Effect of Undernutrition and Obesity on Clinical Outcomes in Adults with Community-Acquired Pneumonia.

Malnutrition comprises two groups of conditions: undernutrition and overweight or obesity. It has been associated with a high risk of contracting infectious diseases and with elevated mortality rates. Community-acquired pneumonia (CAP) is one of the most common infectious diseases worldwide and its prognosis is affected by a large number of recognizable risk factors. This narrative review updates the information on the impact of malnutrition, including both undernutrition and obesity, on the risk and prognosis of adults with CAP. Studies of CAP that have evaluated undernutrition have applied a variety of definitions when assessing the nutritional status of patients. Undernutrition has been associated with unfavorable clinical outcomes, such as prolonged hospital stay, need for intensive care unit admission, and mortality; in contrast, most published studies have found that increased body mass index is significantly associated with higher survival in patients with CAP. However, some authors have presented divergent results, mainly in relation to the etiology of CAP (bacterial versus viral). Influenza infection, caused by influenza A (H1N1) pdm09, has been associated with worse prognosis in obese patients. The current data underscore the need for larger studies to examine the physiological mechanisms that explain the differential impact of malnutrition on outcomes. Achieving a better understanding may help to guide the design of new interventions to improve prognosis.

Artritis séptica de la articulación temporomandibular como complicación de una celulitis facial: reporte de un caso / Septic arthritis of the temporomandibular joint after complication of facial cellulitis: case report

La infección del cóndilo mandibular, artritis séptica, es una enfermedad caracterizada por dolor, fiebre, edema y disminución funcional de la articulación temporomandibular. Predomina en hombres adultos y su etiología incluye distintos factores: enfermedades sistémicas, autoinmunes, trauma local y diseminación de infecciones en la región de cabeza y cuello. Se presenta un caso clínico de artritis séptica en articulación temporomandibular como complicación de una celulitis facial infecciosa. El tratamiento consistió en antibioterapia y artrocentesis seriadas con el objetivo de realizar un aseo intraarticular, acompañado de la movilización temprana de la articulación, idealmente con el apoyo de un equipo de kinesiología. Además, son muy importantes los controles periódicos y de larga data para poder obtener un mejor resultado clínico en el paciente, controlar en el largo plazo, minimizando los riesgos de presentar disminución en la dinámica mandibular y/o anquilosis de la articulación.

Mandibular condyle infection, septic arthritis, is a disease characterized by pain, fever, edema, and functional decrease of the temporomandibular joint. It predominates in adult men and its etiology includes different factors: systemic diseases, autoimmune diseases, local trauma and spread of infections in the head and neck region. A clinical case of septic arthritis in the temporomandibular joint as a complication of infectious facial cellulitis is presented. Treatment consisted of antibiotic therapy and serial arthrocentesis with the aim of performing an intra-articular cleaning, accompanied by early mobilization of the joint, ideally with the support of a kinesiology team. In addition, long-term and periodic controls are very important in order to obtain a better clinical result in the patient, control in the long term, minimizing the risks of presenting a decrease in mandibular dynamics and / or ankylosis of the joint.

Programa de intervención para promoción de salud mental en una comunidad de personas mayores / Intervention program to promote mental health on an elderly community

En Chile muchas veces la atención primaria no es capaz de profundizar en los programas educativos hacia la Salud Mental. Por esto, es importante que los profesionales de salud logren desarrollar su rol educativo en contacto estrecho con la comunidad. Dentro del curso de Enfermería en Salud Mental y Psiquiatría II del Certificado Académico de Salud Mental y Psiquiatría de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, internos realizaron un programa de promoción de salud mental. Este fue dirigido a adultos mayores, por lo que se basó en el Modelo de educación para adultos propuesto por la Dra. Jane Vella. Se realizaron doce sesiones de una hora y treinta minutos en un lugar facilitado por la comuna de Estación Central. A través de un diagnóstico participativo se identificaron variados temas de interés, como el envejecimiento saludable, la memoria, la depresión, las redes de apoyo, relaciones saludables, cuidados del cuidador, utilizando la psicoeducación con un enfoque promocional. Se obtuvieron resultados positivos en relación a la obtención de herramientas para el autocuidado en salud mental. Como elemento negativo a destacar se encuentra la convivencia entre los participantes durante las sesiones debido a opiniones contradictorias, aspecto a tener en cuenta al implementar programas educativos futuros. En conclusión, esta intervención basada en la educación para adultos, demostró ser efectiva para abarcar temas de salud mental, promoviendo el envejecimiento saludable, el autocuidado y las relaciones interpersonales, en una población de personas mayores con diversos niveles educacionales y estilos de vida.

The Chilean Primary Care services are not able to deepen their educational programs towards Mental Health. It is therefore important that health professionals manage to develop their educational role in close contact with the community.In the context of a nursing mental health class of Pontificia Universidad Católica de Chile, 7 interns developed a health promotion intervention, which was created focusing in elderlypopulation. The intervention was based on Adult EducationalModel proposed by Jane Vella. There were 12 sessions of 1 hour anda half, conducted at Casa de la Mujer in Estación Central.The themes of the program were decided through a participative diagnosis. The themes chosen were healthy aging, memory, depression, support system, and caregive-care, which were treated using psychoeducation with a promotional emphasis.There were achieved positive results in relation to obtaining tools for self-care in mental health. As a negative element to highlight were the interactionsbetween the participants during the sessions due to conflicting opinions, aspect to be taken into account when implementing future educational programs.In conclusion, this intervention based on adult education proved to be effective in addressing mental health issues, promoting healthy aging, self-care and interpersonal relationships in a population of older people with different educational levels and lifestyles.

Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo: Serie de casos / Changes in cerebral blood flow velocity in supine and sitting position in patients with aneurysmal subarachnoid hemorrhage

Background: Early mobilization in intensive care units (ICU) provides respiratory, neurological and cardiovascular benefits in hospitalized patients. However, the orthostatic effects of changing from a supine to a sitting position may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH). Aim: To describe the changes in mean cerebral blood flow velocity (MCBFV) in supine and sitting position, in adult patients with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS) at a neurosurgical ICU. Material and Methods: Descriptive case series study in 21 patients with aSAH, both with and without VS. They were positioned in a supine 30° position and then seated at the edge of bed for six minutes. MCBFV was measured by transcranial Doppler (TCD), and hemodynamic variables in both positions were registered. After this basal assessment and for 21 days after the episode of SAH, patients were seated once a day and signs of VS were recorded. Results: No significant changes in MCBFV or hemodynamic variables were detected during position changes, except for an increase in heart rate in the sitting position. No patient with AVS at the onset, had symptomatic VS during the 21 days of follow up when patients were seated. Among patients with a normal MCBFV at baseline, five patients (24%) had VS at a mean of three days after the first time that they were seated on the edge of bed. Conclusions: Sitting patients at the edge of the bed is a safe mobilization alternative for patients who suffered aSAH who did not have VS or had AVS.

[Changes in cerebral blood flow velocity in supine and sitting position in patients with aneurysmal subarachnoid hemorrhage]. / Descripción de los cambios en la velocidad media de flujo sanguíneo cerebral en posición supino y sedente, en pacientes con hemorragia subaracnoidea aneurismática con vasoespasmo asintomático o sin vasoespasmo. Serie de casos.

BACKGROUND: Early mobilization in intensive care units (ICU) provides respiratory, neurological and cardiovascular benefits in hospitalized patients. However, the orthostatic effects of changing from a supine to a sitting position may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH). AIM: To describe the changes in mean cerebral blood flow velocity (MCBFV) in supine and sitting position, in adult patients with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS) at a neurosurgical ICU. MATERIAL AND METHODS: Descriptive case series study in 21 patients with aSAH, both with and without VS. They were positioned in a supine 30° position and then seated at the edge of bed for six minutes. MCBFV was measured by transcranial Doppler (TCD), and hemodynamic variables in both positions were registered. After this basal assessment and for 21 days after the episode of SAH, patients were seated once a day and signs of VS were recorded. RESULTS: No significant changes in MCBFV or hemodynamic variables were detected during position changes, except for an increase in heart rate in the sitting position. No patient with AVS at the onset, had symptomatic VS during the 21 days of follow up when patients were seated. Among patients with a normal MCBFV at baseline, five patients (24%) had VS at a mean of three days after the first time that they were seated on the edge of bed. CONCLUSIONS: Sitting patients at the edge of the bed is a safe mobilization alternative for patients who suffered aSAH who did not have VS or had AVS.