الملخص
Resumen Antecedentes: la histerectomía en bloque es un procedimiento controvertido y con poca literatura actualizada. Se define como la extirpación del útero grávido con su contenido gestacional in situ, las indicaciones para la realización de esta cirugía son los procesos neoplásicos (como la causa más frecuente( procesos sépticos, enfermedad trofoblástica y hemorragia secundaria a inserción placentaria anómala. Caso clínico: paciente de 45 años con embarazo de 8 semanas y 5 días, según la fecha de última regla, con miomatosis uterina gigante asociada con tromboembolismo pulmonar, quien decide la interrupción voluntaria del embarazo y realizarse la histerectomía en bloque. Conclusiones: la histerectomía en bloque es una cirugía poco realizada en la actualidad, sin embargo, este abordaje quirúrgico es una opción segura y efectiva para la interrupción voluntaria del embarazo, y no se debe descartar entre las alternativas de tratamiento quirúrgico, siempre individualizando cada paciente.
ABSTRACT BACKGROUND: En bloc hysterectomy is defined as the removal of the pregnant uterus with its gestational content in situ. The indications for performing this en bloc surgery are neoplastic processes, as the most frequent cause; septic processes, trophoblastic disease and hemorrhage secondary to abnormal placental insertion, however, it is a controversial procedure, and with little updated literature. CLINICAL CASE: 45-year-old patient with a pregnancy of 8 weeks and 5 days, with giant uterine myomatosis associated with pulmonary thromboembolism who decided to voluntarily terminate the pregnancy, and it was decided to perform en bloc hysterectomy. CONCLUSIONS: En bloc hysterectomy is a surgery rarely performed at present, however, this surgical approach is a safe and effective option for the voluntary termination of pregnancy, and it should not be ruled out among the surgical treatment alternatives, always individualizing each patient.
الملخص
Introdução: As queimaduras são um desafio da saúde pública devido à alta morbimortalidade e prejuízo na qualidade de vida da vítima. Elas afetam desproporcionalmente as populações de menor nível socioeconômico, resultando em elevados custos para saúde. Método: Estudo ecológico, retrospectivo, observacional, com abordagem quantitativa e análise de tendência temporal da morbimortalidade por queimadura em Santa Catarina, com dados obtidos dos Sistemas de Informações Hospitalar e de mortalidade disponibilizados pelo Departamento de Informática do Sistema Único de Saúde. Análise temporal pelo Teste de Correlação de Spearman. Resultados: Verificada tendência de crescimento na taxa geral de internação (Spearman=0,806; p<0,005) por queimaduras no estado no período analisado. Maior prevalência no sexo masculino (RP 1,68), na população de 0 a 4 anos (RP 3,08) e na região da Grande Florianópolis (taxa média 23,22%). Predominou o grupo classificado como médio queimado (taxa média 25,67%) e as internações de 0 a 3 dias (taxa média 50,25%). Queimaduras em cabeça, pescoço e tronco (taxa média 32,25%) foram as mais prevalentes. Conclusão: Identificada tendência de crescimento na taxa de internação por queimaduras em crianças no estado. Maior prevalência de internação no sexo masculino, em crianças de 0 a 4 anos e na região da Grande Florianópolis. Predomínio de médio queimados e de queimaduras em cabeça, pescoço e tronco, com maior taxa de internações de curta duração.
Introduction: Burns is a public health challenge due to high morbidity and mortality and impairment of the victim's quality of life. They disproportionately affect populations of lower socioeconomic status, resulting in high health costs. Method: Ecological, retrospective, observational study, with a quantitative approach and temporal trend analysis of morbidity and mortality due to burns in Santa Catarina, with data obtained from the Hospital and Mortality Information Systems made available by the Information Technology Department of the Unified Health System. Temporal analysis by Spearman Correlation Test. Results: There was a growing trend in the general hospitalization rate (Spearman=0.806; p<0.005) for burns in the state in the period analyzed. Higher prevalence in males (RP 1.68), in the population aged 0 to 4 years (RP 3.08), and in the Greater Florianópolis region (mean rate 23.22%). The group classified as medium burn predominated (mean rate 25.67%) and hospitalizations of 0 to 3 days (mean rate 50.25%). Burns to the head, neck, and trunk (mean rate 32.25%) were the most prevalent. Conclusion: A growth trend was identified in the hospitalization rate for burns in children in the state. Higher prevalence of hospitalization in males, in children aged 0 to 4 years, and in the Greater Florianópolis region. Predominance of moderate burns and burns to the head, neck, and trunk, with a higher rate of short-term hospitalizations.
الملخص
Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.
Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.
الموضوعات
Humans , Postoperative Complications , Indicators of Morbidity and Mortality , Health Status Indicators , Quality Assurance, Health Care , Outcome Assessment, Health Care , Patient Acuityالملخص
Introducción. El trasplante hepático es el tratamiento indicado en aquellas enfermedades del hígado en las cuales ya se han agotado otras medidas terapéuticas, y es un procedimiento complejo. Las complicaciones postquirúrgicas se relacionan con alta morbimortalidad y pueden llevar a desenlaces fatales; las complicaciones vasculares son las de mayor mortalidad, por lo que es crucial la detección temprana y el tratamiento oportuno. El objetivo de este estudio fue caracterizar los pacientes que presentaron complicaciones vasculares posterior a trasplante hepático. Métodos. Estudio descriptivo, retrospectivo, con seguimiento a los pacientes sometidos a trasplante hepático en la Fundación Cardiovascular, entre los años 2013 y 2023, que presentaron complicaciones vasculares. Se evaluó el tipo de complicación, los factores de riesgo y los desenlaces postquirúrgicos. Resultados. Se incluyeron en total 82 pacientes trasplantados, con un predominio del sexo masculino 59,8 % (n=49); la principal indicación del trasplante fue el alcoholismo (21,9 %). Veinte pacientes presentaron complicaciones vasculares; la más frecuente fue trombosis de arteria hepática, en el 45 % (n=9). En tres de estos casos se requirió nuevo trasplante. Conclusión. Las complicaciones vasculares empeoran la evolución clínica postoperatoria de los pacientes y están relacionadas con alta morbimortalidad, por lo cual es crucial la valoración multidisciplinaria, el diagnóstico oportuno y la intervención temprana para disminuir los desenlaces fatales.
Introduction. Liver transplant is the treatment indicated for those liver diseases in which other therapeutic measures have already been exhausted, and it is a complex procedure. Post-surgical complications are related to high morbidity and mortality and can lead to fatal outcomes. Vascular complications are the ones with the highest mortality, so early detection and timely treatment are crucial. The objective of this study was to characterize patients who presented vascular complications after liver transplantation. Methods. Descriptive, retrospective study, with follow-up of patients undergoing liver transplant at the Fundación Cardiovascular, between 2013 and 2023, who presented vascular complications. The type of complication, risk factors and postsurgical outcomes were evaluated. Results. A total of 82 transplant patients were included, with a predominance of males with 59.8% (n=49); the main indication for transplant was alcoholism (21.9%). Twenty patients presented vascular complications; the most frequent was hepatic artery thrombosis 45% (n=9). In three of these cases a new transplant was required. Conclusion. Vascular complications worsen the postoperative clinical course of patients and are associated with high morbidity and mortality, which is why multidisciplinary assessment, diagnosis and early intervention are crucial to reduce fatal outcomes.
الموضوعات
Humans , Postoperative Complications , Indicators of Morbidity and Mortality , Liver Transplantation , Reoperation , Mortality , Liverالملخص
Background: Magnesium sulphate (MgSO4) is the most popular anti-convulsant drug for treatment of eclampsia. Pritchard regimen is the most widely used regime worldwide where maintenance dose of MgSO4 is administered for 24-hour after delivery or last fit (whichever is later). As the duration of MgSO4 therapy increases, the incidence of adverse effects also increases. Therefore, the present study has been conducted to compare the maternal outcome with decreased duration of MgSO4 therapy for 12-hour with that of 24 hours for patients with eclampsia. Methods: It was an experimental study which was performed as a single centered, open labelled hospital based randomized control trial. It was conducted for 2 years (December 2019 to November 2021) among the patients of eclampsia admitted at department of obstetrics and gynaecology, AGMC and GBPH. Results: No cases of recurrent seizures in either group with additional benefit of lesser adverse effect of toxicity of MgSO4 in the 12-hour group. Conclusions: In the present study, it has been seen that 12-hour MgSO4 maintenance therapy is as efficacious as standard 24 hours therapy in controlling seizure as there was no case of recurrent seizure in either group.
الملخص
Background: Old age is associated with diminished physiological reserve; so any physical illness, metabolically derangement or pharmacological challenge can worsen cognitive and physical function. The only way to minimize or avoid these will be to be on the lookout and have a proactive approach and assessment in every older patient irrespective of the presenting complaint. This study aimed to assess the socio-demographic profile and self reported morbidity pattern of the elderly population and to estimate the prevalence of depression among the elderly population using the geriatric depression scale. Methods: A pre-designed, pretested and semi-structured questionnaire was used in the study. The data collection technique is by personal interview of the study subjects. A pre-designed, pretested and semi-structured questionnaire was used in the study. The data collection technique is by personal interview of the study subjects. Results: In our study more women were under depression than the men. The most common physical morbidity among the elderly population was cataract (59.7%), followed by arthritis (57.1%), non- specific body pains (40.1%) and hypertension (39%). Conclusions: Prevalence of depression among the elderly population is reported to be high (84.3%) in this study. Multi morbidity, socio economic factors and financial dependence were factors associated with depression in elderly.
الملخص
Background: Understanding the patient flow for health-seeking patterns and utilization of AYUSH care in India has been considered essential for a greater emphasis on mainstreaming and blending into the existing healthcare systems. This study examines the morbidity profiling of patients reporting to Ayothidoss Pandithar Hospital (APH) of the National Institute of Siddha (NIS), Chennai. Methods: The study included new and old/revisit patients who attended the APH, Outpatient Department (OPD), special OPD, and Inpatient Department (IPD) from October 2004 to December 2023. Results: Through OPD and IPD, APH has treated 98,94,373 cases and 7,61,754 cases, respectively. The average number of cases treated per day at OPD was 1484, and 115 in IPD. Men were higher in OPD and IPD. The more common diseases treated during 2012-2023 at OPD were Madhumegam (diabetes mellitus) 13% and Azhal keelvayu (osteoarthritis) 12% whereas, in IPD, it was Thandagavatham (lumbar spondylosis) 9.5% and Pakkavatham (hemiplegia) 9.4%. At APH, 9 X-ray investigations, 44 Varmam therapies, 37 Thokkanam therapies, 497 pathological, 433 biochemical investigations, and 38 microbiological tests were performed each day. Conclusions: This study reveals the scope of the Siddha system of Medicine in managing Musculoskeletal disorders. The patient data generated at APH would enhance the National Health Policy (NHP) objective of strengthening and prioritizing health services' importance, promoting good health, and creating guidelines for high-quality care.
الملخص
Background: Despite the significance of late preterm and early term neonates in neonatal health, comprehensive data on their prevalence, morbidity, mortality, and associated maternal sociodemographic and economic characteristics is grossly lacking in Garissa County, Kenya. This study aimed to determine the prevalence, morbidity, and mortality of late preterm (LPN) and early term neonates (ETN) born at Garissa County Referral Hospital (GCRH), relative to full-term neonates (FTN). Methods: Singleton live neonates in the three groups were enrolled. Prevalence was computed as percentages of births in each category relative to total singleton live births during the study period. Ordinal logistic regression analysis was used to assess morbidity patterns, with statistical significance set at p<0.05. Mortality rates were presented as total deaths per 1,000 live births within the first 28 days. Results: The LPN, ETN, and FTN had a prevalence of 8.47%, 11.86%, and 9.2%, respectively. Maternal age was significantly associated with gestational age (p=0.014; ?c=0.263), while other sociodemographic and economic characteristics were comparable across groups (p>0.05). LPNs had lower odds of respiratory distress diagnosis on day 1 compared to ETNs (OR=-1.68896; 95% CI: -3.012335 to -0.365593; p=0.012). Mortality rates were comparable among gestational age categories (p=0.649). Conclusions: Overall, the study shows that LPN and ETN are considerably prevalent in Garissa County and that, only maternal age impacts on gestational age. Targeted interventions, particularly for younger mothers, should be implemented to mitigate associated risks and improve neonatal outcomes.
الملخص
Background: Children face the greatest risk of disease and death in their first 28 days. Improvements in basic neonatal care such as thermoregulation and breastfeeding have substantially reduced neonatal mortality and morbidity. There is still a need to strengthen the provision of advanced care for neonates. Identifying factors impacting neonatal mortality and morbidity and addressing them through a package of evidence-based interventions are essential to avoiding preventable deaths. Methods: The current study analyses data from a cross-sectional study in the rural outreach area of a tertiary hospital in Hyderabad, India to assess clinical and socio-demographic factors affecting neonatal morbidity. One hundred and fifty neonates admitted in neonatal intensive care unit and their mothers were included. A semi-structured questionnaire was used to obtain responses through face-to-face interview. Descriptive and inferential analyses were performed using R Statistical Software (version 4.3.2). Results: Among the 150 neonates, 99 (66%) neonates were admitted for respiratory distress. 39 (26%) males were low birth weight and 28 (18.67%) females were low birth weight. There was no significant association between low birth weight, high risk pregnancy and gender of the neonate. A significant association was obtained between low socio-economic status and low birth weight. Conclusions: Neonatal mortality and morbidity can be attributed to several factors including neonatal characteristics, maternal characteristics, health infrastructure and health manpower. However, prevalence of socio-demographic risk factors affecting neonates is disproportionately higher in low- and middle-income countries. A multi-pronged approach is required to address the multimodal causation of low birth weight and morbidity in neonates.
الملخص
Resumen Introducción: El trauma craneoencefálico es una patología con altos índices de mortalidad, por lo que es de gran relevancia identificar los factores que inciden en ella. Materiales y métodos: Se elaboró un estudio analítico entre los años 2020 y 2021, donde se incluyeron pacientes con trauma craneoencefálico moderado y severo, se caracterizaron las variables más relacionadas con el pronóstico, como aspectos demográficos, clínicos y radiológicos, y se analizó la asociación entre la mortalidad y estas variables. Resultados: La mortalidad hospitalaria fue del 22,8 %, encontrando como variables relacionadas la frecuencia respiratoria, la anisocoria, el reflejo pupilar y la atención en unidad de cuidados intensivos (UCI), y como factor relacionado con supervivencia, el número de días de estancia hospitalaria. Discusión: La mortalidad por trauma craneoencefálico es más elevada en países de ingresos medianos y bajos, posiblemente en relación con una mayor cantidad de accidentes de tránsito y un acceso limitado a tratamientos. Los factores asociados en el estudio se respaldan con estudios previos y se subraya la importancia de las alteraciones pupilares en la evaluación del paciente. Conclusiones: Es fundamental un examen físico completo desde el momento del ingreso, pues hallar taquipnea, anisocoria, ausencia del reflejo pupilar o signos de choque, puede dictar el pronóstico. Aunque la literatura global se centra en la caracterización del TCE, este estudio subraya la necesidad de una mayor investigación sobre factores que permitan predecir cursos hospitalarios tórpidos con desenlaces fatales.
Abstract Introduction: Traumatic brain injury is a disease with high mortality rates, so it is highly relevant to identify the factors that affect it. Materials and methods: An analytical study was prepared between 2020 and 2021, which included patients with moderate and severe head trauma, characterized the variables most related to prognosis, such as demographic, clinical, and radiological aspects, and analyzed the association between mortality and these variables. Results: Hospital mortality was 22.8%, finding as conditions related to mortality the respiratory rate, anisocoria, pupillary reflex, ICU care and as a factor related to survival, the number of days of hospital stay. Discussion: Mortality due to traumatic brain injury is higher in low- and middle-income countries, possibly due to a higher incidence of traffic accidents and limited access to treatment. The factors identified in this study are consistent with previous research, emphasizing the importance of pupillary abnormalities in patient assessment. Conclusions: A comprehensive physical examination from the time of admission is crucial, as the presence of tachypnea, anisocoria, absence of pupillary reflex, or signs of shock can dictate prognosis. While global literature primarily focuses on characterizing traumatic brain injuries, this study underscores the need for further research on factors predicting protracted hospital courses with fatal outcomes.
الملخص
Fundamento: los síndromes coronarios agudos constituyen un problema de salud debido a su alta morbilidad y mortalidad. Sería razonable asumir que los trabajadores de la salud cuidan y controlan sus propios factores de riesgo coronario, no obstante, los resultados obtenidos en investigaciones muestran que no siempre es así. Objetivo: caracterizar los factores de riesgo coronario en trabajadores del Hospital General Docente Guillermo Domínguez López de Las Tunas. Método: se realizó un estudio descriptivo de corte transversal en el Hospital General Docente Guillermo Domínguez López de Las Tunas entre diciembre de 2019 y diciembre de 2022. La población de estudio fue de 912 trabajadores y la muestra de 200. Fue un muestreo probabilístico, aleatorio simple, dividido en dos grupos: A (con síndrome coronario agudo) y B (sin síndrome coronario agudo). Se analizaron las siguientes variables: edad, sexo, factores de riesgo coronario. La información se obtuvo de expedientes clínicos y se analizó en porcentaje, media, desviación estándar y el estadígrafo z para obtener la influencia de los factores de riesgo en la enfermedad. Resultados: la media de edad del grupo A: 56,5 (±5,03), grupo B: 46,4 (±11,33) años con predominio del sexo masculino (54,5 %). Los factores de riesgo que predominaron fueron: sedentarismo (57 %), tabaquismo (36,5 %) e hipertensión arterial (34 %). Los de mayor influencia fueron: los antecedentes de cardiopatía isquémica, la enfermedad vascular, la obesidad abdominal (z: 0,99), la diabetes mellitus (z: 0,92) y la hipertensión arterial (z: 0,70). Conclusiones: el síndrome coronario predomina en la quinta década de la vida y con mayor frecuencia en el sexo masculino.
Foundation: acute coronary syndromes constitute a health problem due to their high morbidity and mortality. It would be reasonable to assume that health workers take care of and control their own coronary risk factors, however, research results show that this is not always the case. Objective: to characterize coronary risk factors in workers at the Guillermo Domínguez López General Teaching Hospital in Las Tunas. Method: a descriptive cross-sectional study was carried out at the Guillermo Domínguez López General Teaching Hospital in Las Tunas between December 2019 and December 2022. The study population was 912 workers and the sample was 200. It was a probabilistic, simple random sampling divided into two groups: A (with acute coronary syndrome) and B (without acute coronary syndrome). The following variables were analyzed: age, sex, coronary risk factors. The information was obtained from clinical records and analyzed in percentage, mean, standard deviation and the z statistic to obtain the influence of risk factors on the disease. Results: the average age of group A: 56.5 (±5.03), group B: 46.4 (±11.33) years with a predominance of the male sex (54.5 %). The predominant risk factors were: sedentary lifestyle (57 %), smoking (36.5 %) and high blood pressure (34 %). Those with the greatest influence were: a history of ischemic heart disease, vascular disease, abdominal obesity (z: 0.99), diabetes mellitus (z: 0.92) and arterial hypertension (z: 0.70). Conclusions: coronary syndrome predominates in the fifth decade of life and is more common in males.
الملخص
Maternal mortality is one of the important indicators used for the measurement of maternal health. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely haemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health. Here we are presenting case series of near miss mortality cases reported in Muzaffarnagar medical college.
الملخص
Background: A maternal near miss (MNM) case is defined as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. MNM situations tend to mirror the causes of maternal death. Hence, review of these cases has been found to help in the assessment of maternal health services. These cases are called as MNM or severe acute maternal morbidity (SAMM) and auditing these cases is called near miss audit (NMA).Methods: A retrospective study of 201 MNM cases over a period of 12 months from January 2023- December 2023. Demographic data were collected from MNM review form and records. Data studied and analyzed.Results: There were 11,340 deliveries and 11,126 live births during the study period out of which 201 MNM cases were studied. Haemorrhage followed by anemia was the most common cause of near miss events. The most common age group affected in the near miss cases in the present study was 20 to 35 years (80%). Majority of the cases were referred from the nearby PHCs and government hospitals.Conclusions: Most maternal deaths are preventable by optimal utilization of existing MCH facilities, identifying the bottleneck in health delivery system, early identification of high-risk pregnancy and therein timely referral to tertiary care centre.
الملخص
Background: Fetal growth restriction (FGR) is a pathological condition in which a fetus has not achieved its genetic growth potential. FGR incidence is 6 times higher in underdeveloped and developing countries as compared to the developed world.Methods: This is a retrospective study done in the department of obstetrics and gynaecology, civil hospital and B. J. Medical college, Ahmedabad over the period of 6 months from December 2022 to May 2023. A total of 30 cases of intrauterine growth restriction (IUGR) pregnancies were studied.Results: Majority of the study population, 60% belonged to younger age group of 20-30 years. Multiparity was associated with IUGR babies. Majority of patients i.e. 76.66%. Presented at gestational age of ?37 weeks and 23.33% at <37 weeks. Most IUGR babies (73.33%) had a birth weight between 2 to 2.5 kg. One third of babies required NICU admission while the perinatal mortality was 10%. Doppler changes in umbilical artery were noted in 27% of cases of IUGR. Among risk factors anemia, preeclampsia and oligohydramnios had equal contributions at 10% each. Previous history for SGA baby is a significant association in 16% of cases. Induction of labor was done in 60% cases, 63% were delivered vaginally and rest via lower segment caesarean section (LSCS), the most common indication of LSCS was fetal distress.Conclusions: The study concluded that IUGR continues to be one of the major etiological factors for fetal morbidity and mortality and increase in rates of LSCS contributing maternal morbidity. IUGR was commonly observed in multigravida patients lacking antenatal care. Anemia and hypertensive disorders of pregnancy as well as oligohydramnios are the potential risk factors for IUGR.
الملخص
Introducción: La colangiopancreatografía endoscópica retrógrada (CPRE) es un procedimiento terapéutico para diversas patologías biliopancreáticas. Existen diversos centros de formación con una variedad de tiempos de práctica para la realización de CPRE. Objetivo: Evaluar resultados iniciales post entrenamiento en endoscopia terapéutica en el Instituto Chileno-Japonés del Hospital San Borja Arriarán, analizando 150 CPRE consecutivas, describiendo aspectos técnicos, morbilidad y mortalidad, realizadas entre noviembre de 2017 a enero de 2019 por un único operador en un hospital de la Araucanía. Método: Análisis retrospectivo del registro prospectivo de los 150 primeros casos consecutivos de CPRE realizados en el hospital San José de Victoria (HSJV). Se midieron variables clínicas, técnicas y de laboratorio. Se utilizó estadística descriptiva con medidas de tendencia central, dispersión y tendencia extrema. Resultados: Serie de 150 pacientes sometidos a CPRE: Edad promedio 60,1 años, mediana de 65 y edades extremas 16-98 años. Sexo femenino 69,3%. Indicaciones CPRE: 67,3% coledocolitiasis sin colangitis, 16,7% colangitis aguda, 6% estenosis de vía biliar benigna, 3.3% tumor periampular. Todos apoyados por anestesista, 50,7% propofol y 49.3% anestesia general. Tasa de canulación biliar 96,7%. Precorte 19,3%. Complicaciones reportadas alcanzaron el 4,67%, sin mortalidad por el procedimiento en la serie. Conclusiones: Los resultados de esta serie muestran que la formación obtenida por el profesional logró los estándares sugeridos para un procedimiento efectivo y seguro, destacando una tasa de canulación del 96,7%, siendo superior a lo que las guías internacionales describen como exitosa. La morbilidad asociada a CPER es comparable a cifras nacionales e internacionales.
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for various biliopancreatic pathologies. There are different training centers with a variety of practice times for performing ERCP. Objective: This study aims to evaluate the initial post-training results in therapeutic endoscopy at the Chilean-Japanese Institute of San Borja Arriarán Hospital, analyzing 150 consecutive ERCP procedures performed between November 2017 and January 2019 by a single operator at a hospital in La Araucanía, describing technical aspects, morbidity, and mortality. Method: Retrospective analysis of the prospective registry of the first 150 consecutive ERCP cases performed at the San José de Victoria Hospital (HSJV). Clinical, technical and laboratory variables were measured. Descriptive statistics were produced with measures of central tendency, dispersion and extreme tendency. Results: Series of 150 patients undergoing ERCP: mean age 60.1 years, median 65 and extreme ages 16-98 years. Female sex 69.3%. ERCP indications: 67.3% choledocholithiasis without cholangitis, 16.7% acute cholangitis, 6% benign bile duct stenosis, 3.3% periampullary tumor. All supported by an anesthetist, 50.7% propofol and 49.3% general anesthesia. Biliary cannulation rate 96.7%. Precut 19.3%. Reported complications reached 4.67%, with no mortality from the procedure in the series. Conclusions: The results of this series show that the training obtained by the professional improves the standards proposed for an effective and safe procedure, highlighting a cannulation rate of 96.7%, higher than what international guidelines describe as successful. The morbidity associated with ERCP in our series is comparable to national and international figures.
الملخص
Introducción: La esofagectomía es actualmente el tratamiento curativo del cáncer de esófago. El objetivo de este trabajo es conocer los resultados de la esofaguectomía mínimamente invasiva a corto y medio plazo en pacientes intervenidos de carcinoma epidermoide y adenocarcinoma de esófago en nuestro hospital. Material y Métodos: Se recogieron 19 pacientes desde enero de 2020 hasta junio de 2021 y se realizó el seguimiento a todos ellos durante 20 meses. Se recogieron diferentes variables relacionadas con el paciente, el tumor, la cirugía y referentes al postoperatorio. Los datos fueron almacenados y procesados usando el software estadístico R-Comander asumiendo un error α de 0,05. Resultados: La mediana de estancia hospitalaria total fue de 29 días. Seis pacientes, precisaron de reingreso en Reanimación: dos por shock séptico secundario a la fuga de anastomosis grado III, uno por hemorragia digestiva alta y los tres por insuficiencia respiratoria. A los 90 días reingresaron un 5,3% del total de pacientes. No se produjeron fallecimientos en los tres meses siguientes a la cirugía. Todos los pacientes presentaron una supervivencia mayor de seis meses. La supervivencia global a seis, 12 y 18 meses se sitúa en 100, 84 y 63%. La supervivencia libre de enfermedad a los tres meses fue del 84%, a los 6 meses del 63% y al año el 58%. Discusión: Los resultados obtenidos en nuestro estudio coinciden con lo que hay reflejado en la literatura. Por tanto, la esofagectomía mínimamente invasiva es una técnica efectiva en el tratamiento del cáncer de esófago.
Introduction: Oesophagectomy is currently the curative treatment for oesophageal cancer. The aim of this study is to know the results of minimally invasive oesophagectomy in the short and medium term in patients operated on for squamous cell carcinoma and adenocarcinoma of the oesophagus in our hospital. Material and Methods: 19 patients were collected from January 2020 to June 2021 and all of them were followed up for 20 months. Different variables related to the patient, tumour, surgery and postoperative period were collected. Data were stored and processed using R-Comander statistical software assuming an α-error of 0.05. Results: The median total hospital stay was 29 days. Six patients required readmission to resuscitation: two for septic shock secondary to grade III anastomotic leak, one for upper gastrointestinal haemorrhage and three for respiratory failure. At 90 days, 5.3% of the total number of patients were re-admitted. There were no deaths in the three months following surgery. All patients had a survival of more than six months. Overall survival at six, 12 and 18 months was 100, 84 and 63%. Disease-free survival at three months was 84%, at six months 63% and at one year 58%. Discussion: The results obtained in our study coincide with those reported in the literature. Minimally invasive oesophagectomy is therefore an effective technique in the treatment of oesophageal cancer.
الملخص
Introdução:A internação representa um impacto considerável na vida de qualquer pessoa, podendo tomar proporções ainda maiores quando se trata de uma criança. A impossibilidade de realizar sua rotina, como brincar e ir à escola, faz com que a internação infantil assuma um contexto marcante.Dito isso, nota-se que grande parte dessas internações é evitável, sendo denominadasde Internações por Condições Sensíveis à Atenção Primária. Dessa forma, o atendimento ambulatorial de qualidade poderia resolver a maioria das enfermidades infantis, evitando esse desfecho.Objetivo:Elaborar um perfil epidemiológico de internações por doenças infecciosas e bacterianas mais prevalentes em menores de 5 anos, de 2017 a 2021, no Brasil. Metodologia:A pesquisa em questão se trata de um estudo ecológico de série temporal,elaborado através de informações coletadas por vias secundárias.Os dados foram coletados na plataforma DataSUS e no Sistema de Informação Hospitalar. Posteriormente, os dados foram processados e armazenados no aplicativo Microsoft Excel®, onde foram tratados e selecionados de acordo com sua relevância para a pesquisa. Resultados:Constata-se que a faixa etária situadaabaixo do primeiro ano de vidaapresenta um grau de hospitalização superior ao dascrianças que vãodo primeiro ao quarto ano completo.Quanto àfrequência relativa, depreende-se que diarreia e gastroenterite de origem infecciosa presumível apresentaram o maior índice de prevalência em relação às demais patologias, com o maior número chegando a 23,8% no ano de 2017 e o menor situando-se na faixa de 13,22% em 2020. Conclusões: Apesar do avanço na Atenção Primária à Saúde e da cobertura pré-natal, a assistência ainda é deficitária, sendo necessários mais investimentos na área e o fomento de políticas públicas que abranjam essa população (AU).
Introduction: Hospitalization represents a considerable impact on the life of any person, and can even take on even greater proportions when it comes to a child. The impossibility of realizing their routine, such as playing and going to school, means that hospitalization during childhood takes ona remarkable context. That said, it is noted that mostofthese hospitalizations are avoidable,and are called Ambulatory Care Sensitive Conditions. Thus, quality ambulatory care could solve most childhood illnesses, avoiding this outcome.Objective:To elaborate an epidemiological profile of hospitalizations for the most prevalent infectious and bacterial diseases in children under 5 years of age,from 2017 to 2021,in Brazil. Methodology: The research in question is an ecological study of time series, elaborated through information collected through secondary data sources. Data were collected from the DataSUS platform and the Hospital Information System. Subsequently, data were processed and stored in Microsoft Excel® application, where they were managedand selected according to their relevance to the research. Results:It is observed that the age group below the first year of life presents a higher degree of hospitalization thanthat of children ranging from the first to the fourth year. As for the relative frequency, it can be seen that diarrhea and gastroenteritis of presumable infectious origin had the highest prevalence rate compared to other pathologies, with the highest number reaching 23.8% in 2017 and the lowest being in the range of 13.22% in 2020. Conclusions: Despite the advances in Primary Health Care and prenatal coverage, assistance is still deficient, requiring more investments in the area and the promotion of public policies that cover this population (AU).
Introducción: La hospitalización representa un impacto considerable en la vida de cualquier persona, quepuede adquirir proporciones aún mayores cuando se trata de un niño. La imposibilidadde realizar su rutina, como jugar e ir al colegio, hace que la hospitalización infantiltengaun contexto notable. Dicho esto, cabe señalar que una gran parte de estas hospitalizaciones son evitables, denominándose Hospitalizaciones por Condiciones Sensibles a la Atención Ambulatoria. Así pues, una atención ambulatoria de calidad podría resolver la mayoría de las enfermedades infantiles, evitando este desenlace. Objetivo: Elaborar un perfil epidemiológico de las hospitalizaciones por enfermedades infecciosas y bacterianas más prevalentes en niños menores de 5 años, de 2017 a 2021, en Brasil. Metodología: La investigación en cuestión es un estudio ecológico de series temporales, elaborado a partir de información recogida por vías secundarias. Los datos se recogieron de la plataforma DataSUS y del Sistema de Información Hospitalaria. Posteriormente, los datos se procesaron y almacenaron en la aplicación Microsoft Excel®, donde se trataron y seleccionaron en función de su relevancia para la investigación. Resultados: Se observa que el grupo de edad inferior al primer año de vida presenta un mayor grado de hospitalización que los niños del primero al cuarto año completo. En cuanto a la frecuencia relativa, se puede inferirque la diarreay lagastroenteritis presumible origen infeccioso tuvieron la tasa de prevalencia más alta en relación con las demáspatologías, siendola cifra más alto el 23,8% en 2017 y lamás bajael rango del 13,22% en el 2020. Conclusiones: A pesar de los avances en la Atención Primariade Salud y en la cobertura prenatal, la asistencia aún es deficiente, por lo que se requieren mayoresinversiones en el área y la promoción de políticas públicas que cubran a esta población (AU).
الموضوعات
Humans , Infant , Child, Preschool , Bacterial Infections/pathology , Health Profile , Child Health , Communicable Diseases/pathology , Primary Health Care , Respiratory Tract Diseases , Morbidity , Ecological Studies , Hospitalizationالملخص
Introdução: As doenças do sistema respiratório se mostram como uma das causas mais preocupantes de internações hospitalares no país. Nessa perspectiva, o perfil das internações por doenças respiratórias em crianças permite observar os parâmetros desta problemática, fornecendo um conhecimento amplo acerca do processo saúde e doença nessa população. Objetivo: Analisar o perfil epidemiológico das internações hospitalares por causas do aparelho respiratório em crianças de 0 a 9 anos no Brasil e regiões, entre os anos de 2013 e 2022. Metodologia: Trata-se de um estudo ecológico, realizado no Brasil, a partir de dados secundários do Sistema de Informações Hospitalares. A população escolhida para este estudo foram crianças de 0 a 9 anos deidade. Os dados foram coletados em 26 de novembro de 2022. As variáveis dependentes do estudo são as internações de crianças de 0 a 9 anos por doenças do aparelho respiratório no Brasil e suas regiões. Já, como variáveis independentes, tem-se o tempo, do período de janeiro de 2013 a setembro de 2022, regiões e faixa etária. Resultados: Há uma tendência de queda das internações por causa respiratória até o ano de 2016, seguido de um crescimento gradativo até 2019. Entretanto, em 2020, a taxa de hospitalização reduziu drasticamente em todas as localidades. As regiões Sul, Norte e Centro-Oeste permaneceram com taxas maiores que o Brasil em todo o período estudado. A internação em menores de 1 ano representa o maior quantitativo de internações sendo a pneumonia a causa mais prevalente. Conclusões: As taxas de internação infantil por doenças respiratórias representam importante preocupação para saúde pública. Assim, destaca-se a relevância da efetividade da Atenção Primária à Saúde, que possui grande impacto no desfecho dos adoecimentos em crianças, especialmente das doenças respiratórias (AU).
Introduction: Respiratory system diseases are one of the most worrying causes of hospital admissions in the country. From this perspective, the profile of hospitalizations for respiratory diseases in children allows us to notice the parameters of this problem, providing a broad understanding of the health and disease process in this population.Objective: To analyze the epidemiological profile of hospital admissions due to respiratory causes in children aged 0 to 9 in Brazil and its regions between 2013 and 2022. Methodology: This is an ecological study held in Brazil using secondary data from the Hospital Information System. The population chosen for this study consisted of children aged 0 to 9. Data were collected on November 26, 2022. The dependent variables of this study are hospitalizations of children aged 0 to 9 due to respiratory diseases in Brazil and its regions. The independent variables are time, from January 2013 to September 2022, regions, and age group.Results: There was a downward trend in hospitalizations due to respiratory causes until 2016, followed by a gradual increase until 2019. Nonetheless, in 2020, the hospitalization rate fell dramatically in all locations. The South, North and Mid-West regions remained with higher rates than Brazil throughout the studied period. Hospitalization of children under 1 year old represents the largest number of admissions, with pneumonia being Revista Ciência Plural. 2024; 10(1): e31414 3the most prevalent cause.Conclusions: Hospitalization rates during childhood due to respiratory diseases represent a major public health concern. Thus, one can highlight the importance of the effectiveness of Primary Health Care, which has a major impact on the outcome of illnesses in children, especially respiratory diseases (AU).
Introducción: Las enfermedades del sistema respiratorio son una de lascausas más preocupantes de hospitalizaciones en el país. Desde esta perspectiva, el perfil de hospitalizaciones por enfermedades respiratorias en niños permite observar los parámetros de este problema, proporcionando una amplia comprensión del proceso de salud y enfermedad en esta población.Objetivo: Analizar el perfil epidemiológico de las internaciones por causas respiratorias en niños de 0 a 9 años en Brasil y sus regiones entre 2013 y 2022. Metodología: Se trata de un estudio ecológico conducido en Brasil a partir de datos secundarios del Sistema de Información Hospitalaria. La población elegida para este estudio fueron los niños de 0 a 9 años. Los datos se recogieron el 26 de noviembre de 2022. Las variables dependientes del estudio son las hospitalizaciones de niños de 0 a 9 años por enfermedades respiratorias en Brasil y sus regiones. Las variables independientes son el tiempo, de enero de 2013 a septiembre de 2022, las regiones y la franja etaria.Resultados: Se nota una tendencia a la baja de las hospitalizaciones por causas respiratorias hasta 2016, seguida de un aumento gradual hasta 2019. Sin embargo, en 2020, la tasa de hospitalización cayó drásticamente en todas las localidades. Las regiones Sur, Norte y Medio Oeste se mantuvieron con tasas másaltas que Brasil durante todo el período estudiado. Las hospitalizaciones en niños menores de 1 año representan el mayor número de internaciones, siendo la neumonía la causa más prevalente.Conclusiones: Las tasas de hospitalización infantil por enfermedades respiratorias representan un importante problema de salud pública. Así, se subraya la importancia de la eficacia de la Atención Primaria de Salud, que tiene un gran impacto en el resultado de las enfermedades en los niños, especialmente las respiratorias (AU).
الموضوعات
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Respiratory Tract Diseases/pathology , Health Profile , Child Health , Morbidity , Primary Health Care , Hospital Information Systems , Ecological Studies , Hospitalizationالملخص
Background: Students are the wealth of the nation as they constitute one of the important segments of the population. The foundation of good health and sound mind is laid during the school age period. During this period, they are vulnerable to various oral health problems. These conditions are the hurdles in their physical, mental, emotional, and social development. In view of this, a study was conducted to assess the oral health status of the school students in rural areas. Methods: Cross-sectional study was conducted in rural area among school children in the month of March 2023. Standard proforma was used to record the data related to oral morbidity among the subjects. Data entry and statistical analysis was done with the help of Microsoft Excel. ?2 and SE (p1-p2) tests were used to compare difference in categorical variables. The statistical level of significance was fixed at p<0.05. Results: 432 students were examined. 226 (52.31%) subjects were having oral morbidity. 151 (66.81%) subjects in the age group of 5-10 years while 75 (33.19%) in the age group of >10-16 years were having oral health problems (p<0.05). 155 (59.73%) students from primary section and 71 (40.27%) students from secondary section were suffering from oral morbidity (p<0.05). Dental caries was observed among 194 (44.91%) subjects followed by mouth ulcers (09.72%). 143 (53.36%) underweight subjects were suffering from dental caries (p<0.05). Conclusions: Common oral health problems found in school going children can be addressed with the implementation of school health program in effective way. These common infirmities can be prevented by actively involving parents and teachers in school health services.
الملخص
Background: Preterm birth is a substantial global health issue with significant consequences to the newborn, family and society. Preterm deliveries affects nearly 15 million births worldwide.Methods: A retrospective cross-sectional study, conducted in a tertiary healthcare center on 100 preterm births. The data used, was of a period of 6 months in 2023.Results: The incidence of preterm was found to be 100 out of 791 live births (12.4%). Among which majority, (64%), fell into the moderate to late preterm range and with 40% falling within the 21-25 age group .While 41% had less than four antenatal care visits. Among the identified risk factors in the preterm births, high blood pressure and anemia were prevalent medical disorders, affecting 20 and 36 of cases, respectively. In obstetrical factors, 24 were attributed to multiple gestations. Lower socioeconomic status was a significant contributing factor, affecting 55 of the studied population. NICU admission ranged from short stays of 1-3 days (34%) to more extended durations, with 18% requiring care for 10-21 days and tocolytics were employed in 27 cases, with a notable 66.60% instances demonstrating effectiveness in preventing preterm birth.Conclusions: In this study, we found high incidence of preterm birth (12.4%). Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor anticipation and timely interventions will help in the reduction of preterm births and associated mortalities.