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1.
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1449361

RESUMEN

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Introduction: Arterial hypertension is the great challenge of health policies in the world. Its high prevalence, the lack of control (linked to poor adherence to antihypertensive treatment) and its high "burden" (as a non-communicable disease) are responsible for the increase in cardiovascular morbidity and mortality. Objetive: To evaluate, as a pilot test, the benefit of real-time telemonitoring applied to blood pressure (BP) control. Metodology: Inclusion criteria: Diagnosed hypertensives, under pharmacological treatment, assisted in the Maciel Hospital polyclinic in the period June-October 2019. Exclusion criteria: pregnancy and upper arm circumference less than 22 cm or greater than 42 cm. Home blood pressure monitoring was implemented, using a validated electronic blood pressure monitor and a smart cell phone connected to a private web platform in real time. Analytical, experimental, prospective study. Qualitative variables were expressed in absolute frequency and percentage relative frequency. Quantitative variables were expressed as mean and standard deviation. The normality of the distribution was verified using the Kolmogorov Smirnov test. Results: Of a total of 57 patients, the mean age was 59 ± 12.8 years, female sex 64.9%. Presenting 22.8% poor knowledge of the disease. Regarding the control of BP figures, 31.6% reported not checking regularly. Adherence to pharmacological treatment at the beginning of the monitoring was 33.3%. Figures lower than those described by RENATA-2, where half of the treated hypertensives complied with the treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed at the beginning and end of the study. Pre-monitoring measurements were mean SBP: 138.6 ± 17.8 mmHg and mean DBP: 85.4 ± 14.8 mmHg. The records at the end of the immediate monitoring were 131.5 ± 19.9 mmHg and 81.5 ± 14.2 mmHg for PAS and PAD, respectively. Finding a significant difference between the means of the PAS (p 0.019), but not between the means of the DBP (p 0.06). Discussion: Although the percentage of patients achieving good BP control was significant, these results may be closely related to a subtype of observed performance bias, rather than the outcome of the intervention. The mean days of telemonitoring were 8, 85, number of shots was 34.12, and number of interventions performed by the observer (medication change) was 0.30. User satisfaction with the method used was 96.4%, and 100% considered it Easy or very easy to use. 87.5% would use it for long periods of time, including older adults. Conclusions: The studied method shows potential benefits for the control of BP figures, with a wide acceptance by users, facilitating access to the health system, and quality medical care.


Introdução: A hipertensão arterial é o grande desafio das políticas de saúde no mundo. Sua alta prevalência, o descontrole (ligado à baixa adesão ao tratamento anti-hipertensivo) e sua alta "carga" (como doença não transmissível) são responsáveis ​​pelo aumento da morbimortalidade cardiovascular. Objetivo: foi avaliar como teste piloto, o benefício do telemonitoramento em tempo real, aplicado ao controle da pressão arterial (PA). Metodologia: Critérios de inclusão: Hipertensos diagnosticados, em tratamento farmacológico, atendidos na policlínica do Hospital Maciel no período de junho a outubro de 2019. Critérios de exclusão: gravidez e circunferência do braço menor que 22 cm ou maior que 42 cm. Foi implementado o monitoramento domiciliar da pressão arterial, utilizando um monitor eletrônico de pressão arterial validado e um telefone celular inteligente conectado a uma plataforma web privada em tempo real. Estudo analítico, experimental, prospectivo.As variáveis ​​qualitativas foram expressas em frequência absoluta e frequência relativa percentual. As variáveis ​​quantitativas foram expressas como média e desvio padrão. A normalidade da distribuição foi verificada por meio do teste de Kolmogorov Smirnov. Resultados: De um total de 57 pacientes, a média de idade foi de 59 ± 12,8 anos, sexo feminino 64,9%. Apresentando 22,8% conhecimento ruim sobre a doença. Em relação ao controle dos valores da PA, 31,6% relataram não verificar regularmente. A adesão ao tratamento farmacológico no início do acompanhamento foi de 33,3%, valores inferiores aos descritos pelo RENATA-2, onde metade dos hipertensos tratados aderiu ao tratamento. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram analisadas no início e no final do estudo. As medições de pré-monitoramento foram PAS média: 138,6 ± 17,8 mmHg e PAD média: 85,4 ± 14,8 mmHg. Os registros ao final do monitoramento imediato foram de 131,5 ± 19,9 mmHg e 81,5 ± 14,2 mmHg para PAS e PAD, respectivamente. Encontrando diferença significativa entre as médias do PAS (p 0,019), mas não entre as médias do DBP (p 0,06). Discussão: Embora a porcentagem de pacientes que alcançaram um bom controle da PA tenha sido significativa, esses resultados podem estar intimamente relacionados a um subtipo de viés de desempenho observado, e não ao resultado da intervenção. A média de dias de telemonitoramento foi 8, 85, o número de disparos foi 34,12, e o número de intervenções realizadas pelo observador (mudança de medicação) foi de 0,30. A satisfação dos usuários com o método utilizado foi de 96,4%, sendo que 100% consideraram fácil ou muito fácil de usar. 87,5% usariam por longos períodos de tempo, inclusive idosos adultos. Conclusões: O método estudado apresenta potenciais benefícios para o controle dos valores da PA, com ampla aceitação pelos usuários, facilitando o acesso ao sistema de saúde e assistência médica de qualidade.

2.
Emerg Infect Dis ; 28(13): S59-S68, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36502414

RESUMEN

The US President's Emergency Plan for AIDS Relief (PEPFAR) supports molecular HIV and tuberculosis diagnostic networks and information management systems in low- and middle-income countries. We describe how national programs leveraged these PEPFAR-supported laboratory resources for SARS-CoV-2 testing during the COVID-19 pandemic. We sent a spreadsheet template consisting of 46 indicators for assessing the use of PEPFAR-supported diagnostic networks for COVID-19 pandemic response activities during April 1, 2020, to March 31, 2021, to 27 PEPFAR-supported countries or regions. A total of 109 PEPFAR-supported centralized HIV viral load and early infant diagnosis laboratories and 138 decentralized HIV and TB sites reported performing SARS-CoV-2 testing in 16 countries. Together, these sites contributed to >3.4 million SARS-CoV-2 tests during the 1-year period. Our findings illustrate that PEPFAR-supported diagnostic networks provided a wide range of resources to respond to emergency COVID-19 diagnostic testing in 16 low- and middle-income countries.


Asunto(s)
COVID-19 , Infecciones por VIH , Humanos , Prueba de COVID-19 , Patología Molecular , Pandemias , SARS-CoV-2 , COVID-19/diagnóstico
3.
Pediatr. aten. prim ; 22(85): 43-46, ene.-mar. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-193441

RESUMEN

La apendicitis crónica es una entidad poco frecuente, que se manifiesta como dolor abdominal recurrente en la fosa iliaca derecha. Las pruebas complementarias (hemograma, proteína C reactiva y ecografía) pueden ser normales, por lo que sería necesario realizar una laparoscopia con apendicectomía para el diagnóstico. El estudio histológico muestra cambios inflamatorios crónicos no ocasionados por otros procesos infecciosos ni compatibles con una enfermedad inflamatoria intestinal. Se presenta el caso de un niño de 12 años con episodios autolimitados de dolor abdominal agudo en el transcurso de dos años, al que se le realizó tratamiento quirúrgico con diagnóstico definitivo de apendicitis crónica


Chronic appendicitis is a rare entity, manifested by episodes of recurrent abdominal pain located in the right iliac fossa. Complementary tests (blood count, C-reactive protein and ultrasound) may be normal, so it would be necessary a laparoscopy with appendectomy for diagnosis. The histological study shows chronic inflammatory changes, not caused by other infectious processes and not compatible with an inflammatory bowel disease. We present the case of a 12-year-old boy with self-limited episodes of acute abdominal pain during the course of two years. It was necessary a surgical treatment, with a definitive diagnosis of chronic appendicitis


Asunto(s)
Humanos , Masculino , Niño , Apendicitis/complicaciones , Apendicectomía/métodos , Abdomen Agudo/etiología , Proteína C-Reactiva/análisis , Enfermedad Crónica/terapia , Laparoscopía/métodos , Ultrasonografía/métodos , Recurrencia
4.
Virology ; 534: 114-131, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31228725

RESUMEN

Inter-genogroup reassortant group A rotavirus (RVA) strains possessing a G3 VP7 gene of putative equine origin (EQL-G3) have been detected in humans since 2013. Here we report detection of EQL-G3P[8] RVA strains from the Dominican Republic collected in 2014-16. Whole-gene analysis of RVA in stool specimens revealed 16 EQL-G3P[8] strains, 3 of which appear to have acquired an N1 NSP1 gene from locally-circulating G9P[8] strains and a novel G2P[8] reassortant possessing 7 EQL-G3-associated genes and 3 genes from a locally-circulating G2P[4] strain. Phylogenetic/genetic analyses of VP7 gene sequences revealed nine G3 lineages (I-IX) with newly-assigned lineage IX encompassing all reported human EQL-G3 strains along with the ancestral equine strain. VP1 and NSP2 gene phylogenies suggest that EQL-G3P[8] strains were introduced into the Dominican Republic from Thailand. The emergence of EQL-G3P[8] strains in the Dominican Republic and their reassortment with locally-circulating RVA could have implications for current vaccination strategies.


Asunto(s)
Enfermedades de los Caballos/virología , Virus Reordenados/aislamiento & purificación , Infecciones por Rotavirus/veterinaria , Infecciones por Rotavirus/virología , Rotavirus/aislamiento & purificación , Animales , República Dominicana , Genoma Viral , Caballos , Humanos , Filogenia , Virus Reordenados/clasificación , Virus Reordenados/genética , Rotavirus/clasificación , Rotavirus/genética , Tailandia , Proteínas Virales/genética
5.
Rev. Urug. med. Interna ; 1(2): 4-10, ago. 2016. ilus, tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1092289

RESUMEN

RESUMEN Objetivos: Determinar el rendimiento de la tomografía axial computada de cráneo en el diagnóstico etiológico de delirium y qué factores son predictores de causa intracraneana del mismo. Material y métodos: Estudio transversal, observacional. Criterios de inclusión: pacientes con diagnóstico de delirium a los cuales se les haya realizado una Tomografía de cráneo como parte de la valoración etiológica. Criterios de exclusión: factores que imposibiliten la entrevista. Como herramienta diagnóstica se utilizó el CAM (Confusion Assesment Method). Resultados: Se incluyeron en el estudio 114 pacientes. La tomografía confirmó la causa de delirium en 18,4 % de los casos. Las variables que se asociaron con tomografía alterada fueron déficit focal neurológico y antecedentes de Trauma de cráneo. En 2.6% de los pacientes la tomografía confirmó una causa intracraneana de delirium a pesar de no tener signos focales neurológicos ni antecedente de traumatismo de cráneo. Conclusiones: La tomografía de cráneo es una herramienta de gran valor, pero no debería realizarse de urgencia, en forma rutinaria, en todos los pacientes con delirium. La tomografía debe indicarse de urgencia cuando existe antecedente de traumatismo de cráneo, hallazgo de signos focales neurológicos al examen o no se encuentra un factor precipitante. En los pacientes ancianos y/o con deterioro cognitivo previo debe tenerse presente que los factores precipitantes de delirium más frecuentes son extra-craneanos.


ABSTRACT Objectives: To determine the yield of computed tomography brain scan in the etiological diagnosis of delirium, and to determine which factors are predictors of the intracranial cause of delirium. Material and methods: Cross-sectional study, observational. Inclusion criteria: Patients diagnosed with delirium that have undergone a cranial tomography as part of etiological assessment. Exclusion criteria: Factors that prevent the interview. The CAM (Confusion Assessment Method) has been used as a diagnostic tool. Results: 114 patients were included in the study. The tomography confirmed the cause of delirium in 18% of the cases. The variables that were associated with altered tomography were focal neurological deficit and a history of head trauma. 2.6% of patients’ tomography confirmed an intracranial cause of delirium in spite of not having focal neurological signs or history of head trauma. Conclusions: The tomography is a valuable tool, but it should not be made urgently, routinely, in all patients with delirium. The tomography should be requested urgently when there is a history of head trauma, findings of focal neurological signs or a precipitating factor is not found. It should be noted that in elderly patients with previous cognitive impairment, the most common precipitating factors of delirium are nonintracranial.

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