Manifestations oto-rhino-laryngologiques de la COVID-19 chez l' enfant à Brazzaville / Otorhinolaryngological manifestations of COVID-19 in Children in Brazzaville

Introduction.Les infections respiratoires hautes représentent environ 80% des affections ORL de l'enfant. L'objectif de ce travail était de contribuer à la connaissance des manifestations ORL de la covid-19 chez l'enfant afin d'en améliorer la prise en charge. Patients et méthodes. Il s'est agi d'uneétudedescriptive de 12 mois incluant les dossiers des enfants âgés de moins de 18 ans symptomatiques et testés positifs à la COVID-19 par RT-PCR. Il s'agissait des enfants reçus en consultation dans les services d'otorhinolaryngologie de l'hôpital de Référencede Talangaï et du CHU de Brazzaville. Tous les prélèvements étaient acheminés au laboratoire national de santé publique où le diagnostic était fait par RT-PCR. Résultats.Sur un total de 1080 enfants consultés pour une symptomatologie respiratoire ORL, seuls 21 étaient testés positifs à la COVID-19 représentant une prévalence de 1,9%. L'âge moyen était de 12,6 ans ± 5,7 (extrêmes: 3 ­17 ans) avec un ratio de 0,9 légèrement en faveur des filles. La tranche d'âge de 13 à 18 ans était la plus représentative (n=13, soit 61,8%) suivie de 9 à 13 ans (n=4, soit 19,1%) correspondant aux enfants ayant un antécédent personnel d'atopie (80,9%). La symptomatologie était dominée par l'angine érythémateuse (n=17, soit 80,9%) suivie de la rhinopharyngite (n=3, soit 14,4%) et du syndrome de Marschall (n=1, soit 4,7%). Tous les enfants étaient orientés auprès des services habiletés à la prise en charge mais seuls 13 d'entre eux (61,9%) étaient contre-référés et déclarés guéris après un contrôle RT-PCR négatif. Conclusion.Si l'angine érythémateuse domine la symptomatologie COVID-19 chez l'enfant, il en ressort que le syndrome de Marschall reste une exception clinique.

Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management.Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in Introduction. Upper respiratory infections represent about 80% of ENT diseases in children. The objective of this work was to contribute to the knowledge of the ENT manifestations of covid-19 in children in order to improve their management. Patients and methods. This was a 12-month descriptive study including the files of symptomatic children aged 0 to 18 who tested positive for COVID-19 by RT-PCR. These were children seen in consultation in the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positive for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception the otorhinolaryngology departments of the Talangaï Reference Hospital and the Brazzaville University Hospital. All the samples were sent to the national public health laboratory where the diagnosis was made by RT-PCR. Results. Out of a total of 1080 children consulted for ENT respiratory symptoms, only 21 tested positives for COVID-19, representing a prevalence of 1.9%. The average age was 12.6 years ± 5.7 (extremes: 3 ­17 years) with a ratio of 0.9 slightly in favor of girls. The age group of 13 to 18 years was the most representative (n=13, or 61.9%) followed by 9 to 13 (n=4, or 19%) corresponding to children with a personal history of atopy (80.9%). Symptoms were dominated by erythematous angina (n=17, or 80.9%) followed by nasopharyngitis (n=3, or 14.4%) and Marschall's syndrome (n=1, or 4.7%). All the children were referred to the care services but only 13 of them (61.9%) were cross-referred and declared cured after a negative RT-PCR control. Conclusion. If angina dominates the COVID-19 symptomatology, it emerges as Marschall's syndrome remains a clinical exception.

Organisation et le fonctionnement de la surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-est, Côte d'Ivoire de janvier 2022 à juin 2022 / NA

La rougeole est une maladie infantile banale, peut être mortelles quand elle est sous-estimée. Nous avons initié cette étude dont l'objectif général est d'analyser le système de surveillance épidémiologique de la rougeole dans le district sanitaire de Yopougon-Est.MéthodesNous avons procédé à une évaluation normative de la surveillance épidémiologique de la rougeole réalisée en 6 (Six) mois dans ledit district sanitaire. Les critères de sélection nous ont permis de sélectionner 30 personnels de santé impliqués dans la surveillance de la rougeole. RésultatsLes médecins étaient les plus représentés (40%), suivi des infirmiers (33,3%). Les agents avaient plus de 3 ans de service (73,3%). Plus de la moitié des agents étaient formés (56%) la moyenne d'année de service était de 5,33 ans.Dans notre étude, 93,3 % des agents connaissaient la définition d'un cas de rougeole. Les seuils d'alerte et épidémique étaient connus par 56,6% des agents enquêtés. La disponibilité des registres de consultation, fiche de notification hebdomadaire de cas au niveau des structures de santé étaient de 86,7 %. Pour la transmission des données, 70% des enquêtés avaient déclarés que les rapports se transmettaient au district hebdomadairement.Les prélèvements de sang avaient été réalisés chez tous les cas suspects (100%). Les cas confirmés de rougeole représentaient 26,8 % des échantillons.ConclusionLa rougeole est une maladie de l'enfance qui est évitable par la vaccination. Cependant à défaut de vaccination, il est impérieux de mettre en place une organisation pour la détection des cas de rougeole afin d'éviter des épidémies

Teleconsulta de enfermagem: desenvolvimento de plataforma para atendimento de casos de Covid-19 / Nursing teleconsultation: development of a platform for Covid-19 case management / Telecosulta en enfermería: desarrollo de una plataforma para el manejo de casos de Covid-19

Objetivo: Desenvolver uma plataforma virtual de Teleconsulta para atendimento a casos suspeitos de Síndromes Gripais e infecção por COVID-19. Metodologia: Trata-se de um estudo de natureza aplicada, com desenvolvimento de produção tecnológica e inovadora, prospectivo, ecológico, descritivo, de série temporal. A população do estudo foi formada por qualquer pessoa sintomática para Síndromes Gripais por COVID-19, suspeitos ou confirmados, de qualquer local do Brasil. Este estudo foi realizado em duas etapas, a saber: Etapa I: Desenvolvimento da Aplicação para Plataforma de Teleconsulta. Etapa II: atendimento por meio de Teleconsulta de Casos suspeitos de COVID-19 e Sindromes Gripais. A metodologia utilizada para o desenvolvimento da aplicação proposta foi a modelagem por prototipação evolucionária. Resultados: Foram realizados 209 atendimentos na Plataforma de Teleconsulta, sendo 151 (70%) do sexo feminino e 65 (30%) do sexo masculino, com prevalência de idade variando de 20 a 29 anos (41%). Quanto ao risco de infecção por COVID-19, 42 (20%) tinham alto risco, 75 (36%) médio risco e 92 (44%) baixo risco. Os sintomas mais prevalentes foram: secreção nasal ou espirros (53%), dores no corpo (49%), dor de cabeça (47%), dor de garganta (46%), tosse seca (35%), Febre (31%), falta de ar (25%) e diarreia (23%). Inicialmente o teleatendimento foi composto por teletriagem com classificação de risco com base na sintomatologia dos pacientes que foram codificados com pontuações conforme a gravidade do sintoma para formas graves de COVID-19. A classificação de risco categorizou os pacientes em risco baixo (1 a 9 pontos), risco médio (10 a 19 pontos) e risco alto (20 a 36 pontos). Em seguida, a teleconsulta foi agendada conforme disponibilidade do paciente por meio do método SBAR para comunicação efetiva e ao término do atendimento um plano de cuidados com Sistematização da Assistência de Enfermagem ­ SAE era encaminhado ao paciente por meio de WhatsApp ou e-mail. Conclusão: A plataforma de teleconsulta possibilitou a triagem dos pacientes, reduziu as visitas desnecessárias às unidades de emergência, permitiu a avaliação e monitoramento dos casos, bem como o acompanhamento de pacientes ambulatoriais que não necessitam de avaliação presencial.

Objective: To develop a virtual Teleconsultation platform for care of suspected cases of influenza syndromes and infection by COVID-19. Methodology: This is a study of applied nature, with development of technological and innovative production, prospective, ecological, descriptive, time series. The study population was made up of any person symptomatic for COVID-19 influenza syndromes, suspected or confirmed, from any location in Brazil. This study was conducted in two stages, namely: Stage I: Development of the Application for Teleconsultation Platform. Stage II: care through Teleconsultation of suspected cases of COVID-19 and influenza syndromes. The methodology used to develop the proposed application was evolutionary prototyping modeling. Results: There were 209 consultations in the Teleconsultation Platform, 151 (70%) were female and 65 (30%) were male, with prevalence of age ranging from 20 to 29 years (41%). As for the risk of infection by COVID-19, 42 (20%) had high risk, 75 (36%) medium risk and 92 (44%) low risk. The most prevalent symptoms were: nasal discharge or sneezing (53%), body aches (49%), headache (47%), sore throat (46%), dry cough (35%), fever (31%), shortness of breath (25%), and diarrhea (23%). Initially, the telecare was composed of teletry with risk classification based on the symptomatology of the patients who were coded with scores according to symptom severity for severe forms of COVID-19. The risk classification categorized patients into low risk (1 to 9 points), medium risk (10 to 19 points), and high risk (20 to 36 points). Then, the teleconsultation was scheduled according to the patient's availability through the SBAR method for effective communication and at the end of the service a care plan with Nursing Assistance Systematization - SAE was forwarded to the patient through WhatsApp or e-mail. Conclusion: Teleconsultation platform enabled patient triage, reduced unnecessary visits to emergency units, allowed the evaluation and monitoring of cases, as well as the follow- up of outpatients who do not need face-to-face evaluation.

Objetivo: Desarrollar una plataforma de Teleconsulta virtual para atender casos sospechosos de síndromes gripales e infección por COVID-19. Metodología: Se trata de un estudio aplicado, con desarrollo de producción tecnológica e innovadora, prospectivo, ecológico, descriptivo, con serie de tiempo. La población de estudio estuvo formada por cualquier persona sintomática de síndromes gripales por COVID-19, sospechada o confirmada, de cualquier localidad de Brasil. Este estudio se realizó en dos etapas, a saber: Etapa I: Desarrollo de Aplicaciones para la Plataforma de Teleconsulta. Etapa II: atención mediante teleconsulta de casos sospechosos de COVID-19 y síndromes gripales. La metodología utilizada para el desarrollo de la aplicación propuesta fue el modelado por prototipo evolutivo. Resultados: Se realizaron 209 consultas en la Plataforma de Teleconsulta, 151 (70%) del sexo femenino y 65 (30%) del masculino, con prevalencia de edades entre 20 a 29 años (41%). En cuanto al riesgo de infección por COVID-19, 42 (20%) fueron de alto riesgo, 75 (36%) de riesgo medio y 92 (44%) de bajo riesgo. Los síntomas más prevalentes fueron: secreción nasal o estornudos (53%), dolor de cuerpo (49%), dolor de cabeza (47%), dolor de garganta (46%), tos seca (35%), fiebre (31%), falta de aliento (25%) y diarrea (23%). Inicialmente, la teleasistencia consistía en teleselección con clasificación de riesgo en función de la sintomatología de los pacientes a los que se codificaba con puntuaciones según la gravedad del síntoma para formas graves de COVID-19. La clasificación de riesgo clasificó a los pacientes en riesgo bajo (1 a 9 puntos), riesgo medio (10 a 19 puntos) y riesgo alto (20 a 36 puntos). Luego, se programó la teleconsulta de acuerdo a la disponibilidad del paciente a través del método SBAR para una comunicación efectiva y al final de la atención se remitió al paciente un plan de cuidados con Sistematización de Atención de Enfermería - SAE vía WhatsApp o correo electrónico. Conclusión: La plataforma de teleconsulta posibilitó el triaje de pacientes, redujo las visitas innecesarias a las unidades de emergencia, permitió la evaluación y seguimiento de casos, así como el seguimiento de pacientes ambulatorios que no requieren evaluación presencial.

El asma no controlada en la atención primaria: implementación y uso práctico de ReferID / Uncontrolled Asthma in Primary Care: Implementation and Practical Use of ReferID

Introducción: la evidencia de vida real muestra deficiencias en alcanzar los objetivos de control del asma, con elevado consumo de agonistas beta-2 de acción corta (SA-BA) y sobreuso de corticoides sistémicos (CS). Métodos: estudio observacional, des-criptivo, aplicando la herramienta ReferID con 4 preguntas para identificar pacientes con asma no controlada y/o en riesgo de crisis severas: en los últimos 12 meses [1] ¿Re-cibió ≥2 ciclos de CS y/o los usó como mantenimiento?; [2] ¿Tuvo ≥2 visitas a emergen-cias por asma?; [3] ¿Estuvo intubado o en Unidad de Cuidados Intensivos (UCI) por as-ma?; [4] ¿Cuántos inhaladores de SABA ha utilizado? Una respuesta afirmativa a las preguntas 1, 2 o 3, o usar ≥3 envases de SABA, sugieren riesgo de ataque grave, nece-sidad de CS y/o riesgo vital. En estos pacientes se recomienda evaluación por especia-listas. Resultados: participaron 441 pacientes de 7 instituciones del Área Metropolita-na de Buenos Aires. Al 60,1% (intervalo de confianza del 95% [IC95]:55,5%-64,7%) se le recomendó evaluación por especialista. El 33,8% (IC95:29,39%-38,21%) recibió ≥2 ciclos de CS y/o los usaba como mantenimiento. El 36,1% (IC95:31,62%-40,58%) asis-tió ≥2 veces a emergencias. El 41,5% (IC95:30,06%-38,94%) usó ≥3 envases de SABA. El 8,8% (IC95:6,16%-11,44%) tenía historia de intubación o UCI. El 37,2% se atendió en instituciones públicas, con indicadores de gravedad significativamente mayores que en las privadas. Conclusiones: ReferID es una herramienta simple que ayuda a identificar a pacientes en riesgo de crisis severa y/o que pudieran tener diagnóstico de asma gra-ve; y que se beneficiarían de una evaluación por un especialista. AU

Introduction: real-life evidence shows deficiencies in achieving asthma control goals, with high use of short-acting beta-2 agonists (SABA) and overuse of systemic cortico-steroids (SC). Methods: observational, descriptive study, applying the ReferID tool with 4 questions to identify patients with uncontrolled asthma and/or at risk of severe crisis: in the last 12 months [1] Have you received ≥2 cycles of CS and/or used them as main-tenance therapy?; [2] Have you had ≥2 emergency visits for asthma?; [3] Have you ever been intubated or admitted to the Intensive Care Unit (ICU) for asthma?; [4] How many SABA inhalers have you used? An affirmative answer to questions 1, 2 or 3, or using ≥3 canisters of SABA, suggests risk of severe attack, need for CS and/or life-threatening risk. In these patients, evaluation by specialists is recommended. Results: 441 patients from 7 institutions in the Metropolitan Area of Buenos Aires were enrolled. An evalu-ation by specialists was recommended for 60.1% (95% confidence interval [95%CI]: 55.5%-64.7%); 33.8% (95%CI:29.39%-38.21%) received ≥2 cycles of CS and/or used them as maintenance; 36.1% (95%CI:31.62%-40.58%) attended ≥2 times to the emer-gency department; 41.5% (95%CI:30.06%-38.94%) used ≥3 containers of SABA; 8.8% (95%CI:6.16%-11.44%) had a history of intubation or ICU admission; 37.2% were as-sisted in public institutions, with significantly higher severity indicators than in private ones. Conclusions: Refer ID is a simple, useful tool to quickly identify asthma patients who are at risk of severe exacerbations and/or may have a diagnosis of severe asthma and would benefit from evaluation by a specialist. AU

Frecuencia de referencias ambulatorias injustificadas, en base a diagnósticos no pertinentes, realizadas a un hospital peruano de tercer nivel / Frequency of unjustified ambulatory referrals bases on no pertinent diagnosis sent to a third level Peruvian hospital

Objetivo: Determinar la frecuencia y describir las características de referencias injustificadas, en base a diagnósticos no pertinentes, enviadas al servicio de consulta externa adultos de un hospital de tercer nivel. Material y métodos: Estudio transversal, observacional y descriptivo, realizado en el Hospital Cayetano Heredia (HCH) en el periodo abril a diciembre del 2019. Se utilizaron los datos del aplicativo "REFCON" con una población de 99 891 referencias. Para la variable "justificación de la referencia", se utilizó un listado de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte. Adicionalmente, se estudiaron las variables de edad, sexo, grupo etario, especialidad de destino, categoría del EESS de origen, distrito de origen, y diagnóstico del grupo de referencias injustificadas. Se utilizó estadística descriptiva. Resultados: La frecuencia de referencias injustificadas fue de 8,4 %. El 34,2 % fue de pacientes adultos; el 65,8 %, de adultos mayores; y el 67 %, de pacientes mujeres Las especialidades con más referencias injustificadas fueron cardiología, geriatría, medicina interna, medicina familiar y neurología. Los diagnósticos injustificados más frecuentes fueron hipertensión esencial, lumbago no especificado y cefalea. Conclusiones: La frecuencia de referencias injustificadas al HCH por diagnósticos no pertinentes fue 8,4 %, tasa similar a otros dos estudios, pese a la emisión de una lista de diagnósticos que no deberían derivarse a hospitales de la DIRIS Lima Norte.

SUMMARY Objective: To determine the frequency and to describe the characteristics of unjustified ambulatory referrals bases on no pertinent diagnosis done at an adult outpatient clinic of a third level Peruvian hospital. Methods: A cross-sectional study was carried-out from April to December 2019 at Hospital Cayetano Heredia. Data were extracted from REFCON with a population of 99 891 referrals. To justify the reference, a list of diagnosis that does not require referral was used. In addition, variables such as age, sex, specialty of destination, category of EESS, district of origin and diagnosis of the unjustified referral. Descriptive statistics was used. Results: the frequency of unjustified referrals was 8.4%; 34.2% comprised the adult population; 65.8% were elder and 67% were female. Specialties with more unjustified referrals were geriatrics, internal medicine, family medicine and neurology. The most common unjustified diagnosis was essential hypertension, nonspecific low back pain and headache. Conclusions: Despite of socializing a list of unjustified referral diagnosis a frequency of 8,4% remain in this category, which is like results from two previous studies.

Valor añadido de las interconsultas con otras especialidades médicas en el peritaje médico legal / The added value of interconsultations with other medical specialties in forensic expertise

Resumen La pericia médico legal es compleja y su resultado debe estar fundamentado considerando el análisis de varios elementos de juicio, como: la historia médico legal, el examen físico, el análisis de los expedientes médicos, estudios de laboratorio e imágenes radiológicas y en algunos casos, inclusive una interconsulta realizada a otros especialistas. El perito médico forense utiliza la interconsulta a especialistas para solventar la brecha que existe entre el conocimiento profesional y específico que posee una especialidad y una interrogante médico legal, por lo que difiere en gran manera en el objetivo, formulación y resultado de una interconsulta médica hospitalaria. Por esta razón, esta reflexión pretende contextualizar la importancia del recurso de interconsulta médica dentro del análisis pericial forense, que es un tema poco conocido en la medicina asistencial, y justificar la relevancia de la educación médica continua para los médicos especialistas que realizan las interconsultas y para quienes las solicitan.

Abstract The medical-legal report is complex and its result must be based on the análisis of various elements of judgment, such as: the legal medical history, the physical examination, the analysis of the medical records, laboratory and radiological images and in some cases, even an interconsultation with other specialists. The forensic medical expert uses the interconsultation with specialists to solve the gap that exists between the professional and specific knowledge that a specialty has and a legal medical question, for which it differs greatly in the objective, formulation and result of a hospital medical interconsultation. For this reason, this reflection aims to contextualize the importance of the resource of medical interconsultation within the forensic expert analysis, which is a little-known topic in healthcare medicine, and to justify the relevance of continuing medical education for medical specialists who perform interconsultations and for those who request them.

Avaliação das informações contidas nos encaminhamentos dos pacientes da atenção primária do município de Rio do Sul (SC) / Evaluación de las informaciones contenidas en los encaminamientos de pacientes de atención primaria en la ciudad de Rio do Sul (SC) / Evaluation of the information contained in the referrals of primary care patients in the city of Rio do Sul (SC)

Introdução: O processo de encaminhamento é um dos sistemas logísticos em atividade atualmente e tem como função interligar os diferentes níveis de atenção à saúde de determinada Rede de Atenção à Saúde (RAS). Objetivo: Avaliar as informações contidas nas guias de encaminhamento dos pacientes referenciados da atenção primária da RAS do município de Rio de Sul (SC). Métodos: Estudo observacional, analítico e transversal, em que as guias da RAS foram examinadas com base em um formulário contendo variáveis preestabelecidas. As informações coletadas receberam análise descritiva de frequências e foram representadas por n (frequência absoluta) e % (porcentagem). Resultados: Foram analisados 158 encaminhamentos. Dados demográficos estavam presentes em 158 (100%), queixa principal ou motivo da referência em 131 (82,9%), descrição da queixa principal ou do motivo da referência em 82 (51,9%), descrição dos sintomas associados em 21 (13,3%), história patológica pregressa em 61 (38,6%), lista de medicações atuais em 37 (23,4 %), alergias em dez (6,3%), achados de relevância clinica em 75 (47,5%), resultados da investigação prévia em 45 (28,5%), esboço de tratamento prévio em 42 (26,6%), diagnóstico provisório em 75 (47,5%) e declaração do que se espera do encaminhamento em 66 (41,8%). Conclusões: Revelou-se carência de informações nos encaminhamentos da RAS quando comparadas às de outros estudos, principalmente no que concerne a informações históricas do paciente, dados clínicos acerca do motivo do encaminhamento, diagnóstico provisório e declaração do que se espera do encaminhamento. No entanto, o incentivo à descrição dessas informações básicas pode ser uma medida inicial para a mudança da conjuntura atual.

Introduction: The referral process is one of the logistics systems currently in operation, and its function is to link the different levels of health care in a given health care network (HCN). Objective: To evaluate the information contained in the referral guides of patients referred from the primary care of the HCN in the Brazilian city of Rio de Sul (SC). Methods: An observational, analytical, cross-sectional study was conducted, where the HCN guides were examined from a form containing pre-established variables. The information collected was submitted to descriptive analysis of frequencies, which were represented by n (absolute frequency) and % (percentage). Results: A total of 158 referrals were analyzed, with demographic data being present in 158 (100%), main complaint or reason for referral in 131 (82.9%), description of the main complaint or reason for referral in 82 (51.9 %), description of associated symptoms in 21 (13.3%), past pathological history in 61 (38.6%), list of current medications in 37 (23.4%), allergies in 10 (6.3%), clinically relevant findings in 75 (47.5%), previous investigation results in 45 (28.5%), Prior treatment outline in 42 (26.6%), provisional diagnosis in 75 (47.5%) and declaration of what is expected of the referral in 66 (41.8%). Conclusions: There was a lack of information in HCN referrals when compared to other studies, especially concerning patient historical information, clinical data about the reason for the referral, provisional diagnosis, and declaration of what is expected of the referral. However, encouraging the description of this basic information can be an initial measure to change the current situation.

Introducción: El proceso de encaminamiento es uno de los sistemas logísticos actualmente en funcionamiento, y su función es vincular los diferentes niveles de atención en salud en una determinada Red de Atención a la Salud (RAS). Objetivo: Evaluar las informaciones contenidas en las guías de encaminamiento de pacientes derivados de la atención primaria de la RAS de la ciudad de Rio de Sul (SC). Métodos: Estudio observacional, analítico y transversal, donde se examinaron las guías de la RAS desde un formulario que contenía variables preestablecidas. La información recolectada recibió análisis descriptivo de frecuencias y fue representada por n (frecuencia absoluta) y % (porcentaje). Resultados: se analizaron 158 referencias, estando presente el dato demográfico en 158 (100%), queja principal o motivo de referencia en 131 (82,9%), descripción de la queja principal o motivo de referencia en 82 (51,9%), descripción de síntomas asociados en 21 (13,3%), antecedentes patológicos en 61 (38,6%), lista de medicamentos actuales en 37 (23,4%), alergias en 10 (6,3%), hallazgos clínicamente relevantes en 75 (47,5%), resultados de la investigación previa en 45 (28,5%), esquema de tratamiento preliminar en 42 (26,6%), diagnóstico provisional en 75 (47,5%) y declaración de lo que se espera del encaminamiento en 66 (41,8%). Conclusiones: Hubo falta de información en los encaminamientos de la RAS en comparación con otros estudios, especialmente en lo que se refiere a la información histórica del paciente, datos clínicos sobre el motivo del encaminamiento, diagnóstico provisional y declaración de lo que se espera del encaminamiento. Sin embargo, fomentar la descripción de estas informaciones básicas puede ser una medida inicial para cambiar la situación actual.

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Características clínicas e sociodemográficas dos usuários de um centro de atenção psicossocial infantojuvenil em Porto Alegre a partir do Sistema de Gerenciamento de Consultas (GERCON) / Clinical and sociodemographic characteristics of users of centro de atenção psicossocial infantojuvenil in Porto Alegre since the implementation of Sistema de Gerenciamento de Consultas (GERCON)

Introdução: Desde maio de 2019, o acesso aos serviços especializados de saúde mental infantojuvenil do município de Porto Alegre ocorre através da regulação assistencial por intermédio do sistema Gerenciamento de Consultas (GERCON). O objetivo deste estudo foi caracterizar o perfil clínico e sociodemográfico dos usuários encaminhados para um Centro de Atenção Psicossocial Infantojuvenil (CAPSi) nos dois primeiros anos do GERCON. Métodos: Estudo transversal em que foram resgatados dados dos prontuários eletrônicos de crianças e adolescentes encaminhados para primeira consulta em um CAPSi de Porto Alegre, capital do estado do Rio Grande do Sul, no período de maio de 2019 a abril de 2021. Resultados: A maioria dos 134 usuários era do sexo masculino (59,8%), autodeclarados brancos (69,7%), naturais de Porto Alegre (87,9%) e com hipótese diagnóstica inicial de Retardo mental (28,9%), Transtornos emocionais e de comportamento com início usualmente ocorrendo na infância e adolescência (24,2%) e Transtornos do humor (20,3%). A média de idade foi 13,4 anos e a mediana 15 anos. A taxa de absenteísmo na primeira consulta foi de 24,7%. Conclusão: A maioria dos usuários encaminhados para o CAPSi HCPA era do sexo masculino, adolescente, natural de Porto Alegre e com a hipótese diagnóstica inicial de transtornos do neurodesenvolvimento. Há uma elevada taxa de absenteísmo. Ao planejar intervenções para crianças e adolescentes que necessitam de atendimento em CAPSi é importante considerar o perfil nosológico e as características sociodemográficas dos usuários, assim como pensar em estratégias para diminuir o absenteísmo.

Introduction: Since May 2019, access to child and adolescent mental health services in the city of Porto Alegre has been managed through a regulatory system called sistema de regulação assistencial (GERCON). The aim of this study is to describe the clinical and sociodemographic characteristics of users referred to a Child and Adolescent Psychosocial Care Center (Centro de Atenção Psicossocial Infantojuvenil [CAPSi]) in the first two years of GERCON. Methods: This is a cross-sectional study. Data were retrieved from electronic medical records of children and adolescents referred for their first consultation at a CAPSi in Porto Alegre, capital of the state of Rio Grande do Sul, from May 2019 to April 2021. Results: Most of the 134 users were male (59.8%), self declared white (69.7%), from Porto Alegre (87,9%) and with an initial diagnostic hypothesis of Mental retardation (28,9%), Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (24,2%) e Mood disorders (20,3%). The mean age was 13.4 years and the median was 15 years. The rate of absenteeism in the first appointment was 24.7%. Conclusion: Most users referred to the CAPSi HCPA were male, teenagers, born in Porto Alegre and with the initial diagnostic hypothesis of neurodevelopmental disorders. There is a high rate of absenteeism. When planning interventions for children and adolescents who need CAPSi care, it is important to consider the nosological profile and sociodemographic characteristics, as well as thinking about strategies to reduce absenteeism.

Masturbación compulsiva en adolescente / Compulsive Masturbation in Adolescents

Introducción: La masturbación compulsiva provoca una cascada de sentimientos y emociones que pueden recorrer desde la culpabilidad y el rechazo a la satisfacción hasta el bienestar más placentero y deseado. Objetivo: Exponer una forma de presentación poco frecuente de un adolescente con masturbación compulsiva. Presentación del caso: Adolescente masculino de 14 años de edad, de procedencia rural y antecedentes de salud física. Evaluado en consulta de psiquiatría infanto - juvenil por realizar masturbaciones en sitios públicos, que resultaban cada vez más frecuentes, y al final de esta se producía expulsión de materia fecal. Los estudios clínicos y psicométricos confirmaron el diagnóstico de masturbación compulsiva. Conclusiones: El tratamiento se basó en el modelo cognitivo-conductual y farmacológico con imipramina. Se disminuyó la frecuencia e intensidad, así como la duración de la conducta problema. El caso clínico expuesto resulta de interés por ser poco frecuente la presencia de este trastorno dentro de la población adolescente(AU)

Introduction: Compulsive masturbation provokes a cascade of feelings and emotions that can range from guilt and refusal to satisfaction to the most pleasurable and desired well-being. Aim: To present a rare presentation of an adolescent with compulsive masturbation. Case presentation: 14-year-old male adolescent from a rural area with a history of previous physical health. He was evaluated in a child and adolescent psychiatry clinic for masturbation in public places, which became increasingly frequent and ended with the expulsion of fecal matter. Clinical and psychometric studies confirmed the diagnosis of compulsive masturbation. Conclusions: Treatment was based on the cognitive-behavioral and pharmacological model with imipramine. The frequency and intensity, as well as the duration of the problem behavior was reduced. The clinical case presented was of interest due to the infrequent presence of this disorder in the adolescent population(AU)

Aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du District de la Commune IV de Bamako (Mali) / Clinical aspects of internal haemorrhoidal disease in the district hospital of Council IV of Bamako (Mali)

Introduction. La maladie hémorroïdaire interne est la plus fréquente des affections proctologiques et constitue un motif extrêmement répandu de consultation en proctologie. L'objectif de ce travail était de décrire les aspects cliniques de la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako. Patients et méthodes. Nous avons réalisé une étude transversale descriptive sur un groupe de malades vus en consultation à l'unité de Gastro-entérologie de l'hôpital du district de la commune IV de Bamako. Entre le 1er Novembre 2019 et le 31 Octobre 2020, le recrutement des patients a été réalisé. Les variables recueillies étaient les données sociodémographiques (âge, sexe, profession), les symptômes anaux (saignement anal, douleur anale, suintements muco-glaireux, prurit anal), les facteurs de risque (les troubles du transit intestinal, la période du troisième trimestre de la grossesse, l'accouchement, le post-partum immédiat), les stades de la maladie hémorroïdaire interne, les autres pathologies anales associées, les complications, l'hémogramme. Résultats. Durant la période d'étude, 128 patients ont été vus en consultation parmi lesquels 85 avaient une maladie hémorroïdaire interne, soit une fréquence de 66,40%. La procidence hémorroïdaire a été observée chez 18,8% de nos patients. En fonction de son degré, le grade I représentait 34,1%, le grade II 55,3%, le grade III 9,4% et le grade IV 1,2%. Conclusion. Cette première étude réalisée sur la maladie hémorroïdaire interne à l'hôpital du district de la commune IV de Bamako montre que la maladie hémorroïdaire interne est l'affection proctologique la plus fréquente.

Introduction. Internal haemorrhoidal disease is the most common proctological condition and is an extremely common reason of consultation in proctology. The objective of this work was to describe the clinical aspects of internal haemorrhoidal disease in the district hospital of the commune IV of Bamako. Patients and methods. We conducted a descriptive cross-sectional study on a cohort of patients seen in consultation at the Gastroenterology Unit of the District Hospital of Bamako's commune IV. The recruitment was carried out between November 1, 2019 and October 31, 2020. The variables of study were socio-demographic data (age, sex, profession), anal symptoms (anal bleeding, anal pain, muco-glue oozing, anal pruritus), risk factors (intestinal transit disorders, third trimester of pregnancy, childbirth, immediate postpartum), stages of internal haemorrhoidal disease, other associated anal pathologies, complications, blood count. Results. During the study period, 128 patients were seen in consultation, among whom 85 had internal haemorrhoidal disease (66.40%). Hemorrhoidal procidence was found in 18.8% of patients. Concerning the severity, grade I represented 34.1%, grade II 55.3%, grade III 9.4% and grade IV 1.2%. Conclusion. This pioneer study on internal haemorrhoidal disease in the district hospital of commune IV of Bamako (Mali) showed that internal hemorrhoidal disease is the most common proctological condition in Bamako.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

Caractéristiques de l'épilepsie chez les sujets âgés de 65 ans et plus / Characteristics of epilepsy in subjects aged 65 and over

Introduction. L'épilepsie du sujet âgé de 65 ans et plus est une pathologie plus fréquente que chez l'adulte jeune. L'objectif principal de ce travail était de faire la description clinique, étiologique et thérapeutique de l'épilepsie débutante et de l'épilepsie ancienne dans cette population. Méthodes. Il s'agissait d'une étude rétrospective et descriptive. Tout patient de 65 ans et plus, hospitalisé en neurologie ou vu en consultation d'épileptologie au CHU Pontchaillou de Rennes (France), présentant une épilepsie débutante ou une épilepsie ancienne a été inclus du 01 novembre 2018 au 30 avril 2019. Résultats. Nous avons retenu 95 patients. Quatorze patients ont été inclus pour une épilepsie débutante. Les crises focales prédominaient (50%) suivies des crises d'emblée généralisées (28,57%). L'étiologie la plus fréquente était d'origine structurelle dans 57,14% des cas avec 75 % de lésions tumorales et 25 % de lésions neuro-vasculaires. Quatre-vingt et un patients ont été retenus pour une épilepsie ancienne. Les crises focales prédominaient (41,98%) suivies des crises d'emblée généralisées (35,80%). L'étiologie la plus importante était d'origine structurelle (54,78%) avec 38,10% de lésions neuro-vasculaires suivies de lésions tumorales dans 16,68% des cas. Le lé vé tiracé tam était plus utilisé chez les patients ayant une épilepsie débutante et la lamotrigine chez les patients connus épileptiques. Conclusion. L'épilepsie chez le sujet âgé est de diagnostic diffi cile en raison d'un grand polymorphisme des crises et de l'origine souvent plurifactorielle. L'étiologie neuro-vasculaire est dominante dans cette population.

Introduction. Epilepsy in subjects aged 65 and over is a more frequent pathology than in young adults. The main objective of this work was to make the clinical, etiological, and therapeutic description of early epilepsy and old epilepsy in this population. Methods. This was a retrospective and descriptive study. Any patient aged 65 and over, hospitalized in neurology or seen in an epileptology consultation at the CHU Pontchaillou in Rennes (France), presenting with early epilepsy or old epilepsy was included from November 01, 2018, to April 30, 2019. Results. We retained 95 patients. Fourteen patients were included for early epilepsy. Focal seizures predominated (50%) followed by generalized seizures (28.57%). The most common etiology was of structural origin in 57.14% of cases with 75% tumor lesions and 25% neurovascular lesions. Eighty-one patients were selected for old epilepsy. Focal seizures predominated (41.98%) followed by generalized seizures (35.80%). The most important etiology was of structural origin (54.78%) with 38.10% of neurovascular lesions followed by tumor lesions in 16.68% of cases. Levetiracetam was used more in patients with early epilepsy and lamotrigine in patients with known epilepsy. Conclusion. Epilepsy in the elderly is difficult to diagnose due to a large polymorphism of seizures and often multifactorial origin. The neurovascular etiology is dominant in this population.

Audit of emergency obstetric referrals at a Tertiary Center in Kano

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.

Crianças e adolescentes com necessidades especiais de saúde: o cuidado nos serviços de atenção domiciliar / Niños y adolescentes con necesidades especiales de salud: cuidado en los servicios de atención a domicilio / Children and adolescents with special healthcare needs: care in home care services

RESUMO Objetivo descrever o cuidado prestado às crianças com necessidades especiais de saúde nos Serviços de Atenção Domiciliar do estado de Mato Grosso do Sul. Métodos pesquisa quantitativa, descritiva e exploratória. Os participantes do estudo foram profissionais dos Serviços de Atenção Domiciliar do Mato Grosso do Sul. A coleta de dados se deu com a aplicação de dois formulários on-line, no período de 2019 a 2020. Um dos formulários tinha dados descritivos dos serviços e seus atendimentos; o outro se voltava para a validação de protocolo de fluxo de atenção domiciliar às crianças. Para análise de dados, utilizou-se a estatística descritiva. Resultados houve uma predominância de 25 crianças com paralisia cerebral, sendo que a maioria foi classificada como média complexidade, de acordo com a complexidade e as demandas de cuidados. Os profissionais realizam orientações, procedimentos e avaliação, além de serem responsáveis pelo treinamento da família. Os serviços não possuem protocolo de fluxo para atendimento das crianças. Conclusão Implicações para Prática embora os serviços apresentem capacidade de ampliação do atendimento e utilizem o Plano Terapêutico Singular, avanços na assistência às crianças e famílias ainda se fazem necessários. Recomenda-se a elaboração de protocolos de fluxo e propostas organizativas que auxiliem os profissionais em sua prática.

RESUMEN Objetivo Descrever a atención prestada a niños con necesidades especiales de salud en los Servicios de Atención Domiciliaria del Estado de Mato Grosso do Sul. Métodos investigação cuantitativa, descritiva e exploratoria. Los participantes del estudio fueron profesionales de los servicios de atención domiciliaria de Mato Grosso do Sul. La recolección de datos ocurrió a través de la aplicación de dos formularios en línea, de 2019 a 2020, uno con datos descriptivos de los servicios y su atención y el otro para la validación del protocolo para el flujo de atención domiciliaria a los niños. Se utilizó estadística descriptiva para el análisis de datos. Resultados hubo un predominio de 25 niños con parálisis cerebral. La mayoría clasificó como mediana complejidad de acuerdo a la complejidad y demandas de atención. The professionals carry out lineamientos, procedures, evaluation and are responsible for training the family. Los servicios no cuentan con un protocolo de flujo para la atención de niños. Conclusion Implications for Practice Although the services have the capacity to expand care and use the Singular Therapeutic Plan, advances in the care of the child and the family are still needed. The development of flow protocols and organizational proposals that help professionals in their practice are recommended.

ABSTRACT Objective to describe the care provided to children with special health needs in the Home Care Services of the State of Mato Grosso do Sul - Brazil. Methods research, descriptive and exploratory. Study participants were professionals from home care services in Mato Grosso do Sul. Data collection took place through the application of two online forms, from 2019 to 2020, one containing descriptive data of the services and their care and the other for validation of the home care flow protocol for children. It was used for data analysis and descriptive statistics. Results there was a predominance of 25 children with brain flexibility. Most classified as complex average according to the complexity and demands of care. Professionals and guidelines, procedures, assessment are responsible for training the family. The services do not have a flow protocol for the care of children. Conclusion Implications for Practice Services Present ability to deliver care and use the care plan and single use, advances in child care and solutions may still be presented. There is a practice of elaborating flow protocols and organization proposals that help professionals in their.

Cuidados paliativos: la visión del neurólogo en Uruguay / Palliative care from a neurologist's perspective in Uruguay / Cuidados paliativos: a visão do neurologista no Uruguai

Introducción: los cuidados paliativos (CP) han incluido en su abordaje patologías no oncológicas, sin embargo los criterios de inclusión de pacientes con enfermedades neurológicas avanzadas es aún un desafío. Objetivo: conocer la percepción de los neurólogos, residentes y posgrados sobre los CP. Método: se aplicó una encuesta en línea, ad hoc. Se exploró la percepción del profesional en cuatro áreas: experiencia de trabajo conjunto, enfermedades neurológicas pasibles de CP, criterios de derivación y autopercepción de la formación en CP. Resultados: se obtuvieron 60 respuestas, 73% de los neurólogos tenían más de 5 años de ejercicio. El 83% de los encuestados refirió haber compartido pacientes con profesionales de CP, el 87% afirmó que su experiencia fue positiva o muy positiva. El 53% consideró que la esclerosis lateral amiotrófica siempre debe recibir CP y alrededor de 80% evaluó la derivación de otras enfermedades sólo en etapas avanzadas. El principal criterio de derivación evocado fue la toma de decisiones anticipadas (66%), independientemente de los años de ejercicio. En relación a la autopercepción de la capacitación en el manejo del paciente con enfermedad neurológica avanzada al final de la vida, el 62% se percibió muy capacitado o aceptablemente capacitado. Conclusión: en esta primera aproximación de la perspectiva de los neurólogos del Uruguay con respecto a los CP, se destaca la necesidad de desarrollar guías de derivación y estrategias de trabajo conjunto para la asistencia integral de pacientes con enfermedades neurológicas pasibles de ser beneficiados por el enfoque de cuidados paliativos.

Introduction: palliative care (PC) has included non-oncologic conditions among its scope although inclusion criteria for patients with advanced neurological diseases continues to be challenging. Objective: to learn about the perception of neurologists, residents and postgraduates on palliative care. Method: an online, ad hoc survey was conducted. The survey explored the perception of professional in four areas: work experience in collaborative work, neurological conditions that could qualify for PC, criteria for referral and self-perception of palliative care training. Results: 60 replies were obtained. 73% of participants in the survey were neurologists with over 5 years of practice. 83% of surveyed physicians stated they had shared patients with PC professionals; 87% affirmed their experience had been positive or very positive. 53% found amyotrophic lateral sclerosis must receive PC in all cases and 80% considers the appropriateness of referring patients with other conditions only in advanced stages of the disease. The main criteria for referral mentioned was the making of anticipated decisions (66%), regardless of the years of practice. As to their self-perception of training in the handling of patients with advanced neurological disease at the end of life, 62% see themselves as very well prepared or satisfactorily prepared. Conclusions: in this first approach to the perspective of neurologists in Uruguay on palliative care, we stand out the need to create referral guidelines and strategies for collaborative work for the comprehensive handling of patients with neurological conditions that could qualify for benefiting from palliative care.

Introdução: os cuidados paliativos (CP) têm incluído patologias não oncológicas na sua abordagem; no entanto os critérios de inclusão para doentes com doenças neurológicas avançadas ainda são um desafio. Objetivo: conhecer a percepção de neurologistas, residentes e pós-graduandos de neurologia sobre os CP. Método: foi aplicado um questionário online, ad hoc. A percepção do profissional foi explorada em quatro áreas: experiência de trabalho conjunto, doenças neurológicas susceptíveis ao CP, critérios de encaminhamento e autopercepção da capacitação em CP. Resultados: foram obtidas 60 respostas sendo 73% neurologistas com mais de 5 anos de prática. 83% dos entrevistados relataram ter compartilhado pacientes com profissionais de CP; 87% afirmam que sua experiência foi positiva ou muito positiva. 53% consideraram que a Esclerose Lateral Amiotrófica deve sempre receber CP e cerca de 80% avaliaram o encaminhamento de outras doenças apenas em estágios avançados. O principal critério de encaminhamento evocado foi a tomada de decisão precoce (66%), independentemente dos anos de prática. Em relação à autopercepção de capacitação no manejo de pacientes com doença neurológica avançada na fase final da vida, 62% percebem-se altamente capacitados ou com treinamento aceitável. Conclusão: nesta primeira aproximação à perspectiva dos neurologistas uruguaios sobre os CP, destaca-se a necessidade de desenvolver guias de encaminhamento e estratégias de trabalho conjunto para o atendimento integral de pacientes com doenças neurológicas que possam se beneficiar da abordagem de cuidados paliativos.

Reason for referrals to neurology: a community-based study in Brazil / Motivos de derivación a neurología: un estudio de base comunitaria en Brasil / Motivos de encaminhamentos para neurologia: um estudo de base comunitária no Brasil

Objective:to quantify the reasons for referrals of primary care physicians to neurology in Belo Horizonte, Brazil. Method:cross-sectional study evaluating referrals from Primary Care to the specialty of Neurology in Belo Horizonte, registered in the NOVO SISREG regulatory system, from March 2019 to July 2020. Neurologists or family physicians from the Regula Mais Brasil project, with experience in referral protocols for neurology, carried out the evaluation of the main diagnoses. Results:13,844 referrals to neurology were identified, with an average of 814.35 referrals per month. Headache, epilepsy and cerebrovascular disorders were the most common reasons, accounting for 55.5% of referrals. Other neurological conditions identified less frequently were parkinsonism, tremor, syncope and vertigo, responsible for 10.9% of referrals. Conclusion:most referrals did not prioritize only neurology expertise. It is possible that cultural aspects and the routine of physicians, health services and the community itself determined these referrals, raising awareness about the high demand, waiting time and possible clinical conditions that are soon ceasing to be managed by other specialties that also share these skills.

Objetivo:cuantificar los motivos de derivación de médicos de atención primaria a neurología en Belo Horizonte, Brasil. Método:estudio transversalque evaluó las derivaciones de la Atención Primaria a la especialidad de Neurología en Belo Horizonte, registradas en el sistema regulatorio NOVO SISREG, de marzo de 2019 a julio de 2020. Neurólogos o médicos de familia del proyecto Regula Mais Brasil, con experiencia en protocolos de derivación para neurología, realizó la evaluación de los principales diagnósticos. Resultados:se identificaron 13.844 derivaciones a neurología, con una media de 814,35 derivaciones al mes. La cefalea, la epilepsia y los trastornos cerebrovasculares fueron los motivos más frecuentes, representando el 55,5% de las derivaciones. Otras condiciones neurológicas identificadas con menor frecuencia fueron parkinsonismo, temblor, síncope y vértigo, responsables del 10,9% de las derivaciones. Conclusión: la mayoría de las referencias no priorizaron solo la experiencia en neurología. Es posible que los aspectos culturales y la rutina de los médicos, los servicios de salud y la propia comunidad determinaran estas derivaciones, concientizando sobre la alta demanda, tiempo de espera y posibles cuadros clínicos que pronto están dejando de ser manejados por otras especialidades que también comparten estas habilidades.

Objetivo:quantificar os motivos de encaminhamentos de médicos da Atenção Primária para neurologia em Belo Horizonte, Brasil. Método:estudo transversal com avaliação de encaminhamentos da Atenção Básica para especialidade de Neurologia em Belo Horizonte, registrados no sistema de regulação NOVO SISREG, no periodo de março de 2019 a julho de 2020. Neurologistas ou médicos de família do projeto Regula Mais Brasil, com experiência em protocolos de encaminhamentos para neurologia, realizaram a avaliação dos principais diagnósticos. Resultados:foram identificados 13.844 encaminhamentos para neurologia, com uma média de 814,35 encaminhamentos por mês. Cefaleia, epilepsia e distúrbios cerebrovasculares foram os motivos mais comuns, representando 55,5% dos encaminhamentos. Outras condições neurológicas identificadas em menor frequência foram o parkinsonismo, tremor, síncope e vertigem, responsáveispor 10,9% dos encaminhamentos. Conclusão:a maioria dos encaminhamentos não priorizou somente a expertise da neurologia. É possível que aspectos culturais e a rotina de médicos, serviços de saúde e da própria comunidade determinaram esses encaminhamentos, ascendendo alerta quanto a alta demanda, tempo de espera e possíveis condições clínicas que estão deixando de ser brevemente manejadas por outras especialidades que também compartilham dessas competências.

De un centro de trauma a un sistema de trauma en el suroccidente colombiano / From a Trauma Center to a Trauma System in Southwest Colombia

Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad

Introduction. This study aims to evaluate the impact on mortality by admission profile to a trauma center in Southwest Colombia between direct and referred patients, as a method to understand the dynamics of trauma care.Methods. A sub-analysis of the Panamerican Trauma Society registry associated with a trauma center in Southwest Colombia was performed. Patients attended between 2012-2021 were analyzed. Patients with direct admission and referred condition were compared. Analyses of populations of interest such as patients with severe trauma (ISS > 15) and patients with/without brain trauma were made. The impact of referred patients and their admission status on mortality was evaluated. Results. A total of 10,814 patients were included. The proportion of referred patients was 54.7%. Patients admitted referred vs. with direct admission have differences regarding trauma severity and physiological compromise on admission. The referred patient has a higher risk of mortality (RR: 2.81; 95% CI 2.44-3.22). There is a high proportion of penetrating trauma by gunshot wounds. However, it is the physiological state at admission that impacts mortality. Conclusion. Patients referred from other institutions have a higher mortality risk, being a health inequity that invites the articulation of institutional actors in trauma care. A trauma center should relate to partner institutions to create a trauma system that optimizes care and timeliness

Estudio clínico, radiológico y derivación en tumores musculoesqueléticos / Diagnosis and referral of musculoskeletal tumors

Musculoskeletal tumors are uncommon. However, the true burden of all bone and soft tissue tumors of extremities is underestimated. Usually, the diagnosis of sarcomas is missed or delayed. Therefore, an adequate clinical and radiological assessment, along with the awareness and application of simple guidelines for referral to a specialized center, are of utmost importance. These are critical steps for an appropriate diagnosis and treatment of sarcomas, improving their prognosis.

Manual de organización del primer nivel de atención / First level care organization manual

El manual de Organización del Primer Nivel de Atención es un instrumento que apoya el que hacer institucional y está considerado como un documento fundamental para la coordinación, dirección y evaluación, así como para consulta en el desarrollo cotidiano de actividades de los Recursos Humanos que se encuentran realizando funciones en servicios de salud del Primer Nivel de Atención, en todas sus modalidades y relacionadas a este, en coordinación con las demás dependencias del MSPyBS.