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Abstract Objectives The present study aimed to evaluate the measurement invariance of a general measure of the perception of governmental responses to COVID-|19 (COVID-SCORE-10) in the general population of 13 Latin American countries. Methods A total of 5780 individuals from 13 Latin American and Caribbean countries selected by non-probabilistic snowball sampling participated. A confirmatory factor analysis was performed and the alignment method was used to evaluate invariance. Additionally, a graded response model was used for the assessment of item characteristics. Results The results indicate that there is approximate measurement invariance of the COVID-SCORE-10 among the participating countries. Furthermore, IRT results suggest that the COVID-SCORE-10 measures with good psychometric ability a broad spectrum of the construct assessed, especially around average levels. Comparison of COVID-SCORE-10 scores indicated that participants from Cuba, Uruguay and El Salvador had the most positive perceptions of government actions to address the pandemic. Thus, the underlying construct of perception of government actions was equivalent in all countries. Conclusion The results show the importance of initially establishing the fundamental measurement properties and MI before inferring the cross-cultural universality of the construct to be measured.

https://doi.org/10.1186/s41155-023-00277-9

Caracterización de pacientes operados de nódulos benignos de tiroides. Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos, 2014-2019
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Aíras Cañizares, José Carlos

; Puerto Lorenzo, José Alberto

; Torres Aja, Lidia

MediSur

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oct 2022, Volume 20 N. 5 Pages 895 - 906

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Background: benign nodular disease of the thyroid is a frequent reason for medical consultation, its knowledge is of vital importance for the surgeon. Objective: to characterize patients operated on for benign thyroid nodules. Methods: a retrospective case series study was carried out on patients operated on for benign thyroid nodules at the Dr. Gustavo Aldereguia Lima Hospital, over a period of five years. Medical records and biopsy protocols were reviewed; whose data were emptied into a collector model. The variables sex, age, skin color, location of the tumor, as well as its physical and imaging characteristics, were analyzed. In addition, biopsy modalities used, as well as the histological variety, the surgical technique used and the complications. Results: women older than 50 years of age and white skin predominated. The predominant clinical manifestation was the increase in volume in the neck, as well as the presence of single and solid nodules. Likewise, the association of fine-needle aspiration biopsy and paraffin were the most used modalities. Multinodular goiter was the most frequently diagnosed entity. Conclusions: Although benign nodular thyroid disease is not a serious health problem, it is very frequently diagnosed in our environment and surgical treatment is performed, mainly in women over 50 years of age.

RESUMEN Fundamento la enfermedad nodular benigna de tiroides es motivo frecuente de consulta médica, su conocimiento es de vital importancia para el cirujano. Objetivo: caracterizar pacientes operados de nódulos benignos de tiroides. Métodos: se realizó un estudio retrospectivo de serie de casos sobre los pacientes operados de nódulos benignos de tiroides en el Hospital Dr. Gustavo Aldereguia Lima, en un periodo de cinco años. Se revisaron las historias clínicas y protocolos de biopsias, cuyos datos fueron vaciados en un modelo recolector. Se analizaron las variables sexo, edad, color de la piel, localización del tumor, así como sus características físicas e imagenológicas. Además, modalidades de biopsias utilizadas, así como la variedad histológica, la técnica quirúrgica empleada y las complicaciones. Resultados: predominaron las femeninas mayores de 50 años de edad y de piel blanca. La manifestación clínica predominante fue el aumento de volumen en el cuello, así como la presencia de nódulos únicos y sólidos. La asociación de la biopsia por aspiración con aguja fina y parafina fueron las modalidades más utilizadas. El bocio multinodular fue la entidad diagnosticada con mayor frecuencia. Conclusiones: la enfermedad nodular benigna de tiroides, aunque no constituye un grave problema de salud, sí, en el medio del estudio, se diagnostica con mucha frecuencia y se realiza tratamiento quirúrgico, fundamentalmente en mujeres mayores de 50 años.

Perfil de pacientes con cronicidad avanzada y necesidades paliativas: un cambio que no llega
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Barrena-Urieta, Iñigo

; Rodríguez-Rocha, Adelino José

; Wang-Gao, Yu

; Rol-Hoyas, Carlos Manuel

; Aira-Ferrer, Pilar

; Domínguez-Lorenzo, Carmen

Revista Clínica de Medicina de Familia

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2022, Volume 15 N. 2 Pages 85 - 92

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN Objetivo: estudiar los posibles cambios en el perfil de pacientes con cronicidad avanzada entre dos cohortes en el momento de su inclusión en un equipo de soporte de atención paliativa domiciliaria (ESAPD) en el marco de la implementación de estrategias de cronicidad. Método: estudio observacional retrospectivo con enfoque analítico de pacientes no oncológicos derivados a un ESAPD de la Comunidad de Madrid, divididos en dos cohortes (2014 y 2019) definidas por el momento de inclusión en programa. Las variables principales fueron: tiempo de permanencia en programa (TPP), carga sintomática (CS) y situación funcional (SF). Se recogieron variables sociodemográficas y clínicas. Se comparó globalmente y por sexo el efecto de la cohorte (bruto y ajustado) sobre las variables principales mediante LogRank y Cox para el TPP, t-Student para la CS y SF y Modelo Lineal Generalizado para la SF. Resultados: las cohortes 2014 y 2019 constaron, respectivamente, de 98 y 116 pacientes, 63% y 52% de mujeres, 48% y 35% del ámbito rural y 43% y 27% de institucionalizados, con una media de edad y lugar de fallecimiento similares. En el TPP no se evidenciaron diferencias entre ambas cohortes (p=0,098); el análisis de Cox tampoco mostró asociación (HR = 1,01 [0,75; 1,36]). En la CS no se encontraron diferencias clínicamente relevantes. No se observaron diferencias en la SF una vez ajustada por las variables edad, sexo e institucionalización. Conclusión: no se observaron diferencias en el perfil de pacientes con cronicidad avanzada incluidos en el programa del ESAPD entre los años 2014 y 2019 en el marco de la implementación de estrategias de cronicidad.

ABSTRACT Objective: to study possible changes in the profile of patients with advanced chronic conditions between two cohorts at the time of their inclusion in a palliative-care-home care support team (PCHCST) in the framework of implementation of chronicity strategies. Method: A retrospective, observational analytical study was performed on non-oncological patients referred to a PCHCST in Madrid, divided into two cohorts (2014 and 2019) defined by the time of inclusion in the programme. The main variables were time spent in the programme (TSP), symptom burden (SB) and functional status (FS). Sociodemographic and clinical variables were collected. The effect of the cohort (crude and adjusted) on the main variables was compared overall and by sex using LogRank and Cox for TSP, student t test for SB and FS and Generalized Linear Models for FS. Results: The 2014 and 2019 cohorts consisted respectively of 98 and 116 patients, 63% and 52% female, 48% and 35% rural and 43% and 27% nursing home residents, with similar mean age and place of death. For TSP, no statistically significant differences were detected between the two cohorts (P = 0.098); Cox analysis did not reveal any association either (HR = 1.01 [0.75; 1.36]). No clinically relevant differences were found for SB. No differences were observed for FS adjusted for age, sex and nursing home residence. Conclusion: No differences were observed in the profile of patients with advanced chronic conditions included in the PCHCST between 2014 and 2019 in the framework of implementation of chronicity strategies.

Efectividad de la terapia cognitivo conductual en el episodio depresivo
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Lorenzo-Díaz, José Carlos

; Díaz-Alfonzo, Humbelina

; Carrete-Friol, Zulaimy Dayami

; Hernández-Quiñones, Orestes Luis

; Barrios-Licor, Rita Aimee

Revista de Ciencias Médicas de Pinar del Río

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dec 2021, Volume 25 N. 6 elocation e5311

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Introduction: depression is a prevalent neuropsychiatric disease worldwide, which is why it is important to conduct studies on the current situation regarding knowledge, attitudes and practices about this disorder. Objective: to determine the effectiveness of cognitive behavioral therapy in mild and moderate depressive episode in patients hospitalized at Abel Santamaria Cuadrado General Teaching Hospital during July 2020 and June 2021. Methods: an observational, descriptive and cross-sectional research was carried out in patients with a diagnosis of mild and moderate depressive episode admitted Abel Santamaria Cuadrado General Teaching Hospital, Pinar del Rio province during the period from July 2020 to June 2021. The target group and the sample coincided and comprised 94 patients with this diagnosis. The processing and analysis techniques comprised the distribution in absolute and relative frequencies, as well as the chi-squared test. Bioethical principles were met. Results: in the research female predominated, 60 years and older. Symptom reduction was evidenced after cognitive-behavioral therapy, symptom chronicity and relapses were scarce. The reduction of symptoms and the regression of the feeling of well-being in the frame of mind stood out. Conclusions: cognitive behavioral therapy was effective in patients diagnosed with mild and moderate depressive episode, reducing mortality and associated behaviors. Cognitive behavioral therapy is shown to be an effective intervention in patients diagnosed with mild and moderate depressive episode in the hospital institution.

RESUMEN Introducción: la depresión es una enfermedad neuro-psiquiátrica prevalente a nivel mundial, motivo por el cual resulta trascendente realizar estudios sobre la situación actual respecto a los conocimientos, actitudes y prácticas acerca de este trastorno. Objetivo: determinar la efectividad de la terapia cognitiva conductual en el episodio depresivo leve y moderado en pacientes hospitalizados en el Hospital General Docente Abel Santamaría Cuadrado durante julio 2020 y junio 2021. Métodos: se realizó una investigación observacional, descriptiva y transversal en pacientes con diagnóstico de episodio depresivo leve y moderado ingresados en el Hospital General Docente Abel Santamaría Cuadrado, de Pinar del Río durante el periodo de julio 2020 a junio 2021. El universo y la muestra coincidieron y estuvo constituido por 94 pacientes con dicho diagnóstico. Las técnicas de procesamiento y análisis fueron la distribución en frecuencias absolutas y relativas, así como la prueba estadística de chi cuadrado. Se respetaron los principios bioéticos. Resultados: en la investigación predomino el sexo femenino, las edades de 60 años y más. Se evidencio la disminución de los síntomas después de instaurada la terapia cognitiva conductual, la cronificación de los síntomas y las recaídas fueron escasas. Sobresalió la disminución de los síntomas y la regresión del bienestar en el estado de humor. Conclusiones: resultó efectiva la terapia cognitiva conductual en pacientes con diagnóstico de episodio depresivo leve y moderado disminuyendo la mortalidad y comportamientos asociados. La terapia cognitiva conductual se muestra como una intervención efectiva en pacientes con diagnóstico de episodio depresivo leve y moderado en la Institución hospitalaria.

Importancia del índice neutrófilo-linfocito en su asociación con mortalidad en pacientes con COVID-19: Experiencia en un centro de salud en Argentina
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Carreras, Matías

; Dasque, Camila

; Stolar, Mora

; Parodi, María Noel

; Barrios, Rocío Nahir

; Estramiana, Yamila

; Gastaldi, María Victoria

; Mouse, Carlos

; Presas, José Luis

; Marovelli, Lorenzo

; Gandino, Ignacio Javier

Revista chilena de infectología

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dec 2021, Volume 38 N. 6 Pages 768 - 773

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background: COVID-19 rapidly progresses to acute respiratory failure and mortality. A pandemic needs an urgent requirement for low-cost and easy-access tools that assess the infection evolution. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker used in several diseases. Aim: To estimate the association between NLR > 3 with mortality in hospitalized patients with COVID 19. Methods: NLR was analyzed in patients with COVID-19 seen at Hospital Fernandez between March and August 2020. Patients were grouped in those with NLR < 3 and those with NLR > 3. Clinical characteristics and mortality were analyzed and compared between groups. A multivariable regression model was used to estimate the association between NLR > 3 and mortality. Results: We included 711 patients with COVID-19. In a multivariable regression model, NLR > 3 associated with mortality (OR 3.8; 95% CI 1.05 to 13.7; p 0.04) adjusting by age, days of hospitalization, intensive care requirement, severe pneumonia, C-reactive protein levels, arterial hypertension, and comorbidities. Conclusion: NLR was associated with mortality, and it is an accessible and easy tool to use in the first evaluation of hospitalized patients with COVID-19.

Resumen Antecedentes: El COVID-19 presenta una progresión a cuadros respiratorios graves que pueden culminar con la muerte. Al ser una pandemia, hay necesidad de herramientas de bajo costo que permitan determinar su evolución. El índice neutrófilo-linfocito (INL) es un marcador inflamatorio estudiado en diversas patologías. Objetivo: Estimar la asociación entre INL > 3 y mortalidad en pacientes hospitalizados con COVID 19. Pacientes y Métodos: Se incluyeron pacientes con diagnóstico de COVID 19 que ingresaron a la sala de internación general de nuestro hospital, desde marzo hasta agosto de 2020. Los pacientes se dividieron en dos grupos: con INL < 3 y con INL > 3. Se realizó un modelo de regresión logística múltiple para estimar la asociación entre el INL > 3 y mortalidad. Resultados: Se incluyeron 711 pacientes con COVID-19. El modelo de regresión logística múltiple mostró asociación entre INL > 3 y mortalidad (OR 3.8; IC95% 1,05 a 13,7; p 0,04) ajustado por edad, días de internación, traslados a terapia intensiva, neumonía grave, valores de proteína-C-reactiva, hipertensión arterial, y comorbilidad neurológica, renal crónica, cardiaca y oncológica previas. Conclusión: El INL es accesible en la evaluación inicial de los pacientes que se internan con COVID-19, habiéndose asociado en nuestra serie con mortalidad.

https://doi.org/10.4067/s0716-10182021000600768 42 downloads

Impacto de la COVID-19 en la mortalidad de la comunidad autónoma de Castilla y León
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Ochoa Sangrador, Carlos

; Garmendia Leiza, José Ramón

; Pérez Boillos, María José

; Pastrana Ara, Fernando

; Lorenzo Lobato, María del Pilar

; Andrés de Llano, Jesús María

Gaceta Sanitaria

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oct 2021, Volume 35 N. 5 Pages 459 - 464

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Objective To estimate the increase in mortality associated with the SARS-CoV-2 coronavirus pandemic in the autonomous community of Castilla y León (Spain). Method Ecological study based on population and death data for the months of March 2016 to 2020 in Castilla y León. The general and provincial standardized rates, the relative risks of the year 2020 with respect to previous years and the risks adjusted by sex, periods and province, using Poisson regression, were calculated. Trend analysis was performed using joinpoint linear regression. Results An increase in mortality was observed in March 2020 with respect to previous years, with an increase of 39% for men (relative risk [RR]: 1.39; 95% confidence interval [95%CI]: 1.32-1.47) and 28% for women (RR: 1.28; 95%CI: 1.21-1.35). The model predicts excess mortality of 775 deaths. In the trend analysis there is a significant turning point in 2019 in men, globally and for almost all provinces. The increase in mortality is general, although heterogeneous by sex, age group and province. Conclusions Although the observed increase in mortality cannot be totally attributed to the disease, it is the best estimate we have of the real impact on deaths directly or indirectly related to it. The number of declared deaths only reaches two thirds of the increase in mortality observed.

Resumen Objetivo Estimar el aumento de la mortalidad asociado a la pandemia por SARS-CoV-2 en la comunidad autónoma de Castilla y León. Método Estudio ecológico basado en los datos de población y los fallecimientos correspondientes a los meses de marzo de los años 2016 a 2020 en Castilla y León. Se calcularon las tasas estandarizadas globales y por provincias, los riesgos relativos del año 2020 respecto a los años previos y los riesgos ajustados por sexo, periodo y provincia mediante regresión de Poisson. Se hizo un análisis de tendencias mediante regresión lineal joinpoint. Resultados En marzo de 2020 se observó un aumento de la mortalidad respecto a los años previos, con un incremento del 39% para los hombres (riesgo relativo [RR]: 1,39; intervalo de confianza del 95% [IC95]: 1,32-1,47) y del 28% para las mujeres (RR: 1,28; IC95: 1,21-1,35). El modelo predice un exceso de mortalidad en 2020 de 775 fallecimientos. En el análisis de tendencias hay un punto de inflexión significativo en 2019 para los varones, globalmente y para casi todas las provincias. El aumento de la mortalidad es global, aunque heterogéneo por sexos, grupos de edad y provincias. Conclusiones Aunque el aumento de la mortalidad observado no puede ser totalmente atribuido a la enfermedad, es la mejor estimación que tenemos del impacto real en muertes directamente o indirectamente relacionadas con ella. El número de muertes declaradas solo alcanza dos terceras partes del aumento de la mortalidad observado.

https://doi.org/10.1016/j.gaceta.2020.04.009

Impacto de la COVID-19 en la mortalidad de la comunidad autónoma de Castilla y León
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Ochoa Sangrador, Carlos

; Garmendia Leiza, José Ramón

; Pérez Boillos, María José

; Pastrana Ara, Fernando

; Lorenzo Lobato, María del Pilar

; Andrés de Llano, Jesús María

Gaceta Sanitaria

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oct 2021, Volume 35 N. 5 Pages 459 - 464

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

https://doi.org/10.1016/j.gaceta.2020.04.009

COVID-19: presentación clínica en pacientes hospitalizados en el Instituto de Medicina Tropical “Pedro Kourí”
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Jiménez Pérez, Narciso Argelio

; Fonseca Gómez, Carlos Miguel

; Fonseca Marrero, Carlos Alejandro

; de la Paz Bermúdez, Tania

; Martínez Rodríguez, Alina

; Herrera Marrero, Nuris Liem

; Rodríguez Bacallao, José Alberto

; Cárdenas García, Angely

; Baldoquín Rodríguez, Waldemar

; Castro Peraza, Osvaldo Enrique

; Ortega González, Lilia María

; Marrero Martínez, Odalys

; Pérez Díaz, Ana Beatriz

; Sierra Vázquez, Beatriz

; Castaño Araújo, Olga

; Miranda Lorenzo, Yanisledi

; González Rubio, Daniel

Revista Cubana de Medicina Tropical

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apr 2021, Volume 73 N. 1 elocation e603

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Introduction: Upon appearance of the first COVID-19 cases in Cuba, early identification of patients at risk of developing severe forms of the disease became a necessity. Objective: Describe the clinical behavior of COVID-19 in patients admitted to Pedro Kourí Tropical Medicine Institute and identify factors associated to severity. Methods: A presentation was made of the first 73 COVID-19 cases admitted to Pedro Kourí Tropical Medicine Institute from 11 March to 5 May 2020. The patients were divided into two groups: severe and mild disease. A comparison was made of clinical, demographic, laboratory and imaging variables at admission, and their possible association to disease severity. Results: Seven patients (9.6%) were critically ill; five died. Age > 60 years, more than one comorbidity, arterial hypertension and bronchial asthma were more common among critical patients. Fever for more than six days (p= 0.00), dyspnea (p= 0.00), presence of humid stertors (p= 0.00), respiratory rate > 24/min (p= 0.00) and lymphocytes < 0.8 x109/l (p= 0.00), ferritin > 500 µg/L (p =0.00), C-reactive protein 10 μg/l (p= 0.01) and LDH 500 U/l (p= 0.01) were related to disease severity. 18.2% of the chest radiographs showed alterations, with a predominance of bilateral foci of inflammatory condensation. The most common complications were respiratory distress, shock, bacterial sepsis and heart disorders. Conclusions: Some clinical and laboratory characteristics identifiable at admission may be associated to disease severity, which makes them useful for risk stratification and the appropriate management of patients.

RESUMEN Introducción: Con los primeros casos de COVID-19 en Cuba era necesario el reconocimiento temprano de los pacientes con riesgo de evolucionar hacia formas graves de la enfermedad. Objetivo: Describir el comportamiento clínico de la COVID-19 en pacientes hospitalizados en el Instituto de Medicina Tropical “Pedro Kourí” e identificar factores asociados a la gravedad. Métodos: Se presentaron los primeros 73 casos de COVID-19 hospitalizados en el Instituto de Medicina Tropical “Pedro Kourí” desde el 11 de marzo al 5 mayo de 2020. Los pacientes se clasificaron en dos grupos: graves y con enfermedad ligera. Se compararon variables clínicas, demográficas, de laboratorio e imagenológicas en el momento del ingreso, y su posible asociación con la gravedad de la enfermedad. Resultados: Hubo siete pacientes graves (9,6 %), cinco fallecieron. La edad > 60 años, tener más de una comorbilidad, hipertensión arterial y asma bronquial, fueron más frecuentes en pacientes graves. La fiebre más de seis días (p= 0,00), disnea (p= 0,00), presencia de estertores húmedos (p= 0,00), frecuencia respiratoria > 24/min (p= 0,00) y valores de linfocitos < 0,8 x109/L (p= 0,00), de ferritina > 500µg/L (p =0,00), proteína C reactiva ( 10μg/L (p= 0,01) y LDH ( 500 U/L (p= 0,01) se relacionaron con la gravedad. El 18,2 % de las radiografías de tórax mostró alteraciones, con predominio de focos de condensación inflamatoria bilateral. Las complicaciones más frecuentes fueron: distrés respiratorio, choque, sepsis bacteriana y afecciones cardíacas. Conclusiones: Existen características clínicas y de laboratorio, identificables al ingreso, que están relacionadas con la gravedad de la enfermedad; lo que puede ser útil para la estratificación del riesgo y el manejo adecuado de los pacientes.

Perfil microbiologico y de resistencia antimicrobiana en infecciones adquiridas en la comunidad. Hospital Universitario San José de Popayán
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Vargas-Zabala, Dairo Lorenzo

; Cabrera-Velasco, Carlos

; Lozano-Fernandez, Victor

; Cardeño-Sanchez, John

; Vargas-Uricoechea, Hernando

Infectio

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mar 2021, Volume 25 N. 1 Pages 39 - 44

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Objetivo. Describir el perfil microbiológico y de resistencia bacteriana de los aislamientos en adultos con infecciones adquiridas en comunidad en el Hospital Universitario San José de junio 2016 a diciembre 2019. Metodología. Se realizó un estudio descriptivo de corte transversal, análisis retrospectivo de los aislamientos microbiológicos en adultos desde junio 2016 a diciembre 2019, basado en la data institucional. Se analizó la información con STATA15,0. Se obtuvo la aprobación del comité de ética del hospital. Resultados. Se incluyeron 5121 aislamientos microbiológicos, el 61% en el servicio de urgencias. El urocultivo fue la muestra más frecuente. Escherichia coli fue el germen más común tanto a nivel general como en urocultivos, hemocultivos y cultivos de líquido peritoneal. La resistencia a ampicilina y amp/sul fue elevada, hasta del 68% para E. coli. El 20% de los Staphylococcus aureus fueron resistentes a meticilina. Se observó una resistencia inusual a carbapenémicos por parte de Pseudomonas aeruginosa. Discusión. El perfil microbiológico concuerda con la literatura mundial y nacional, sin embargo, el HUSJ tiene un comportamiento microbiológico que debe ser estudiado a profundidad. Conclusión. Los porcentajes de resistencia a antibióticos de uso frecuente son elevados. Se requiere ajustes de las guías de manejo institucionales y nacionales.

Abstract Objetive. To describe the microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose university hospital from june 2016 to december 2019 Methodology. A retrospective transverse descriptive study of microbial organisms found in adults in the institution from June 2016 to December 2019, the study is based in the hospital data. The analysis of the information was made with SATA 15.0. Results. 5121 samples were included, 61% from the emergency department. Urine culture was the most frequent sample taken. Escherichia coli was the most frequent isolated bacterial, in all samples, urine culture, blood culture, and peritoneal culture. Ampiciline r and ampiciline/sulbactam was high up to 68% of the E. Coli cultures. 20% of Staphylococcus aureus were methicillin resistant. Unusual carbapenemic resistance was found in the Pseudomona aeruginosa isolates.. Discussion. The data of the bacterial resistance spectrum Concord which was is found in the general medical literature, nevertheless the HUSJ, has a microbial behaviour that must be studied thoroughly. Conclusion. The antibiotic bacterial resistance to common used antibiotics is high. Adjustments are required in the instucional and national management guidelines

https://doi.org/10.22354/in.v25i1.907 356 downloads

10.

Galectina-3 Associada a Formas Graves e Mortalidade em Longo Prazo em Pacientes com Doença de Chagas
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Fernandes, Fábio

; Moreira, Carlos Henrique Valente

; Oliveira, Lea Campos

; Souza-Basqueira, Marcela

; Ianni, Barbara Maria

; Lorenzo, Claudia di

; Ramires, Felix José Alvarez

; Nastari, Luciano

; Cunha-Neto, Edecio

; Ribeiro, Antonio L.

; Lopes, Renato Delascio

; Keating, Sheila M.

; Sabino, Ester Cerdeira

; Mady, Charles

Arquivos Brasileiros de Cardiologia

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feb 2021, Volume 116 N. 2 Pages 248 - 256

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento As características histopatológicas da doença de Chagas (DCC) são: presença de miocardite, destruição das fibras cardíacas e fibrose miocárdica. A Galectina-3 (Gal-3) é um biomarcador envolvido no mecanismo de fibrose e inflamação que pode ser útil para a estratificação de indivíduos com DCC por risco. Objetivos Nosso objetivo foi avaliar se níveis elevados de Gal-3 estão associados a formas graves de cardiomiopatia chagásica (CC) e são preditivos de mortalidade. Métodos Estudamos doadores de sangue (DS) positivos para anti-T. cruzi: não-CC-DS (187 DS sem CC com eletrocardiograma [ECG] e fração de ejeção do ventrículo esquerdo [FEVE] normais); CC-Não-Dis-DS (46 DS com CC e apresentando ECG anormal, mas FEVE normal); e 153 controles negativos correspondentes. Esta amostra foi composta por 97 pacientes com CC grave (CC-Dis). Usamos as correlações de Kruskall-Wallis e Spearman para testar a hipótese de associações, assumindo um p bicaudal <0,05 como significativo. Resultados O nível de Gal-3 foi de 12,3 ng/mL para não-CC-DS, 12,0 ng/mL para CC-Não-Dis-DS, 13,8 ng/mL para controles e 15,4 ng/mL para CC-Dis. FEVE <50 foi associada a níveis mais elevados de Gal-3 (p=0,0001). Em nosso modelo de regressão linear ajustado, encontramos associação entre os níveis de Gal-3 e os parâmetros do ecocardiograma em indivíduos positivos para T. cruzi. Nos pacientes CC-Dis, encontramos uma associação significativa de níveis mais elevados de Gal-3 (≥15,3 ng/mL) e morte ou transplante cardíaco em acompanhamento de cinco anos (Hazard ratio – HR 3,11; IC95% 1,21– 8,04; p=0,019). Conclusões Em pacientes com CC, níveis mais elevados de Gal-3 estiveram significativamente associados a formas graves da doença e maior taxa de mortalidade em longo prazo, o que significa que pode ser um meio efetivo para identificar pacientes de alto risco. (Arq Bras Cardiol. 2021; 116(2):248-256)

Abstract Background The histopathological characteristics of Chagas disease (ChD) are: presence of myocarditis, destruction of heart fibers, and myocardial fibrosis. Galectin-3 (Gal-3) is a biomarker involved in the mechanism of fibrosis and inflammation that may be useful for risk stratification of individuals with ChD. Objectives We sought to evaluate whether high Gal-3 levels are associated with severe forms of Chagas cardiomyopathy (CC) and whether they are predictive of mortality. Methods We studied anti-T. cruzi positive blood donors (BD): Non-CC-BD (187 BD without CC with normal electrocardiogram [ECG] and left ventricular ejection fraction [LVEF]); CC-Non-Dys-BD (46 BD with CC with abnormal ECG but normal LVEF); and 153 matched serum-negative controls. This cohort was composed of 97 patients with severe CC (CC-Dys). We used Kruskall-Wallis and Spearman’s correlation to test hypothesis of associations, assuming a two-tailed p<0.05 as significant. Results The Gal-3 level was 12.3 ng/mL for Non-CC-BD, 12.0 ng/mL for CC-Non-Dys-BD, 13.8 ng/mL for controls, and 15.4 ng/mL for CC-Dys. LVEF<50 was associated with higher Gal-3 levels (p=0.0001). In our linear regression adjusted model, we found association between Gal-3 levels and echocardiogram parameters in T. cruzi-seropositive subjects. In CC-Dys patients, we found a significant association of higher Gal-3 levels (≥15.3 ng/mL) and subsequent death or heart transplantation in a 5-year follow-up (Hazard ratio – HR 3.11; 95%CI 1.21–8.04; p=0.019). Conclusions In ChD patients, higher Gal-3 levels were significantly associated with severe forms of the disease and more long-term mortality, which means it may be a useful means to identify high-risk patients. (Arq Bras Cardiol. 2021; 116(2):248-256)

https://doi.org/10.36660/abc.20190403 575 downloads

11.

Sexually Transmitted Infections in the Community of Santa Ana Batha, Hidalgo, Mexico
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Muller Sanjuan, José Alejandro

; Ruvalcaba Ledezma, Jesús Carlos

; Dorantes Peña, Horacio Gabriel

; Ortega Villegas, Karla Mercedes

; Reynoso Vázquez, Josefina

; Aguirre Rembao, Lorenzo Octavio

; Reyes Garnica, Alfonso

Journal of Negative and No Positive Results

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2021, Volume 6 N. 7 Pages 968 - 976

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Sexually transmitted infections [STI] represent a serious public health problem, which triggers different biological, economic and social complications, which is also related to migration, prostitution, and other factors. The present investigation was carried out with the aim of establishing an endemic channel on Sexually Transmitted Infections and its association with migration, vacation periods and other factors of risk. Methods. A retrospective descriptive observational study was carried out from a bibliographic review of the subject on the internet network retrospectively from 2016 to 2010 collected from SUIVE, in order to establish the endemic ITS channel of the Santa Ana Batha region, Chilcuautla Municipality, Hidalgo, compared with the influx of spas in the study region, it was also taken into account that the region is a migration step from the south to the north, and the epidemiological weeks were also related to the vacation periods. Results. it was obtained as a result that during these periods the number of cases increased considerably and exceeded the alert zone. Conclusion. The results obtained allow to establish as risk factors for STI the phenomenon of migration, the vacation periods and the influx to spas during vacation periods. This study allows us to establish that if we do not pay attention to risk factors, STIs will continue to mean negative results in the health of those involved.

Resumen Las infecciones de transmisión sexual [ITS] representan un grave problema de salud pública, que desencadena distintas complicaciones biológicas, económicas y sociales, que también se relacionan con la migración, la prostitución y otros factores. La presente investigación se realizó con el objetivo de establecer un canal endémico sobre Infecciones de Transmisión Sexual y su asociación con la migración, los periodos vacacionales y otros factores de riesgo. Métodos. Se realizó un estudio Observacional descriptivo de caracter retrospectivo a partir de una revisión bibliográfica del tema en la red de internet de forma retrospectiva del año 2016 al 2010 recolectada del SUIVE, con el fin de establecer el canal ITS endémico de la región Santa Ana Batha, Municipio Chilcuautla, Hidalgo, comparado con la afluencia de balnearios en En la región de estudio, también se tomó en cuenta que la región es un paso migratorio de sur a norte, y las semanas epidemiológicas también se relacionaron con los períodos vacacionales. Resultados. Se obtuvo como resultado que durante estos períodos el número de casos aumentó considerablemente y superó la zona de alerta. Conclusión. Los resultados obtenidos permiten establecer como factores de riesgo de ITS el fenómeno de la migración, los períodos vacacionales y la afluencia a balnearios durante los períodos vacacionales.

https://doi.org/10.19230/jonnpr.4103

12.

Sexually Transmitted Infections in the community of Santa Ana Batha, Hidalgo, Mexico
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Muller-Sanjuan, José Alejandro

; Ruvalcaba-Ledezma, Jesús Carlos

; Dorantes-Peña, Horacio Gabriel

; Ortega-Villegas, Karla Mercedes

; Reynos-Vázquez, Josefina

; Aguirre-Rembao, Lorenzo Octavio

; Reyes-Garnica, Alfonso

Journal of Negative and No Positive Results

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2021, Volume 6 N. 7 Pages 968 - 976

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Abstract Sexually transmitted infections [STI] represent a serious public health problem, which triggers different biological, economic and social complications, which is also related to migration, prostitution, and other factors. The present investigation was carried out with the aim of establishing an endemic channel on Sexually Transmitted Infections and its association with migration, vacation periods and other factors of risk. Methods. A retrospective descriptive observational study was carried out from a bibliographic review of the subject on the internet network retrospectively from 2016 to 2010 collected from SUIVE, in order to establish the endemic ITS channel of the Santa Ana Batha region, Chilcuautla Municipality, Hidalgo, compared with the influx of spas in the study region, it was also taken into account that the region is a migration step from the south to the north, and the epidemiological weeks were also related to the vacation periods. Results. It was obtained as a result that during these periods the number of cases increased considerably and exceeded the alert zone. Conclusion. The results obtained allow to establish as risk factors for STI the phenomenon of migration, the vacation periods and the influx to spas during vacation periods. This study allows us to establish that if we do not pay attention to risk factors, STIs will continue to mean negative results in the health of those involved.

https://doi.org/10.19230/jonnpr.4103

13.

Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study,
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Prata-Barbosa, Arnaldo

; Lima-Setta, Fernanda

; Santos, Gustavo Rodrigues dos

; Lanziotti, Vanessa Soares

; Castro, Roberta Esteves Vieira de

; Souza, Daniela Carla de

; Raymundo, Carlos Eduardo

; Oliveira, Felipe Rezende Caino de

; Lima, Lucio Flavio Peixoto de

; Tonial, Cristian Tedesco

; Colleti Jr., José

; Bellinat, Ana Paula Novaes

; Lorenzo, Vivian Botelho

; Zeitel, Raquel de Seixas

; Pulcheri, Lucas

; Costa, Fernanda Ciuffo Monte da

; La Torre, Fabíola Peixoto Ferreira

; Figueiredo, Elaine Augusta das Neves

; Silva, Thiago Peres da

; Riveiro, Paula Marins

; Mota, Isabele Coelho Fonseca da

; Brandão, Igor Bromonschenkel

; Azevedo, Zina Maria Almeida de

; Gregory, Simone Camera

; Boedo, Fernanda Raquel Oliveira

; Carvalho, Rosana Novais de

; Castro, Natália Almeida de Arnaldo Silva Rodriguez

; Genu, Daniel Hilário Santos

; Foronda, Flavia Andrea Krepel

; Cunha, Antonio José Ledo A.

; Magalhães-Barbosa, Maria Clara de

Jornal de Pediatria

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dec 2020, Volume 96 N. 5 Pages 582 - 592

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Descrever as características clínicas de crianças e adolescentes internados em unidade de terapia intensiva com COVID-19 confirmada. Método: Estudo prospectivo, multicêntrico, observacional, em 19 unidades de terapia intensiva pediátrica. Foram incluídos pacientes entre um mês e 19 anos, admitidos consecutivamente (março a maio de 2020). As características demográficas, clínico-epidemiológicas, o tratamento e os resultados foram coletados. Os subgrupos foram comparados de acordo com as comorbidades, idade < 1 ano e necessidade de ventilação mecânica invasiva. Um modelo de regressão logística multivariável foi utilizado para preditores de gravidade. Resultados: Setenta e nove pacientes foram incluídos (10 com síndrome inflamatória multi-ssistêmica). Mediana de idade, quatro anos; 54% eram do sexo masculino (síndrome inflamatória multissistêmica, 80%); 41% tinham comorbidades (síndrome inflamatória multissistêmica, 20%). Febre (76%), tosse (51%) e taquipneia (50%) foram comuns nos dois grupos. Sintomas graves egastrointestinais e marcadores inflamatórios mais elevados foram mais frequentes na presença de síndrome inflamatória multissistêmica. Infiltrados intersticiais pulmonares foram comuns em ambos os grupos, mas o derrame pleural foi mais prevalente no grupo com síndrome inflamatória multissistêmica (43% vs. 14%). A ventilação mecânica invasiva foi utilizada em 18% (mediana 7,5 dias); antibióticos, oseltamivir e corticosteroides foram utilizados em 76%, 43% e 23%, respectivamente, mas não a hidroxicloroquina. A mediana do tempo de permanência na unidade de terapia intensiva pediátrica foi de 5 dias; duas mortes ocorreram (3%) no grupo não- síndrome inflamatória multissistêmica. Os pacientes com comorbidades eram mais velhos, e as comorbidades foram independentemente associadas à necessidade de ventilação mecânica invasiva(OR 5,5; IC95%, 1,43-21,12; P 0,01). Conclusões: Nas unidades de terapia intensiva pediátrica brasileiras, a COVID-19 apresentou baixa mortalidade, a idade inferior a um ano não foi associada a um pior prognóstico, os pacientes com síndrome inflamatória multissistêmica apresentaram sintomas mais graves, biomarcadores inflamatórios mais elevados e uma grande predominância no sexo masculino, mas apenas a presença de comorbidades e doenças crônicas foi um preditor independente de gravidade.

Abstract Objective: To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. Method: Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March-May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. Results: Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43-21.12; p = 0.01). Conclusions: In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.

https://doi.org/10.1016/j.jped.2020.07.002 2718 downloads

14.

Nefrectomía parcial vs enucleación tumoral
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Gayarre-Abril, Paula

; López-Lorenzo, Jesús

; Subirá-Ríos, Jorge

; Hijazo-Gascón, Daniel

; Hijazo-Conejos, José Ignacio

; García-Magariño, Jesús

; Medrano-Llorente, Pilar

; Elizalde-Benito, Francisco-Xavier

; Rioja-Zuazu, Jorge

; Murillo-Pérez, Carlos

; Ramírez-Fabián, Manuel

; Blasco-Beltrán, Benjamín

; Carrera-Lasfuentes, Patricia

Revista mexicana de urología

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dec 2020, Volume 80 N. 6 elocation e07

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background and aims: Nephron-sparing surgery has become the standard surgical technique for small renal masses, taking the place of traditional radical nephrectomy. The aim of the present study was to compare partial nephrectomy and tumor enucleation, with respect to morbidity and oncologic results. Materials and methods: A retrospective cohort study was conducted on patients that underwent partial nephrectomy or enucleation at the Hospital Clínico Universitario Lozano Blesa de Zaragoza, between August 2011 and October 2019. Demographics, clinical and surgical characteristics, and oncologic results were the variables analyzed. Results: Forty-eight patients were followed for 36,1±28,0 months. Compared with the partial nephrectomy group, the patients that underwent tumor enucleation presented with lower values of mean blood loss (117,7±95.1 ml and 221±293.1 ml, p=0,488), ischemia (46% and 95%, p<0,001), mean ischemia time (24,6±7,2 min and 25,1±10,4 min, p=0,844), and complications (11,5% and 22,7%, p=0,442), respectively. No local recurrence was observed. Conclusions: Both groups were comparable in relation to tumor stage. The enucleation group presented with less blood loss, less need for vascular clamping, and similar ischemia time, compared with the partial nephrectomy group. Both techniques were oncologically safe, with a low rate of compromised surgical margins. Postoperative morbidity with the two techniques was low.

Resumen Antecedentes y objetivo: La cirugía conservadora de nefronas se ha convertido en la técnica quirúrgica estándar para masas renales de pequeño tamaño, desbancando la tradicional nefrectomía radical. El objetivo del estudio es comparar nefrectomía parcial y enucleación tumoral en función de morbilidad y resultados oncológicos. Material y métodos: Estudio de cohortes retrospectivo de pacientes sometidos a nefrectomía parcial o enucleación en el Hospital Clínico Universitario Lozano Blesa de Zaragoza, entre agosto de 2011 y octubre de 2019. Variables demográficas, clínicas, quirúrgicas y resultados oncológicos han sido analizadas. Resultados: 48 pacientes fueron seguidos 36.1±28.0 meses. Los pacientes sometidos a enucleación tumoral, respecto al grupo de nefrectomía parcial presentaron valores inferiores de sangrado medio (117.7±95.1 ml y 221±293.1 ml, p=0.488), isquemia (46% y 95%, p<0.001), tiempo de isquemia medio (24.6±7.2 min y 25.1±10.4 min, p=0.844) y complicaciones (11.5% y un 22.7%, p=0.442) respectivamente. No se observó recidiva local. Conclusiones: Ambos grupos son comparables en cuanto a estadio tumoral, presentando en el grupo de enucleación un menor sangrado, menor necesidad de clampaje vascular y un tiempo de isquemia similar al grupo de nefrectomía parcial. Ambas técnicas son seguras a nivel oncológico, con una baja tasa de márgenes afectos. Ambas técnicas presentan una baja morbilidad postoperatoria.

https://doi.org/10.48193/revistamexicanadeurologa.v80i6.709

15.

Calidad de vida asociada a la hipertensión arterial en el adulto mayor
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Lorenzo Díaz, José Carlos

; Vitón Castillo, Adrián Alejandro

Revista Médica Electrónica

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jun 2020, Volume 42 N. 3 Pages 1960 - 1963

Abstract: Es | Text: Es | PDF: Es

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