Indicators of Clinical Trajectory in Patients With Cancer Who Receive Cardiopulmonary Resuscitation.

BACKGROUND: Patients with cancer who require cardiopulmonary resuscitation (CPR) historically have had low survival to hospital discharge; however, overall CPR outcomes and cancer survival have improved. Identifying patients with cancer who are unlikely to survive CPR could guide and improve end-of-life discussions prior to cardiac arrest. METHODS: Demographics, clinical variables, and outcomes including immediate and hospital survival for patients with cancer aged ≥18 years who required in-hospital CPR from 2012 to 2015 were collected. Indicators capturing the overall declining clinical and oncologic trajectory (ie, no further therapeutic options for cancer, recommendation for hospice, or recommendation for do not resuscitate) prior to CPR were determined a priori and manually identified. RESULTS: Of 854 patients with cancer who underwent CPR, the median age was 63 years and 43.6% were female; solid cancers accounted for 60.6% of diagnoses. A recursive partitioning model selected having any indicator of declining trajectory as the most predictive factor in hospital outcome. Of our study group, 249 (29%) patients were found to have at least one indicator identified prior to CPR and only 5 survived to discharge. Patients with an indicator were more likely to die in the hospital and none were alive at 6 months after discharge. These patients were younger (median age, 59 vs 64 years; P≤.001), had a higher incidence of metastatic disease (83.0% vs 62.9%; P<.001), and were more likely to undergo CPR in the ICU (55.8% vs 36.5%; P<.001) compared with those without an indicator. Of patients without an indicator, 145 (25%) were discharged alive and half received some form of cancer intervention after CPR. CONCLUSIONS: Providers can use easily identifiable indicators to ascertain which patients with cancer are at risk for death despite CPR and are unlikely to survive to discharge. These findings can guide discussions regarding utility of resuscitation and the lack of further cancer interventions even if CPR is successful.

Self-Extubation Revisited: A Case-Control Study.

BACKGROUND: To increase the understanding of the self-extubation phenomena, we assessed its rate in our medical ICU and aimed to identify the risk factors of self-extubation and the risk factors for re-intubation. METHODS: We prospectively identified subjects who self-extubated. Their baseline characteristics, including the Richmond Agitation Severity Scale score, reason for intubation, shift, distance of the endotracheal tube tip to the carina, and outcomes were collected retrospectively. For every subject who self-extubated, a control subject was selected from the mechanical ventilation database. RESULTS: During the study period, there were 2,578 admissions with 4,072 mechanical ventilation days. Fifty-three cases of self-extubation were recorded, which resulted in a self-extubation event rate of 1.3 per 100 days of mechanical ventilation. Forty-five controls were identified. The most common reason for intubation was hypoxic respiratory failure, followed by the need for airway protection and hypercapnic respiratory failure. Sedation was administered continuously in 34% of the subjects. Thirty-seven percent received no sedation. At the time of the event, the subjects who self-extubated had a higher Richmond Agitation Severity Scale score, a longer distance from the endotracheal tip to carina on the chest radiograph preceding the event, and a shorter duration of mechanical ventilation, and were more likely to be on volume-controlled mechanical ventilation. ICU mortality was lower in the self-extubation group, despite having a trend toward a higher Simplified Acute Physiology Score II. Sixteen subjects required re-intubation. Independent predictors of re-intubation were hypoxic respiratory failure as the reason for the initial intubation and self-extubation that occurred at night. The need for re-intubation was not associated with higher mortality. CONCLUSIONS: Results of our study showed that, in the era of reduced use of sedatives in the ICU, clinicians must be vigilant of the risk of self-extubation in the first 2 d of mechanical ventilation in patients who are agitated and with a longer endotracheal tube to carina distance on chest radiograph.

Nivel de riesgo e incidencia de caries en niños atendidos en clínica estomatológica de pregrado / Risk level and caries incidence in children attended at a predoctoral stomatology clinic

Antecedentes: La caries tiene etiología multifactorial, se presenta por desbalance entre factores patológicos y protectores, es un problema de salud pública que en México afecta a 95% de los niños. Objetivo: Determinar la prevalencia de caries, establecer el nivel de riesgo y evaluar su relación con la incidencia de caries a los tres y seis meses. Material y métodos: Estudio observacional, descriptivo y longitudinal en clínica estomatológica de una universidad ubicada al sur de la Ciudad de México. Previo consentimiento informado, se realizó revisión bucal por dos cirujanos dentistas calibrados para el diagnóstico de caries/ICDAS (kappa 95.37%), llevada a cabo en sillón dental con luz artificial bajo principios para el control de infecciones. Se estableció nivel de riesgo mediante el Sistema Internacional para la Gestión de Caries/ICCMS empleando como indicadores: consumo de alimentos cariogénicos (Lipari/Andrade), pH (tiras Hidryon), prueba de saliva estimulada, experiencia de caries (CPOD/ceod), higiene bucal (O'Leary) y cultivo de Streptococcus mutans. Se realizó análisis estadístico para determinar medidas de tendencia central, dispersión y asociación entre variables mediante exacta de Fisher, STATA.SE/10. Resultados: La población en estudio fue de 42 niños con rango de edad de tres a 15 años, mediana de 7.04 (RIC = 5-9). La prevalencia de caries fue 95.23%, con estadios severos en 83.3%, el nivel de riesgo fue alto en 73.7% y se asoció con severidad de caries (p = 0.000), consumo de carbohidratos (p = 0.000), experiencia de caries (ceod) (p = 0.000) y S. mutans (p = 0.000). La incidencia de caries a los tres meses fue de 71.0% y a los seis meses de 11.1%. Conclusiones: La prevalencia de caries fue alta (95.23%) así como el riesgo de caries (73.7%), con elevada incidencia a tres meses (71%), aun cuando los pacientes estaban en tratamiento odontológico. La atención restaurativa prevalece a pesar de hacer diagnóstico de lesiones reversibles y determinación del nivel de riesgo (AU)

Background: Caries has multifactorial etiology, presented by the imbalance between pathological/protective factors, is a public health problem, affecting 95% of children in México. Objective: To determine the prevalence of caries, to establish the level of risk and to evaluate its relation with incidence of caries at three and six months. Material and methods: Observational, descriptive and longitudinal study in the stomatologic clinic of the UAM-Xochimilco. Before informed consent, oral revision was performed by two dental surgeons calibrated for the diagnosis of caries/ICDAS (kappa 95.37%), carried out in dental chair with artificial light under principles for the control of infections. Risk level was established through the International System for Caries Management/ICCMS; using as indicators: consumption of cariogenic foods (Lipari/Andrade), pH (Hidryon strips), stimulated saliva test, caries experience (CPOD/ceod), oral hygiene (O'Leary) and culture of Streptococcus mutans. Statistical analysis was performed to determine measures of central tendency, dispersion and association between variables with Fisher's exact, STATA.SE/10. Results: The study population consisted of 42 children with ages ranging from 3 to 15 years, median of 7.04 (Q1 = 5-Q3 = 9). The prevalence of caries was 95.23%, with severe stages in 83.3%, the risk level was high in 73.7% and was associated with caries severity (p = 0.000), carbohydrate consumption (p = 0.000), caries experience (ceod) (p = 0.000) and S. mutans (p = 0.000). The incidence of caries at three months was 71.0% and at six months 11.1%. Conclusions: The prevalence of caries was high (95.23%), as well as the risk for caries (73.7%), and high incidence at three months (71%), despite the fact that the patients were in dental treatment. Restorative care prevails despite the diagnosis of reversible lesions and determination of the level of risk (AU)

Suffocation From Balloon Bronchoplasty.

Negative pressure pulmonary edema is a well-described complication of upper airway obstruction. However, the simultaneous occurrence of blood-stained secretions and petechial tracheobronchial hemorrhage are rarely recognized and a potential complication of transient intentional occlusion of the airways. We described a case of "hemorrhagic bronchial mucosa syndrome" and asymptomatic blood-tinged pulmonary edema after balloon bronchoplasty for a concentric tracheal stenosis using a flexible bronchoscopy. This was characterized by interval appearance of diffuse petechial tracheobronchial bleeding and a persistent blood-tinged alveolar effluent after sustained occlusion of the airway. The simultaneous occurrence of both phenomena in this patient suggests different degrees of injury in a common pathogenic spectrum. We postulate that sustained, complete occlusion of the airway produces variable degrees of mechanical disruption of the bronchial and alveolar vasculature that lead to the development of negative pressure pulmonary edema and tracheobronchial hemorrhage. In this case, the syndrome was self-limited and without major consequences but highlights an unrecognized potential complication of balloon bronchoplasty.

Physical symptoms screening for cardiopulmonary complications of obesity using audio computer-assisted self-interviews.

PURPOSE: The main study objective was to assess the predictive value of selected physical symptoms for screening obstructive sleep apnea and major cardiac conditions in adults with obesity, thus providing the evidence for routine symptom screening of obesity complications endorsed by obesity management clinical practice guidelines. METHODS: We performed a retrospective cohort study using patient-reported outcomes data including the physical symptoms severity component of the Memorial Symptom Assessment Scale administered through Audio Computer-Assisted Self-Interviews combined with data from the electronic medical records of an urban safety-net primary care clinic. Non-underweight ambulatory patients completing the standardized survey assessment were included. The prevalence of pre-selected symptoms and the diagnostic characteristics at various severity cut-points were determined for obstructive sleep apnea or major cardiac conditions separately for patients with and without obesity. RESULTS: Of the 1399 patients included in this analysis, most (77%) were non-hispanic black or hispanic. Step-wise increases in positive likelihood ratios ranging between 1.2 and 4.6 with greater severity cough, dyspnea, fatigue, bloating, dizziness, and nausea were observed for both obstructive sleep apnea and major cardiac complications. Likelihood ratio estimates for both obese and non-obese patients were statistically significant. CONCLUSIONS: Our findings provide a basis to support current guideline recommendations for routine symptom screening to identify medical complications among patients with BMI 30 kg/m2 or greater.

Trabajo, estrés y salud: la costura a domicilio en Ciudad de México / Work, stress and health: domestic seamstresses and tailors in Mexico City

Las personas que laboran en la costura enfrentan condiciones de trabajo y de vida precarias, el trabajo a domicilio intensifica la nocividad de sus procesos, por lo cual se ven forzadas a desempeñarse en condiciones laborales que repercuten negativamente en su salud. En este estudio, se planteó identificar condiciones de trabajo nocivas, potencialmente estresantes y su asociación con los daños a la salud en un grupo dedicado a las labores de la costura en México, D.F.. Se aplicaron 138 encuestas con información demográfica, socioeconómica, de riesgos y exigencias laborales y salud. Se aplicó un cuestionario de estrés, otro de carga de trabajo doméstica y una guía de observación de proceso de trabajo. Se realizó análisis univariado y bivariado. Fueron entrevistados 26 varones y 112 mujeres con edad promedio de 40.8 años (DS±10.3). Se reportaron diversos riesgos y exigencias potencialmente estresantes. La tasa de morbilidad fue de 390 daños (por cada 100). Los padecimientos más frecuentes fueron conjuntivitis crónica, várices, lumbalgia, trastornos musculoesqueléticos, fatiga crónica, cefalea, ansiedad, trastornos del sueño, hipoacusia, rinofaringitis crónica, depresión, hemorroides y dermatitis. El estrés mostró una prevalencia de 23 (por cada 100). Se encontraron, entre otras asociaciones significativas: posiciones incómodas y asiento incómodo con lumbalgia, repetitividad y trabajo pesado con fatiga crónica, trabajo aburrido con depresión y jornada prolongada; la jornada prolongada, la exposición a ruido, la repetitividad y no poder desatender su tarea más de 5 minutos se asoció con estrés. Se concluye que los padecimientos identificados se encuentran relacionados con condiciones de trabajo; son urgentes medidas ergonómicas y organizacionales, rediseño del puesto y cobertura de servicios de salud.

People who work in sewing face precarious working and living conditions; the domestic setting of this work increases harm, as many workers are subjected to working conditions that can adversely affect their health. The aim of this study was to identify hazardous and potentially stressful working conditions and their association with adverse health outcomes in a group of seamstresses and tailors in Mexico City. One hundred thirty-eight surveys were administered, centered on demographic, socioeconomic, and occupational risk factors, together with job demands and health. We applied a stress questionnaire, a domestic workload questionnaire and a guide to observe the work process. We performed univariate and bivariate analysis. We interviewed 26 men and 112 women; mean age was 40.8 years (SD ± 10.3). Several occupational risks and potentially stressful demands were reported; morbidity was 390 incidents per 100 workers. The most common adverse health effects were chronic conjunctivitis, varicose veins, back pain, musculoskeletal disorders, chronic fatigue, headache, anxiety, sleep disorders, hearing loss, chronic nasopharyngitis, depression, hemorrhoids, and dermatitis. The prevalence of stress was 23 per 100 workers. Among others, the following statistically significant associations were found: prolonged awkward positions and uncomfortable seating with back pain, repetitive and heavy work with chronic fatigue, monotonous work with depression; long working hours, exposure to noise, repetitiveness and inability to be away from work for more than 5 minutes was associated with stress. We conclude that these adverse health effects are associated with poor working conditions. Interventions targeted at work organization, ergonomics, job redesign and better coverage of health services are urgently needed.

Necesidades insatisfechas de atención odontológica en trabajadores de la costura en México DF / Unmet needs for dental care in garment workers in Mexico City

La salud bucal de los trabajadores no recibe interés suficiente en estudios sobre salud laboral, problemas dentales se suman a sus perfiles patológicos agravándose cuando no tienen una atención odontológica oportuna. Se realizó un estudio transversal, entre trabajadores de la costura en México, D.F., cuyo objetivo fue estimar la prevalencia de caries, higiene bucal y pérdida de dientes asociándola con condiciones socioeconómicas, laborales, acceso a servicios dentales y autopercepción de salud bucal. Se aplicó un cuestionario a 93 trabajadores que fueron examinados usando los criterios de la Organización Mundial de la Salud (OMS), respecto al índice CPOD que mide el promedio de dientes cariados, perdidos y obturados, obteniendo los siguientes resultados: 85% fue del género femenino, la edad de 14 a 64 años con una media y DS de 41.56 ± 10.7. El índice CPOD alcanzó 13,7 siendo más alto 17,56 para los de 55-64 años, asociándose los dientes perdidos con edad, ser mujer y el número de hijos (p < 0.05). La visita al dentista durante los últimos 12 meses fue por dolor en 38,7%, a un dentista privado 62%, asociándose con escolaridad y mejores ingresos (p < 0.05). La autopercepción de su salud bucal fue mala y muy mala en 48,5% relacionándose con dientes cariados (p < 0.05). Se concluyó que el CPOD y los dientes perdidos aumentaron conforme la edad, siendo junto con dientes cariados los valores más altos del índice. Se identificaron necesidades no atendidas y peores condiciones de salud bucal en mujeres.

Oral health has not been adequately addressed in occupational health. Dental caries and treatment needs affect low income workers, particularly those with no suitable access to dental services. We estimated the prevalence of dental caries, poor oral hygiene and tooth loss in garment workers in Mexico City, and examined their association with socioecomic status, employment and self-perceived oral health. This was a cross-sectional survey of 93 participants who completed a questionnaire. Oral examination was performed following standards recommended by the World Health Organization. Dentition status and treatment needs were calculated, along with counts of decayed, missing and filled teeth (DMFT). The age ranged from 14 to 64 years (mean ± SD, 41.56 ± 10.7); 85% of subjects were women. Mean DMFT for all age groups was 13.7, with the highest mean (17.64) being in the 55 to 64 year age group. The missing tooth component was related to age, being a woman and number of children (p < 0.05). Tooth pain was the main reason to visit a dentist (38.7%); 62% sought care through a private dentist and this was closely associated with a higher level of education and income (p < 0.05). Oral health was self-perceived as bad or very bad in 48.5% of cases and was associated with decayed tooth component. Mean DMFT and missing teeth increased with age; missing and decayed teeth had the highest scores within the DMFT. These findings indicate that the dental treatment needs of the study population are unmet and that this situation is worse among women.

Satisfacción de usuarios de dos servicios odontológicos en Tláhuac, Distrito Federal / Satisfaction of end users in two dental services in Tláhuac, Federal District

El propósito del presente estudio fue conocer la opinión de los pacientes del servicio de odontología de los Centros de Salud Comunitarios de Zapotitla y San José, en Tláhuac, D.F., acerca de sus percepciones sobre la eficacia y calidad humana de la atención que estaban recibiendo. En la atención clínica participaron, durante dos semanas consecutivas y se les aplicó un cuestionario donde se exploraban diferentes aspectos de su proceso de atención odontológica. Se construyó una escala para medir el grado de satisfacción obtenido. A través del análisis de los resultados, que en general fueron positivos, se establecen algunas hipótesis para estudios futuros sobre este tema

Satisfacción de usuarios de dos servicios odontológicos en Tláhuac, Distrito Federal / User satisfaction of two dental services at Tlahuac, Federal District

El propósito del presente estudio fue conocer la opinión de los pacientes del servicio de Odontología de los Centros de Salud Comunitarios de Zapotitla y San José, en Tláhuac, DF, acerca de sus percepciones sobre la eficacia y calidad humana de la atención que estaban recibiendo. En la atención clínica participaron, durante ese año, alumnos de la carrera de Estomatología de la UAM-Xochimilco, como parte de su práctica docente. Se seleccionó una muestra no proabilística de pacientes que acudieron durante dos semanas consecutivas y se les aplicó un cuestionario donde se exploraban diversos aspectos de su proceso de atención odontológica. Se construyó una escala para medir el grado de satisfacción obtenido. A través del análisis de los resultados, que en general fueron positivos, se establecen algunas hipótesis para estudios futuros sobre este tema

Aplicacion de la técnica de reacción en cadenade la polimerasa para la detección de secuencias de Papillomavirus humano / Aplication of polymerase chain reaction to detect sequences of human Papillomavirus

Se aplicó la técnica dereacción en cadena de la polimerasa para la detección de secuencias de papillomavirus humano (PVH) mediante controles de líneas celulares de cáncer cervical y tejidos obtenidos por biopsia con diagnóstico clínico positivo a PVH. Se utilizóun juego de oligonucleótidos consenso, que son complementarios a una región altamente conservada dentro del marco de lectura abierta. El del genoma viral de los PVH que afectan la mucosa cervical. Con este juego de cebadores fue posible amplificar secuencias de ácido desoxirribonucleico (ADN) correspondientes a los PVH 6 y 11, considerados dentro del grupo de bajo riesgo y de los PVH 16, 18, 31 y33 comprendidos en el grupo de alto riesgo. El estudio de la sensibilidad de latécnica de amplificación arrojó como resultado un nivel de detección de 3,5 partículas virales por cada genoma diploide celular