RESUMO
La afectación de la infección por SARS-CoV-2 en el personal de salud constituye un serio problema para el control de los efectos de la pandemia. El contagio del personal de salud constituye no sólo un riesgo para los profesionales que son contagiados; sino también, para su entorno laboral, familiar y social, constituyéndose en un vector de confianza durante el período de incubación de la enfermedad. El desconocimiento de un período de contagio viral exacto y la alta posibilidad de que pacientes totalmente asintomáticos u oligosintomáticos sean transmisores del virus constituyen un serio problema y es uno de los factores del rápido y creciente número de infecciones. El avance de la pandemia, su rápida aceleración y fácil propagación, el acceso del personal de salud al equipo de protección adecuado para el manejo de pacientes portadores o con riesgo de ser portadores del virus SARS-CoV-2 es una preocupación creciente. En muchos países, los trabajadores de la salud tienen prioridad en el acceso a los escasos equipos de protección personal (EPP), pero frecuentemente se ven en la obligación de asistir pacientes posiblemente en períodos de contagio sin manifestación clínica. Convertirse en vectores de esta patología es una causa de preocupación más para los trabajadores de la salud. El hecho de que estos trabajadores deban muchas veces trabajar en varias instituciones aumenta aun más el riesgo de transmisión, y ante el contagio se ven obligados al aislamiento total, dejando sin cobertura a sus lugares de trabajo, obligados al contrato de nuevo personal, muchas veces sin la formación adecuada o desconociendo la metodología de trabajo en dicho lugar con el consecuente incremento de errores en el manejo adecuado de los pacientes. Es vital que las autoridades no vean a los trabajadores de la salud como simples peones para ser desplegados en un campo de batalla sin el armamento adecuado para combatir la pandemia. Deben priorizar los recursos indispensables, además del económico, y brindar no sólo las medidas de protección personal para él y para sus pacientes; sino también, la provisión de descanso adecuado, apoyo a él y a su familia e incluso apoyo psicológico y legal que permitan sobrellevar esta batalla con la menor cantidad de víctimas. Por cierto, uno puede adquirir los elementos de protección en el mercado, quizá de un día para otro, pero no podrá formar personal de salud capacitado en tan poco tiempo. La siguiente presentación intenta brindar a las autoridades y a los profesionales de la salud una visión de las formas de protección que se hacen absolutamente necesarias, aún después del fallecimiento del paciente, para evitar convertirse en vectores de la enfermedad y continuar trabajando como los héroes de esta pandemia. Es absolutamente necesario comprender que protegiéndolos a ellos se protege a su entorno, a otros pacientes, a su familia y finalmente a la comunidad, evitando así el círculo vicioso que mantiene la pandemia.
The involvement of SARS-CoV-2 infection in health personnel constitutes a serious problem for controlling the effects of the pandemic. The contagion of health personnel constitutes not only a risk for the professionals who are infected, but also for their work, family and social environment, becoming a vector of trust during the incubation period of the disease. The ignorance of an exact viral contagion period and the high possibility that totally asymptomatic or oligosymptomatic patients are transmitters of the virus constitutes a serious problem and is one of the factors of the fast and increasing number of infections. The advance of the pandemic, its rapid acceleration and easy spread, the access of health personnel to the adequate protection equipment for the management of patients who are carriers or at risk of being carriers of the SARS-CoV-2 virus is a growing concern. In many countries, health workers have priority in accessing the scarce personal protective equipment (PPE), but frequently they are obliged to assist patients, possibly in periods of infection without clinical manifestations. Becoming vectors of pathology is another cause of concern for health workers. The fact that these workers often have to work in various institutions further increases the risk of transmission and, due to the contagion, they are forced to complete isolation, leaving their workplaces uncovered, forced to hire new personnel, often without adequate training or unaware of the work methodology in that place with the consequent increase in errors in the proper management of patients. It is vital that the authorities do not see health workers as mere pawns to be deployed on a battlefield without the adequate weapons to combat the pandemic, but must prioritize the indispensable resources in addition to the economic one and provide, in addition to the measures of personal protection for him and his patients, but also of the resources, provision of adequate rest, support for him and his family and even psychological and legal support that allow him to carry out this battle with the least amount of victims. By the way, one can acquire the protection elements on the market perhaps from one day to the next, but they will not be able to train trained health personnel in such a short time. The following presentation tries to provide authorities and health professionals with a vision of the forms of protection that are absolutely necessary, even after the patients death, to avoid becoming vectors of the disease and continue working as the heroes of this disease. pandemic. It is absolutely necessary to understand that protecting them protects their environment, other patients, their family and finally the community, thus avoiding the vicious circle that maintains the pandemic.
O envolvimento da infecção por SARS-CoV-2 na equipe de saúde constitui um problema sério para controlar os efeitos da pandemia. O contágio do pessoal de saúde constitui não apenas um risco para os profissionais infectados; mas também para seu trabalho, ambiente familiar e social, tornando-se um vetor de confiança durante o período de incubação da doença. O desconhecimento de um período exato de contágio viral e a alta possibilidade de pacientes totalmente assintomáticos ou oligossintomáticos serem transmissores do vírus constituem um problema sério e são um dos fatores do número crescente e rápido de infecções. O avanço da pandemia, sua rápida aceleração e fácil disseminação, o acesso do pessoal da saúde ao equipamento de proteção adequado para o gerenciamento de pacientes portadores ou em risco de serem portadores do vírus SARSCoV-2 é uma preocupação crescente. Em muitos países, os profissionais de saúde têm prioridade no acesso aos escassos equipamentos de proteção individual (EPI), mas frequentemente são obrigados a ajudar os pacientes, possivelmente em períodos de infecção sem manifestações clínicas. Tornar-se vetores de patologia é outra causa de preocupação para os profissionais de saúde. O fato de esses trabalhadores frequentemente trabalharem em várias instituições aumenta ainda mais o risco de transmissão e, devido ao contágio, são forçados a completar o isolamento, deixando seus locais de trabalho descobertos, forçados a contratar novos funcionários, muitas vezes sem treinamento adequado ou desconhecem a metodologia de trabalho naquele local, com o consequente aumento de erros no manejo adequado dos pacientes. É vital que as autoridades não vejam os trabalhadores da saúde como meros peões a serem implantados em um campo de batalha sem as armas adequadas para combater a pandemia, mas devem priorizar os recursos indispensáveis além do econômico e fornecer, além das medidas de proteção pessoal para ele e seus pacientes, mas também recursos, provisão de descanso adequado, apoio a ele e sua família e até apoio psicológico e jurídico que lhe permitam realizar essa batalha com o menor número de vítimas. A propósito, é possível adquirir os elementos de proteção no mercado, talvez de um dia para o outro, mas eles não poderão treinar pessoal de saúde treinado em tão pouco tempo. A apresentação a seguir tenta fornecer às autoridades e profissionais de saúde uma visão das formas de proteção que são absolutamente necessárias, mesmo após a morte do paciente, para evitar se tornarem vetores da doença e continuar trabalhando como heróis dessa doença. pandemia. É absolutamente necessário entender que protegê-los protege o meio ambiente, os demais pacientes, a família e, finalmente, a comunidade, evitando o círculo vicioso que mantém a pandemia.
RESUMO
BACKGROUND: Noninvasive methods are needed to evaluate reperfusion success in patients with acute myocardial infarction (MI). The AMISTAD trial was analyzed to compare MI size and myocardial salvage determined by electrocardiogram (ECG) with technetium Tc 99m sestamibi single-photon emission computerized tomography (SPECT) imaging. METHODS: Of 236 patients enrolled in AMISTAD, 166 (70 %) with no ECG confounding factors and no prior MI were included in this analysis. Of these, group 1 (126 patients, 53%) had final infarct size (FIS) available by both ECG and SPECT. Group 2 (56 patients, 24%) had myocardium at risk, FIS, and salvage index (SI) assessed by both SPECT and ECG techniques. Aldrich/Clemmensen scores for myocardium at risk and the Selvester QRS score for final MI size were used. Salvage index was calculated as follows: SI = (myocardium at risk-FIS)/(myocardium at risk). RESULTS: In group 1, FIS was 15% (6, 24) as measured by ECG and 11% (2, 27) as measured by SPECT. In the adenosine group, FIS was 12% (6, 21) and 11% (2, 22). In the placebo group, FIS was 16.5% (7.5, 24) and 11.5% (3.0, 38.5) by ECG and SPECT, respectively. The overall correlation between SPECT and ECG for FIS was 0.58 (P = .0001): 0.60 in the placebo group (P = .0001) and 0.54 (P = .0001) in the adenosine group. In group 2, myocardium at risk was 23% (17, 30) and 26% (10, 50) with ECG and SPECT, respectively (P = .0066). Final infarct size was 17% (6, 21) and 12% (1, 24) (P < .0001). The SI was 29% (-7, 57) and 46% (15, 79) with ECG and SPECT, respectively (P = .0510). CONCLUSIONS: The ECG measurement of infarct size has a moderate relationship with SPECT infarct size measurements in the population with available assessments. This ECG algorithm must further be validated on clinical outcomes.
Assuntos
Adenosina/uso terapêutico , Eletrocardiografia , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/patologia , Terapia Trombolítica , Humanos , Infarto do Miocárdio/fisiopatologia , Estudos ProspectivosRESUMO
BACKGROUND: Current methods for risk stratification after acute myocardial infarction (MI) include several noninvasive studies. In this cost-containment era, the development of low-cost means should be encouraged. We assessed the ability of an electrocardiogram (ECG) MI-sizing score to predict outcomes in patients enrolled in the Economics and Quality of Life (EQOL) sub study of the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries -I (GUSTO-I) trial. METHODS: We classified patients by electrocardiographic Selvester QRS score at hospital discharge: those with a score 0-9 versus > or =10. Endpoints were 30-day and 1-year mortality, resource use, and quality-of-life measures. RESULTS: Patients with a QRS score <10 were well-matched with those with QRS score > or =10 with the exception of a trend to more anterior MI in the higher scored group. Patients with QRS score > or =10 had increased risk of death at 30-days (8.9% vs. 2.9% P < .001), and this difference persisted at 1 year (12.6% vs. 5.4%, P = .001). Recurrent chest pain, use of angiography, and angioplasty were similar during follow-up. However, there was a trend toward less coronary bypass surgery in patients with a QRS score > or =10. Readmission rates were higher at 30 days but similar at 1 year. CONCLUSIONS: Stratification of patients after acute MI by a simple measure of MI size identifies populations with different long-term prognoses; patients with a QRS score > or =10 (approximately 30% of the left ventricle infarcted) at discharge have poorer outcomes in both the short- and long-term. The standard 12-lead ECG provides a simple, economical means of risk stratification at discharge.