Pesquisa | SciELO

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

Dados de Vida Real sobre o Uso da Hidroxicloroquina ou da Cloroquina Combinadas ou Não à Azitromicina em Pacientes com Covid-19: Uma Análise Retrospectiva no Brasil
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Souza-Silva, Maíra Viana Rego

; Pereira, Daniella Nunes

; Pires, Magda Carvalho

; Vasconcelos, Isabela Muzzi

; Schwarzbold, Alexandre Vargas

; Vasconcelos, Diego Henrique de

; Pereira, Elayne Crestani

; Manenti, Euler Roberto Fernandes

; Costa, Felício Roberto

; Aguiar, Filipe Carrilho de

; Anschau, Fernando

; Bartolazzi, Frederico

; Nascimento, Guilherme Fagundes

; Vianna, Heloisa Reniers

; Batista, Joanna d’Arc Lyra

; Machado-Rugolo, Juliana

; Ruschel, Karen Brasil

; Ferreira, Maria Angélica Pires

; Oliveira, Leonardo Seixas de

; Menezes, Luanna Silva Monteiro

; Ziegelmann, Patricia Klarmann

; Tofani, Marcela Gonçalves Trindade

; Bicalho, Maria Aparecida Camargos

; Nogueira, Matheus Carvalho Alves

; Guimarães-Júnior, Milton Henriques

; Aguiar, Rúbia Laura Oliveira

; Rios, Danyelle Romana Alves

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 Nº 9 elocation e20220935

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Background Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil. Objectives To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls. Methods A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant. Results From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 - 71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682). Conclusion COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and in-hospital mortality were similar.

Resumo Fundamento Apesar da ausência de evidência mostrando benefícios da hidroxicloroquina e da cloroquina combinadas ou não à azitromicina no tratamento da covid-19, esses medicamentos têm sido amplamente prescritos no Brasil. Objetivos Avaliar desfechos, incluindo moralidade hospitalar, alterações eletrocardiográficas, tempo de internação, admissão na unidade de terapia intensiva, e necessidade de diálise e de ventilação mecânica em pacientes hospitalizados com covid-19 que receberam cloroquina ou hidroxicloroquina, e comparar os desfechos entre aqueles pacientes e seus controles pareados. Métodos Estudo multicêntrico retrospectivo do tipo coorte que incluiu pacientes com diagnóstico laboratorial de covid-19 de 37 hospitais no Brasil de março a setembro de 2020. Escore de propensão foi usado para selecionar controles pareados quanto a idade, sexo, comorbidades cardiovasculares, e uso de corticosteroides durante a internação. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados Dos 7850 pacientes com covid-19, 673 (8,6%) receberam hidroxicloroquina e 67 (0,9%) cloroquina. A idade mediana no grupo de estudo foi 60 (46-71) anos e 59,1% eram mulheres. Durante a internação, 3,2% dos pacientes apresentaram efeitos adversos e 2,2% necessitaram de interromper o tratamento. Alterações eletrocardiográficas foram mais prevalentes no grupo hidroxicloroquina/cloroquina (13,2% vs. 8,2%, p=0,01), e o prolongamento do intervalo QT corrigido foi a principal diferença (3,6% vs. 0,4%, p<0,001). O tempo mediano de internação hospitalar foi maior no grupo usando CQ/HCQ em relação aos controles (9,0 [5,0-18,0] vs. 8,0 [4,0-14,0] dias). Não houve diferenças estatisticamente significativas entre os grupos quanto a admissão na unidade de terapia intensiva (35,1% vs. 32,0%; p=0,282), ventilação mecânica invasiva (27,0% vs. 22,3%; p=0,074) ou mortalidade (18,9% vs. 18,0%; p=0,682). Conclusão Pacientes com covid-19 tratados com cloroquina ou hidroxicloroquina apresentaram maior tempo de internação hospitalar, em comparação aos controles. Não houve diferença em relação a admissão em unidade de terapia intensiva, necessidade de ventilação mecânica e mortalidade hospitalar.

https://doi.org/10.36660/abc.20220935

Presencia de bacterias en bombillas para infusiones y en cavidad oral de pacientes con salud periodontal y antecedentes de enfermedad periodontal: análisis exploratorio.
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Monges, Lider

; Defazio, Diego

; Martinez, Gisselle

; Rios-González, Carlos Miguel

Memorias del Instituto de Investigaciones en Ciencias de la Salud

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Dez 2021, Volume 19 Nº 3 Páginas 54 - 60

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT The retention and survival of oral microorganisms (OM) in the bombillas to take infusions represents a possible source of contamination of the mouth, mainly in people with periodontal diseases. The objective was to identify the presence of bacteria in infusion bombillas and in the oral cavity of patients with periodontal health and a history of periodontal disease. This was an observational, descriptive, cross-sectional study with analytical component. Study participants were grouped into G1 (patients with periodontal health, sterile infusion bulbs, with ethylene oxide for use for 30 days) and G2 (patients with a history of periodontal disease, sterile infusion bulbs, with ethylene oxide for use for 30 days). Fifty patients participated in the study. In healthy patients (Group1) the mean CFU was 676 ± 226, while in patients with periodontal disease (Group 2) the mean of Colony Forming Units (CFU) was 817 ± 345. In healthy patients (Group1) the mean OM It was 668 ± 165, while in patients with periodontal disease (Group 2) the mean OM was 774 ± 156. The presence of microorganisms is evidenced in bombillas for infusions and in the oral cavity of patients with periodontal health and a history of periodontal disease. The count of CFU present in the oral cavity of patients with periodontal health and a history of periodontal disease was similar.

RESUMEN La retención y sobrevivencia de microorganismos orales (MO) en la bombilla para tomar infusiones representa una posible fuente de contaminación de la boca, principalmente en personas con enfermedades periodontales. El objetivo del trabajo fue identificar la presencia de bacterias en bombillas para infusiones y en cavidad oral de pacientes con salud periodontal y antecedentes de enfermedad periodontal. Este fue un estudio observacional, descriptivo de corte transversal con componente analítico. Los participantes del estudio se agruparon en G1 (pacientes con salud periodontal, bombillas estériles para infusiones, con oxido etileno para su uso por 30 días) y G2 (pacientes con antecedente de enfermedad periodontal, bombillas estériles para infusión, con oxido etileno para su uso por 30 días). Participaron del estudio 50 pacientes. En los pacientes sanos (Grupo1) el promedio de Unidades Formadoras de Colonias (UFC) fue de 676± 226, mientras que en los pacientes con enfermedad periodontal (Grupo 2) el promedio de UFC fue de 817± 345. En los pacientes sanos (Grupo1) el promedio de MO fue de 668± 165, mientras que en los pacientes con enfermedad periodontal (Grupo 2) el promedio de MO fue de 774± 156. Se evidencia la presencia de microorganismos en bombillas para infusiones y en cavidad oral de pacientes con salud periodontal y antecedentes de enfermedad periodontal. El recuento de UFC presentes en la cavidad oral de los pacientes con salud periodontal y antecedentes de enfermedad periodontal fue similar.

https://doi.org/10.18004/mem.iics/1812-9528/2021.019.03.54 82 downloads

Uso do SAPS 3 no escore NUTrition RIsk in the Critically ill modificado tem precisão preditiva comparável ao uso do APACHE II como marcador de gravidade
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Pasinato, Valeska Fernandes

; Franzosi, Oellen Stuani

; Loss, Sérgio Henrique

; Nunes, Diego Silva Leite

; Foletto, Kelly Carraro

; Salazar, Gabriela Soranço

; Vieira, Silvia Regina Rios

Revista Brasileira de Terapia Intensiva

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Set 2021, Volume 33 Nº 3 Páginas 394 - 400

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss’ Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

https://doi.org/10.5935/0103-507x.20210064 41 downloads

Presentación atípica de pie diabético en pacientes pos-COVID-19
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Carro, Gabriela V.

; Dini, Andrés

; De Los Rios Espada, Grecia B.

; Tamashiro, Gustavo

; Llanos, María De Los Ángeles

; Claros Fuentes, Diego E.

Medicina (Buenos Aires)

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Ago 2021, Volume 81 Nº 6 Páginas 1076 - 1080

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Medical attention of patients with a diabetic foot has been disrupted since de COVID-19 pandemic began, because health systems had to provide care to those patients affected by this disease to the detriment of the control of chronic diseases. Several reports show an increase in amputations during the pandemic, primarily due to the lack of health controls in patients suffering from diabetes or diabetic foot. This could have resulted in later consultation and more severe presentations. We describe three medical cases that had recently been affected by COVID-19 and developed a rare and rapidly evolving diabetic foot that required a major amputation. One possible explanation for this atypi cal presentation could be that COVID-19 predisposes patients to vein and arterial thrombosis due to systemic inflammation, platelet activation, endothelial dysfunction and stasis from prolonged immobility. This could have exacerbated chronic ischemia secondary to diabetes in which metabolic disturbances often seen in these patients predispose to atherosclerosis.

Resumen La atención de pacientes con pie diabético se vio afectada luego de la aparición de COVID-19, ya que los sistemas de salud debieron dar prioridad a la atención de dicha enfermedad y se restringió el control de las enfermedades crónicas. Existen algunas comunicaciones sobre el aumento de las amputaciones durante la pandemia, el cual fue atribuido principalmente a la falta de controles de los pacientes con diabetes y pie diabético. Esto pudo haber influido en la consulta tardía y en la aparición de presentaciones más graves. Presentamos los casos de tres pacientes con reciente enfermedad por COVID-19 que desarrollaron una forma atípica de pie diabético grave y rápidamente evolutiva cuyo desenlace fue la amputación mayor. Una posible explicación estaría relacionada a que los pacientes con COVID-19 tienen mayor riesgo de enfermedad trombótica, tanto venosa como arterial, debido a la intensa respuesta inflamatoria, la activación plaquetaria, la disfunción endotelial y la estasis sanguínea por inmovilización, que se asocia a esta enfermedad. Esto podría agravar la isquemia crónica que desarrollan las personas con diabetes, causada por el estado metabólico anormal que favorece la ateroesclerosis de todo el árbol vascular.

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Caracterización y permanencia de signos y síntomas en pacientes COVID-19 positivos y negativos que acuden al Consultorio de Neumología del Hospital General de Luque, Paraguay
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Pérez Bejarano, Domingo

; Medina, Diego

; Aluán, Adib

; González, Lourdes

; Cuenca, Elisa

; López, Estela

; Enciso, Ana

; Duarte, Javier

; Arbo, Guillermo

; Rolón, Ángel Ricardo

; Rios-González, Carlos Miguel

Revista de salud publica del Paraguay

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Jun 2021, Volume 11 Nº 1 Páginas 41 - 47

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT Introduction: The coronavirus, the cause of the COVID-19 disease, continues to pose unknowns, many of them related to its symptoms and their durability according to the clinical characteristics of each patient. Objective: To characterize and the permanence of signs and symptoms in positive and negative COVID-19 patients who attend the Pneumology Clinic of the General Hospital of Luque, Paraguay during 2020. Methodology: An observational, descriptive, cross-sectional study with an analytical component. The data were analyzed according to two groups: a) COVID-19 (+) patients: those with diagnostic confirmation by RT-PCR or in whom high levels of anti-SARS-CoV-2 antibodies were verified and b) COVID-19 patients (-) those who did not show RNA in RT-PCR and did not develop antibodies. Results: 145 patients were included in the study. The interval between the onset of symptoms and the date of the interview was 44.8 days on average (range 15-186 days), 92% had symptoms for 21 days or more, 85.9% for 30 days or more, and 23% at 60 days or more. The persistent symptoms referred to were: fatigue (42%), anosmia and / or dysgeusia (13.3%), cough (12%), headache (9.5%), palpitations (7%), sleep disorders (6%) ), dyspnea (5%), occasional dizziness (5%), poor concentration (8%), memory disorders (3%), myalgia (3%), postural dizziness (3%), arthralgia (2% ), tingling (2%), back pain (2%) and chest tightness (1%). Conclusion: The most persistent symptoms found in the study were fatigue, anosmia and / or dysgeusia, cough, headache, palpitations, sleep disorders, dyspnea and occasional dizziness.

RESUMEN Introducción: El coronavirus, causante de la enfermedad COVID-19, continúa planteando incógnitas, muchas de ellas relacionadas con sus síntomas y la perdurabilidad de estos de acuerdo a las características clínicas de cada paciente. Objetivo: Caracterizar y la permanencia de los signos y síntomas en pacientes COVID-19 positivos y negativos que acuden al Consultorio de Neumología del Hospital General de Luque, Paraguay durante el 2020. Metodología: Estudio observacional, descriptivo, de corte transversal con componente analítico. Los datos se analizaron según dos grupos: a) los pacientes COVID-19 (+): aquellos con confirmación diagnóstica mediante RT-PCR o en quienes se comprobó niveles elevados de anticuerpos anti-SARS-CoV-2 y b) los pacientes COVID-19 (-) aquellos quienes no demostraron RNA en RT-PCR y que no desarrollaron anticuerpos. Resultados: Fueron incluidos en el estudio, 145 pacientes. El intervalo transcurrido entre el inicio de síntomas y fecha de entrevista fue de 44,8 días en promedio (rango de 15 - 186 días), 92% presentaba síntomas los 21 días o más, 85,9% a los 30 días o más y el 23% a los 60 días o más. Los síntomas persistentes referidos fueron: fatiga (42%), anosmia y/o disgeusia (13,3%), tos (12%), cefalea (9,5%), palpitaciones (7%), trastornos del sueño (6%), disnea (5%), mareos ocasionales (5%), falta de concentración (8%), trastornos de la memoria (3%), mialgias, (3%), mareos posturales (3%), artralgias (2%), hormigueos (2%), dolor de espalda (2%) y opresión torácica (1%). Conclusión: Los síntomas más persistentes encontrados en el estudio fueron la fatiga, la anosmia y/o disgeusia, la tos, la cefalea, las palpitaciones, los trastornos del sueño, la disnea y mareos ocasionales.

https://doi.org/10.18004/rspp.2021.junio.41 1197 downloads

Modificações no perfil de paradas cardíacas após implantação de um Time de Resposta Rápida
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Viana, Marina Verçoza

; Nunes, Diego Silva Leite

; Teixeira, Cassiano

; Vieira, Silvia Regina Rios

; Torres, Grazziela

; Brauner, Janete Salles

; Müller, Helena

; Butelli, Thais Crivellaro Dutra

; Boniatti, Marcio Manozzo

Revista Brasileira de Terapia Intensiva

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Jan 2021, Volume 33 Nº 1 Páginas 96 - 101

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar as modificações nas características das paradas cardíacas no hospital após a implantação de um Time de Resposta Rápida. Métodos: Este foi um estudo observacional prospectivo de paradas cardíacas ocorridas no hospital entre janeiro de 2013 e dezembro de 2017. O critério de exclusão foi parada cardíaca na unidade de terapia intensiva, na emergência ou na sala cirúrgica. O Time de Resposta Rápida foi introduzido no hospital do estudo em julho de 2014. Os pacientes foram classificados em dois grupos: Pré-Time de Resposta Rápida (parada cardíaca no hospital antes da implantação do Time de Resposta Rápida) e Pós- Time de Resposta Rápida (parada cardíaca no hospital após a implantação do Time de Resposta Rápida). Os pacientes foram seguidos até a alta hospitalar ou óbito. Resultados: Ocorreram 308 paradas cardíacas (64,6 ± 15,2 anos; 60,3% homens; 13,9% com ritmo inicial chocável). Houve diminuição de 4,2 para 2,5 no índice de parada cardíaca no hospital por 1.000 admissões após o início da atuação do Time de Resposta Rápida, além de cerca de 124 chamados por 1.000 admissões. A parada antes da implantação do Time de Resposta Rápida se associou com hipóxia (29,4 versus 14,3%; p = 0,006) e alteração da frequência respiratória (14,7 versus 4,2%; p = 0,004) em comparação aos dados referentes à parada cardíaca após a implantação do Time de Resposta Rápida. Parada cardíaca por hipóxia foi mais comum antes da implantação do Time de Resposta Rápida (61,2 versus 38,1%; p < 0,001). Na análise multivariada, o retorno à circulação espontânea se associou com ritmo chocável (RC 2,97; IC95% 1,04 - 8,43) e parada cardíaca testemunhada (RC 2,52; IC95% 1,39 - 4,59) mas não com a implantação do Time de Resposta Rápida (RC 1,40; IC95% 0,70 - 2,81) ou sinais premonitórios (RC 0,71; IC95% 0,39 - 1,28). Na análise multivariada, a mortalidade hospitalar se associou com ritmo não chocável (RC 5,34; IC95% 2,28 - 12,53) e idade (RC 1,03; IC95% 1,01 - 1,05), porém não com a implantação do Time de Resposta Rápida (RC 0,89; IC95% 0,40 - 2,02). Conclusão: Apesar de a implantação de um Time de Resposta Rápida se associar com redução na incidência de parada cardíaca no hospital, ela não se associou com a redução da mortalidade das vítimas de parada cardíaca no hospital. Observou-se significante diminuição nas paradas cardíacas devidas a causas respiratórias após a implantação do Time de Resposta Rápida.

ABSTRACT Objective: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. Methods: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-hospital cardiac arrest in the intensive care unit, emergency room or operating room. The Rapid Response Team was implemented in July 2014 in the study hospital. Patients were classified into two groups: a Pre-Rapid Response Team (in-hospital cardiac arrest before Rapid Response Team implementation) and a Post-Rapid Response Team (in-hospital cardiac arrest after Rapid Response Team implementation). Patients were followed until hospital discharge or death. Results: We had a total of 308 cardiac arrests (64.6 ± 15.2 years, 60.3% men, 13.9% with initial shockable rhythm). There was a decrease from 4.2 to 2.5 in-hospital cardiac arrest/1000 admissions after implementation of the Rapid Response Team, and we had approximately 124 calls/1000 admissions. Pre-Rapid Response Team cardiac arrest was associated with more hypoxia (29.4 versus 14.3%; p = 0.006) and an altered respiratory rate (14.7 versus 4.2%; p = 0.004) compared with post-Rapid Response Team cardiac arrest. Cardiac arrest due to hypoxia was more common before Rapid Response Team implementation (61.2 versus 38.1%, p < 0.001). In multivariate analysis, return of spontaneous circulation was associated with shockable rhythm (OR 2.97; IC95% 1.04 - 8.43) and witnessed cardiac arrest (OR 2.52; IC95% 1.39 - 4.59) but not with Rapid Response Team implementation (OR 1.40; IC95% 0.70 - 2.81) or premonitory signs (OR 0.71; IC95% 0.39 - 1.28). In multivariate analysis, in-hospital mortality was associated with non-shockable rhythm (OR 5.34; IC95% 2.28 - 12.53) and age (OR 1.03; IC95% 1.01 - 1.05) but not with Rapid Response Team implementation (OR 0.89; IC95% 0.40 - 2.02). Conclusion: Even though Rapid Response Team implementation is associated with a reduction in in-hospital cardiac arrest, it was not associated with the mortality of in-hospital cardiac arrest victims. A significant decrease in cardiac arrests due to respiratory causes was noted after Rapid Response Team implementation.

https://doi.org/10.5935/0103-507x.20210010 323 downloads

Predictive Factors of Mortality in Acute Aortic Dissection and Validity of the EuroSCORE Algorithm in a Small-Sized Cardiac Surgery Institution
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Rios, Facundo

; Perez, Diego

; Soca, Gerardo

; Robaina, Ricardo

; Dayan, Victor

Brazilian Journal of Cardiovascular Surgery

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Dez 2020, Volume 35 Nº 6 Páginas 878 - 883

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution’s database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.

https://doi.org/10.21470/1678-9741-2020-0053 285 downloads

Repercussões da Pandemia de COVID-19 na Prática Assistencial de um Hospital Terciário
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Almeida, André Luiz Cerqueira

; Santo, Thyago Monteiro do Espírito

; Mello, Maurício Silva Santana

; Cedro, Alexandre Viana

; Lopes, Nilson Lima

; Ribeiro, Ana Paloma Martins Rocha

; Mota, João Gustavo Cerqueira

; Mendes, Rodrigo Serapião

; Almeida, Paulo André Abreu

; Ferreira, Murilo Araújo

; Arruda, Diego Moreira

; Santos, Adriana Aguiar Pepe

; Rios, Vinícius Guedes

; Dantas, Maria Rosa Nascimento

; Silva, Viviane Almeida

; Silva, Marcos Gomes da

; Sampaio, Patrick Harrison Santana

; Guimarães, André Raimundo

; Santos Jr, Edval Gomes

Arquivos Brasileiros de Cardiologia

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Nov 2020, Volume 115 Nº 5 Páginas 862 - 870

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Ainda não temos informações acerca do impacto da pandemia da COVID-19 sobre a atividade médica assistencial no Brasil. Objetivo Descrever as repercussões da pandemia da COVID-19 na rotina de atendimentos em um hospital terciário, referência regional em cardiologia e oncologia. Métodos Estudo de corte transversal. Foi realizado levantamento dos atendimentos no período de 23/03/2020 (fechamento do comércio local) até 23/04/2020 (P20) e comparado com o mesmo período em 2019 (P19).Resultados: Detectamos redução no número de consultas cardiológicas, teste ergométrico, Holter, monitorização ambulatorial da pressão arterial, eletrocardiograma e ecocardiograma (90%, 84%, 94%, 92%, 94% e 81%, respectivamente). Em relação à cirurgia cardíaca e cateterismo cardíaco, houve redução de 48% e 60%, respectivamente. Aumento no número de angioplastia transluminal coronária (33%) e de implante de marca-passo definitivo (29%). Houve 97 internamentos na UTI em P19, contra 78 em P20, redução de 20%. Diminuição dos atendimentos no pronto-socorro cardiológico (45%) e nos internamentos na enfermaria de cardiologia (36%). Houve diminuição nas consultas oncológicas de 30%. Sessões de quimioterapia reduziram de 1.944 para 1.066 (45%). Sessões de radioterapia diminuíram 19%. Conclusão A COVID-19 provocou redução considerável no número de consultas nos ambulatórios de cardiologia, oncologia e demais especialidades. Houve uma preocupante diminuição no número de cirurgias cardíacas e nas sessões de quimioterapia e radioterapia nas semanas iniciais da pandemia. A procura por atendimento no pronto-socorro cardiológico, assim como as internações na UTI e enfermaria cardiológicas, também reduziram, gerando preocupação acerca da evolução e prognóstico destes pacientes portadores de outras patologias, que não a COVID-19, nestes tempos de pandemia. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background We still do not have information regarding the impact of the COVID-19 pandemic on medical care activity in Brazil. Objective To describe the repercussions of the COVID-19 pandemic on the care routine of a tertiary hospital, which is a regional reference in cardiology and oncology. Methods Cross-sectional cohort study. We conducted a survey of medical visits from March 23, 2020 (when local commerce was closed) to April 23, 2020 (P20), in comparison with the same period in 2019 (P19). Results We found decreases in the number of cardiology consultations, exercise tests, Holter, ambulatory blood pressure monitoring, electrocardiogram, and echocardiogram (90%, 84%, 94%, 92%, 94%, and 81%, respectively). In relation to cardiac surgery and cardiac catheterization, there were 48% and 60% decreases, respectively. There was an increase in the number of percutaneous transluminal coronary angioplasties (33%) and definitive pacemaker implantations (29%). There were 97 admissions to the ICU during P19, in contrast with 78 during P20, a 20% decrease. Visits to the cardiac emergency room (45%) and admissions to the cardiology ward (36%) also decreased. The decrease in oncology consultations was 30%. Chemotherapy sessions decreased from 1,944 to 1,066 (45%), and radiotherapy sessions decreased by 19%. Conclusion COVID-19 has led to a considerable decrease in the number of consultations in outpatient clinics for cardiology, oncology, and other specialties. There was a concerning decrease in the number of cardiac surgeries, chemotherapy sessions, and radiotherapy sessions during the initial weeks of the pandemic. The number of people seeking care in the cardiac emergency room and the number of admissions to the cardiology ward and ICU also decreased, generating concern regarding the evolution and prognosis of these patients with pathologies other than COVID-19 during this pandemic time. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

https://doi.org/10.36660/abc.20200436 1791 downloads

10.

Prevalencia de enfermedades cardiovasculares en el Hospital Nacional Dos de Mayo de Perú
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Chambergo-Michilot, Diego

; Velit-Rios, Bruno

; Cueva-Parra, Angel

Revista mexicana de angiología

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Set 2020, Volume 48 Nº 3 Páginas 84 - 89

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Objective: To know the prevalence of heart diseases and their comorbidities in all patients of a cardiology service from a Peruvian hospital. Material and methods: A descriptive observational study was conducted in a third level Peruvian hospital (Dos de Mayo National Hospital, Lima, Peru) between January 2016 and December 2017. Results: We included 446 patients who entered the service. The most frequent heart diseases were heart failure (51.57%), congenital heart defects (23.99%), atrial fibrillation (17.49%) and acute myocardial infarction (14.57%). The most frequent comorbidities were arterial hypertension (7.62%), chronic kidney disease (5.38%) and diabetes mellitus (2.02%). Conclusions: This study reports heart diseases and comorbidities in a cardiology service. The results will serve for the approach of the sample of other studies, and could be useful for health administrators, since they will have evidence to prioritize resources for the most frequent diseases.

Resumen Objetivo: Conocer la prevalencia de las enfermedades cardíacas y sus comorbilidades en todos los pacientes de un servicio de cardiología de un hospital peruano. Material y métodos: Se realizó un estudio observacional descriptivo en un hospital peruano de tercer nivel (Hospital Nacional Dos de Mayo, Lima, Perú) entre enero del 2016 y diciembre del 2017. Resultados: Se incluyó 446 pacientes que ingresaron al servicio. Las enfermedades cardíacas más frecuentes fueron la falla cardíaca (51.57%), cardiopatías congénitas (23.99%), fibrilación auricular (17.49%) e infarto miocárdico agudo (14.57%). Las comorbilidades más frecuentes fueron la hipertensión arterial (7.62%), enfermedad renal crónica (5.38%) y diabetes mellitus (2.02%). Conclusiones: Este estudio reporta las enfermedades y comorbilidades cardiovasculares en un servicio de cardiología. Los resultados servirán para el planteamiento de la muestra de otros estudios, y podrían ser de utilidad para los administradores en salud, ya que tendrán evidencia para priorizar los recursos para las enfermedades más frecuentes.

https://doi.org/10.24875/rma.20000012 603 downloads

11.

Relationship between the polymorphism in the interleukin 1-β and the treatment time of patients subjected to a modified piezocision technique
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Aristizábal, Juan Fernando

; Rios, Héctor

; Rey, Diego

; Álvarez, María Antonia

; Parra, Beatriz

; Ortiz, Mario

Colombia Médica

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Mar 2020, Volume 51 Nº 1 elocation e4141

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen Objetivo: Evaluar la correlación entre el polimorfismo de la interleucina 1-Beta (IL1-β, +3954 C> T) y el movimiento de los dientes, en un grupo de pacientes colombianos sometidos a un movimiento dental ortodóncico acelerado quirúrgicamente. Métodos: Este fue un estudio secundario derivado de un ensayo clínico aleatorio controlado. Se tomaron muestras de sangre de 11 mujeres y 29 voluntarios varones colombianos sanos entre 18 y 40 años, después de 1 año de comenzar el tratamiento de ortodoncia. Los pacientes presentaron maloclusión clase I, con grado II o III. Para detectar el polimorfismo genético del nucleótido +3954 C a T en el gen IL-1β, se usó un ensayo de PCR en tiempo real. Resultados: 11 individuos presentaron el alelo 2 (T) heterocigoto con el alelo 1 (T / C) y 19 individuos fueron homocigotos para el alelo 1 (C / C). Al analizar la presencia del SNP, no se encontraron diferencias significativas en ninguna de las variables. El mejor tratamiento se reflejó en el Grupo 3 (decorticación alveolar superior e inferior selectiva y matriz de colágeno 3D) y el Grupo 4 (solo decorticación alveolar selectiva en el arco superior, con matriz de colágeno 3D), con un 27% y un 35% más de velocidad, respectivamente, que en el grupo de control. Conclusiones: Los análisis indicaron que una reducción en el tiempo total de tratamiento puede potenciarse principalmente mediante el uso de decorticación y matrices de colágeno y no por la presencia del alelo 2 en la IL-1β. Sin embargo, es importante que otros estudios investiguen si el polimorfismo podría estar asociado con la velocidad del movimiento de los dientes y analizar los niveles de proteína de referencia.

Abstract Aim: We aimed to evaluate the correlation between the polymorphism of the interleukin 1-Beta (IL1-β, +3954 C>T) and tooth movement, in a group of Colombian patients undergoing surgically accelerated orthodontic tooth movement. Methods: The study was nested to a controlled clinical trial. Blood samples were taken from 11 women and 29 healthy Colombian male volunteers between 18 and 40 years old, after 1 year of starting orthodontic treatment. The patients presented malocclusion class I, with grade II or III. To detect the genetic polymorphism of the nucleotide +3954 C to T in the IL-1β gene, we used a real-time PCR assay. Results: Eleven individuals presented the allele 2 (T) heterozygous with the allele 1 (T/C) and 19 individuals were homozygous for the allele 1 (C/C). When analyzing the presence of the SNP, no significant differences were found in any of the variables. The best treatment was reflected in Group 3 (selective upper and lower alveolar decortication and 3D collagen matrix) and Group 4 (only selective alveolar decortication in the upper arch, with 3D collagen matrix), with 27% and 35% more speed respectively than in the control group. Conclusions: Our analyses indicated that a reduction in the total treatment time can be mostly potentiated by using decortication and collagen matrices and not for the presence of the allele 2 in the IL-1β. Nevertheless, it is important that further studies investigate if the polymorphism could be associated with the speed of tooth movement and analyze the baseline protein levels.

https://doi.org/10.25100/cm.v51i1.4141 275 downloads

12.

Growing broccoli under salinity: the influence of cultivar and season on glucosinolates content
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Rios, Juan J.

; Agudelo, Agatha

; Moreno, Diego A.

; Carvajal, Micaela

Scientia Agricola

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2020, Volume 77 Nº 6 elocation e20190028

Resumo: En | Texto: En | PDF: En

ABSTRACT: The evaluation of factors that affect glucosinolates (GLS) concentrations in the roots, leaves, and inflorescence of broccoli plants is important in the improvement of the concentration of bioactive compounds and thus in the enhancement of the nutritional properties. In this work, the yield and the concentration of GLS of seven broccoli cultivars (Brassica oleracea var. italica) grown under salinity in field conditions were studied during three different seasons (autumn, winter, and spring). The results show that, generally, salinity did not alter significantly the inflorescence yield during any of the seasons, indicating a high tolerance of the cultivars tested. Yield was reduced only in cultivar Gea in autumn and in cultivar Parthenon in spring. The distribution of the GLS showed that their accumulation was greater in inflorescences and leaves, with higher concentrations in autumn and spring. The activation of GLS synthesis by salinity was restricted to several cultivars and depended on the season, with no reductions compared to control plants. In this study, we discuss the appearance of a Cinnamoyl-indol-GLS derivative in some of the cultivars and seasons with higher incidence in NaCl-treated plants.

https://doi.org/10.1590/1678-992x-2019-0028 891 downloads

13.

Endocarditis Marántica asociada a linfoma de Hodgkin
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Medina Acuña, Diego Arnaldo

; Gabriaguez Gonzalez, Lorena

; Vargas Viveros, Melissa Raquel

; Rios-González, Carlos Miguel

Memorias del Instituto de Investigaciones en Ciencias de la Salud

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Dez 2019, Volume 17 Nº 3 Páginas 72 - 75

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT Non-bacterial thrombotic endocarditis (NBTE) is defined as the presence of sterile thrombi on the heart valves, correspond to non-infected platelet and fibrin aggregates associated with hypercoagulable states such as malignant neoplasms, which is also called Marantic Endocarditis. We present the case of a patient with a history of prolonged febrile syndrome who underwent antibiotic treatment for an Infective Endocarditis (EI) due to a compatible image with vegetation in the transthoracic echocardiogram. However, the patient persisted feverish and without clinical improvement, until the biopsy of a cervical ganglion diagnosed a Hodgkin lymphoma, improving later with the specific hemato treatment.

RESUMEN La endocarditis trombótica no bacteriana (ETNB) se define como la presencia de trombos estériles sobre las válvulas cardiacas, corresponden a agregados de plaquetas y fibrina no infectados asociados a estados de hipercoagulabilidad como las neoplasias malignas, en donde se denomina también endocarditis marántica. Se presenta el caso de un paciente con historia de síndrome febril prolongado al que se le inició tratamiento antibiótico por una endocarditis infecciosa (EI) por presentar una imagen compatible con vegetación en el ecocardiograma transtorácico. Sin embargo, el paciente persistió febril y sin mejoría clínica, hasta que la biopsia de un ganglio cervical diagnosticó un linfoma de Hodgkin mejorando posteriormente con el tratamiento hemato específico.

https://doi.org/10.18004/mem.iics/1812-9528/2019.017.03.72-075 478 downloads

14.

Producción científica peruana sobre cannabis en tres bases de datos
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Chambergo-Michilot, Diego

; Velit-Rios, Bruno

Anales de la Facultad de Medicina

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Jul 2019, Volume 80 Nº 3 Páginas 397 - 398

Resumo: Es | Texto: Es | PDF: Es

https://doi.org/10.15381/anales.803.16311

15.

Seroprevalencia de anticuerpos anti-Toxoplasma gondii en mujeres menores de 18 años de una localidad de Colombia
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Giraldo-Ospina, Beatriz

; Garzón-Castaño, Sandra Catalina

; López-Muñoz, Diego Fernando

; Cardozo-Rios, Laura

; Millán-Benavidez, Natalia

Ginecología y obstetricia de México

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2019, Volume 87 Nº 6 Páginas 356 - 361

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract OBJECTIVE: To determinate seroprevalence of Toxoplasma gondii in the female population of the municipality of Dosquebradas. MATERIALS AND METHODS: Cross-sectional prevalence study in reproductive age female of two school of the from a locality of Dosquebradas, Colombia, during 2016, was approved by the ethics committees of the participating institutions. The study volunteers signed the consent and completed the survey with demographic data, excluding women older than 18 years, and having had previous pregnancies. The samples were analyzed against IgM, IgG and avid IgG antibodies using highly purified recombinant antigens for Toxoplasma gondii using RecomLine test with development of Western blot mikrogen DIAGNOSTIK. To define the infectious moment, anti-IgG avidity against antigens p30, MAG1, GRA1 and rSAG1 were determined in samples positive for total IgG. The test was performed and interpreted according to the manufacturer's instructions. RESULTS: 80 patients were studied with average age of 15 years, 4 presented IgM anti-Toxoplasma gondii, infection less than 3 months; 28 IgG anti-Toxoplasma gondii, with infection greater than 3 months and 17 IgG of avidity with infection greater than 6 months, representing a prevalence of 61.3%. CONCLUSIONS: The global seroprevalence of anti-toxoplasma antibodies was 61.3%, which shows that toxoplasmosis is a disease in which it must be thought to diagnose and treat it in a timely manner.

Resumen OBJETIVO: Determinar la seroprevalencia de Toxoplasma gondii en mujeres menores de 18 años de dos instituciones educativas de un municipio de Colombia. MATERIALES Y MÉTODOS: Estudio de prevalencia, transversal, efectuado en 2016 en mujeres de dos colegios de Dosquebradas, Colombia, aprobado por los comités de ética de las instituciones participantes. Criterios de inclusión: ser menores de 18 años, firmar el consentimiento informado y responder las preguntas de una encuesta de datos demográficos. Criterios de exclusión: tener más de 18 años y haber tenido embarazos previos. Las muestras se analizaron contra anticuerpos IgM, IgG e IgG de avidez con antígenos recombinantes para Toxoplasma gondii altamente purificados con la prueba recomLine, con desarrollo de Western blot mikrogen Diagnostik. Para definir el momento infeccioso se determinó la avidez anti-IgG contra antígenos p30, MAG1, GRA1 y rSAG1 en muestras positivas para IgG total. La prueba se realizó e interpretó de acuerdo con las instrucciones del fabricante. RESULTADOS: Se estudiaron 80 pacientes con edad media de 15 años: 4 resultaron con IgM anti-Toxoplasma gondii, infección menor de 3 meses; 28 IgG anti-Toxoplasma gondii, con infección mayor a 3 meses y 17 IgG de avidez con infección superior a 6 meses. La prevalencia fue de 61.3%. CONCLUSIÓN: La seroprevalencia global de anticuerpos anti-toxoplasma encontrada fue de 61.3%, lo que pone de manifiesto que la toxoplasmosis es una enfermedad en la que debe pensarse para diagnosticarla y tratarla oportunamente.

https://doi.org/10.24245/gom.v87i6.2627 139 downloads

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