Incidence of confusional syndrome (delirium) in a Latin American university hospital.

BACKGROUND: Little is known about the incidence of delirium and its subtypes in patients admitted to different departments of university hospitals in Latin America. OBJECTIVE: To determine the incidence of delirium and the frequency of its subtypes, as well as its associated factors, in patients admitted to different departments of a university hospital in Bogotá, Colombia. METHODS: A cohort of patients over 18 years of age admitted to the internal medicine (IM), geriatrics (GU), general surgery (GSU), orthopaedics (OU) and intensive care unit (ICU) services of a university hospital was followed up between January and June 2018. To detect the presence of delirium, we used the CAM (Confusion Assessment Method) and the CAM-ICU if the patient had decreased communication skills. The delirium subtype was characterised using the RASS (Richmond Agitation and Sedation Scale). Patients were assessed on their admission date and then every two days until discharged from the hospital. Those in whom delirium was identified were referred for specialised intra-institutional interdisciplinary management. RESULTS: A total of 531 patients admitted during the period were assessed. The overall incidence of delirium was 12% (95% CI, 0.3-14.8). They represented 31.8% of patients in the GU, 15.6% in the ICU, 8.7% in IM, 5.1% in the OU, and 3.9% in the GSU. The most frequent clinical display was the mixed subtype, at 60.9%, followed by the normoactive subtype (34.4%) and the hypoactive subtype (4.7%). The factors most associated with delirium were age (adjusted RR = 1.07; 95% CI, 1.05-1.09), the presence of four or more comorbidities (adjusted RR = 2.04; 95% CI, 1.31-3.20), and being a patient in the ICU (adjusted RR = 2.02; 95% CI, 1.22-3.35). CONCLUSIONS: The incidence of delirium is heterogeneous in the different departments of the university hospital. The highest incidence occurred in patients that were admitted to the GU. The mixed subtype was the most frequent one, and the main associated factors were age, the presence of four or more comorbidities, and being an ICU patient.

Incidencia del Síndrome Confusional (delirio) en un Hospital Universitario Latinoamericano / Incidence of confusional syndrome (delirium) in a Latin American university hospital

resumen Introducción: Poco se conoce acerca de la incidencia del delirio en pacientes hospitalizados en diferentes servicios de hospitales universitarios en Latinoamérica y de los subtipos que se presentan. Objetivo: Determinar la incidencia del delirio, la frecuencia de los subtipos motores y los factores asociados en pacientes hospitalizados en diferentes servicios de un hospital uni versitario en Bogotá, Colombia. Métodos: Se dio seguimiento a una cohorte de pacientes mayores de 18 arios hospitalizados en los servicios de Medicina Interna, Geriatría, Cuidado Intensivo, Cirugía General y Orto pedia de un hospital universitario entre enero y junio de 2018. Para identificar la presencia de delirio, se utilizó la escala CAM (Confusion Assessment Method) y la CAM-ICU si el paciente presentaba disminución de las capacidades de comunicación. El subtipo de delirio se carac terizó utilizando la escala RASS (Richmond Agitation and Sedation Scale). Los pacientes fueron valorados el día de ingreso y luego cada 2 días hasta su alta hospitalaria. Se derivó a los pacientes en quienes se identificó delirio para tratamiento especializado interdisciplinario intrainstitucional. Resultados: Se evaluó a 531 pacientes que ingresaron durante ese periodo a los servicios mencionados. La incidencia global del delirio fue del 12% (IC95%, 0,3-14,8). En orden des cendiente, el 31,8% de los pacientes hospitalizados en el servicio de Geriatría, el 15,6% en Cuidado Intensivo, el 8,7% en Medicina Interna, el 5,1% en Ortopedia y el 3,9% en Cirugía. El subtipo motor más frecuente fue el mixto (60,9%), seguido por el normoactivo (34,4%) y el hipoactivo (4,7%). Los factores asociados con la incidencia del delirio fueron la edad (RR ajustada = 1,07; IC95%, 1,05-1,09), la presencia de 4 o más comorbilidades (RR ajustada = 2,04; IC95%, 1,31-3,20) y la hospitalización en Cuidado Intensivo (RR ajustada = 2,02; IC95%, 1,22 3,35). Conclusiones: La incidencia del delirio es heterogénea en los diferentes servicios del hospital universitario. La mayor incidencia se presentó en pacientes ingresados en el servicio de Geriatría; el subtipo más frecuente fue el mixto y los principales factores asociados fueron la edad, la presencia de 4 o más comorbilidades y la hospitalización en Cuidado Intensivo.

abstract Bacfeground: Little is known about the incidence of delirium and its subtypes in patients admitted to different departments of university hospitals in Latin America. Objective: To determine the incidence of delirium and the frequency of its subtypes, as well as its associated factors, in patients admitted to different departments of a university hospital in Bogotá, Colombia. Methods: A cohort of patients over 18 years of age admitted to the internal medicine (IM), geriatrics (GU), general surgery (GSU), orthopaedics (OU) and intensive care unit (ICU) ser vices of a university hospital was followed up between January and June 2018. To detect the presence of delirium, we used the CAM (Confusion Assessment Method) and the CAM-ICU if the patient had decreased communication skills. The delirium subtype was characterised using the RASS (Richmond Agitation and Sedation Scale). Patients were assessed on their admission date and then every two days until discharged from the hospital. Those in whom delirium was identified were referred for specialised intra-institutional interdisciplinary management. Results: A total of 531 patients admitted during the period were assessed. The overall incidence of delirium was 12% (95% CI, 0.3-14.8). They represented 31.8% of patients in the GU, 15.6% in the ICU, 8.7% in IM, 5.1% in the OU, and 3.9% in the GSU. The most frequent clinical display was the mixed subtype, at 60.9%, followed by the normoactive subtype (34.4%) and the hypoactive subtype (4.7%). The factors most associated with delirium were age (adjusted RR = 1.07; 95% CI, 1.05-1.09), the presence of four or more comorbidities (adjusted RR = 2.04; 95% CI, 1.31-3.20), and being a patient in the ICU (adjusted RR = 2.02; 95% CI, 1.22-3.35). Conclusions: The incidence of delirium is heterogeneous in the different departments of the university hospital. The highest incidence occurred in patients that were admitted to the GU. The mixed subtype was the most frequent one, and the main associated factors were age, the presence of four or more comorbidities, and being an ICU patient.

Mental health and psychosocial impact of the COVID-19 pandemic and social distancing measures among young adults in Bogotá, Colombia.

We sought to explore mental health and psychosocial impact among young people (18 to 24 years old) in Bogotá during the first months of the COVID-19 pandemic. Methods: We carried a cross sectional study using a web-based survey to assess mental health and personal impact among 18 to 24 years old living in Bogotá during the first 4 months of the 2020 COVID-19 pandemic lockdown. The depressive symptoms were measured with PHQ-8 and anxiety symptoms with (GAD-7). We also designed a questionnaire exploring changes in personal, family and social life. Results: Overall, 23% of the sample (n = 834) reported mild depressive symptoms (males 24% and females 23%); 29% reported moderate depressive symptoms (males 28%, females 30%); 22% moderate-severe symptoms (males 20%, females 23%) and 17% severe symptoms (males 15%, females 17%). Mild anxiety symptoms were reported by 29% of the sample (males 30%, females 29%); moderate anxiety symptoms by 29% (males 26%, females 30%); moderate-severe 18% (males 15%, females 20%) and severe anxiety by 6.0% (males 6.0% and females 6.0%). High symptoms of depression (PHQ-8 ≥ 10) were associated with being female, considering that the quarantine was stressful, having one member of the family losing their job, worsening of family relationships, decrease of physical activity and having a less nutritious diet. Having high anxiety symptoms (GAD-7 ≥ 10) were associated with sometimes not having enough money to buy food. Conclusions: The first months of the pandemic lockdown were associated with high depressive and anxiety symptoms among young persons living in Bogotá, Colombia. Increasing public health measures to provide support for young people is needed during lockdowns and it is necessary to further explore the long-term mental health impact due to personal, family and social changes brought by the COVID-19 pandemic.

Impact of Complicated Urinary Tract Infection on Renal Graft Function.

BACKGROUND: Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. It is uncertain whether the development of UTI has an impact on renal graft function. The objective of this study was to evaluate the effects of complicated and recurrent UTI on 2-year renal graft function. METHODS: This was a historical cohort study in renal transplantation patients in a kidney transplant center. All renal transplant recipients from June 2004 to September 2016 were included. A linear regression analysis was performed to study the association between the outcome (variation in estimated glomerular filtration rate [eGFR] by the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation between month 1 and month 24 post-transplant) and the UTI. The approval of the Ethics and Research Committee to carry out this study was obtained. RESULTS: In total, 276 kidney transplants were performed during the observation period. Of the transplant patients, 193 (69.9%) did not develop a UTI and 83 (30.1%) presented at least 1 complicated UTI. Patients who presented at least 1 UTI had a variation in eGFR during the observation period of -12.6 mL/min/1.73 m2 (95% confidence interval [CI] -4.5 to -20.7 mL/min/1.73 m2; P = .02), compared with those without a UTI. Said difference persisted in the adjusted model controlling for variables that have an impact on the eGFR. This difference was -10.7 mL/min/1.73 m2 (95% CI -3.1 to -18.2 mL/min/1.73 m2; P = .006). CONCLUSION: The findings suggest that the occurrence of complicated UTI has a negative impact on graft function and that prevention and monitoring of UTIs should be stepped up to avoid their deleterious effects on graft function.

Characterization of kidney transplant patients with expanded criteria donors / Caracterización de trasplantados renales con donantes de criterios expandidos

Abstract Introduction: Kidney transplantation is the treatment of choice for patients with chronic kidney disease; however, the number of donors is insufficient, and waiting lists grow exponentially each year. Transplantation from expanded criteria donors benefits a significant number of patients, improving their survival when compared to those who remain on dialysis. The objective of this study is to describe the characteristics of patients who have received transplants from expanded criteria donors and their renal function at the first and third years after transplantation. Methods: A descriptive observational study was conducted. Patients older than 18 years who received transplants from an expanded criteria donor were chosen between 2007 and 2015. Results: Of a total of 227 patients analyzed, 18 received transplants from an expanded criteria donor. The recipients were 59.5 years old (37-79) and had spent 22.4 months on the waiting list (2.6-77.8) and 4.5 years on dialysis (0.5-18.4). The donors' age was 61 years (50-73). Graft survival at one year was 88.9%; at three years, it was 80%. A total of 11.1% of the patients presented acute cellular rejection at one year, and the average glomerular filtration rate at the first and third years was 58.4 mL/min/1.73 m2. Conclusion: Patients who received transplants from expanded criteria donors have good kidney graft function at three years, with graft and patient survival, similar to that reported for patients who received transplants from standard criteria donors (Acta Med Colomb 2019; 44. DOI: https://doi.org/ 10.36104/amc.2019.1185).

Resumen Introducción: el trasplante renal es el tratamiento de elección para pacientes con enfermedad renal crónica, sin embargo, el número de donantes es insuficiente y las listas de espera crecen exponencialmente cada año. El trasplante con donante de criterios expandidos beneficia a un número importante de pacientes, mejorando su supervivencia al compararlos con los que permanecen en diálisis. El objetivo de este estudio es describir las características de pacientes trasplantados con donantes de criterios expandidos y su función renal al primer y tercer año del trasplante. Métodos: se realizó un estudio descriptivo observacional. Se eligieron pacientes mayores de 18 años trasplantados con donante de criterios expandidos entre 2007 y 2015. Resultados: de un total de 227 pacientes analizados, 18 fueron trasplantados con donante de criterios expandidos. Los receptores tenían 59.5 años (37-79), tiempo en lista de espera de 22.4 meses (2.6-77.8), tiempo en diálisis de 4.5 años (0.5-18.4). La edad del donante fue 61 años (50-73). La supervivencia del injerto al año fue 88.9% y a los tres años de 80%. El 11.1% de los pacientes presentaron rechazo celular agudo al año y el promedio de la tasa de filtración glomerular al primer y tercer año fue de 58.4 mL/min/1.73m2 Conclusión: los pacientes trasplantados con donante de criterios expandidos tienen una buena función del injerto renal a tres años, con supervivencia del injerto y del paciente, similar a la reportada con donante con criterio estándar. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.n85).