Prevalencia de Staphylococcus aureusy su sensibilidad antibiótica en aislamientos en infecciones de piel y partes blandas en pacientes ambulatorios / Staphylococcus aureus prevalence and antimicrobial susceptibility in isolates from skin and soft tissue infections in outpatients

ntroducción: Las infecciones de piel y partes blandas (IPPB) constituyen la tercera causa de consulta en nuestro centro. S.aureus es el agente etiológico más frecuente en este tipo de infecciones y la meticilino resistencia es clínicamente el mecanismo de resistencia más importante. El objetivo de este trabajo fue analizar la prevalencia de los distintos agentes etiológicos en IPPB en pacientes ambulatorios, así como también estudiar su sensibilidad a los antibióticos y resistencias acompañantes más frecuentes. Materiales y métodos: Estudio descriptivo y retrospectivo que incluyó todas las muestras provenientes de IPPB de pacientes ambulatorios desde octubre de 2017 a abril de 2022. Resultados: Se obtuvieron 180 cultivos positivos de muestras provenientes de IPPB durante el periodo estudiado, 12 fueron infecciones polimicrobianas. En total se obtuvieron 307 aislamientos: el microorganismo aislado con mayor frecuencia fue S.aureus (111; 36,2%). Se hallaron 71 SAMR (64%) y 40 SAMS (36%). De los SAMR, 67 (95%) fueron comunitarios (SAMRC) por criterios microbiológicos, y 4 SAMR hospitalarios (5%). De las cepas SAMRC, 44 (66%) no presentaron resistencias acompañantes, 15 (22% ) fueron resistentes a eritromicina, 12 (18%) a gentamicina y 7 (10%) a clindamicina. Conclusiones: El microorganismo más frecuentemente aislado en IPPB en pacientes ambulatorios fue el S.aureus y 67 aislamientos fueron categorizados como SAMRC por lo cual es necesario considerar al SAMRC como un patógeno frecuente. Debido a la baja resistencia hallada para CLI y TMS ambos podrían ser de elección en el tratamiento empírico en las IPPB en pacientes ambulatorios

Background:S. aureus is the main cause of skin and soft tissues infections (SSTIs) in immunocompetent patients. This type of infection is the third cause of medical consultation in our center. Our objective was to evaluate the prevalence of S. aureus, as well as its sensitivity to antimicrobials, isolated from skin and soft tissue samples from outpatients at an interzonal general acute care hospital located in Buenos Aires, Argentina.Methods: Descriptive and retrospective study that included all outpatient SSTIs samples from October 2017 to April 2022.Results: We obtained 215 positive cultures of samples from SSTIs during the study period. Of a total of 276 isolates: the most frequently isolated microorganism wasS. aureus (111; 40.22%). The prevalence of S. aureuswas 51.63%. We found 71 MRSA (63.96%). Of the SAMR strains, 60.56% did not present accompanying resistance, and only 8 isolates (11.27%) showed resistance to clindamycin. All SAMRs remained sensitive to minocycline and trimethoprim-sulfamethoxazole.Conclusions: The most frequently isolated microorganism in SSTIs was S. aureus and 71 isolates were categorized as SAMR, therefore it is necessary to consider SAMR as a frequent pathogen. Due to the low resistance found for CLI and TMS, they should be considered for empirical treatment in SSTIs in outpatients

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Biomarcadores de laboratorio y afección clínica en pacientes positivos a COVID-19 / Laboratory biomarkers and clinical condition in patients positive for COVID-19

El nuevo coronavirus SARS-CoV-2, causante de la enfermedad denominada COVID-19, fue identificado por primera vez en Wuhan (China) en noviembre del 2019. Como en otros escenarios clínicos, el laboratorio desempeña un papel esencial, más allá del diagnóstico etiológico y la enfermedad, para definir el pronóstico y seguimiento, así como, ayudar a monitorear su tratamiento. Los datos concernientes al diagnóstico clínico y de laboratorio de la enfermedad por COVID-19, en la población adulta, son insuficientes para comprender la evolución de la misma hacia los casos graves y críticos sin comorbilidades; para ello, este estudio pretende describir los exámenes de laboratorio en los pacientes atendidos en cuerpo de guardia del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» con el diagnóstico de COVID-19, con el propósito de contar con una herramienta que diagnostique oportunamente una complicación grave y poder realizar el seguimiento del tratamiento al paciente.

The new SARS-CoV-2 coronavirus causing the disease called COVID-19 was first identified in Wuhan (China) in November 2019. The laboratory, as in other clinical scenarios, plays an essential role beyond the etiological diagnosis and the disease in order to define the prognosis and follow-up, as well as to help monitoring its treatment. Data concerning clinical and laboratory diagnosis of COVID-19 disease in the adult population are insufficient to understand its evolution towards severe and critical cases without comorbidities, that is why this study aims to describe the laboratory tests in patients treated in the emergency room at "Arnaldo Milián Castro" Clinical and Surgical University Hospital with the diagnosis of COVID-19, with the purpose of having a tool that timely diagnoses a serious complication and to be able to monitor patient treatment.

Evaluación e impacto de la educación de la técnica inhalatoria en pacientes adultos que usan inhalador de dosis medida / Evaluation and Impact of Education on the Inhalation Technique in Adults who Use a Metered Dose Inhaler

Introducción: los inhaladores de dosis medida (MDI) ocupan un lugar fundamental en el tratamiento de las enfermedades obstructivas. Sin embargo, existe evidencia de su in-correcta utilización y, por consiguiente, limitados beneficios. El objetivo de este traba-jo es evaluar el uso de los MDI y conocer el impacto que tiene la educación en la técnica inhalatoria. Método: estudio prospectivo, antes-después realizado en pacientes hos-pitalizados y ambulatorios. Se registraron datos demográficos y sobre el uso del MDI. Posteriormente, se pidió al paciente que realizara dos inhalaciones con su MDI y aero-cámara, se otorgó un puntaje según la escala ESTI y se educó en forma oral, visual y con folleto explicativo. Los pacientes fueron reevaluados antes de cumplir un mes de la primera evaluación. Resultados: se incluyeron 119 pacientes, 53,8% masculinos, con edad media de 60,6 (± 16) años. El 60,5% utilizaba aerocámara siempre y el 19,3% casi siempre. El 65% tenía la percepción de que su técnica inhalatoria era buena o muy bue-na. El 32% no sabía identificar su inhalador de rescate. El puntaje en la escala ESTI ba-sal fue de 6,8 (± 2,3) ptos. el que mejoró en la reevaluación, 8,7 (± 1,5) ptos.; p<0,0001. La técnica inhalatoria calificada de muy buena o buena mejoró de un 24,4% a un 63%; p<0.0001. Conclusión: nuestros resultados muestran que la técnica de inhalación con MDI es deficiente y una educación activa evidencia un impacto significativo en el co-rrecto uso de estos dispositivos. (AU)

Introduction: metered dose inhalers (MDI) are fundamental in treating obstructive dis-eases. However, there is evidence of its incorrect use and therefore limited benefits. This work aims to evaluate the use of MDIs and to know the impact of education on the cor-rect inhalation technique. Method: prospective, before-after study, carried out in hospitalized and outpatients. Demographic data and data on the use of the MDI are re-corded. Subsequently, the patient was asked to take 2 inhalations with his MDI and valved-holding chamber, a score was given according to the ESTI score and he was ed-ucated orally, visually, and with an explanatory brochure. The patients were reassessed within 1 month of the first evaluation. Results: 119 patients were included, 53.8% male, with a mean age of 60.6 (±16) years. 60.5% always used an aero chamber and 19.3% almost always. 65% had the perception that their inhalation technique was good or very good. 32% did not know how to identify their rescue inhaler. The score on the base-line ESTI scale was 6.8 (± 2.3) points, which improved in the reassessment, 8.7 (± 1.5) points; p<0.0001. The inhalation technique rated as very good or good improved from 24.4% to 63%; p<0.0001. Conclusion: our results show that the inhalation technique with MDI is deficient and active education demonstrates a significant impact on the cor-rect use of these devices. (AU)

Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature

Abstract Background and objectives: In this systematic review, we carried out an assessment of perioperative costs of local or regional anesthesia versus general anesthesia in the ambulatory setting. Methods: A systematic literature search was conducted to find relevant data on costs and cost-effectiveness analyses of anesthesia regimens in outpatients, regardless of the medical procedure they underwent. The hypothesis was that local or regional anesthesia has a lower economic impact on hospital costs in the outpatient setting. The primary outcome was the average total cost of anesthesia calculated on perioperative costs (drugs, staff, resources used). Results: One-thousand-six-hundred-ninety-eight records were retrieved, and 28 articles including 27,581 patients were selected after reviewing the articles. Data on the average total costs of anesthesia and other secondary outcomes (anesthesia time, recovery time, time to home readiness, hospital stay time, complications) were retrieved. Taken together, these findings indicated that local or regional anesthesia is associated with lower average total hospital costs than general anesthesia when performed in the ambulatory setting. Reductions in operating room time and postanesthesia recovery time and a lower hospital stay time may account for this result. Conclusions: Despite the limitations of this systematic review, mainly the heterogeneity of the studies and the lack of cost-effectiveness analysis, the economic impact of the anesthesia regimes on healthcare costs appears to be relevant and should be further evaluated.

Predictive Factors of Tolerance in Office Hysteroscopy - a 3-Year Analysis from a Tertiary Center

Abstract Objective Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Methods Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. Results A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Conclusion Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.

Chest x-ray findings of paediatric patients seen at a Teaching Hospital in North-western Nigeria

Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.

Evaluation of anticholinergic burden in elderly outpatients and the risk factors / 中南大学学报(医学版)

OBJECTIVES@#The use of anticholinergic drugs in the elderly may lead to negative events such as falls, delirium, urinary retention and cognitive decline, and the higher the number of anticholinergic drugs use, the more such negative events occur. This study aims to analyze the risk factors associated with the prescription of total anticholinergic drugs in elderly outpatients and evaluate the rationality of anticholinergic drugs, and to provide a reference for reducing the adverse effects of anticholinergic drugs.@*METHODS@#A list of drugs with anticholinergic activity based on the Beers criteria was established. The basic information (such as age and gender), clinical diagnosis, and medications of elderly outpatient were extracted from hospital electronic medical records, and the Anticholinergic Cognitive Burden (ACB) Scale was used to calculate the anticholinergic burden for each patient. Logistic regression analysis was used to identify the potential risk factors for the occurrence of problems such as multiple medication and insomnia.@*RESULTS@#A total of 1 840 prescriptions for elderly patients were reviewed. Of these patients, ACB score was more than or equal to 1 in 648 (35.22%) patients. Number of prescription medication (95% CI: 1.221 to 1.336) and insomnia (95% CI: 3.538 to 6.089) were independent factors affecting ACB scores (both P<0.01). Medications for patients of ACB scores were most commonly treated with the central nervous system drugs (such as alprazolam and eszopiclone) and for the cardiovascular system drugs (such as metoprolol and nifedipine).@*CONCLUSIONS@#There is a high rate of ACB drugs use in geriatric patients, and the clinical focus should be on multiple medication prescriptions, especially on the central nervous system drugs (such as alprazolam and eszopiclone) and cardiovascular system drugs (such as metoprolol and nifedipine). The prescription review should be emphasized to reduce adverse reactions to anticholinergic drugs in elderly patients.

Health-related internet usage in the Service Outpatient Department of De La Salle University Center

Background@#Health related internet usage is common among patients globally. The literature review showed no local study regarding health- related internet usage in the Philippines hence investigation of internet use for medical information in the outpatient department was done@*Objective@#To describe the health-related internet usage; its prevalence, reasons & experience on use, perceived effects and sources of medical information in the Outpatient Department of a tertiary Hospital.@*Method@#A single center, observational, sectional study utilizing a modified 33-item self- administered questionnaire about Health-related Internet usage of patients consulting at the service outpatient department of De La Salle University Medical Center, Dasmariñas City, Cavite, Philippines fromSeptember-October 2020. 381 eligible participants were included in the study based on the computed sample size. The data were reported as frequencies and percentage distribution.@*Results@#Majority of the participants belongs to the 26-35 years old group (32.02%) and most were Females (69%). Most used the Internet in general (88%) and Health-related internet usage was high among these users (78.42%). Despite the high internet usage, majority stated that the primary source of medical information was Doctors (76.25%). Commercial websites such as (Google & Yahoo) were the most commonly used during health- related searches (40.49%) and most searches were about their medical condition (36.22%). Most of the participants stated that sometimes they trust information from the internet (58.63%) and find it useful (68%). Forty five percent stated that medical information obtained from the internet were applied without consulting a doctor and subsequently, many does not disclose this information during medical consultation with a doctor (64%). Participants stated that their primary reason for Health-related internet use was personal knowledge about medical condition (57%). Also, most of the participants believed that Health-related searches do not have an effect on their medical condition (62%) and relationship with their doctor (61%).@*Conclusion@#The study clearly indicated that Health- related Internet Usage was a common practice in the outpatient department. Although, majority of the patients stated that their Doctors were the primary source of medical information, many individuals still do not divulge medical information obtained from the internet hence physicians should regularly inquire regarding health-related internet usage and educate regarding erroneous online medical information to correct misperception that may affect their health. Lastly, due to the overwhelming use of the internet among patients, health institutions and practitioners may develop mobile friendly applications to render sufficient medical service and provide holistic care to patients especially in this time of pandemic.

Clinical practice guidelines for the diagnosis and management of Dyspnea in primary care and outpatient setting

Background@#Dyspnea also referred to as shortness of breath or breathlessness is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a symptom of the disease, rather than a disease itself. Its etiology can be designated as arising from four primary categories: respiratory, cardiac, neuromuscular, psychogenic, systemic illness, or a combination of these.@*Objective@#The general objective in developing this guideline is to improve the quality and outcomes of care to adult patients with dyspnea or shortness of breath in primary care and outpatient setting.@*Methods@#The ADAPTE process was utilized in the development of the initial guideline recommendations where the following steps were followed: 1) definition of clinical questions, 2) searching, screening and appraisal of guidelines, 3) decision and selection of evidence and 4) iterative drafting of guideline recommendation was done. The retrieved guidelines were systematically evaluated for their quality and validity using the Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument, which is a tool developed to assess the methodological quality of practice guidelines. If the adopted guideline did not have recommendations for our clinical question, we developed the recommendations de novo using the GRADE approach. We prioritized retrieving systematic reviews and meta-analysis articles that are relevant to our clinical questions. In the development of recommendations, the guideline development team prioritized the interventions that address the following outcomes i.e., decrease in severity of dyspnea, resolution of dyspnea, improved quality of life and decrease mortality. Data from the articles were extracted and the evidence was then summarized and appraised based on the type of study. The recommendations were then developed by the team as the initial draft that was subjected to external review and consensus panel discussion for finalization.

Aspectos psicológicos e estratégias de enfrentamento evidenciados em pacientes com doenças cardiovasculares / Psychological aspects and coping strategies evidenced in patients with cardiovascular diseases

As doenças cardiovasculares (DCV) fazem parte de grupo de doenças crônicas e apresentam alto índice de mortalidade. Deste modo, representam grande demanda aos serviços hospitalares, contribuindo para um número alto de internações. Apesar dos grandes avanços tecnológicos e do conhecimento clínico, os aspectos psicológicos ainda são pouco conhecidos. Objetivo: A presente pesquisa tem como objetivo verificar a prevalência de alterações psicológicas entre pacientes com DCV em tratamento ambulatorial. Métodos: Trata-se de um estudo transversal descritivo-quantitativo. Foram aplicados um questionário sociodemográfico, o Inventário Breve de Sintomas (BSI), o Inventário de Depressão de Beck (BDI-II) e a Escala Brief Cope. A coleta de dados ocorreu entre o período de março a abril de 2022, exclusivamente no ambulatório do Hospital Estadual de Urgências de Goiás Dr. Valdomiro Cruz. As variáveis sociodemográficas e clínicas foram analisadas por estatística descritiva ­ frequência absoluta e relativa, média, mediana e desvio padrão (DP). Resultados: O estudo revelou uma prevalência de sintomas psicológicos entre pacientes com doenças cardiovasculares em tratamento ambulatorial. Conclusão: Os principais sintomas psicológicos evidenciados foram psicoticismo, ansiedade e depressão e as principais estratégias de coping foram suporte instrumental, suporte emocional e religiosidade

: Cardiovascular diseases (CVD) are part of a group of chronic diseases and have a high mortality rate. Thus, they represent a great demand for hospital services, representing a high number of hospitalizations. Despite the great technological advances and clinical knowledge, the psychological aspects are still little known. Objective: This research aims to verify the prevalence of psychological changes among patients with CVD undergoing outpatient treatment. Methodology: This is a descriptive-quantitative cross-sectional study. A sociodemographic questionnaire, the Brief Symptom Inventory (BSI), the Beck Depression Inventory (BDI-II) and the Brief Cope Scale were applied. Data collection took place between March and April 2022, exclusively at the outpatient clinic of the Hospital Estadual de Urgências de Goiás Dr. Valdomiro Cruz. Sociodemographic and clinical variables were accompanied by descriptive statistics ­ absolute and relative frequency, mean, median and standard deviation (SD). Results: The study revealed a prevalence of psychological alterations among patients with cardiovascular diseases in outpatient treatment. Conclusion: The main psychological symptoms evidenced were psychoticism, anxiety and depression and the main coping strategies were instrumental support, emotional support and religiosity

Evaluation of prescribing patterns for pediatric community-acquired pneumonia in the outpatient department of a tertiary-care medical center in the Philippines

OBJECTIVES@#This study evaluated the antibiotic prescribing patterns in pediatric patients in the Out Patient Department (OPD) of the Philippine Children’s Medical Center (PCMC) where it may encourage drug monitoring and improvement in the utilization of antibiotics in the department.@*MATERIALS AND METHODS@#A descriptive, cross-sectional study involving patient encounters selected using convenience sampling was conducted at the outpatient department of PCMC. All previously healthy pediatric patients aged 3 months to 18 years diagnosed with pediatric community- acquired pneumonia (PCAP) with no known acute and chronic comorbidities were included. The observed values of the antibiotic prescribing indicators were compared with the optimal values recommended by the World Health Organization (WHO), and the Index of Rational Drug Prescribing (IRDP) was calculated.@*RESULTS@#A total of 600 patients diagnosed with PCAP were included in the study seen at the PCMC OPD from January 2020 to July 2022. Ninety-six percent of the patient encounters had at least one antibiotic prescribed (SD + 0.20). The average number of medicines prescribed per patient encounter was 2.05 (SD + 0.85). Of these, 100% were prescribed by generic name and were prescribed from the essential drug list. The most commonly prescribed medications were antibiotics (43.17%) with coamoxiclav (42.93%), amoxicillin (37.76%), and cefuroxime (7.59%) being the top three commonly prescribed antibiotics.@*CONCLUSION@#With respect to the IRDP, PCMC scores well with 3.16 where the most rational score is 4. However, this study highlights the high occurrence of prescribing antibiotics in the institution.

A preliminary study on salivary microbiota of patients with laryngopharyngeal reflux / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the characteristics of salivary microbiota in patients with laryngopharyngeal reflux (LPR). Methods: A case-control study was applied to enroll 60 patients and healthy subjects who were outpatients of the Department of Otorhinolaryngology Head and Neck Surgery of the Eighth Medical Center of the PLA General Hospital from December 2020 to March 2021, including 35 males and 25 females, aged from 21 to 80 (33.75±11.10) years. Thirty patients with suspected laryngopharyngeal reflux were selected as study group and thirty healthy volunteers without pharyngeal symptoms were selected as control group. Their salivary samples were collected, and the salivary microbiota was detected and analyzed by 16S rDNA sequencing. SPSS 18.0 software was used for statistical analysis. Results: There was no significant difference in the diversity of salivary microbiota between the two groups. At the phylum classification level, the relative abundance of Bacteroidetes in the study group was higher than that in the control group[37.86(31.15, 41.54)% vs 30.24(25.51, 34.18)%,Z=-3.46,P<0.01]. And the relative abundance of Proteobacteria in the study group was lower than that in the control group [15.76(11.81, 20.17)% vs 20.63(13.98, 28.82)%, Z=-1.98,P<0.05]. At the genus level, the relative abundance of Prevotella, Lactobacillus, Parascardovia and Sphingobium in the study group was higher than that in the control group(Z values were-2.92, -2.69, -2.05, -2.31, respectively, P<0.05).And the relative abundance of Streptococcus, Cardiobacterium, Klebsiella and Uruburuella of study group was lower than that of control group(Z values were -2.43, -2.32, -2.17, -2.32, respectively, P<0.05). LEfSe difference analysis showed that there were 39 bacteria with significant differences between the two groups, including Bacteroidetes, Prevotellaceae and Prevotella, which were enriched in the study group, and Streptococcaceae, Streptococcus and other taxa, which were enriched in the control group(P<0.05). Conclusion: The changes of the microflora in the saliva between LPR patients and healthy people suggest that the dysbacteriosis might exist in LPR patients, which may play an important role in the pathogenesis and development of LPR.

Survey on the current situation and influencing factors of humanistic care ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City / 中华劳动卫生职业病杂志

Objective: To investigate the humanistic care consciousness and ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City. Methods: In June 2021, a total of 345 outpatient and emergency nurses from 6 tertiary Grade A hospitals in Zhengzhou City were selected as the survey objects by random number table method. The humanistic care ability of outpatient and emergency nurses was investigated. Multiple linear regression analysis was used to analyze the related factors influencing the humanistic care ability of outpatient and emergency nurses. Results: The total score of humanistic care ability of outpatient and emergency nurses in Zhengzhou tertiary Grade A hospital was (194.18±30.53). The scores of humanistic care ability of outpatient and emergency nurses with different gender, age, educational background, professional title, length of service, night shift frequency, marital status, children's status, employment patterns and average monthly household income were significantly different (P<0.05). Regression analysis showed that education background, length of service, professional title and night shift frequency were independent influencing factors for outpatient and emergency nurses' humanistic care ability (β=0.243, 0.139, 0.163, -0.126, P<0.05) . Conclusion: At present, the humanistic care ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City is still low. Education, length of service, professional title and night shift frequency are independent influencing factors affecting the humanistic care ability of nurses.

Investigation and influencing factors on pelvic floor muscle strength of 929 adult females in gynecological outpatient department / 中华妇产科杂志

Objective: To investigate the present situation of pelvic floor muscle strength, and to analyze the factors affecting pelvic floor muscle strength. Methods: The data of patients who were admitted into the general outpatient department of gynecology, Peking University People's Hospital from October 2021 to April 2022 were collected, and the patients who met the exclusion criteria were included in this cross sectional study. The patient's age, height, weight, education level, defecation way and defecation time, birth history, maximum newborn birth weight, occupational physical activity, sedentary time, menopause, family history and disease history were recorded by questionnaire. Morphological indexes such as waist circumference, abdomen circumference and hip circumference were measured with tape measure. Handgrip strength level was measured with grip strength instrument. After performing routine gynecological examinations, the pelvic floor muscle strength was evaluated by palpation with modified Oxford grading scale (MOS). MOS grade>3 was taken as normal group and ≤3 as decreased group. Binary logistic regression was used to investigate the related factors of deceased pelvic floor muscle strength. Results: A total of 929 patients were included in the study, and the average MOS grade was 2.8±1.2. By univariate analysis, birth history, menopausal time, defecation time, handgrip strength level, waist circumference and abdominal circumference were related to the decrease of pelvic floor muscle strength (all P<0.05). By binary logistic regression analysis, the level of handgrip strength (OR=0.913, 95%CI: 0.883-0.945; P<0.001) was correlated with normal pelvic floor muscle strength; waist circumference (OR=1.025, 95%CI: 1.005-1.046; P=0.016), birth history (OR=2.224, 95%CI: 1.570-3.149; P<0.001), sedentary time> 8 hours (OR=2.073, 95%CI: 1.198-3.587; P=0.009) were associated with the decrease of pelvic floor muscle strength. Conclusions: The level of handgrip strength is related to the normal pelvic floor muscle strength of females, while the waist circumference, birth history and sedentary time>8 hours are related to the decrease of pelvic floor muscle strength of females. In order to prevent the decrease of pelvic floor muscle strength, it is necessary to carry out relevant health education, enhance exercise, improve the overall strength level, reduce daily sedentary time, maintain symmetry, and carry out comprehensive overall intervention to improve pelvic floor muscle function.

Mode establishment and preliminary clinical application of anterior cervical surgery in outpatient setting / 中国修复重建外科杂志

OBJECTIVE@#To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness.@*METHODS@#A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting ( n=35, outpatient setting group) or in inpatient setting ( n=35, inpatient setting group). There was no significant difference between the two groups ( P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10.@*RESULTS@#The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group ( P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group ( P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss ( P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation ( P<0.05). There was no significant difference in the improvement of the above scores between the two groups ( P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference ( t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups.@*CONCLUSION@#The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients' medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.

Vivencia de la espiritualidad en el paciente con cáncer en quimioterapia ambulatoria / Experience of spirituality in cancer patients undergoing ambulatory chemotherapy / Experiências de espiritualidade em pacientes com câncer em quimioterapia ambulatorial

Objetivo: Analizar la vivencia de la espiritualidad en el paciente con cáncer en tratamiento con quimioterapia ambulatoria. Materiales y métodos: Se realizó una investigación cualitativa con enfoque histórico hermenéutico. Participaron seis personas con diagnóstico de cáncer que se encontraban en tratamiento de quimioterapia ambulatoria en tres centros asistenciales de la ciudad de Medellín, Colombia entre julio de 2020 y julio de 2021. La información se recolectó a través de entrevistas semiestructuradas. El proceso de análisis se realizó utilizando técnicas de la teoría fundamentada de Strauss y Corbin, tales como: microanálisis, codificación abierta, codificación axial y comparación constante. Resultado: La forma como los pacientes con cáncer en tratamiento de quimioterapia ambulatoria viven la espiritualidad se representa a través de las siguientes categorías: "Emociones vividas durante el tratamiento como impulso para seguir adelante", "Las redes de apoyo, una fuente de fortaleza y esperanza", "El cáncer, una prueba divina entre las limitaciones y el aprendizaje", "La empatía del personal de salud, un mecanismo para afrontar la enfermedad y generar bienestar" y "La espiritualidad, una fuerza que cambia la perspectiva de la enfermedad". Conclusiones: Pese a la connotación negativa del diagnóstico de cáncer, la dimensión espiritual en el paciente con cáncer en tratamiento de quimioterapia ambulatoria contribuye a que la persona vea la enfermedad desde una perspectiva positiva, aumente la fe y la esperanza para continuar luchando, le dé un sentido de que todo ha valido la pena, permite ver más allá y proporcionatranquilidad para enfrentar las adversidades ocasionadas por el cáncer.

Objective: To analyze the experience of spirituality in cancer patients undergoing treatment with ambulatory chemotherapy. Materials and methods: A qualitative research with a historica hermeneutic approach. Six people with a diagnosis of cancer who were undergoing outpatient chemotherapy treatment in three health care centers in the city of Medellin, Colombia between July 2020 and July 2021 participated. The information was collected through semi-structured interviews. The analysis process was carried out using Strauss and Corbin's grounded theory techniques: microanalysis, open coding, axial coding, and constant comparison. Results: The way cancer patients undergoing outpatient chemotherapy treatment experience spirituality is represented through the following categories: "Emotions experienced during treatment as an impetus to move forward", "Support networks, a source of strength and hope", "Cancer, a divine test between limitations and learning", "Empathy of health personnel, a mechanism to coping with the disease and generate well-being", and "Spirituality, a force that changes the perspective of the disease". Conclusions: Despite the negative connotation of the diagnosis of cancer, the spiritual dimension in the cancer patient undergoing outpatient chemotherapy treatment contributes to the person seeing the disease from a positive perspective, increases faith and hope to continue fighting, gives a sense that everything has been worthwhile, allows seeing beyond and provides peace of mind to facethe adversities caused by cancer.

Objetivo: Analisar a experiência da espiritualidade em pacientes com câncer em quimioterapia ambulatorial. Materiais e Métodos: Realizou-se uma pesquisa qualitativa com uma abordagem histórico hermenéutico. Participaram seis pessoas diagnosticadas com câncer que estavam em tratamento quimioterápico ambulatorial em três centros de atendimento da cidade de Medellín, Colômbia, entre julho de 2020 e julho de 2021. As informações foram coletadas por meio de entrevistas semiestruturadas. O processo de análise foi realizado utilizando as técnicas de teoria fundamentada de Strauss e Corbin, tais como: microanálise, codificação aberta, codificação axial e comparação constante. Resultado: A forma como os pacientes oncológicos em tratamento quimioterápico ambulatorial vivenciam a espiritualidade é representada por meio das seguintes categorias: "Emoções experimentadas durante o tratamento como um ímpeto para seguir em frente", "Redes de apoio, fonte de força e esperança", "Câncer, teste divino entre limitações e aprendizagem", "A empatia do pessoal de saúde, um mecanismo para enfrentamento da doença e gerar bem-estar" e "A espiritualidade, uma força que muda a perspectiva da doença". Conclusões: Apesar da conotação negativa do diagnóstico de câncer, a dimensão espiritual em pacientes com câncer em tratamento quimioterápico ambulatorial ajuda a pessoa a ver a doença de uma perspectiva positiva, aumenta a fé e a esperança de continuar lutando, dá a sensação de que tudo valeu a pena, permite você enxergar além e traz tranquilidade para enfrentar as adversidades causadas pelo câncer.

Outpatient pharmaceutical office: access to medicines in public health

Abstract We evaluated the implementation of the outpatient pharmaceutical office in a teaching hospital regarding the access to medicines available in the Unified Health System - SUS. This is a descriptive-analytical study, based on secondary data analysis of 735 appointments performed by the pharmacist from 2015 to 2017. Of the drugs prescribed to patients attended at the outpatient pharmacist office, 86.39% were listed in the National List of Essential Medicines - RENAME, of which 95.43% belonged to the Specialized Component of Pharmaceutical Assistance. Evaluating the patient's diagnosis against the inclusion criteria of the Clinical Protocols and Therapeutic Guidelines (PCDT), that the most frequent pharmaceutical interventions were: adequacy of the medication request documents (56.4%) and examination requests for pharmacotherapeutic follow up (28.5%). When the prescribed drugs were not included in RENAME/PCDT, the intervention was accepted in 90.3% of the proposals for exchange with available drug in SUS. Still, it was possible to refer the patient to primary care for renewal of continuity of treatment in 95.1% of cases. In conclusion, the role of the clinical pharmacist contributes to the resolution of untreated health problems by promoting access to medicines within the scope of SUS and their rational use in accordance with the PCDT.

Nivel de información sobre factores de riesgo de Infarto agudo de miocardio en pacientes ambulatorios, Corrientes año 2021 / Level of information on risk factors for acute myocardial infarction in outpatients, Corrientes year 2021

Determinar el nivel de información sobre factores de riesgo de Infarto agudo de miocardio en los pacientes ambulatorios que asisten a una institución de salud de la provincia de Corrientes año 2021. Metodología: Estudio cuantitativo descriptivo, transversal y observacional. Muestra obtenida mediante muestreo probabilístico aleatorio simple compuesta por 108 pacientes que asistieron a los consultorios de Diabetes, Presurometría y Hospital de Día. Se aplicó un cuestionario validado mediante una prueba piloto. Variables: edad, sexo, nivel de instrucción, Nivel de información sobre alimentación, hábitos nocivos, actividad física y preguntas generales. Los resultados fueron volcados a una matriz diseñada en programa Excel. Resultados: La población en estudio presento una mediana de edad de 43, moda 39 y predomino del sexo masculino 56%, sobre el femenino 44%, en el nivel de instrucción prevaleció el secundario completo 19% seguido de primario incompleto 15%. Abordando los niveles de información sobre factores de riesgo de Infarto agudo de miocardio predominaron los niveles altos en todas las variables trabajadas, obteniendo un nivel general de información alto del 82%, se apreció en la alimentación 65%, hábitos nocivos 70%, aspectos generales un 86% y actividad física 48%. Conclusión: Esta investigación remarca la importancia de la educación permanente y en etapas tempranas sobre los factores de riesgo de Infarto Agudo de Miocardio. La población en estudio presento un nivel alto de información. No obstante, la educación debe fomentarse para llegar al 37% restante que obtuvo niveles inferiores[AU]

To determine the level of information on risk factors for acute myocardial infarction in outpatients attending a health institution in the province of Corrientes in 2021. Methodology: Quantitative descriptive, cross-sectional and observational study. Sample obtained by simple random probabilistic sampling made up of 108 patients who attended the Diabetes, Blood Pressure and Day Hospital clinics. A validated questionnaire was applied by means of a pilot test. Variables: age, sex, level of education, level of information on food, harmful habits, physical activity and general questions. Te results were dumped into a matrix designed in Excel program. Results: Te population under study presented a median age of 43, mode 39 and a predominance of males 56%, over females 44%, on the level of education the complete secondary prevailed 19% followed by incomplete primary 15%. Addressing the levels of information on risk factors for acute myocardial infarction, high levels predominated in all the variables worked on, obtaining a high general level of information of 82%, disaggregating 65%, harmful habits 70%, aspects general 86% and physical activity 48%. Conclusion: Tis research highlights the importance of permanent education and in early stages about the risk factors of Acute Myocardial Infarction. Te study population presented a high level of information. However, education should be encouraged to reach the remaining 37% who obtained lower levels[AU]

: Determinar o nível de informação sobre fatores de risco para infarto agudo do miocárdio em pacientes ambulatoriais atendidos em uma instituição de saúde na província de Corrientes em 2021. Metodologia: Estudo quantitativo descritivo, transversal e observacional. Amostra obtida por amostragem probabilística aleatória simples composta por 108 pacientes atendidos nas clínicas de Diabetes, Pressão Arterial e Hospital Dia. Foi aplicado um questionário validado por meio de teste piloto. Variáveis: idade, sexo, escolaridade, nível de informação sobre alimentação, hábitos nocivos, atividade física e questões gerais. Os resultados foram despejados em uma matriz projetada no programa Excel. Resultados: A população em estudo apresentou mediana de idade de 43 anos, moda 39 e predominância do sexo masculino 56%, sobre o feminino 44%, no nível de escolaridade o ensino médio completo prevaleceu 19% seguido do ensino fundamental incompleto 15%. Abordando os níveis de informação sobre fatores de risco para infarto agudo do miocárdio, predominaram níveis elevados em todas as variáveis trabalhadas, obtendo um nível geral de informação elevado de 82%, desagregando 65%, hábitos nocivos 70%, aspectos gerais 86% e atividade física 48%. Conclusão: Esta pesquisa destaca a importância da educação permanente e precoce sobre os fatores de risco do Infarto Agudo do Miocárdio. A população do estudo apresentou um alto nível de informação. No entanto, a educação deve ser incentivada para atingir os 37% restantes que obtiveram níveis mais baixos[AU]

Lineamientos técnicos para la atención nutricional y manejo ambulatorio de las personas con malnutrición en el ciclo de vida / Technical guidelines for nutritional care and outpatient management of people with malnutrition in the life cycle

Para contribuir a reducir o mejorar la problemática, se hace necesario fortalecer la atención nutricional, la cual tiene presencia en los diferentes niveles de atención en salud, sin embargo, no se cuenta con una normativa que determine como llevar a cabo el proceso; así como el manejo integral de la malnutrición. Sumado a ello se encuentra la brecha de cobertura con nutricionistas en los establecimientos de salud que aborden y desarrollen este tipo de atención; dicha situación da lugar a que los profesionales en nutrición empleen técnicas de manejo para la malnutrición no estandarizadas en el nivel nacional, a nivel público y privado. El presente documento, "Lineamientos Técnicos para la atención nutricional y manejo ambulatorio de las personas con malnutrición en el ciclo de vida", contiene las disposiciones técnicas del proceso de atención nutricional, manejo integral de la malnutrición; y referencia, interconsulta y retorno

To help reduce or improve the problem, it is necessary to strengthen nutritional care, which is present at different levels of health care, however, there are no regulations that determine how to carry out the process; as well as the comprehensive management of malnutrition. Added to this is the coverage gap with nutritionists in health establishments that address and develop this type of care; This situation leads nutrition professionals to use management techniques for malnutrition that are not standardized at the national, public, and private levels. This document, "Technical Guidelines for nutritional care and outpatient management of people with malnutrition in the life cycle", contains the technical provisions of the nutritional care process, comprehensive management of malnutrition; and reference, interconsultation and return