraoperative hypotension (OR = 1.739, 95% CI 1.039-2.912, p = 0.035), and schooling (OR = 2.655, 95% CI 1.338-5.268) were independent risk factors for POD. The association between intraoperative hypotension and POD was significantly influenced by surgery duration (p for interaction = 0.008), with a stronger association in prolonged surgeries (adjusted OR = 4.902; 95% CI 1.816-13.230). CONCLUSIONS: Intraoperative hypotension and low education level are associated with an increased risk of POD in elderly male patients undergoing laryngectomy, especially with prolonged surgery duration.

Primary signet-ring cell carcinoma of the urinary bladder ‒ A rare bladder tumor.

AIM: Primary Signet Ring Cell Carcinoma (SRCC) of the bladder accounts for only 1%‒4% of all bladder malignancies. To date, few studies have been conducted to investigate the characteristics of SRCC. This study aimed to investigate the clinical features and treatments of SRCC and explore the independent risk factors of survival in SRCC patients. PATIENTS AND METHODS: A retrospective study was conducted on 32 eligible patients. The survival rate was calculated with the Kaplan-Meier method, and the COX proportional hazards model was used to investigate the independent risk factors of prognosis. RESULTS: In the present study, the 1-year and 2-year survival rates of SRCC patients were 53.1% and 9.4%, respectively. The TNM stage, tumor differentiation, and metastasis after treatment were risk factors for the prognosis of SRCC patients (p < 0.05), while surgical treatment, chemotherapy, and positive GATA3 expression were protective for prognosis (p < 0.05). Multivariate analysis showed that GATA3 was an independent protective factor for prognosis (p < 0.05), and T-stage was an independent risk factor (p < 0.05). CONCLUSIONS: Primary SRCC of the bladder is highly malignant and has a poor prognosis. Its clinical and imaging findings are usually non-specific. Early radical cystectomy and postoperative adjuvant systemic chemotherapy are helpful to improve the survival rate. T-stage is an independent risk factor for survival, and positive GATA3 expression is protective for primary SRCC of the bladder.

High prevalence and risk factors of feline leukemia virus infection in Chilean urban cats (Felis catus).

Feline Leukemia Virus is a retrovirus causing fatal disease in domestic cats. While FeLV has been controlled in many countries, it remains a major concern in Latin American countries. This study conducted an epidemiological survey of FeLV in 182 Chilean domestic cats using PCR to detect provirus infection. The results were analysed using Multivariate Logistic Regression to examine risk factors associated with FeLV detection. The FeLV prevalence was 54.95 %, and statistically significant associations (p < 0.05) were found for two protective factors and one risk factor. Cats from Concepcion city (95 %CI 0.08-0.56 %) and cats sampled in 2022 (95 %CI 0.1-0.06 %) had lower odds ratios for provirus positivity, whereas non-vaccinated cats (95 %CI 2.3-15.8 %) had an increased odds ratio. No other factors were statistically significant. The high FeLV prevalence is similar to other Latin American countries and the geographical differences highlighted in this study likely correspond to the socioeconomic status of the owners. This study highlights the need for improved FeLV control measures such as promoting FeLV vaccination, implementing health screening prior to adoption of new cats, and educating owners about FeLV to control its circulation.

Corrigendum: The transition of Chilean adolescents from the child welfare system to the adolescent justice system: a continuation or an accumulation of adverse factors?

[This corrects the article DOI: 10.3389/fpsyg.2023.1194294.].

Associations between obesity and severity of coronavirus disease 2019 in Brazilian inpatients: A 2021 secondary data analysis.

In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID-19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID-19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in-hospital mortality among individuals with and without obesity. Using a comprehensive cross-sectional study methodology, encompassing adult COVID-19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in-hospital mortality among the individuals with obesity across all age groups (p < .001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1-1.3) for those under 50 years, 1.1 (95%CI 1.0-1.2) for the 50-59 age group, and 1.1 (95%CI 1.0-1.2) for the 60-69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9-1.1). In summary, hospitalized COVID-19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in-hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID-19 patients in 2021.

Factors associated with infection-related severe maternal outcomes in pregnant and recently pregnant women: A secondary analysis of the WHO global maternal sepsis study.

OBJECTIVE: The aim of the present study was to identify the risk factors for severe maternal outcomes (SMO) of women with suspected or confirmed infections using the data from the WHO global maternal sepsis study (GLOSS). METHODS: We conducted a secondary analysis of the GLOSS cohort study, which involved pregnant or recently pregnant women with suspected or confirmed infection around 713 health facilities in 52 low- and middle-income countries, and high-income countries. A nested case-control study was conducted within the GLOSS cohort. Cases included infection-related maternal deaths or near misses, while controls represented non-SMO. Logistic mixed models, adjusting for country variations, were employed. Using univariate analysis, we calculated crude odds ratios (crude OR) and their 95% confidence interval (95% CI). Variables were identified with less than 16% missing data, and P values less than 0.20 were used to perform the multivariate logistic model multilevel. RESULTS: A total of 2558 women were included in the analysis. As for the cases, 134 patients were found in the pregnant in labor or not in labor group and 246 patients in the postpartum or postabortion group. Pregnant women with prior childbirths faced a 64% increased risk of SMO. Ante- or intrapartum hemorrhage increased risk by 4.45 times, while trauma during pregnancy increased it by 4.81 times. Pre-existing medical conditions elevated risk five-fold, while hospital-acquired infections increased it by 53%. Secondary infections raised risk six-fold. Postpartum/postabortion women with prior childbirths had a 45% elevated risk, and pre-existing medical conditions raised it by 2.84 times. Hospital-acquired infections increased risk by 93%. Postpartum hemorrhage increased risk approximately five-fold, while abortion-related bleeding doubled it. Previous cesarean, abortion, and stillbirth also elevated risk. CONCLUSIONS: Key risk factors for SMO include prior childbirths, hemorrhage, trauma, pre-existing conditions, and hospital-acquired or secondary infections. Implementing effective alert systems and targeted interventions is essential to mitigate these risks and improve maternal health outcomes, especially in resource-limited settings.

Moderate altitude as a risk factor for isolated congenital malformations. Results from a case-control multicenter-multiregional study.

BACKGROUND: Living in high-altitude regions has been associated with a higher prevalence of some birth defects. Moderate altitudes (1500-2500 m) have been associated with some congenital heart diseases and low birth weight. However, no studies have been conducted for other isolated congenital malformations. OBJECTIVES: To estimate the prevalence at birth of isolated congenital malformations in low and moderate altitudes and to determine if moderate altitudes are a risk factor, such as high altitudes, for isolated congenital malformations adjusted for other factors. METHODS: The study consisted of a case-control multicenter-multiregional study of 13 isolated congenital malformations. Cases included live births with isolated congenital malformations and controls at low (10-1433 m) and moderate altitudes (1511-2426 m) from a Mexican registry from January 1978 to December 2019. Prevalence per 10,000 (95% CI) per altitude group was estimated. We performed unadjusted and adjusted logistic regression models (adjusted for maternal age, parity, malformed relatives, socioeconomic level, and maternal diabetes) for each isolated congenital malformation. RESULTS: Hydrocephaly and microtia had a higher at-birth prevalence, and spina bifida, preauricular tag, and gastroschisis showed a lower at-birth prevalence in moderate altitudes. Moderate altitudes were a risk factor for hydrocephaly (aOR 1.39), microtia (aOR 1.60), cleft-lip-palate (aOR 1.27), and polydactyly (aOR 1.32) and a protective effect for spina bifida (aOR 0.87) compared with low altitudes. CONCLUSIONS: Our findings provide evidence that moderate altitudes as higher altitudes are an associated risk or protective factor to some isolated congenital malformations, suggesting a possible gradient effect.

Molecular overlaps of neurological manifestations of COVID-19 and schizophrenia from a proteomic perspective.

COVID-19, a complex multisystem disorder affecting the central nervous system, can also have psychiatric sequelae. In addition, clinical evidence indicates that a diagnosis of a schizophrenia spectrum disorder is a risk factor for mortality in patients with COVID-19. In this study, we aimed to explore brain-specific molecular aspects of COVID-19 by using a proteomic approach. We analyzed the brain proteome of fatal COVID-19 cases and compared it with differentially regulated proteins found in postmortem schizophrenia brains. The COVID-19 proteomic dataset revealed a strong enrichment of proteins expressed by glial and neuronal cells and processes related to diseases with a psychiatric and neurodegenerative component. Specifically, the COVID-19 brain proteome enriches processes that are hallmark features of schizophrenia. Furthermore, we identified shared and distinct molecular pathways affected in both conditions. We found that brain ageing processes are likely present in both COVID-19 and schizophrenia, albeit possibly driven by distinct processes. In addition, alterations in brain cell metabolism were observed, with schizophrenia primarily impacting amino acid metabolism and COVID-19 predominantly affecting carbohydrate metabolism. The enrichment of metabolic pathways associated with astrocytic components in both conditions suggests the involvement of this cell type in the pathogenesis. Both COVID-19 and schizophrenia influenced neurotransmitter systems, but with distinct impacts. Future studies exploring the underlying mechanisms linking brain ageing and metabolic dysregulation may provide valuable insights into the complex pathophysiology of these conditions and the increased vulnerability of schizophrenia patients to severe outcomes.

Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador.

BACKGROUND: Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies. OBJECTIVES: To evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador. DESIGN: A cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05. RESULTS: The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia. CONCLUSION: The prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.

[Association between previous appendectomy and cognitive impairment in adults: a case-control study]. / Vliyanie predshestvuyushchei appendektomii na kognitivnye narusheniya u vzroslykh: issledovanie «sluchai-kontrol'¼.

OBJECTIVE: To determine the relationship between appendectomy and cognitive impairment in adults aged 50-70 years. MATERIAL AND METHODS: A case-control study was carried out with 270 patients between May and July 2023. Ninety cases (with cognitive impairment) and 180 controls (without impairment), diagnosed by the Montreal Cognitive Assessment (MoCA), were assessed. RESULTS: 31.11% of the total cases with cognitive impairment were submitted to an appendectomy, with an average of 25 years since surgery. Regarding other surgeries: 40% with impairment underwent cholecystectomy and 23.33% reported other operations. The analysis revealed significant differences in age, body mass index, hypertension, diabetes and smoking between the groups. However, there was no significant difference by gender. Logistic regression analysis highlighted that age and past appendectomy were strongly associated with cognitive impairment, with an Odds Ratio (OR) of 1.20 and 12.91, respectively. Associations were also found with cholecystectomy (OR 7.33), other surgeries (OR 13.39) and smoking (OR 6.91). CONCLUSION: Appendectomy might be a significant risk factor for cognitive impairment in adults aged 50-70 years.

Survival at 3, 6 and 12 months in patients diagnosed with community-acquired pneumonia in Colombia: a retrospective cohort study.

BACKGROUND: The primary aim of this study is to assess the survival rates of individuals diagnosed with Community-Acquired Pneumonia (CAP) post-hospitalization in Colombia. Additionally, explore potential risk factors associated with decreased long-term survival. METHODS: A retrospective cohort study was conducted in a hospital in Colombia, evaluating survival at 3, 6 and 12 months in CAP patients, using the Kaplan-Meier method. Stratifications were made by age, sex, comorbidity, and severity. The comparison of survival curves was performed using the Log-Rank test, a multivariate analysis with Cox regression was performed to study possible risk factors that affected 12-month survival in patients with CAP. RESULTS: 3688 subjects were admitted, with a mortality of 16.3 % per year. Survival at three, six, and twelve months was 92.9 % (95 % CI 92-93 %), 88.8 % (95 % CI 87-90 %), and 84.2 % (95 % CI 82-85 %), respectively. Analysis stratified by pneumonia severity index, 12-month survival was 98.7 % in Class I, 95.6 % in Class II, 87.41 % in Class III, 77.1 % in Class IV, and 65.8 % in class-V (p < 0.001). Cox-regression showed that being male (HR = 1.44; 95 % CI 1.22‒1.70; p < 0.001), an elevated pneumonia severity index (HR = 4.22; 95 % CI 1.89‒9.43; p < 0.001), a high comorbidity index (HR = 2.29; 95 % CI 1.89‒2.84; p < 0.001) and vasopressor requirement (HR = 2.22; 95 % CI < 0.001) were associated with a lower survival at twelve months of follow-up. CONCLUSION: Survival in patients with CAP who require hospitalization decreases at 3, 6, and 12 months of follow-up, being lower in patients older than 65 years, men, high comorbidity, and in subjects with severe presentation of the disease.

Intellectual Development in Mexican Preterm Children at Risk of Perinatal Brain Damage: A Longitudinal Study.

Preterm birth accounts for about 10% of births worldwide. Studying risk factors for perinatal brain damage is essential, as findings suggest that almost 20% of disabilities are linked to risks in the early stages of development. This research aimed to study longitudinal changes in intelligence from 6 to 8 years of age in a sample of 39 preterm children with a history of risk of brain damage and a control group of 35 children born at term. The Wechsler Intelligence Scale (WISC-IV) was used to measure cognitive ability at six, seven, and eight years old. The results showed that the preterm group obtained significantly lower scores than the control group. The working memory indicator significantly affected the interaction between age and prematurity. We consider it crucial to expand the knowledge we have about the neurocognitive development of premature infants, both in specific cognitive domains and in age ranges, so that the information obtained can help predict the probability of presenting cognitive alterations from early stages. This, therefore, helps in implementing intervention strategies and programs based on scientific evidence, and their design is complemented by clinical experience and empirical and theoretical knowledge of the different professionals involved in infant cognitive intervention.

The accuracy of self-reported family history in glaucoma in Brazil.

PURPOSE: To evaluate the accuracy of a positive self-reported glaucoma family history. MATERIAL AND METHODS: Cross-sectional study. Each subject was asked if they had a first-degree relative diagnosed with glaucoma. If their answer was affirmative, the relative was invited to attend on ophthalmic evaluation and underwent complementary exams to confirm or exclude the glaucoma diagnosis. Only one relative was included per subject. RESULTS: We included 204 subjects in the study (102 subjects and their respective relatives). The accuracy of family history of glaucoma was 76.96% of the cases. In the univariable analysis, subjects with college degree had 2.34 [(P = 0.010; 95% confidence interval (CI) 1.18-4.63)], with higher family income 3.72 (P = 0.003; 95% CI 1.57-8.85) and those with health insurance 3.42 (P = 0.001; 95% CI 1.67-6.98) more chances to have a true positive family history for glaucoma. In the multivariable logistic regression analysis, none of the variables presented significant association. CONCLUSION: Around 24% of patients may not provide reliable information about family history for glaucoma. When asking about a glaucoma family history, clinicians should consider the real accuracy of this self-reported data.

Looking beyond psychosocial adversity and sex: Clinical factors associated with ADHD and other psychiatric disorders in a non-Caucasian sample of high-risk siblings.

This study examined the association of clinical factors, independent of sex and high psychosocial adversity (HPAd), with the presence of ADHD or other mental disorders, specifically within a middle-income country with a non-Caucasian population. A multi-centric cross-sectional study was conducted in three sites in Colombia. Our study recruited trios of an ADHD proband, one sibling, and one parent. We used valid instruments for assessing parents and siblings. The sample included 223 siblings, an average age of 12.3 (SD 3.9), and 51.1% Females. The ADHD recurrence risk ratio (λ) was 12. The clinical factors mainly associated with the presence of ADHD, independent of sex and HPAd, were 1) Pregnancy and childbirth complications, 2) Delayed psychomotor development, 3) Temperament, and 4) Sleep disturbances. Our research showed that, independently of HPAd and the male sex, there were other clinical factors associated with ADHD and other psychiatric disorders in this population. These findings need to be replicated in similar populations globally.

Risk factors for mortality in coronavirus disease 2019 patients with silent hypoxemia.

OBJECTIVE: To describe the predictors of mortality in hospitalized patients with severe acute respiratory syndrome (SARS) due to COVID-19 presenting with silent hypoxemia. MATERIAL AND METHODS: Retrospective cohort study of hospitalized patients with SARS due to COVID-19 and silent hypoxemia at admission, in Brazil, from January to June 2021. The primary outcome of interest was in-hospital death. Multivariable logistic regression analysis was performed. RESULTS: Of 46,102 patients, the mean age was 59 ±â€¯16 years, and 41.6% were female. During hospitalization, 13,149 patients died. Compared to survivors, non-survivors were older (mean age, 66 vs. 56 years; P < 0.001), less frequently female (43.6% vs. 40.9%; P < 0.001), and more likely to have comorbidities (74.3% vs. 56.8%; P < 0.001). Non-survivors had higher needs for invasive mechanical ventilation (42.4% vs. 6.6%; P < 0.001) and intensive care unit admission (56.9% vs. 20%; P < 0.001) compared to survivors. In the multivariable regression analysis, advanced age (OR 1.04; 95%CI 1.037-1.04), presence of comorbidities (OR 1.54; 95%CI 1.47-1.62), cough (OR 0.74; 95%CI 0.71-0.79), respiratory distress (OR 1.32; 95%CI 1.26-1.38), and need for non-invasive respiratory support (OR 0.37; 95%CI 0.35-0.40) remained independently associated with death. CONCLUSIONS: Advanced age, presence of comorbidities, and respiratory distress were independent risk factors for mortality, while cough and requirement for non-invasive respiratory support were independent protective factors against mortality in hospitalized patients due to SARS due to COVID-19 with silent hypoxemia at presentation.

Preeclampsia in pregnant women with COVID-19: a prospective cohort study from two tertiary hospitals in Southern Brazil.

Background: COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods: Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results: The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53-43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52-38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34-4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions: Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia.

[Effectiveness of the CNIC polypill in secondary cardiovascular prevention in the subgroup of patients of the NEPTUNO study using atorvastatin doses of 20 mg]. / Efectividad de la polipíldora CNIC en prevención cardiovascular secundaria en el subgrupo de pacientes del estudio NEPTUNO con dosis de atorvastatina de 20 mg.

Objective: To analyse the incidence and risk of recurrent major adverse cardiovascular events (MACE), level of risk factor control, treatment persistence and cost of the CNIC polypill version containing acetylsalicylic acid (ASA) 100 mg, atorvastatin 20 mg (A20), and ramipril 2.5, 5.0 or 10 mg in secondary cardiovascular prevention patients. Method: Subanalysis of the observational, retrospective, multicentre, NEPTUNO study in patients treated for two years with the CNIC polypill A20, the same monocomponents as single drugs, equipotent drugs, and other therapies. Results: 922 patients were included in each group. The risk of recurrent MACE was lower among CNIC A20 polypill users than all others (21%, 23% and 26% increased risk among the monocomponents, equipotent or other therapy cohorts, respectively; p < 0.05). The magnitude of the mean change in low-density lipoprotein cholesterol and blood pressure, as well as the increase in the proportion of patients achieving target goals, was also greater among patients treated with the CNIC A20 polypill than in any of the other cohorts (all p < 0.001). Treatment persistence was significantly higher in patients treated with the CNIC A20 polypill (p < 0.001) and was a less costly strategy than any other therapeutic option. Conclusions: In patients in secondary cardiovascular prevention, the CNIC A20 polypill (ASA 100 mg, atorvastatin 20 mg, and ramipril 2.5, 5.0 or 10 mg) constitutes a valid therapeutic option with similar benefits and outcomes to the version of the polypill with atorvastatin 40 mg.

Objetivo: Analizar la incidencia y el riesgo de eventos adversos cardiovasculares mayores (MACE) recurrentes, el nivel de control de factores de riesgo, la persistencia al tratamiento y el coste de la versión de la polipíldora CNIC que contiene 100 mg de ácido acetilsalicílico (AAS), 20 mg de atorvastatina (A20) y 2.5/5.0 ó 10 mg de ramipril en pacientes en prevención cardiovascular secundaria. Método: Subanálisis del estudio observacional, retrospectivo y multicéntrico NEPTUNO en pacientes tratados durante 2 años con la polipíldora CNIC A20, los mismos monocomponentes por separado, medicamentos equipotentes uotras terapias. Resultados: Se incluyeron 922 pacientes en cada grupo. El riesgo de sufrir un MACE recurrente en el grupode polipíldora CNIC A20 fue menor que en todas las demás cohortes (21%, 23% y 26% de aumento del riesgo en las cohortesde monocomponentes, equipotentes u otras terapias, respectivamente; p < 0.05). La magnitud del cambio en el colesterol unidoa lipoproteínas de baja densidad y la presión arterial, así como el incremento en la proporción de pacientes que alcanzaron losobjetivos establecidos, fueron mayores en los pacientes tratados con la polipíldora CNIC A20 que en cualquiera de las otrascohortes (p < 0.001). La persistencia al tratamiento fue mayor en los pacientes tratados con la polipíldora CNIC A20 (p < 0.001)y esta estrategia resultó ser menos costosa que cualquier otra opción terapéutica. Conclusiones: En pacientes en prevencióncardiovascular secundaria, la polipíldora CNIC A20 (AAS 100 mg; atorvastatina 20 mg; ramipril 2.5/5.0 ó 10 mg) constituye unaopción terapéutica válida con beneficios y resultados similares a la versión de la polipíldora con 40 mg de atorvastatina.

Prevención del cáncer de piel en preescolares: experiencia parental en fotoprotección

Fundamento: como promedio se han generan tres millones de casos de cáncer de piel a nivel global en los últimos años. Esta situación ocurre entre otras razones por la constante exposición a la radiación solar y la no aplicación de fotoprotección. Objetivo: determinar la experiencia parental en fotoprotección durante la infancia. Método: se realizó un estudio etnográfico en la Unidad Educativa de la Parroquia San Juan del Cantón Riobamba, Provincia Chimborazo, durante el período de estudio de octubre 2022 a octubre 2023. Se realizaron 14 entrevistas a cuidadores de preescolares, los que fueron escogidos a través del muestreo no probabilístico. Se dispuso de dos técnicas de recolección de la información: el autorreportaje y la entrevista semiestructurada. Resultados: se describieron cada una de las categorías que emergieron en el estudio según el nivel de frecuencia: fotounidad, fotoexperiencia-conocimiento y fotosanidad. Se construyó un mapa representacional en el cual se determinó que la familia en sí representa la fotounidad, mediante la participación de todos sus miembros en la protección de los efectos nocivos del sol. La sombrilla que cubre a la familia refleja la fotoexperiencia-conocimiento adquiridos por los cuidadores, que actúan como protección al daño solar mediante medidas preventivas y de cuidado. El sol y sus rayos solares simbolizan la fotosanidad, que corresponde a la exposición a rayos solares y sus efectos nocivos para la salud. Conclusiones: la implementación de medidas de fotoprotección desde edades tempranas resulta de vital importancia para la prevención del cáncer de piel, por lo que es necesario brindarles a los padres información adecuada sobre los riesgos solares y las medidas preventivas.

Foundation: on average, three million cases of skin cancer have been generated globally in recent years. This situation occurs among other reasons due to constant exposure to solar radiation and non-application of photoprotection. Objective: determine parental experience in photoprotection during childhood. Method: an ethnographic study was carried out in the Educational Unit of the San Juan Parish of the Cantón Riobamba, Chimborazo Province, during the study period from October 2022 to October 2023. 14 interviews were carried out with preschool caregivers, who were chosen through of non-probabilistic sampling. Two information collection techniques were available: self-report and semi-structured interview. Results: each of the categories that emerged in the study were described according to the level of frequency: photounity, photoexperience-knowledge and photosanity. A representational map was constructed in which it was determined that the family itself represents photounity, through the participation of all its members in protecting themselves from the harmful effects of the sun. The umbrella that covers the family reflects the photo-experience-knowledge acquired by the caregivers, which act as protection from sun damage through preventive and care measures. The sun and its solar rays symbolize photosanity, which corresponds to exposure to sunlight and its harmful effects on health. Conclusions: the implementation of photoprotection measures from an early age is of vital importance for the prevention of skin cancer, so it is necessary to provide parents with adequate information about sun risks and preventive measure.