Abordaje endoscópico extendido del seno frontal: Experiencia en Hospital Clínico Universidad de Chile / Extended endoscopic approach of the frontal sinus: Experience at Hospital Clínico Universidad de Chile

Introducción: El seno frontal es una estructura compleja y desafiante en términos quirúrgicos, siendo descritas numerosas técnicas para su abordaje. Dentro de ellas se destaca el abordaje endoscópico extendido de seno frontal: Draf IIB y Draf III, como una importante alternativa para resolución de patología refractaria de seno frontal. Objetivo: Describir las características de pacientes sometidos a abordaje endoscópico extendido de seno frontal en Hospital Clínico Universidad de Chile (HCUCH). Material y Método: Estudio retrospectivo, descriptivo. Se incluyeron a pacientes sometidos a abordaje endoscópico extendido de seno frontal entre los años 2013 y 2021. Se analizaron variables clínicas, intraoperatorias y de seguimiento. Resultados: Se registraron 118 pacientes, de los cuales 64 cumplieron criterios de inclusión al estudio, con una edad promedio de 48 años. La patología más frecuente fue la rinosinusitis crónica poliposa (42%) seguido del mucocele (20%). Del total de pacientes, el 68% fue sometido a cirugía Draf IIB y el resto a Draf III. Todos los pacientes fueron estudiados con endoscopía e imágenes, y seguidos con parámetros clínicos y endoscópicos. El porcentaje de estenosis postoperatoria se estimó en 10%. Conclusión: El abordaje endoscópico nasal extendido figura como una alternativa útil para manejo de patología de seno frontal refractario a tratamiento. En nuestra experiencia las indicaciones, tipos de cirugía y tasa de complicaciones son concordantes con la literatura internacional.

Introduction: The frontal sinus is a complex and challenging structure in surgical terms, numerous techniques have been described for its approach, among them the extended endoscopic approach: Draf IIB and Draf III, figures as an important alternative for the resolution of refractory pathology of frontal sinus. Aim: To describe the characteristics of patients who underwent an extended endoscopic approach to the frontal sinus at the Hospital Clínico Universidad de Chile (HCUCH). Material and Method: A retrospective, descriptive study included patients who underwent an extended endoscopic approach to the frontal sinus between 2013 and 2021. Clinical, intraoperative, and follow-up variables were analyzed. Results: 118 patients were registered, of which 64 met the inclusion criteria for the study, with an average age of 48 years. The most frequent pathology was chronic polypous rhinosinusitis (42%), followed by mucocele (20%). Of the patients, 68% underwent Draf IIB surgery, while the rest received a Draf III type procedure. All patients were studied with endoscopy and images and followed up with clinical and endoscopic parameters. The percentage of post operatory stenosis was 10%. Conclusion: The extended nasal endoscopic approach appears as a valuable alternative for managing frontal sinus pathology refractory to treatment. In our experience, the indications, types of surgery, and rate of complications are consistent with the international literature.

Functionality and disease severity in spinocerebellar ataxias / Relação entre a função e a gravidade nas ataxias espinocerebelares

ABSTRACT Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative diseases characterized by deterioration of balance and functionality that tends to follow disease progression. There is no established link between formal clinical markers for severity and functional/balance scores that could guide rehabilitation teams. Objective: To evaluate the relationship between functional scales and ataxia severity in order to identify cutoff landmarks for functional loss and estimate the mean SARA (Scale for Assessment and Rating of Ataxia) score for the risk ratings for falls on the BBS (Berg Balance Scale). Methods: Consecutive patients with a molecular diagnosis of SCA (total 89: 31 with SCA2 and 58 with SCA3) were assessed for functionality FIM-ADL (Functional Independence Measure-activities of daily living and Lawton-IADL (instrumental activities of daily living), balance (BBS) and disease severity (SARA). Results: The main disability cutoff landmarks were that the need for supervision for FIM-ADL starts with 12 points on SARA and the need for supervision for Lawton-IADL starts with 14 points on SARA. The first items to require assistance were "expression" and "shopping", respectively. At 20 points on SARA, patients were dependent on all FIM and Lawton items. The item with the greatest impact on distinguishing dependents from independents was "means of transport" in Lawton-IADL and the domain "locomotion" in FIM-ADL. The mean SARA score for patients classified as low risk in the BBS was 9.9 points, and it was 17.4 for medium risk and 25.2 for high risk. Conclusions: Analysis on the correlation between the severity of ataxia and functional scales can form an important guide for understanding the progression of functional dependence among individuals with SCAs.

RESUMO Antecedentes: As ataxias espinocerebelares (SCA) são um grupo de doenças neurodegenerativas caracterizadas pela deterioração do equilíbrio e da funcionalidade, que tende a acompanhar a progressão da doença. Não existe uma ligação estabelecida entre os marcadores clínicos formais de gravidade e escores funcionais e de equilíbrio que possam orientar as equipes de reabilitação. Objetivo: Avaliar a relação entre escalas funcionais e de gravidade da ataxia, buscando identificar pontos de corte para a perda funcional relacionados aos escores de gravidade e aos patamares de Risco de Quedas. Métodos: Uma amostra consecutiva de 89 pacientes com diagnóstico molecular de SCA (31-SCA2 e 58-SCA3) foram avaliados para funcionalidade MIF-AVDs (Medida de independência funcional-Atividades da vida diária) e Lawton-AIVDs (Atividades instrumentais da vida diária), equilíbrio (EEB-escala de Equilíbrio de Berg), e gravidade da ataxia (SARA-escala para avaliação e graduação de ataxia). Resultados: Os principais pontos de corte de deficiência foram: com 12 pontos no SARA começa a necessidade de supervisão para MIF-AVDs e com 14 pontos no SARA começa a necessidade de supervisão para Lawton-AIVDs. Os primeiros itens a necessitar de assistência foram "expressão" e "compras", respectivamente. Com 20 pontos no SARA os pacientes eram dependentes em todos os itens MIF/LAWTON. O item com maior impacto na discriminação entre dependentes e independentes foi "meio de transporte" na Lawton e o domínio "locomoção" na MIF. O escore médio no SARA foi de 9,9 pontos para pacientes classificados com baixo risco na EEB, 17,4 para médio risco e 25,2 para alto risco. Conclusões: A análise da correlação entre a gravidade da ataxia e as escalas funcionais pode ser um importante guia no entendimento da progressão da dependência funcional em indivíduos com SCA.

Hipertensión pulmonar. Definiendo la estructura y la función departamental a partir del riesgo / Pulmonary hypertension. Defining the structure and the departmental function based on risk

Se presenta un modelo departamental para la atención integral de pacientes con hipertensión pulmonar. Se resume el conocimiento actual de la hipertensión pulmonar, su mortalidad, pronóstico y la estratificación de su severidad que justifican la propuesta de la estructura y la función departamental.

A departmental model for the comprehensive care of patients with pulmonary hypertension is presented. The current knowledge of pulmonary hypertension, its mortality, prognosis and the stratification of its severity that justify the proposal of the departmental structure and function are summarized.

Mortalidad secundaria a SARS-CoV-2 en pacientes con trasplante renal de un centro del nordeste colombiano / Mortality Related to SARS-CoV-2 in Patients with Kidney Transplant from a Center in Northeastern Colombia

Objetivo Describir la tasa de mortalidad de infección por coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, en inglés) y los factores de riesgo asociados a la severidad de la enfermedad en pacientes con trasplante renal de un centro del nordeste colombiano. Materiales y Métodos Estudio descriptivo de una cohorte de pacientes en seguimiento postrasplante renal, en el que se hizo una búsqueda retrospectiva de los que presentaron infección por SARS-CoV-2 entre marzo del 2020 y mayo del 2021. Para el análisis, se incluyeron los pacientes con infección confirmada mediante pruebas de reacción en cadena de la polimerasa (polymerase chain reaction, PCR, en inglés), de antígenos, o de anticuerpos. Se realizó un análisis descriptivo de las variables sociodemográficas y clínicas, y un análisis bivariado de los posibles factores asociados con el riesgo de mortalidad. Resultados Con un total de 307 individuos en seguimiento, se encontró una prevalencia del 14,3% (n = 44) de infección por enfermedad por coronavirus 2019 (coronavirus disease 2019, COVID-19, en inglés). La media de edad fue de 56 años, con predominio del género masculino. El esquema de inmunosupresión más frecuente fue micofenolato­tacrolimus­prednisona. Entre los pacientes infectados, la mortalidad fue del 34,1% (15/44), lo que representa el 4,8% de toda la población a estudio. Maás de la mitad de los pacientes requirieron hemodiálisis, y en el 86,7% fue necesario hacer ajustes en el esquema de inmunosupresión. Conclusión La prevalencia de infección por SARS-CoV-2 en nuestro grupo de trasplantes fue similar a la reportada por otros grupos de trasplante del país, y mayor a la de la población no trasplantada. El valor de creatinina previo a la infección, la edad y las comorbilidades se asociaron con un mayor riesgo de mortalidad.

Objective To describe the mortality related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk factors associated with disease severity in patients submitted to a kidney transplant from a center in northeastern Colombia. Materials and Methods The present is a descriptive study of a cohort of patients in follow-up care after kidney transplant, with a retrospective search for those who presented SARS-CoV-2 infection between March 2020 and May 2021. Patients with confirmed infection by polymerase chain reaction (PCR), antigens or antibodies tests were included for analysis. We performed a descriptive analysis of the sociodemographic and clinical variables as well as a bivariate analysis to evaluate the possible factors associated with the risk of mortality. Results With a total of 307 individuals in follow-up care, a prevalence of 14.3% (n = 44) of coronavirus disease 2019 (COVID-19) infection was found. The mean age of the sample was of 56 years, with a male predominance. The most frequent immunosuppression regimen was mycophenolate-tacrolimus-prednisone. Among the infected patients, the mortality rate was of 34.1% (15/44), representing 4.8% of the entire study population. More than half of the patients required hemodialysis, and 86.7% required adjustments to the immunosuppression regimen. Conclusion The prevalence of SARS-CoV-2 infection in our transplant group was similar to that reported by other transplant groups in the country and higher than among the non-transplanted population. The preinfection creatinine value, age, and comorbidities were associated with a higher risk of mortality.

C-reactive protein for the diagnosis and prognosis of visceral leishmaniasis caused by Leishmania infantum

Acute-phase reaction (APR) and its marker C-reactive protein (CRP) are heightened in some infectious diseases. APR may contribute to clinical manifestations of systemic inflammation such as hemorrhages, anemia and edema. These symptoms are shared by visceral leishmaniasis (VL), a disease caused by the protozoa Leishmania infantum and L. donovani. The former is zoonotic, hitting mostly children and the immunosuppressed, with higher mortality. As APR and CRP have not been studied in VL caused by L. infantum, we decided to investigate their role as diagnostic and prognostic tools in Brazil. We measured CRP in 136 patients before the treatment of VL and 128 who survived and returned 30 days later and compared it to the clinical presentation, HIV status, and disease severity. Sensitivity for the disease was 97.8% (95%CI: 93.7 - 99.5) and specificity was 85.9% (95%CI: 78.7 - 91.0) with the cut-off of 10mg/L. There was no association of CRP concentration with demographic, clinical and laboratory data. The correlation between pre-and post-treatment levels existed but was poor. Marginal association with the presence of parasites in the bone marrow and death was noticed. The role of APR in the pathogenesis of VL and disease severity remains to be explored. However, the study reveals the significant role of CRP for VL caused by L. infantum and should be routinely required for the diagnosis and follow-up.

Depressão em idosos que vivem na comunidade: incidência, fatores preditivos e análise de sobrevivência / Depression in community-dwelling elderly: incidence, predictive factors and survival analysis

Introdução: Idosos com depressão e sintomas depressivos apresentam repercussões na funcionalidade, fragilidade e interações sociais, o que se reflete em uma pior qualidade de vida. Na perspectiva da saúde física, a depressão tem associação com multimorbidades, adoecimento cardiovascular e à mortalidade por todas as causas. Com o aumento da prevalência da depressão/sintomas depressivos (DSD) relacionado à mudança demográfica e ao envelhecimento da população global, a demanda de conhecimento aumenta, em especial quanto aos fatores preditivos da DSD, bem como à análise da associação entre esta variável e a mortalidade. Dois objetivos nortearam a presente pesquisa: Primeiro, sintetizar informações obtidas a partir da literatura científica mundial acerca da incidência e fatores preditivos da DSD na população de idosos que vivem na comunidade; segundo, analisar sintomas depressivos (SD) como preditivo de mortalidade em idosos domiciliares em uma cidade de médio porte no Nordeste brasileiro decorridos 138 meses. Método: Diferentes métodos foram utilizados para cada objetivo: Elaboração de Protocolo de Revisão Sistemática e Metanálise acerca dos fatores preditivos do espectro depressivo, registrado na PROSPERO. Estabeleceram-se 6 bases de dados para a aquisição do material a ser avaliado: PubMed, Web of Science, Scopus, Lilacs, Scielo e Cochrane. Todas as etapas foram executadas de maneira pareada. Para o segundo objetivo, realizou-se um uma análise de sobrevivência após 138 meses da participação de uma amostra de idosos com 65 anos e mais, vinculada à Rede FIBRA na cidade de Campina GrandePB, entre os anos de 2008 e 2009. Os dados de mortalidade foram coletados a partir do Sistema de Informação sobre Mortalidade do Município até fevereiro de 2020. A técnica de KaplanMeier (KM) e teste de hipótese com Log Rank foram utilizados na análise bivariada, seguido de Regressão de Cox para o gênero feminino. Resultados: Ao direcionar para obtenção da incidência de DSD na Revisão Sistemática, observaram-se 17.336 documentos encontrados nas bases de dados. Após processo de seleção, foram incluídos 46 artigos. A incidência acumulada (IA) foi sintetizada de acordo com os instrumentos utilizados para avaliação da DSD. Em ordem crescente observou-se que a IA para ferramentas diagnósticas foi 5,24% (IC 95% 4,75-5,77), seguida pela utilização de ferramentas de rastreio: Escala de Depressão do Centro de Estudos Epidemiológicos 10,92% (IC 95% 10,52-11,33), Escala de Depressão Geriátrica 13,24% (IC 95% 13,03-13,45) e outras escalas e 14,35% (IC 95% 14,04-14,67). Na análise de sobrevida, SD em idosos na linha de base não apresentaram um menor tempo de sobrevida decorridos 138 meses, seja por todas as causas de mortalidade (p=0.746), seja por causas cardiovasculares (p=0.3). Conclusão: A despeito da variação de IA anual, observa-se uma frequente ocorrência de DSD no contexto comunitário por parte dos idosos, o que deflagra a necessidade de ações preventivas e de cuidados precoces mais bem direcionados na Atenção Primária a Saúde. Na análise de sobrevivência, a falta de associação pode revelar que outros fatores podem exercer papel mediador na relação encontrada na literatura científica entre a DSD e mortalidade, o que não quer dizer que SD não tenham associação com a mortalidade, visto que alteram comportamentos, estilo de vida e adesão ao tratamento de outras doenças (AU).

Introduction: Older adults with depression and depressive symptoms exhibit impairment in functionality, frailty, and social interactions, which is reflected in a worse quality of life. From a physical health perspective, depression is associated with multimorbidities, cardiovascular disease, and all-cause mortality. With the increasing prevalence of depression/depressive symptoms (DDS) related to demographic change and the aging of the global population, the demand for knowledge increases, especially regarding predictive factors of DDS, as well as the analysis of the association between this variable and mortality. Two objectives guided the present research: First, to synthesize information obtained from the world scientific literature about the incidence and predictive factors of DDS in the community-dwelling older adults' population; second, to analyze depressive symptoms (DS) as a predictor of mortality in homebased older adults living in a medium-sized city in the Northeast of Brazil after 138 months. Method: Different methods were used for each objective: Development of a Systematic Review and Meta-Analysis Protocol about predictive factors of the depressive spectrum, registered in PROSPERO. Six databases were established for the acquisition of the material to be evaluated: PubMed, Web of Science, Scopus, Lilacs, Scielo and Cochrane. All steps were performed in a paired manner. For the second objective, we carried out a survival analysis after 138 months of participation of a sample of older adults aged 65 years and over, linked to the FIBRA Network in the city of Campina Grande-PB, between the years 2008 and 2009. Mortality data were collected from the Municipality Mortality Information System until February 2020. The Kaplan-Meier (KM) technique and hypothesis test with Log Rank were used in the bivariate analysis, followed by Cox Regression for female gender. Results: By directing to only retrieving incidence from the Systematic Review, 17,336 documents found in the databases were observed. After selection process, 46 articles were included. The cumulative incidence (CI) was synthesized according to the instruments used to evaluate DDS. In an increasing order we observed that the CI for diagnostic tools was 5.24% (95% CI 4.75-5.77), followed by the use of screening tools: Center for Epidemiologic Studies Depression Scale 10.92% (95% CI 10.52-11.33), Geriatric Depression Scale 13.24% (95% CI 13.03-13.45) and other scales and 14.35% (95% CI 14.04-14.67). In survival analysis, DS in older adults at baseline did not have a shorter survival time after 138 months, either from all-cause mortality (p=0.746) or from cardiovascular causes (p=0.3). Conclusion: Despite the variation in CI observed, it is evident a frequent occurrence of DDS in the community-dwelling older adults' context, which triggers the necessity of preventive actions and better-targeted early care in Primary Health Care. In survival analysis, the lack of association may reveal that other factors may play a mediating role in the relationship found in the scientific literature between DDS and mortality, which does not mean that DS have no association with mortality, since they alter behaviors, lifestyle, and adherence to treatment of other diseases (AU).

Predictores clínicos de severidad en pacientes de COVID-19 / Clinical predictors of severity in COVID-19 patients

En la actualidad se han encontrado múltiples variables clínicas y paraclínicas predictores de pronóstico en pacientes con COVID-19. La identificación de los factores pronósticos, permitirá graduar el riesgo de los pacientes y controlar activamente la gravedad de la enfermedad. El objetivo de este artículo era identificar, a través de una revisión bibliográfica, las variables que puede estar asociado a desenlace fatal a causa de la infección por SARS-CoV-2, un panorama que anticipe a la severidad en pacientes con COVID-19. Por tanto, se confirma que la edad avanzadas conjuntamente con comorbilidades preexistente como: diabetes, hipertensión y otras enfermedades cardiovasculares, insuficiencia renal aguda, enfermedad hepática crónica, además de factores genéticos y demencia neurodegenerativa, son factores de mal pronóstico, en los pacientes con COVID-19(AU)

Currently, multiple clinical and paraclinical variables have been found to predict prognosis in patients with COVID-19. The identification of prognostic factors will allow patients' risk to be graded and actively control the severity of the desease. The goal of this article was to identify, through a bibliographic review, the variables that may be associated with a fatal outcome due to SARS-CoV-2 infection, a scenario that anticipates severity in patients with COVID-19. Therefore, it is confirmed that advanced age together with pre-existing comorbidities such as: diabetes, hypertension and other cardiovascular diseases, acute renal failure, chronic liver disease, in addition to genetic factors and neurodegenerative dementia, are poor prognostic factors in patients with COVID-19(AU)

Evaluation of D-dimer as a predictor of severity, degree of pulmonary involvement and mortality in patients with COVID-19 / Avaliação do D-dímero como preditor de gravidade, grau de envolvimento pulmonar e mortalidade em pacientes com COVID-19

Objective: To verify D-dimer values to predict disease severity, degree of lung involvement and mortality in patients with COVID-19. Method: The D-dimer levels of 200 confirmed COVID-19 patients were prospectively measured in the Emergency Department of Razi Hospital of Ahvaz on the admission day, and its relations with the illness severity, computed tomography (CT) score, and mortality were assessed. Results: D-dimer level > 1.04 µg/mL and ≤ 1.12 µg/mL could indicate severe illness and high grade of pulmonary involvement but low risk of death. The mortality rate in the patients with D-dimer level > 1.12 µg/mL (was significantly higher than its rate in those with D-dimer level ≤ 1.12 µg/mL (17.2% x 1.5%; P:0.02). An independent positive correlation was found between D-dimer and Chest CT score as well as the disease severity (OR: 1.84; 95%CI:1.38 - 2.45; P:0.0001). Conclusion: D-dimer level > 1.12 µg/mL on the early stage of COVID-19 infection may independently predict the severe illness, high grade of pulmonary involvement, and high risk of death, indicating its beneficial role in timely management of critical patients.

Objetivo: Verificar os valores do D-dímero para predizer a gravidade da doença, o grau de envolvimento pulmonar e a mortalidade em pacientes com COVID-19. Método: Os níveis de dímero D de 200 pacientes confirmados com COVID-19 foram medidos, prospectivamente, no Departamento de Emergência do Hospital Razi de Ahvaz, no dia da admissão, e suas relações com a gravidade da doença, escore de tomografia computadorizada (CT) e mortalidade foram avaliadas. Resultados: Os níveis do D-dímero > 1,04 µg/mL e ≤ 1,12 µg/mL podem indicar doença grave e alto grau de envolvimento pulmonar, mas baixo risco de morte. A taxa de mortalidade nos pacientes com valor de D-dímero > 1,12 µg/mL foi significativamente maior do naqueles com nível de D-dímero ≤ 1,12 µg/mL (17,2% x 1,5%; P:0,02). Foi encontrada uma correlação positiva independente entre o D-dímero e o escore de CT de tórax e a gravidade da doença (OR: 1,84; IC 95%:1,38 - 2,45; P:0,0001). Conclusão: O nível do D-dímero > 1,12 µg/mL no estágio inicial da infecção por COVID-19 pode prever independentemente a doença grave, alto grau de envolvimento pulmonar e alto risco de morte, indicando seu papel benéfico no manejo oportuno de pacientes críticos.

Desgaste erosivo en preescolares de 5 años de Montevideo­Uruguay: primer estudio poblacional / Erosive tooth wear in 5 -year- old preschool children of Montevideo­Uruguay: first population study / Desgaste erosivo em preescolares de 5 anos de MontevideoUruguai: primer estudo populacional

Objetivo: determinar prevalencia, extensión, severidad y distribución del desgaste erosivo (DE) en preescolares de Montevideo. Metodología: estudio transversal de base poblacional, muestra representativa de centros educativos públicos y privados. Fueron indagados aspectos sociodemográficos, biológicos y de comportamiento con un cuestionario auto-reportado por padres/responsables. Los exámenes fueron realizados por dos operadores Kappa ≥ 0,7. DE fue registrado con el índice O´Brien modificado, reportándose porcentaje y promedio; intervalo de confianza (IC) 95%. Se realizaron análisis de asociación con sexo y nivel socioeconómico. Resultados: se examinaron 614 preescolares. Prevalencia: 57,6% (IC95%: 52,7-62,5). Extensión: 4,8 (IC95%: 4,3-5,3). DE severo: 8,2% (IC95%: 5,5-10,9) Las superficies más afectadas fueron palatino de incisivos superiores. Los preescolares de nivel socioeconómico alto presentaron mayor DE que los de nivel bajo; 73,1% (IC95%:61,9-84,2) y 48,4% (IC95%:39,2-57,7) respectivamente (p≤0,01). Conclusiones: la prevalencia y extensión del DE fue alta. Estos datos pueden contribuir en la modificación de medidas que apunten a controlar la prevalencia de DE.

Aims: assess the prevalence, extent,severity, and distribution of erosive tooth wear (ETW) in preschoolers of Montevideo. Methods: cross-sectional populationbased study of representative sample of public and private educational centers. Sociodemographic, biological, and behavioral aspects were investigated with a self-reported questionnaire to parents /guardians. The examinations were performed by two examiners (Kappa ≥ 0.7). The ETW was registered with modified O´Brien index, reported in percentage and average, confidence interval (CI) 95%. Analysis of association with sex and socioeconomic level were carried out.Results: 614 preschoolers were examined. Prevalence: 57.6% [95%CI=52.7-62.5]. Severe ETW: 8.2% [95%CI 5.5-10.9]. ETW extension: 4.8 [95%CI=4.3-5.3]. The most affected surfaces were palatal upper incisors. Preschoolers of high socioeconomic level presented higher ETW than those of low level; 73.1% (95% CI: 61.9-84.2) and 48.4% (95% CI: 39.2-57.7) respectively (p≤0.01). Conclusion: ETW prevalence and extent was high. These data can contribute to the modification of measures that aim to control ETW prevalence.

Objetivo: determinar prevalência, extensão, severidade e distribuição do desgaste erosivo (DE) em pré-escolares de Montevidéu. Metodologia: estudo transversal de base populacional, amostra representativa de centros educacionais públicos e privados. Aspetos sociodemográficos, biológicos e comportamentais foram investigados por meio de questionário autorreferência pelos pais/responsáveis. Os exames foram realizados por dois operadores Kappa ≥ 0,7. DE foi registado com o Índice O´Brien modificado, relatando porcentagem e média; intervalo de confiança (IC) 95%. Foi realizada análise de associação com sexo e nível socioeconômico. Resultados: 614 pré-escolares foram examinados. Prevalência: 57,6% (IC95%: 52,7-62,5). Extensão: 4,8 (IC 95%: 4,3-5,3). DE grave: 8,2% (IC 95%: 5,5-10,9). As superfícies mais afetadas foram palatinas dos incisivos superiores. Pré-escolares de alto nível socioeconômico apresentaram maior DE que os de baixo nível; 73,1% (IC 95%: 61,9-84,2) e 48,4% (IC 95%: 39,2-57,7) respetivamente (p≤0,01). Conclusões: a prevalência e extensão da DE foi alta. Esses dados podem contribuir em la modificação de medidas que visam controlar a prevalência de DE.

Variables asociadas a la severidad en pacientes con Covid-19 / Variables associated with severity in COVID-19 patients

En la COVID-19 un porcentaje de los enfermos desarrolla cuadros severos, con una elevada mortalidad, siendo necesario el estudio de sus características con el objetivo de frenar la progresión de la enfermedad. Se realizó un estudio retrospectivo en una cohorte de 150 pacientes adultos atendidos en el hospital Manuel Fajardo de Villa Clara, Cuba, en el período de marzo a junio de 2020. Se analizaron variables demográficas, clínicas, de laboratorio, gasométricas y radiológicas medidas al ingreso hospitalario; definiéndose dos grupos de pacientes según la evolución clínica: severos y no severos. Para la comparación de los grupos se realizó un análisis bivariado con el objetivo de determinar aquellas variables con asociación significativa a la severidad. Del total de pacientes, 26 (17,3%) evolucionaron a la severidad y 124 (83.7%), evolucionó satisfactoriamente. Los pacientes severos se caracterizaron por tener edad avanzada (media: 83 años) y presentar comorbilidades; siendo las más significativas: hipertensión arterial, diabetes mellitus, cardiopatía, enfermedad renal crónica y cáncer (p<0.0001). La polipnea y diarrea fueron las manifestaciones clínicas con mayor asociación a la severidad (p<0.0001), seguido por la fiebre (p=0.0157). La escala pronóstica quick SOFA mostró ser un instrumento útil para evaluar a los pacientes al ingreso. Las variables de laboratorio: neutrófilos, linfocitos, índice neutrófilos/linfocitos, hemoglobina. y lactato deshidrogenasa fueron las que mayor asociación tuvieron con la severidad (p<0.0001). Los leucocitos, lactato, dímero D, proteína C reactiva, glicemia y calcio también mostraron resultados significativos (p< 0.05). De las variables gasométricas, la presión y saturación arterial de oxígeno fueron las más significativamente asociadas a la severidad; así como la presencia de infiltrados o consolidación pulmonar en la radiografía de tórax (p <0.0001). El estudio permitió identificar variables al ingreso hospitalario, asociadas a progresión hacia formas severas de la enfermedad

In COVID-19, a percentage of patients develop severe disease, with high mortality, since has been necessary to study its characteristics to stop the progression of the disease. A retrospective study was carried out in a cohort of 150 adult patients attended at Manuel Fajardo Hospital in Villa Clara, Cuba, from March to June 2020. Demographic, clinical, laboratory, gasometric and radiological variables measured at hospital admission were analyzed, defining two groups of patients according to clinical evolution: severe and non-severe. For the comparison of the groups a bivariate analysis was performed, with the objective of determining those variables with a significant association to severity. Of the total number of patients, 26 (17.3%) evolved to severity and 124 (83.7%) evolved satisfactorily. Severe patients were characterized by advanced age (mean: 83 years) and comorbidities; the most significant being hypertension, diabetes mellitus, heart disease, chronic kidney disease and cancer (p< 0.0001). Polypnea and diarrhea were the clinical manifestations with the highest association with severity (p<0.0001), followed by fever (p=0.0157). The quick SOFA prognostic scale proved to be a useful instrument to evaluate patients at admission. Laboratory variables: neutrophils, lymphocytes, neutrophil/lymphocyte ratio, hemoglobin and lactate dehydrogenase were the most associated with severity (p<0.0001). Leukocytes, lactate, D-dimer, C-reactive protein, glycemia and calcium also showed significant results (p<0.05). Of the gasometric variables, arterial oxygen pressure and saturation were the most significantly associated with severity; as well as the presence of pulmonary infiltrates or consolidation in the chest X-ray (p<0.0001). The study allowed us to identify variables at hospital admission associated with progression to severe forms of the disease.

O uso emergente da teleodontologia durante a pandemia de Covid-19: experiência de um município do sul do Brasil / The emerging use of teleodontology during the Covid-19 pandemic: experience from a municipality in southern Brazil

Objetivo: descrever a experiência do serviço de teleodontologia no município de Palhoça, Santa Catarina, durante a pandemia da Covid-19. Métodos: trata-se de um estudo observacional, de caráter transversal. A pesquisa foi realizada com os dados de pacientes atendidos pelo serviço de teleodontologia do município Palhoça, Santa Catarina. Foram registrados dados referentes ao perfil sociodemográfico do usuário, agravos bucais e desfecho do caso. Resultados: houve 20.745 teleatendimentos e 7.666 agendamentos. A maioria dos usuários era do sexo feminino, sendo a faixa etária mais prevalente composta por jovens adultos. As principais queixas relatadas foram para monitoramento de caso e dor. Dos casos agendados, 91,23% dos usuários foram encaminhados para as unidades básicas de saúde. Conclusão: diante dos achados, a teleodontologia demonstrou ser uma excelente ferramenta, contribuindo para a diminuição no fluxo de pessoas em unidades de saúde e colaborando com os processos instituídos no atendimento, possibilitando a manutenção da assistência de casos.(AU)

Objective: to describe the experience of a Dentistry- by-phone (Teleodontologia) service in the city of Palhoça, SC, Brazil, during the Covid-19 pandemic. Methods: this is an observational, cross-sectional study. The research was carried out with data from patients assisted by the service. Data regarding the user's sociodemographic profile, oral health problems and case results were recorded. Results: there were 20745 calls and 7666 appointments. Most users were female, with the most prevalent age group being young adults. Main reported complaints were for case monitoring and pain. From the scheduled cases, 91% of users were referred to the UBSs (Health Basic Units). Conclusion: the service was considered to be an excellent tool, assisting on reducing the flow of people in health units and collaborating with the processes established in the service, allowing for health care maintenance.(AU)

Prevalência e características da disfunção temporomandibular de pacientes de uma clínica escola de Odontologia / Prevalence and characteristics of temporomandibular dysfunction of patients in a Dentistry clinic-school

Objetivos: determinar a prevalência da disfunção temporomandibular (DTM) em pacientes de uma clínica escola de Odontologia, descrever o perfil epidemiológico da amostra analisada, caracterizar o grau dessas disfunções e identificar os sinais e sintomas orofaciais mais frequentes. Método: estudo epidemiológico, do tipo transversal, que avaliou pacientes da Clínica Escola de Odontologia da Universidade de Rio Verde, GO. A pesquisa foi realizada através de três questionários: Índice Anamnésico Simplificado de Fonseca (IASF), Questionário para Triagem para Dor Orofacial (QTDO), questionário sociodemográfico e econômico. Resultados: foram analisados 200 pacientes, dentre os quais 78,5% apresentaram algum grau de DTM, sendo o mais prevalente a DTM de leve intensidade, presente em 38% da amostra. Conclusão: nesse cenário, conclui- -se que a maioria dos participantes apresentou DTM, sendo que a intervenção multidisciplinar seria de suma relevância no tratamento, podendo oferecer uma abordagem mais completa e com melhores resultados.(AU)

Objectives: to determine the prevalence of TMD in patients at a dental school clinic, as well as describe its epidemiological profile for the evaluated sample, characterizing the degree of this dysfunction and identifying the most frequent orofacial signs and symptoms. Method: it is an epidemiological, cross-sectional study that evaluated patients at the School of Dentistry clinic, University of Rio Verde, GO, Brazil. The study was carried out using three questionnaires: Simplified Fonseca Anamnesis Index (SFAI), Orofacial Pain Screening Questionnaire (OPSQ), and the socio-demographic and economic questionnaire. Results: 200 patients were evaluated, among which 78.5% had some degree of TMD, the most prevalent being mild TMD, present in 38% of the sample. Conclusion: most participants had TMD, and multidisciplinary intervention would be of paramount importance in the treatment, being able to offer a more complete approach and with better results.(AU)

Determinants of self-efficacy in patients with Parkinson's disease / Determinantes de autoeficacia en pacientes con enfermedad de Parkinson

ABSTRACT Background: Self-efficacy is the individual's assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases. Objective: To investigate self-efficacy in a population of Parkinson's disease (PD) patients in Mexico and study the factors that are associated with this measure. Methods: We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded. Results: We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (<7.75) had worse scores in MDS-UPDRS, NMSS, and PDQ-8 scales. CDSES scores were significantly correlated with MDS-UPDRS Part I (r=-0.497, p=<0.001), Part II (r= -0.271, p=0.020), Part III (r=-0.304, p=<0.001), PDQ-8 (r=-0.472, p=<0.001), and NMSS (r=-0.504, p=<0.001). Furthermore, when assessing the simultaneous effect of covariates associated with CDSES score, only Mood/Apathy domain of NMSS was significant (beta= -0.446, t= -3.807, p= 0.012). Conclusions: PD patients with lower self-efficacy scores had worse motor and non-motor symptomatology and quality of life. Mood/Apathy disorders were negatively associated with self-efficacy and contributed significantly to this measure.

RESUMEN Antecedentes: La autoeficacia es la autoevaluación de un individuo sobre su capacidad para completar una tarea con éxito y se ha relacionado con automanejo y calidad de vida en otras enfermedades. Objetivo: Investigar la autoeficacia en una población de pacientes con enfermedad de Parkinson (EP) en México y estudiar factores asociados con esta medida. Métodos: Realizamos un estudio observacional transversal con pacientes con EP en una clínica de neurología en México. Se registraron datos demográficos y escalas que evalúan la función motora (MDS-UPDRS), no motora (NMSS) y cognitiva (MoCA), así como la calidad de vida (PDQ-8). Para valorar autoeficacia se utilizó la versión en español de la Escala de autoeficacia de enfermedades crónicas (CDSES). Resultados: Se incluyeron 73 pacientes, con una edad media de 65 años y la mayoría eran hombres. Pacientes con puntajes CDSES más bajos (<7.75) tuvieron peores puntajes en las escalas MDS-UPDRS, NMSS y PDQ-8. Las puntuaciones de CDSES se correlacionaron significativamente con la escala MDS-UPDRS Parte I (r=-0.497, p=<0.001), Parte II (r= -0.271, p=0.020), Parte III (r=-0.304, p=<0.001), PDQ-8 (r= -0.472, p=<0.001), y NMSS (r=-0.504, p=<0.001). Al evaluar el efecto simultáneo de covariables asociadas con la escala CDSES, solo el dominio estado de ánimo/apatía del NMSS resultó significativo (Beta = -0.449, t = -3.783, p = <0.001). Conclusiones: Los pacientes con menores puntajes de autoeficacia tienen peor calidad de vida y sintomatología motora y no motora. Los trastornos del estado de ánimo contribuyen negativamente a la autoeficacia.

Diabetes, hiperglucemia y evolución de pacientes con la COVID-19 / Diabetes, hyperglycemia and evolution of patients with COVID-19

Introducción: La diabetes mellitus e hiperglucemia, en pacientes con la COVID-19, predisponen a mayor gravedad de la enfermedad y peores resultados a corto plazo. Objetivo: Identificar diferencias clínicas, de parámetros humorales, evolución y en el uso de medicamentos en pacientes infectados con el SARS-CoV-2, en relación con el estado glucémico, durante la pandemia de la COVID-19. Métodos: Estudio retrospectivo, de todos los pacientes infectados con SARS-CoV-2, atendidos en el Hospital Militar Dr. Mario Muñoz Monroy, desde el 17 de marzo hasta el 4 de junio de 2020. Se recopilaron variables demográficas, evolución de los síntomas, estadía hospitalaria, antecedentes patológicos personales, parámetros humorales al ingreso, complicaciones y uso de medicamentos. Fueron creados tres grupos: diabéticos (n = 16), hiperglucémicos (glucemia en ayunas ≥ 7,8 mmol/L; n = 10) y normoglucémicos (n = 219). Se utilizaron las pruebas de ji cuadrado y H de Kruskal - Wallis, para las comparaciones entre los grupos. Se usó un intervalo de confianza del 95 por ciento. Resultados: Los pacientes diabéticos e hiperglucémicos, en relación con normoglucémicos, tuvieron mayor proporción de sintomáticos al ingreso, hipertensión arterial, cardiopatía isquémica, insuficiencia renal crónica, otros antecedentes, complicaciones, mortalidad, uso de esteroides y Jusvinza. Además, tuvieron menores valores de hematocrito y linfocitos, mayores de neutrófilos, plaquetas, creatinina, aspartato amino transferasa, glutamil transpeptidasa, fosfatasa alcalina y deshidrogenasa láctica. Conclusiones: Tanto la diabetes como la hiperglucemia predisponen a formas clínicas más graves de COVID-19, con peores parámetros humorales, evolución y mayor mortalidad. En estos pacientes se usa con mayor frecuencia esteroides y Jusvinza(AU)

Introduction: Diabetes mellitus and hyperglycemia, in patients with COVID-19, predispose to greater severity of the disease and worse short-term outcomes. Objective: To identify clinical differences, of humoral parameters, evolution and in the use of medications in patients infected with SARS-CoV-2; in relation to glycemic status, during the COVID-19 pandemic. Methods: Retrospective study of all patients infected with SARS-CoV-2, treated at the Hospital Militar Dr. Mario Muñoz Monroy _until June/2020. Demographic variables, evolution of symptoms, hospital stay, personal pathological history, humoral parameters on admission, complications and use of medications were collected. Three groups were created: diabetic (n = 16), hyperglycemic (fasting blood glucose ≥ 7.8 mmol/L; n = 10) and normo glycemic (n = 219). Chi-square and Kruskal-Wallis H test were used for comparisons between groups. A 95 percent confidence interval was used. Results: Diabetic and hyperglycemic patients had a higher proportion of symptoms on admission, arterial hypertension, ischemic heart disease, chronic renal insufficiency, other antecedents, complications, mortality, and use of steroids and Jusvinza. In addition, they had lower values of hematocrit and lymphocytes, and higher values of neutrophils, platelets, creatinine, aspartate amino transferase, glutamyl transpeptidase, alkaline phosphatase and lactic dehydrogenase. Conclusions: Both diabetes and hyperglycemia predisposed to more severe clinical forms of COVID-19, with worse humoral parameters, evolution and higher mortality. Steroids and Jusvinza were used more frequently in these patients(AU)

Epidemiología de COVID-19 en un hospital de tercer nivel mexicano / COVID-19 epidemiology in a Mexican tertiary care hospital

Resumen Introducción: A consecuencia de COVID-19, numerosos hospitales sufrieron una reconversión para la atención de esta enfermedad. Objetivo: Analizar el comportamiento epidemiológico hospitalario de COVID-19 entre marzo y agosto de 2020. Métodos: En una serie de casos se analizó el comportamiento epidemiológico de COVID-19 en un hospital de tercer nivel, para lo cual se estimaron frecuencias simples de casos, porcentajes e incidencia por cada 100 egresos hospitalarios. Resultados: De 491 sujetos con prueba positiva para SARS-CoV-2, 156 (31.7 %) fueron hospitalizados por datos clínicos de enfermedad moderada a grave. La edad promedio fue de 59.1 años; 121 casos (75 %) egresaron por mejoría y 32 (20.5 %), por defunción. El promedio de edad de quienes fallecieron fue de 69.7 años y el grupo etario más afectado fue el de 60 a 80 años (45.4 %). La letalidad calculada fue de 20.5 por 100 egresos hospitalarios, mientras que la calculada tomando en cuenta los pacientes positivos (ambulatorios y hospitalizados) fue de 6.5. Conclusiones: El comportamiento epidemiológico de COVID-19 fue similar al descrito en otros estudios; sin embargo, la letalidad y la mortalidad están por encima de la media nacional. Está pendiente el análisis de estas y de los factores que las favorecieron en nuestra población.

Abstract Introduction: As a result of COVID-19, many hospitals underwent a conversion for the care for this disease Objective: To analyze COVID-19 hospital epidemiological behavior from March to August 2020. Methods: Through a series of cases, COVID-19 epidemiological behavior at the hospital was analyzed, for which simple case rates, percentages and incidence of COVID-19 per 100 hospital discharges were estimated. Results: Out of 491 subjects who tested positive for SARS-CoV-2, 156 (31.7 %) were hospitalized for clinical data of moderate to severe disease. Average age was 59.1 years; 121 cases (75 %) were discharged due to improvement, and 32 (20.5 %), due to death. Average age of those who died was 69.7 years, and the most affected age group was 60 to 80 years (45.4 %). Calculated lethality was 20.5 per 100 hospital discharges, while that calculated taking into account positive patients (outpatients and hospitalized patients) was 6.5. Conclusions: COVID-19 epidemiological behavior was similar to that described in other studies; however, lethality and mortality are above national average. The analysis of this and of the factors that favored it in our population is pending.

Determinantes sociales de la salud asociados a la severidad y mortalidad en pacientes con COVID-19 / Social determinants of health associated with severity and mortality in patients with COVID-19

Resumen Introducción: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. Objetivo: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. Métodos: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). Resultados: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). Conclusiones: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.

Abstract Introduction: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. Objective: To determine the relationship between SDH and COVID-19 severity and mortality. Methods: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). Results: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). Conclusions: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.

Secuestro pulmonar: caracterización y tratamiento en pacientes adultos y pediátricos / Pulmonary sequestration: characteristics and treatment in adult and pediatric patients

Resumen Introducción: El secuestro pulmonar (SP) es una malformación congénita caracterizada por tejido pulmonar con vascularización de una arteria sistémica anómala. Objetivo: Analizar las características y tratamiento de pacientes adultos y pediátricos con secuestro pulmonar. Materiales y Método: Estudio descriptivo transversal. Periodo: enero de 1988 a diciembre de 2018. La información se obtuvo de fichas clínicas y registros de anatomía patológica. Se describen edad, sexo, características clínicas, diagnóstico, tratamiento quirúrgico y hallazgos anatomopatológicos. Se realizó análisis estadístico mediante SPSS25® y se usó la prueba Mann-Whitney y X2, considerándose significativo p < 0,05. Resultados: Total 33 pacientes, 25 (75,8%) mujeres. Edad promedio 30,2 años, rango: 0-68. Adultos 23 (69,7%) pacientes y pediátricos (< 15 años) 10 (30,3%) pacientes. La presentación clínica fue sintomatología pulmonar en 23 (69,7%) casos y 9 (27,3%) eran asintomáticos. Tres (9,1%) presentaron malformación congénita asociada. Diagnóstico preoperatorio en 15 (45,5%) pacientes. La ubicación más frecuente fue lóbulo inferior izquierdo. El tipo intralobar fue el más frecuente en 23 (69,7%) casos. La cirugía más frecuente fue la lobectomía con identificación y ligadura del vaso sistémico. El vaso aberrante se originó en aorta torácica en 27 (81,8%) casos e infradiafragmático (no precisado) en 3 (9,1%) casos. Vaso único en 26 (78,8%) y doble en 5 (15,2%) casos. No hubo mortalidad. Existen diferencias en las características entre los secuestros en pacientes adultos y pediátricos. Discusión y Conclusión: Los SP son infrecuentes, se presentan principalmente en adultos jóvenes como neumopatías a repetición, se distinguen diferencias en las características entre los pacientes adultos y pediátricos, y tienen excelente pronóstico posoperatorio.

Background: Pulmonary sequestration (PS) is a congenital malformation characterized by lung tissue with vascularization from anomalous systemic arteries. Aim: To analyze characteristics and treatment of adult and pediatric patients with pulmonary sequestration. Materials and Method: Transversal descriptive study. Period: January-1988 to December-2018. Information was obtained from clinical files and pathological anatomy records. Age, sex, clinical characteristics, diagnosis, surgical treatment and pathological findings are described. Statistical analysis was performed using SPSS25® and the Mann-Whitney and Chi square test were used, considering p < 0.05 to be significant. Results: Total 33 patients, 25 (75.8%) women. Average age 30.2 years, range: 0-68. Adults 23 (69.7%) patients and pediatric (< 15 years) 10 (30.3%) patients. The clinical presentation was pulmonary symptoms in 23 (69.7%) cases and 9 (27.3%) were asymptomatic. Three (9.1%) presented another congenital malformation. Preoperative diagnosis in 15 (48.4%) patients. The most frequent location was the left lower lobe. The intralobar type was the most frequent: 23 (69.7%) cases. The most frequent surgery was lobectomy with identification and ligation of the systemic vessel. The systemic vessel originated in the thoracic aorta in 27 (81.8%) cases and infradiaphragmatic (not specified) in 3 (9.1%) cases. Single vessel in 26 (78.8%) and double in 5 (15.2%) cases. There was no mortality. Differences were found in characteristics between adult and pediatric patients. Conclusion: SP are infrequent, they mostly appear in young adults as recurrent lung diseases, differences in characteristics are distinguished between adult and pediatric patients and they have an excellent postoperative prognosis.

Fenotipos clínicos de la enfermedad pulmonar obstructiva crónica en los pacientes atendidos en el Hospital neumológico de La Habana / Clinical phenotypes of chronic obstructive pulmonary disease in patients treated at the Hospital Neumológico de La Habana

Introducción: La identificación de los fenotipos clínicos son claves en la modulación de la expresión clínica, para un tratamiento integrado de la EPOC. Objetivos: Caracterizar los fenotipos clínicos de la EPOC en los pacientes atendidos en el Hospital Neumológico Benéfico Jurídico. Métodos:Se realizó un estudio observacional descriptivo retrospectivo, en 172 pacientes con diagnóstico de EPOC, en el Hospital Neumológico Benéfico Jurídico durante el año 2017.Resultados: El 38,4 % de los pacientes tenían edad entre 70-79 años. Del total de pacientes, el 54,6 % eran del sexo masculino. El 52,9 % eran fumadores activos y el 41,3 % exfumadores. Aunque las diferencias no fueron significativas, la edad avanzada y el sexo masculino fueron más frecuentes en el fenotipo enfisematoso agudizador y agudizador bronquítico crónico. El tabaquismo activo fue más frecuente en el fenotipo enfisematoso agudizador. Todos los pacientes con el fenotipo agudizador bronquítico crónico tuvieron dos o más exacerbaciones, mientras que el enfisematoso agudizador se relacionó con una severidad grave de la EPOC (46,7 %). Conclusiones: El sexo masculino y la edad avanzada muestran una tendencia a relacionarse con el fenotipo enfisematoso agudizador y agudizador bronquítico crónico, mientras que el tabaquismo activo es más frecuente en el fenotipo enfisematoso agudizador. El fenotipo agudizador bronquítico crónico se relaciona con mayores exacerbaciones y el enfisematoso agudizador con una mayor severidad de la EPOC.

Introduction: The identification of clinical phenotypes are key in the modulation of clinical expression, for an integrated treatment of COPD. Objectives: To characterize the clinical phenotypes of COPD in patients treated at the Hospital Neumológico Benéfico Jurídico. Methods: A retrospective descriptive observational study was carried out in 172 patients with a diagnosis of COPD at the Hospital Neumológico Benéfico Jurídico in 2017. Results: 38.4 % of the patients were between 70-79 years of age. Of the total number of patients, 54.6 % were male. 52.9 % were active smokers and 41.3 % ex-smokers. Although the differences were not significant, advanced age and male sex were more frequent in the exacerbator emphysematous and chronic bronchial exacerbator phenotype. Active smoking was more frequent in the exacerbating emphysematous phenotype. All patients with the chronic bronchial exacerbator phenotype had two or more exacerbations, while exacerbation emphysematous was associated with severe severity of COPD (46.7 %). Conclusions: Male sex and advanced age show a tendency to be related to the exacerbating emphysematous phenotype and chronic bronchitis exacerbator, while active smoking is more frequent in the exacerbating emphysematous phenotype. The chronic bronchitis exacerbator phenotype is related to greater exacerbations and exacerbation emphysematous with a greater severity of COPD

Budesonide inhalado para el tratamiento de pacientes con COVID-19 / Inhaled budesonide for treating COVID-19 patients

INTRODUCCIÓN: En los primeros informes de China, Italia y Estados Unidos que describen a los pacientes con COVID-19 ingresados en el hospital, los pacientes con asma y enfermedad pulmonar obstructiva crónica (EPOC) estaban significativamente sub-representados.3-6 Surgió entonces la hipótesis que esta subrepresentación de las primeras cohortes, podría deberse al uso generalizado de glucocorticoides inhalados en esta población. 7 El uso de glucocorticoides inhalados en pacientes con asma y EPOC tiene la finalidad de disminuir la inflamación de las vías aéreas y de este modo contribuir a reducir las exacerbaciones, que a menudo se deben a infecciones de origen viral. 8 Los estudios in vitro han demostrado que los glucocorticoides inhalados reducen la replicación de SARS-CoV-2 en las células epiteliales de las vías respiratorias, además de la regulación en menos de la expresión de los genera ACE2 y TMPRSS2, que son críticos para la entrada de células virales en este epitelio.9 Budesonide inhalado se encuentran ampliamente disponible en Argentina y está aprobada por la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) para la prevención de los síntomas respiratorios relacionados con la inflamación bronquial aguda o crónica. Se realizó una evaluación de tecnología sanitaria, basada en evidencia proveniente de revisiones sistemáticas vivas y guías de práctica clínica de alta calidad metodológica para brindar parámetros actualizados y balanceados que sean de utilidad para la toma de decisiones en los diferentes niveles de gestión. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad, conveniencia y recomendaciones disponibles acerca del uso de esteroides inhalados para el tratamiento de pacientes con COVID-19. MÉTODOS: Efectos en la Salud: Se desarrolló un protocolo sustentado en proyectos que resume activamente la evidencia científica a medida que la misma se hace disponible. Con este fin se utilizó la plataforma Love de Epistemonikos para identificar revisiones sistemáticas "vivas". Se seleccionaron aquellas con una calidad metodológica apropiada evaluada a través de la herramienta AMSTAR-2, y que a su vez llevaran un proceso de actualización frecuente.10 De cada una de las revisiones sistemáticas identificadas se extractaron los efectos de la intervención sobre los desenlaces priorizados como importantes o críticos separando los efectos del tratamiento sobre pacientes con COVID-19 (mortalidad, ingreso en asistencia ventilatoria mecánica, duración de estadía hospitalaria, tiempo a la resolución de síntomas o mejoría clínica al día 7-28 y eventos adversos graves) y la certeza en dichos efectos. Adicionalmente se extractaron datos relacionados a efectos de subgrupo potencialmente relevantes para la toma de decisión, con especial énfasis en el tiempo de evolución y la severidad de la enfermedad. Implementación: Este domino contempla dos subdominios: la existencia de barreras y facilitadores para la implementación de la tecnología evaluada no consideradas en los otros dominios analizados, y los costos comparativos en relación con otras intervenciones similares. Recomendaciones: se utilizó la plataforma COVID recmap. Se seleccionaron aquellas guías con rigor metodológico apropiado según la herramienta AGREE II (> 70%) y se incorporaron sus recomendaciones al informe. RESULTADOS: Efectos en la Salud: Se identificaron dos revisiones sistemáticas que cumplen con los criterios de inclusión del presente informe y que reportan sobre budesonide inhalado para pacientes con COVID-19. Se identificaron 2 ECA que incluyeron 1929 participantes en los que budesonide inhalado se comparó con la atención estándar u otros tratamientos. CONCLUSIONES: El cuerpo de evidencia disponible hasta el momento sugiere que budesonide inhalado podría mejorar el tiempo de resolución de los síntomas y disminuir las hospitalizaciones. Existe incertidumbre en el efecto de budesonide inhalado sobre la mortalidad, los efectos advsersos severos o el ingreso en asistencia ventilatoria mecánica. Budesonide inhalado se encuentran ampliamente disponible en Argentina y está aprobada por ANMAT para el tratamiento de síntomas respiratorios relacionados con la inflamación bronquial aguda o crónica. Su costo comparativo es bajo y no se identificaron recomendaciones que aborden el uso de esteroides inhalados para el tratamiento de COVID-19.