Mortality in patients with severe COVID-19 who underwent tracheostomy due to prolonged mechanical ventilation / Mortalidad en pacientes con COVID-19 grave sometidos a traqueostomía por ventilación mecánica prolongada

BACKGROUND: The usefulness of tracheostomy has been questioned in patients with COVID-19 and prolonged invasive mechanical ventilation (IMV). AIM: To compare the 90-day mortality rate of patients who underwent a tracheostomy due prolonged IMV with those that did not receive this procedure. MATERIAL AND METHODS: We studied a historical cohort of 92 patients with COVID-19 and prolonged IMV (> 10 days). The primary outcome was the 90-day mortality rate. Secondary outcomes included days on IMV, hospital/intensive care unit (ICU) length of stay, frequency of nosocomial infections, and thrombotic complications demonstrated by images. A logistic regression was performed to adjust the effect of tracheostomy by SOFA score and days on IMV. RESULTS: Forty six patients aged 54 to 66 years (72% males) underwent tracheostomy. They had a median of two comorbidities, and received the procedure after a median of 20.5 days on IMV (interquartile range: 17-26). 90-day mortality was lower in patients who were tracheostomized than in the control group (6.5% vs. 32.6%, p-value < 0.01). However, after controlling for confounding factors, no differences were found in mortality between both groups (relative risk = 0.303, p-value = 0.233). Healthcare-associated infections and hospital/ICU length of stay were higher in patients with tracheostomy than in controls. Thrombotic complications occurred in 42.4% of the patients, without differences between both groups. No cases of COVID-19 were registered in the healthcare personnel who performed tracheostomies. CONCLUSIONS: In patients with COVID-19 undergoing prolonged IMV, performing a tracheostomy is not associated with excess mortality, and it is a safe procedure for healthcare personnel.

ANTECEDENTES: La utilidad de la traqueostomía en pacientes COVID-19 sometidos a ventilación mecánica invasiva (VMI) prolongada ha sido cuestionada. OBJETIVO: Comparar la mortalidad a 90 días en estos pacientes, con y sin traqueostomía. MATERIAL Y MÉTODOS: Estudiamos una cohorte histórica de 92 pacientes COVID-19 con VMI prolongada (>10 días). El desenlace prima-rio fue mortalidad a 90 días. Se consideraron desenlaces secundarios los días en VMI, estadía hospitalaria/UCI, frecuencia de infecciones nosocomiales, y eventos trombóticos. Mediante regresión logística se ajustó el efecto de la traqueostomía en la mortalidad, por SOFA y días de VMI. RESULTADOS: Cuarenta y seis pacientes de 54 a 66 años (72% hombres) fueron traqueostomizados. Ellos tenían una mediana de dos comorbilidades, y recibieron el procedimiento luego de una mediana de 20,5 días en VMI (rango intercuartílico: 17-26). En el análisis crudo, la mortalidad a 90 días fue menor en los pacientes con traqueostomía que en el grupo control (6,5% vs. 32,6%; p < 0,001). No obstante, luego de controlar por factores de confusión, no se encontraron diferencias en mortalidad (riesgo relativo 0,303; p = 0,233). Las infecciones asociadas a la atención de salud y la estadía en hospital/UCI fueron mayores en los pacientes traqueostomizados que en los controles. Los eventos trombóticos ocurrieron en el 42,4% de los pacientes, sin diferencias entre grupos. No hubo casos de COVID-19 en el personal de salud que realizó las traqueostomías. CONCLUSIONES: En pacientes con COVID-19 sometidos a VMI prolongada, la realización de una traqueostomía no se asocia a un exceso de mortalidad, y es un procedimiento seguro para el personal sanitario.

Mortality in patients with severe COVID-19 who underwent tracheostomy due to prolonged mechanical ventilation.

BACKGROUND: The usefulness of tracheostomy has been questioned in patients with COVID-19 and prolonged invasive mechanical ventilation (IMV). AIM: To compare the 90-day mortality rate of patients who underwent a tracheostomy due prolonged IMV with those that did not receive this procedure. MATERIAL AND METHODS: We studied a historical cohort of 92 patients with COVID-19 and prolonged IMV (> 10 days). The primary outcome was the 90-day mortality rate. Secondary outcomes included days on IMV, hospital/intensive care unit (ICU) length of stay, frequency of nosocomial infections, and thrombotic complications demonstrated by images. A logistic regression was performed to adjust the effect of tracheostomy by SOFA score and days on IMV. RESULTS: Forty six patients aged 54 to 66 years (72% males) underwent tracheostomy. They had a median of two comorbidities, and received the procedure after a median of 20.5 days on IMV (interquartile range: 17-26). 90-day mortality was lower in patients who were tracheostomized than in the control group (6.5% vs. 32.6%, p-value < 0.01). However, after controlling for confounding factors, no differences were found in mortality between both groups (relative risk = 0.303, p-value = 0.233). Healthcare-associated infections and hospital/ICU length of stay were higher in patients with tracheostomy than in controls. Thrombotic complications occurred in 42.4% of the patients, without differences between both groups. No cases of COVID-19 were registered in the healthcare personnel who performed tracheostomies. CONCLUSIONS: In patients with COVID-19 undergoing prolonged IMV, performing a tracheostomy is not associated with excess mortality, and it is a safe procedure for healthcare personnel.

Trypanosoma cruzi infection follow-up in a sylvatic vector of Chagas disease: Comparing early and late stage nymphs.

Chagas disease is caused by Trypanosoma cruzi and transmitted by the triatomine Mepraia spinolai in the southwest of South America. Here, we examined the T. cruzi-infection dynamics of field-caught M. spinolai after laboratory feeding, with a follow-up procedure on bug populations collected in winter and spring of 2017 and 2018. Bugs were analyzed twice to evaluate T. cruzi-infection by PCR assays of urine/fecal samples, the first evaluation right after collection and the second 40 days after the first feeding. We detected bugs with: the first sample positive and second negative (+/-), the first sample negative and second positive (-/+), and with both samples positive or negative (+/+; -/-). Bugs that resulted positive on both occasions were the most frequent, with the exception of those collected in winter 2018. Infection rate in spring was higher than winter only in 2018. Early and late stage nymphs presented similar T. cruzi-infection rates except for winter 2017; therefore, all nymphs may contribute to T. cruzi-transmission to humans. Assessment of infection using two samples represents a realistic way to determine the infection a triatomine can harbor. The underlying mechanism may be that some bugs do not excrete parasites unless they are fed and maintained for some time under environmentally controlled conditions before releasing T. cruzi, which persists in the vector hindgut. We suggest that T. cruzi-infection dynamics regarding the three types of positive-PCR results detected by follow-up represent: residual T. cruzi in the rectal lumen (+/-), colonization of parasites attached to the rectal wall (-/+), and presence of both kinds of flagellates in the hindgut of triatomines (+/+). We suggest residual T. cruzi-infections are released after feeding, and result 60-90 days after infection persisting in the rectal lumen after a fasting event, a phenomenon that might vary between contrasting seasons and years.

O cuidado de enfermagem como objeto de conhecimento nas teses e dissertações de Enfermagem no período de 2001 – 2013 / THE NURSING CARE AND THE OBJECT OF THESES AND DISSERTATIONS KNOWLEDGE IN NURSING FOR THE PERIOD 2001 – 2013

Este trabalho tem como objetivo analisar os dados referentes à aplicação do cuidado de enfermagem desenvolvidos pela enfermagem brasileira, a partir das teses e dissertações publicadas sobre a prática do cuidado de enfermagem no período de 2001 à 2013. Foi utilizado como fonte de pesquisa o banco de teses e dissertações da Associação Brasileira de Enfermagem. Através da análise do banco de dados obteve-se 44 estudos. O tratamento dos dados foi realizado em três etapas: primeiro foi evidenciado o perfil do trabalho, em segundo realizou-se a análise e seleção dos temas referentes ao cuidado de enfermagem; posteriormente este material foi organizado em cinco eixos temáticos: O cuidado de enfermagem com pacientes acometidos por HIV e AIDS, o cuidado na atenção a criança, o cuidado com pacientes psiquiátricos, a assistência de enfermagem na saúde coletiva e a sistematização da assistência de enfermagem. Constata-se, que a sistematização da assistência é o meio pelo qual o enfermeiro elabora os seus cuidados de maneira cientifica, buscando contribuir para um melhor atendimento às necessidades de saúde do individuo e da coletividade.

Síndrome de tensión premenstrual: análisis de 83 casos

Con el objetivo de recabar datos relacionados com las alteraciones tanto físicas como psíquicas que produce el síndrome de tensión premenstrual en la mujer, realizamos un estudio en la Zona C del Instituto Dominicano de Seguros Sociales en el período comprendido entre maio - noviembre de 1987. Entrevistamos un total de 193 pacientes en edad menstrual que asistían a la consulta de ginecología, a estas pacientes se les realizó una historia clínica, se consignaron los síntomas y se evaluó cada caso en particular para determinar si padecía o no el síndrome premenstrual. Seleccionamos 83 pacientes de estas como positivas (43%), evaluamos las manifestaciones físicas y psíquicas de cada una de ellas y tratamos de hacer correlación clínica entre las manifestaciones sintomáticas y conductuales. El grupo etatio más afectado fue el comprendido entre los 20-39 años, 91.5% (76 casos). El síntoma físico más frecuente fue la inflamación de los senos 44.5% (37 casos), el dolor de espalda se presentó en un 37.7% (31 casos) y la cefalea 27.7% (23 casos). El síntoma psíquico más frecuente fue la depresión con 32.5% (22 casos), la ansiedad y tensión se representó en 30.1% (25 casos). El síntoma psíquico más frecuente fue la depresión con 32.5% (22 casos), la ansiedad y tensión se presentó en 30.1% (25 casos) y la irritabilidad 25.3% (21 casos)