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BACKGROUND: Hypertensive disorders of pregnancy (HDP) is the most common cause of indicated preterm delivery, but the impact of prenatal steroid exposure on the outcomes of preterm infants born to HDP mothers, who may be at risk for intrauterine hypoxia-ischemia, remains uncertain. The study objective is to evaluate the mortality and morbidities in HDP for very preterm infants (VPIs) exposed to different course of ANS. METHODS: This is a prospective cohort study comprising infants with < 32 weeks gestation born to women with HDP only from 1 Jan. 2019 to 31 Dec. 2021 within 40 participating neonatal intensive care units (NICUs) in Sino-northern network. ANS courses included completed, partial, repeated, and no ANS. Univariate and multivariable analyses were performed on administration of ANS and short-term outcomes before discharge. RESULTS: Among 1917 VPIs born to women with HDP only, 987(51.4%) received a complete course of ANS within 48 h to 7 days before birth, 560(29.2%) received partial ANS within 24 h before delivery, 100(5.2%) received repeat ANS and 270 (14.1%) did not receive any ANS. Compared to infants who received complete ANS, infants unexposed to ANS was associated with higher odds of death (AOR 1.85; 95%CI 1.10, 3.14), Severe Neurological Injury (SNI) or death (AOR 1.68; 95%CI 1.29,3.80) and NEC or death (AOR 1.78; 95%CI 1.55, 2.89), the repeated ANS group exhibits a significant negative correlation with the duration of oxygen therapy days (correlation coefficient - 18.3; 95%CI-39.2, -2.1). However, there were no significant differences observed between the full course and partial course groups in terms of outcomes. We can draw similar conclusions in the non-SGA group, while the differences are not significant in the SGA group. From KM curve, it showed that the repeated group had the highest survival rate, but the statistical analysis did not indicate a significant difference. CONCLUSIONS: Even partial courses of ANS administered within 24 h before delivery proved to be protective against death and other morbidities. The differences mentioned above are more pronounced in the non-SGA group. Repeat courses demonstrate a trend toward protection, but this still needs to be confirmed by larger samples.
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Hipertensão Induzida pela Gravidez , Doenças do Prematuro , Pré-Eclâmpsia , Lactente , Recém-Nascido , Gravidez , Humanos , Feminino , Recém-Nascido Prematuro , Estudos Prospectivos , Hipertensão Induzida pela Gravidez/epidemiologia , Corticosteroides/uso terapêutico , Doenças do Prematuro/prevenção & controle , Idade Gestacional , Retardo do Crescimento Fetal , MorbidadeRESUMO
BACKGROUND AND OBJECTIVES: There is deficient control of dyslipidaemia after an acute myocardial infarction with ST-segment elevation (STEAMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment compliance after a first episode of type 1 STEAMI, the factors that determine the compliance and its impact on cardiovascular morbidity and mortality during the first year of progression. DESIGN: We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS: We determined the compliance using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. The relationship with cardiovascular morbidity and mortality was determined with a cumulative incidence analysis. RESULTS: The study included 552 patients (64.7 ± 13.7; 73.9% men) of the 613 analysed. There was less compliance among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = 0.001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = 0.834). CONCLUSIONS: Statin treatment compliance during the first year after a STEAMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.
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Introduction: Cancer is a leading cause of death in cats, and the rate of such disease has been increasing recently. Nonetheless, feline oncology represents an important area of study not only for the health and wellbeing of cats but also for human health since various types of cancer in cats share similarities to those found in humans. Therefore, epidemiological studies on feline oncology may suggest environmental and genetic factors contributing to cancer in cats, which can eventually be translated to improve human cancer care. Method: To provide an initial understanding of the epidemiology of feline neoplasms, a descriptive study was undertaken using a dataset documenting cases of feline cancer gathered from the Liguria region (northwest Italy) spanning from 2002 to 2022. The database includes tumor location, morphological codes of the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3), feline's breed, sex, neuter status, date of birth, date of diagnosis, national territorial unit code of the town of the owner's residence, and an alphanumeric string uniquely identifying the owner's surname. Results and discussion: The dataset involves a population of 4,399 cats, including 3,195 females (1,425 neutered) and 1,204 males (750 neutered). Our results indicate that mammary gland tumors are the most represented tumors in the female population, while soft tissue and skin cancers appear to have a higher abundance in the male population during the periods investigated (2002-2022). Moreover, Poisson regression analysis showed that not neutered female cats have a significantly increased risk of developing mammary gland tumors compared to the neutered female population [proportional morbidity ratio (PMR) neutered vs. not neutered = 0.58, 95% CI: 0.47-0.72]; meanwhile, for both sexes, for soft tissue and skin tumors, being neutered appears to be a risk factor (PMR neutered vs. not neutered = 2.26, 95% CI: 1.86-2.73; PMR neutered vs. not neutered = 1.16, 95% CI: 0.89-1.51). Finally, the evaluation of the Ligurian municipalities pollution, based on wild boars data (i.e., biomonitors), which coexisted with cats, was correlated to cancer development for all the tumors investigated (in polluted areas, estimated PMRs ranged from 42.61 to 80.13, 95% CI: 29.94-105.11). Overall, the data presented here suggest the use of the feline population as a possible animal model for human health, i.e., sentinel.
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Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.
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BACKGROUND AND OBJECTIVES: There is deficient control of dyslipidaemia after ST-elevation myocardial infarction (STEMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment adherence after a first type 1 STEMI episode, the factors that determine the adherence and its impact on cardiovascular outcomes during the first year of progression. DESIGN: We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS: We determined the adherence using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with adherence. RESULTS: The study included 552 patients (64.7⯱â¯13.7; 73.9% men) of the 613 analysed. There was less adherence among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; pâ¯=â¯.001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; pâ¯=â¯.834). CONCLUSIONS: Statin adherence during the first year after a STEMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Infarto do Miocárdio com Supradesnível do Segmento ST , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Resultado do TratamentoRESUMO
Objective: We analized patients treated for osteoporotic rami fractures in our hospital. Methods: We examined the records of patients presenting to the emergency department with osteoporotic low-impact rami fractures. We describe demographic, previously ambulatory ability, diagnosis, associated injuries, comorbility, complications and 1 year mortality. Results: 60 patients (51 women) with a mean age of 83,5 (range, 65,1-99) years had osteoporotic rami fracture. Six patients had previously a rami fracture and 23 a osteoporotic fracture. 27 patients associated other pelvic fracture. Three pacientes had other extrapelvic fracture and six a craneoencephalic trauma. 41 patients had any complication at follow up. Eigth patients (13,3%) were admitted to hospital with a median length of stay in the hospital of 18 days. Eight (13,3%) patients died within 1 year of injury. Conclusions: Low-impact rami fractures affect predominantly elderly women with pre-existing comorbidities. A substantial amount of complications are described in this fractures with a high 1 year mortality. Early rehabilitation therapy with adequate analgesic therapy should be recommended.
Objetivo: Analizar los pacientes tratados por fractura osteoporótica de ramas pélvicas en nuestro hospital. Métodos: Analizamos retrospectivamente pacientes con fracturas de ramas pélvicas atendidos en el Servicio de Urgencias de nuestro hospital. Los parámetros analizados incluyen datos demográficos, diagnósticos, lesiones asociadas, comorbilidades, autonomía previa, complicaciones y mortalidad al año. Resultados: 60 pacientes (51 mujeres) con una edad media de 83,5 años (rango, 65,1-99) presentaron fractura osteoporótica de ramas pélvicas. 6 pacientes presentaban antecedentes de fractura de ramas pélvicas y 23 de fractura osteoporótica de otra localización. En 27 casos se asociaban a lesiones en otras localizaciones de la pelvis. 3 pacientes asociaban fracturas extrapélvicas y 6 traumatismos craneoencefálicos. 41 pacientes experimentaron complicaciones de algún tipo. Se requirió ingreso hospitalario en 8 casos, con una estancia media de 18 días. La mortalidad al año fue de 13,3%. Conclusiones: Las fracturas osteoporóticas de ramas pélvicas afectan predominantemente a mujeres con numerosas comorbilidades. Muchas son las complicaciones descritas en estos pacientes con una mortalidad anual elevada. Es remendable un adecuado tratamiento analgésico que permita una movilización precoz del paciente tras descartar lesiones asociadas en la pelvis.
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Fraturas por Osteoporose/epidemiologia , Osso Púbico/lesões , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Masculino , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/mortalidade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Espanha/epidemiologiaRESUMO
Fundamento: durante el puerperio existen causas de complicaciones maternas que comprometen la vida de la mujer, etapa que requiere un monitoreo continuo y un accionar exitoso de los profesionales de la salud. Es de importancia en el mundo y en Cuba el seguimiento del comportamiento de las causas de muertes maternas y la morbilidad de maternas en estado crítico, para la aplicación de estrategias organizativas, de control y de acción en mejora de este indicador. Objetivo caracterizar el comportamiento de la morbilidad materna durante el puerperio. Métodos: estudio descriptivo, transversal sobre la morbilidad de puérperas en el Hospital Provincial de Cienfuegos, durante el año 2020. Se trabajó con el universo de 3563 nacimientos ocurridos. Se elaboró un formulario para la recogida de datos. Las variables analizadas fueron: edad materna, tipo de parto, peso al nacimiento, edad gestacional, estado del recién nacido al nacimiento y morbilidad materna grave y no grave. Resultados: predominaron las mujeres entre 20 y 34 años de edad (76 %); el 57,9 % tuvo parto eutócico. Las puérperas con morbilidad materna por sepsis grave fueron 79 mujeres (2,2 %) y con morbilidad no grave 397 mujeres (11,1 %). Conclusiones: la sepsis grave, preeclampsia-eclampsia y hemorragia posparto son las entidades que mayormente se observaron en la morbilidad materna grave; las que presentaron morbilidad no grave tuvieron recién nacidos bajo peso y anemia posparto.
Foundation: during the puerperium there are causes of maternal complications that compromise the woman's life, a stage that requires continuous monitoring and successful action by health professionals. It is important in the world and in Cuba to monitor the maternal deaths causes' behavior and the maternal patients morbidity in critical condition, for the application of organizational, control and action strategies to improve this indicator. Objective: to characterize the maternal morbidity behavior during the puerperium. Methods: descriptive, cross-sectional study on the morbidity of puerperal women at the Cienfuegos Provincial Hospital, during the year 2020. The universe was composed of 3563 births that occurred. A form for data collection was developed. The analyzed variables were: maternal age, type of delivery, birth weight, gestational age, state of the newborn at birth, and severe and non-serious maternal morbidity. Results: there was women predominance between 20 and 34 years of age (76%); 57.9% had eutocic delivery. The postpartum women with maternal morbidity due to severe sepsis were 79 women (2.2%) and with non-serious morbidity 397 women (11.1%). Conclusions: severe sepsis, preeclampsia-eclampsia, and postpartum hemorrhage are the entities that were mostly observed in severe maternal morbidity; those with non-serious morbidity had low birth weight newborns and postpartum anemia.
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Resumen Introducción: la preeclampsia severa antes de 34 semanas de gestación tiene alto riesgo de complicaciones maternas y fetales. El manejo expectante, pudiera reducir el riesgo de complicaciones de un parto prematuro. Objetivo: evaluar la efectividad comparativa del manejo expectante en la prevención de desenlaces adversos maternos y perinatales de las pacientes con preeclampsia severa remota del término. Metodología: estudio de cohorte retrospectivo en gestantes con preeclampsia severa entre la 24 a 33,6 semanas, admitidas en un centro de alta complejidad colombiano entre 2011 y 2019. Se compararon medidas descriptivas según el manejo expectante o intervencionistas como grupo de referencia y, de asociación con los desenlaces compuestos maternos y neonatales, además se ajustó por edad gestacional menor a 28 semanas al parto. Resultados: se analizaron 134 pacientes, 110 con manejo expectante y 24 con intervencionista. El manejo expectante tuvo menor probabilidad de cesárea (RR 0,79 IC95% 0,69-0,91) y de resultado compuesto materno (RR 0,67 IC95% 0,57-0,79), que no persistió luego del ajuste. El manejo expectante presentó menor probabilidad de APGAR <7 al minuto (21,6% vs. 40%, RR 0,53 IC95% 0,29-0,97) y de resultado neonatal compuesto (60% vs. 83,3%, RR 0,72 IC95% 0.57-0.90). Al realizar ajuste con edad menor a 28 semanas al parto, el manejo expectante mostró menor probabilidad de APGAR menor a 7 al minuto (RR 0,43 IC95% 0,24-0,75), resultado perinatal adverso compuesto (RR 0,62 IC95% 0,48-0,81), muerte neonatal (RR 0,26 IC95% 0,29-0,71), síndrome de dificultad respiratoria (RR 0,65 IC95% 0,48-0,88), hemorragia intraventricular (RR 0,31 IC95% 0,11-0,89) e ingreso a unidad de cuidados intensivos neonatales (RR 0,80 IC95% 0,70-0,92). Conclusión: la preeclampsia severa remota del término es una patología grave y compleja que enfrenta los intereses maternos y los fetales. Debido al controversial enfoque, su manejo debe realizarse en centros de alta complejidad, con participación interdisciplinaria y anteponiendo la individualidad de cada binomio; nuestros hallazgos sugieren que el manejo expectante es razonable cuando las condiciones maternas y fetales lo permiten, especialmente para gestaciones menores a 28 semanas en favor de mejorar los desenlaces fetales sin detrimento de los desenlaces maternos.
Abstract Introduction: severe preeclampsia before 34 weeks of gestational age has a high risk of maternal and fetal complications. Expectant management could decrease the risk of complications associated with premature birth. Objective: to evaluate the efficacy of expectant management in the prevention of maternal and perinatal adverse events of patients with severe preeclampsia remote from term. Methodology: a retrospective cohort study in pregnant women diagnosed with severe preeclampsia between 24 and 33.6 weeks of gestational age who were admitted in a Colombian high complexity medical center between 2011 and 2019 was carried out. Descriptive measurements of the expectant management and the interventionist management were compared and the association with maternal and neonatal composite outcomes. Results were adjusted by gestational age under 28 weeks of delivery. Results: 134 patients were analyzed; 110 patients with expectant management and 24 interventionist management. Expectant management had a lower probability of cesarean section (RR 0.79 CI95% 0.69-0.91) and maternal composite result (RR 0.67 CI95% 0.57-0.79) that did not persist after the adjustment. Expectant management had a lower probability of APGAR <7 the first minute (21.6% vs. 40%, RR 0.53 CI95% 0.29-0.97) and neonatal composite result (60% vs. 83.3%, RR 0.72 CI95% 0.57-0.90). When adjusting the age under 28 weeks of delivery, the expectant management showed a lower probability of APGAR under 7 at minute one (RR 0.43 CI95% 0.24-0.75), composite outcome of perinatal adverse events (RR 0.62 CI95% 0.48-0.81), neonatal death (RR 0.26 CI95% 0.29-0.71), respiratory distress syndrome (RR 0.65 CI95% 0.48-0.88), intraventricular hemorrhage (RR 0.31 CI95% 0.11-0.89) and admission to the neonatal intensive care unit (RR 0.80 CI95% 0.70-0.92). Conclusion: severe preeclampsia remote from term is a severe and complex disease which faces maternal and neonatal interests. Due to approach controversies, management should be performed in high complexity centers with a multidisciplinary approach individualizing each binomial; our findings suggest expectant management is reasonable when both maternal and fetal conditions allow it, especially in pregnancies under 28 weeks of gestational age to improve fetal outcomes without risking maternal outcomes.
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Introducción: Las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía. Objetivo: Determinar la morbilidad de las lesiones de la vía biliar en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech". Métodos: Se realizó un estudio descriptivo, prospectivo y observacional de pacientes que ingresaron en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech" con diagnóstico de lesión de la vía biliar, desde septiembre del 2018 hasta enero del 2022. El universo estuvo conformado por 12 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: La mayor incidencia de los pacientes fue del sexo femenino y de piel blanca, con un 61,4 por ciento y 85,7 por ciento, respectivamente. Predom inó el tipo de cirugía convencional y diagnóstico intraoperatorio con un 66,7 por ciento y 50 por ciento, respectivamente. El tipo E1 y E2 de la clasificación de Strasberg y la hepaticoyeyunostomía fue la operación con mayor frecuencia con un 66,7 por ciento. La bilirragia fue la complicación que predominó con el 70 por ciento. Conclusiones: La mayoría de los pacientes son del sexo femenino y de piel blanca, donde la cirugía convencional y el diagnóstico intraoperatorio son los hallazgos más frecuentes. Más de la mitad de los pacientes son clasificados como tipo E1 y tipo E2 según clasificación de Strasberg. La hepaticoyeyunostomía en Y de Roux y en asa de Braum transmesocólica es el proceder realizado en casi la totalidad de los pacientes. La fuga biliar es la complicación más frecuente(AU(
Introduction: Iatrogenic bile duct lesions represent a serious surgical complication of cholecystectomy. Objective: To determine the morbility of bile duct lesions in the surgical service of Hospital Universitario "Manuel Ascunce Domenech". Methods: A descriptive, prospective and observational study was carried out with patients admitted to the surgery service of Hospital Universitario "Manuel Ascunce Domenech" with a diagnosis of bile duct lesion, from September 2018 to January 2022. The study universe consisted of twelve patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: The highest incidence of patients corresponded to the female sex and the white skin, accounting for 61.4 percent and 85.7(Percent(, respectively. Conventional surgery and intraoperative diagnosis predominated, accounting for 66.7 % and 50 %, respectively. Types E1 and E2 according to the Strasberg classification, together with hepaticojejunostomy, was the most frequent surgery type, accounting for 66.7 %. Biliary bleeding was the predominant complication, accounting for 70 %. Conclusions: Most of the patients belong to the female sex and have white skin, in which cases conventional surgery and intraoperative diagnosis are the most frequent findings. More than half of the patients are classified as types E1 or E2 according to the Strasberg classification. Transmesocolic Braun loop and Roux-en-Y hepaticojejunostomy is the procedure performed in almost all patients. Biliary leakage is the most frequent complication(AU)
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Humanos , Feminino , Ductos Biliares/lesões , Colecistectomia/métodos , Morbidade , Epidemiologia Descritiva , Estudos Prospectivos , Estudo ObservacionalRESUMO
RESUMEN Fundamento: las urgencias estomatológicas son afecciones que provocan grandes molestias en los pacientes, en la mayoría de los casos no implican peligro para la vida, pero sí requieren la atención inmediata del estomatólogo. Objetivo: caracterizar la morbilidad por urgencias estomatológicas durante la pandemia por la COVID-19. Métodos: se realizó un estudio descriptivo observacional de corte trasversal en la Clínica Estomatológica Reynaldo Aday López del municipio Nuevitas, provincia Camagüey, en el período marzo a mayo de 2021. El universo se conformó por los 1 257 pacientes que recibieron atención estomatológica de urgencias. Para la recolección de la información se confeccionó un formulario que constituyó el registro primario, contentivo de las variables de estudio: edad y sexo, tipo de urgencias estomatológicas y tratamientos realizados. Los datos se procesaron a través del procesador estadístico SPSS versión 15.0 para Windows. Se utilizó la estadística descriptiva y se realizaron distribuciones de frecuencia a todas las variables en estudio y se presentaron los resultados en valores absolutos y relativos. Resultados: en los pacientes examinados predominó el sexo femenino y el grupo de edades de 35 a 59 años, la principal urgencias estomatológicas fue por caries dental y a los pacientes de urgencia se les aplicó como modalidad de tratamiento el sellado con óxido de zinc y eugenol. Conclusiones: durante la atención estomatológica de urgencia por la COVID-19 predominó el sexo femenino, de la tercera a la quinta década de vida, se destacó la caries dental, el absceso alveolar agudo y el dolor en la articulación temporomandibular como principales urgencias y predominaron como modalidades de tratamiento el sellado temporal con óxido de zinc y eugenol, la terapia medicamentosa y la medicina natural y tradicional.
ABSTRACT Background: dental emergencies are conditions that cause great discomfort in patients, and in most cases they do not imply danger to life, but the immediate attention of the dentist is required. Objective: to characterize the morbidity due to dental emergencies during the COVID-19 pandemic. Methods: a descriptive, cross-sectional observational study was carried out at the Reynaldo Aday López Dentistry Clinic of the municipality of Nuevitas, Camagüey province, in the period March to May 2021. The universe was made up of 1 257 patients who received emergency dental care. To collect the information, a form was prepared that constituted the primary registry, containing the study variables: age and sex, type of stomatological emergencies and treatments performed. The data were processed through the statistical processor SPSS version 15.0 for Windows. Descriptive statistics were used and frequency distributions were made to all the variables under study and the results were presented in absolute and relative values. Results: of the patients examined, the female sex and the age group of 35 to 59 years predominated, dental caries, acute alveolar abscess and pain in the temporomandibular joint stood out as the main dental emergencies, and patients were treated with zinc oxide and eugenol. Conclusions: during the emergency dental care in times of the health emergency, the female sex predominated, from the third to the fifth decade of life, dental caries, acute alveolar abscess and pain in the temporomandibular joint were highlighted as the main emergencies. They used zinc oxide and eugenol cure, drug therapy, and natural and traditional medicine as treatment modalities.
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RESUMEN La infección intraabdominal posoperatoria, es un problema de salud a escala mundial y precisa de atención multidisciplinaria para corregirla. Su complejidad radica en el diagnóstico precoz y la relaparotomía para controlarla. Es una complicación de la cirugía abdominal, cuya atención clínico quirúrgica integral compete a cirujanos generales, cirujanos pediátricos, obstetras, proctólogos, urólogos, imagenólogos, anestesiólogos e intensivistas. Se impone por tanto en los médicos tratantes, el dominio de aspectos esenciales, como parte de la superación profesional permanente y continuada que les permita garantizar la necesaria calidad atencional del afectado, como única vía para disminuir las altas tasas de morbilidad y mortalidad debido a esta temida afección.
ABSTRACT Postoperative intra-abdominal infection is a global health problem and requires multidisciplinary care to correct it. Its complexity lies in the early diagnosis and relaparotomy to control it. It is a complication of abdominal surgery, whose comprehensive clinical surgical care is the responsibility of general surgeons, pediatric surgeons, obstetricians, proctologists, urologists, imaging specialists, anesthesiologists, and intensivists. Therefore, the mastery of essential aspects is necessary on the treating doctors, as part of the permanent and continuous professional improvement that allows them to guarantee the necessary quality of care of the affected, as the only way to reduce the high rates of morbidity and mortality due to this dreaded condition.
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BACKGROUND: The use of surgical drains in abdominal surgery is still today controversial. While accepting their role in certain circumstances, their systematic use advocated by other schools, is not fully accepted. We present a case of secondary blind drilling drainage tube perineum following an abdominoperineal amputation of the rectum that forced a surgical repair in a neoplastic patient CLINICAL CASE: This is a patient who underwent abdomino perineal resection for rectal neoplasia. It was decided to leave a silicone-type drain tube for perineum and in late postoperative he presented cecum perforation due to traumatic introduction thereof into the cecal light, which forced his reoperation and surgical repair. DISCUSSION: There is a tendency to use less and less drains in abdominal surgery, although there are certain occasions when it becomes inevitable. On the other hand it entails morbidity associated with its use that significantly complicates and delays the recovery of the patient. It is accepted that is not useful to prevent the occurrence of fistulas, although it contributes to its early detection. CONCLUSIONS: The cecal perforation due to drain is a rare complication which must always be taken into account, and that perhaps could be avoided by using soft and less rigid drains.
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Ceco/lesões , Drenagem/efeitos adversos , Perfuração Intestinal/etiologia , Amputação Cirúrgica , Fístula Anastomótica/etiologia , Carcinoma/cirurgia , Carcinoma/terapia , Ceco/cirurgia , Quimiorradioterapia , Terapia Combinada , Drenagem/instrumentação , Emergências , Hepatectomia/métodos , Humanos , Perfuração Intestinal/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Pneumonectomia/métodos , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Reto/cirurgiaRESUMO
Objetivo: determinar la morbimortalidad de pacientes luego del alta en una UCI en Boyacá durante un periodo de 20 meses. Materiales y métodos: estudio descriptivo trasversal con análisis de información de registros, historias clínicas y datos derivados de la aplicación de una encuesta; la población fue de 592 pacientes egresados vivos entre los meses de enero de 2015 a agosto de 2016 de la UCI con base en los promedios mensuales de atención. Resultados: de los 592 pacientes atendidos se encuentra una sobrevida del 63,9% dentro del primer mes del alta y una mortalidad del 36.1%, la cual fue mayor dentro de los primeros diez días pos egreso. Del total de la población atendida, el 55,2% corresponde a pacientes de sexo masculino y el restante 44,8% pacientes femeninas. La edad promedio fue de 58,9 años. La morbilidad reportada obedece principalmente a enfermedades metabólicas entre el 24,5% y 26,5%, alteraciones cardiovasculares, 14,7% y 19,7%, infecciosas con un 14,3% y 11,1% y politraumatismos el 8,7%. Conclusiones: el porcentaje de personas que sobreviven tras recibir atención en UCI corresponde a un indicador de eficiencia en la atención del paciente en condición crítica de salud. Las patologías prevalentes en los individuos fueron de etiología metabólica como diabetes mellitus, insuficiencia renal crónica, infarto agudo de miocardio, septicemias, politraumatismos e infecciones. Los datos constituyen un elemento determinante para formular políticas y planes de atención e intervenir efectivamente a los pacientes en condición crítica de salud tanto a nivel regional como nacional..Au
Objective: to determine the morbidity and mortality of patients after discharge from an ICU in Boyacá over a period of 20 months. Materials and methods: cross-sectional descriptive study with analysis of information records, medical records, and data derived from the application of a survey; The population consisted of 592 patients discharged from the ICU from January 2015 to August 2016 based on monthly care averages. Results: of the 592 patients attended, there is a survival of 63,9% within the first month of discharge and a mortality of 36,1%, which was the highest within the first ten days after discharge. Of the total population served, 55,2% correspond to male patients and the remaining 44,8% female patients. The average age was 58,9 years. The reported morbidity is mainly due to metabolic diseases between 24,5% and 26,5%, cardiovascular disorders between 14,7% and 19,7%, infectious 14,3% and 11,1% and multiple injuries 8,7%. Conclusions: the percentage of people who survive after receiving ICU care corresponds to an indicator of efficiency in patient care in a critical health condition. The prevalent pathologies in the individuals were of metabolic etiology such as diabetes mellitus, chronic renal failure, acute myocardial infarction, sepsis, multiple injuries and infections. The data affected is a determining element in the formulation of policies and care plans, to effectively intervene in patients in critical health conditions at both the regional and national levels..Au
Assuntos
Humanos , Assistência ao Paciente , Unidades de Terapia Intensiva , Indicadores de MorbimortalidadeRESUMO
Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas de edad avanzada. MATERIALES Y MÉTODOS: Estudio de dos cohortes, prospectivo y retrospectivo efectuado con base en la información de expedientes clínicos de pacientes atendidas en el Complexo Hospitalario Universitario de Ourense entre 2017 y 2018. Se establecieron dos cohortes: la cohorte A con edad mayor o igual a 40 años y la cohorte B con edad menor de 40 años. Se realizaron pruebas paramétricas y no paramétricas para determinar la asociación potencial entre las variables de estudio (χ2, t de Student, U de Mann-Whitney). RESULTADOS: Las pacientes de la cohorte A (n = 207) tuvieron significación estadística: índice de masa corporal mayor al inicio del embarazo (p = 0.028), mayor cantidad de embarazos previos (p = 0.001), a expensas de mayor cantidad de abortos (p < 0.001), estados hipertensivos del embarazo (p = 0.03), prematurez (p = 0.009), retraso en el crecimiento intrauterino (p = 0.006), macrosomía fetal (p = 0.04), inducciones (p < 0.001), cesáreas programadas o intraparto y hemorragia posparto (p = 0.001). No se encontraron diferencias en la paridad, amenorrea al parto, diabetes pregestacional-gestacional, peso fetal medio, Apgar, pH de la arteria umbilical y cantidad de recién nacidos con requerimiento de ingreso a la unidad de Neonatología. CONCLUSIONES: La edad materna avanzada es un factor de riesgo importante de morbilidad materna y perinatal. La mayor tasa de complicaciones descritas refleja la importancia del control exhaustivo del embarazo y vigilancia periparto minuciosa.
Abstract OBJECTIVE: To describe the maternal and perinatal results in pregnant women with advanced age. MATERIALS AND METHODS: A cohort study was conducted with prospective follow-up and retrospective data collection of the Clinical History of the University Hospital Complex of Ourense between 2017 and 2018. Two cohorts were established, cohort A with age greater than and equal to 40 years and the cohort B with age under 40 years. Parametric and non-parametric tests were performed to determine the potential association between the study variables (Chi-Square, Student's T, Mann-Whitney U). RESULTS: The cohort A patients (n = 207) presented with statistical significance: body mass index higher at the beginning of pregnancy (p = 0.028), higher number of previous pregnancies (p = 0.001), but at the expense of a higher number of abortions (p <0.001), hypertensive states of pregnancy (p = 0.03), prematurity (p = 0.009), intrauterine growth retardation (p = 0.006), fetal macrosomia (p = 0.04), inductions (p < 0.001), of both scheduled and intrapartum caesarean sections and postpartum hemorrhage (p = 0.001). No differences were found in parity, amenorrhea at delivery, pregestational / gestational diabetes, mean fetal weight, Apgar score, umbilical artery pH and number of newborns who required admission to the Neonatal Unit. CONCLUSIONS: Advanced maternal age is an important risk factor for maternal and perinatal morbidity. The higher rate of complications described reflects the importance of thorough pregnancy control and careful peripartum surveillance.
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RESUMEN La actual pandemia de COVID 19 producida por el virus SARS-CoV2, dada su condición de proceso emergente, presenta una serie de características clínicas, evolutivas y epidemiológicas que permiten catalogarla como fenómeno complejo. Evidentemente dicha pandemia constituye un reto para las ciencias médicas en los aspectos atencionales, investigativos y de la educación médica. Para la actividad docente actual y futura, con vistas a su perfeccionamiento y sostenibilidad, nuestros directivos, profesores y tutores, en quienes descansa la dirección del aprendizaje de los estudiantes en nuestras universidades de ciencias médicas tanto en la formación inicial de pregrado como en las diferentes formas del posgrado, las conclusiones preliminares derivadas de la lectura crítica e inferencial de dicha pandemia exigen interpretaciones que deriven en concepciones, diseños curriculares, procesos docentes, trabajo metodológico, evaluaciones y actividad científica que contengan aquellas esencialidades que los autores catalogan como categorías primordiales y obligatorias que deben abarcar los diferentes procesos referidos de la educación médica superior cubana, objetivo pretendido de este trabajo. Mediante la utilización de diferentes métodos teóricos y empíricos, se desarrolla una sistematización que resume y explicita las categorías de problemas complejos, inter-transdisciplinariedad, teoría de sistemas, multimorbilidad, multireferencialidad, actividad científica desde la universidad, tecnologías de la información y la comunicación y sus necesarios abordajes en la concepción, diseño e instrumentación didáctica de la educación médica superior cubana, de interés para el perfeccionamiento de dichos procesos.
ABSTRACT Due to its emerging process status, the current COVID 19 pandemic caused by the SARS-CoV2 virus presents a series of clinical, evolutionary and epidemiological characteristics which allow it to be classified as a complex phenomenon. Obviously, this pandemic constitutes a challenge for medical sciences in assistance, research and medical education aspects. Preliminary conclusions derived from the critical and inferential reading of this pandemic require interpretations that derive in conceptions, curricular designs, teaching processes, methodological work, evaluations and scientific activity that contain those essentialities that the authors classify as essential and mandatory categories that must cover the different referred processes of Cuban higher medical education, the intended objective of this work. Through the use of different theoretical and empirical methods, a systematization is developed which summarizes and makes explicit the categories of complex problems, inter-transdisciplinarity, systems theory, multimorbidity, multireference, scientific activity from the university, information and communication technologies, and its necessary approaches in the conception, design and didactic instrumentation of Cuban higher medical education, of interest for the improvement of these processes.
RESUMO
La operación cesárea que hoy en día realizamos de forma casi rutinaria en la mayoría de centros hospitalarios del mundo es consecuencia de una apasionante búsqueda de mejoras por las generaciones precedentes de obstetras. A lo largo de los años, la cesárea ha experimentado importantes cambios en la técnica quirúrgica, en la frecuencia de su práctica y en sus indicaciones, tanto maternas como fetales. En los siglos XVII, XVIII y XIX implicaba una elevadísima mortalidad materna, por lo que únicamente se realizaba en casos desesperados, con la esperanza del salvar al nasciturus. La introducción de los principios de asepsia-antisepsia por Semmelweis, Koch, Lister y Halsted, la sutura de la herida uterina, la incisión en el segmento uterino inferior y la incisión transversa en el segmento inferior del útero supusieron una importante disminución de la mortalidad materna. En la segunda mitad del siglo XX, el empleo de la antibio-ticoterapia, la transfusión sanguínea, el perfeccionamiento de la anestesia y de los cuidados perioperatorios, así como la modificación ulterior de algunas técnicas quirúrgicas, ha conseguido reducir ampliamente la morbimortalidad asociada a esta intervención. Todos estos cambios han conseguido que la cesárea haya pasado de ser una operación in extremis que condenaba con gran probabilidad a la paciente, a una técnica que en la actualidad es demandada por algunas mujeres como sustitución del parto vaginal.
The cesarean section is an operation routinely performed in the majority of hospitals around the world. The cesarean section came to be as an early generation of obstetricians passionately searched for a way to improve their field. Throughout the years, it has experien-ced numerous changes: the surgical technique, it's frequency, and it's medical indications (both fetal and maternal). During the 17th, 18th, and 19th centuries it implied a very high maternal mortality rate, which left it as a last resort option with the only hope to save the nasciturus. The introduction of asepsis and antisepsis (Semmelweis, Koch, Lister, and Halsted at the end of the 19th century), the suture of the uterine wall, and the transverse incision in the lower uterine segment drastically reduced maternal mortality. During the second half of the 20th century, the use of antibiotics and blood transfusions, improvements in anesthesia and perioperative care, and the further modifications to the surgical technique considerably reduced the morbidity and mortality associated with the operation. All these changes transformed the cesarean section from a surgical intervention done in extremis, where the mother would probably die, to a technique currently demanded by some women as a substitute to the vaginal delivery.
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Cesárea , História , Morbidade , MãesRESUMO
Introducción. Los estudios de vigilancia epidemiológica mejoran los cuidados de salud al permitir la identificación de la tendencia y distribución de las enfermedades. El estudio se hizo en la Unidad de Cuidado Intensivo polivalente del Hospital del tercer nivel en la ciudad de Quito-Ecuador. Objetivos. Determinar el perfil epidemiológico de las principales patologías que atiende la unidad; establecer el porcentaje de mortalidad por patología en pacientes con una estancia mayor a 48 horas; comparar los hallazgos con estudios similares. Material y Métodos. Realizamos un estudio de corte transversal con pacientes ingresados a la UCI de adultos-HECAM, en el período 2014-2016. Las variables cuantitativas fueron representadas con medidas de tendencia central y de dispersión. Las variables cualitativas con porcentajes. Resultados. Durante el periodo de estudio ingresaron a la UCI 4549 pacientes. El 60,4% fueron varones, la tasa bruta de mortalidad fue de 23,4% y del 21,16% en hospitalizaciones superiores a 48 horas. La mediana de edad fue de 59 años (RIQ 41 - 72 años). El grupo de edad >65 años correspondió al 38,7%. La mediana de estadía fue de 3,16 días (RIQ 1,357,16 días) pero la moda estuvo en el grupo de <48 horas. El promedio de APACHE-II fue de 17,07±9,71. Las patologías más frecuentes fueron insuficiencia respiratoria (48,10%), trastornos metabólicos (42,94%) y shock séptico (30,4%). Patologías que incrementan el riesgo de mortalidad son: NAV tardía (OR 13,02); delirio (OR 6,88), polineuropatía (OR 6,06). Conclusiones. Los pacientes adultos mayores fueron la población atendida con mayor frecuencia en la UCI-HECAM. La mortalidad es similar a estudios locales e internacionales. La disfunción orgánica más frecuente fue la insuficiencia respiratoria. La NAV tardía, el delirio y la polineuropatía tienen un incremento de riesgo de mortalidad en el análisis multivariable.
Introduction. Epidemiological surveillance studies improve health care quality, allowing identification of local trends and specific burden of disease. This study was carried out in a polyvalent Intensive Care Unit at a third level hospital in Quito-Ecuador. Objectives. Assess the epidemiologic profile of the main diseases; Establish mortality adjusted rates in patients staying longer than 48 hours; Compare our findings with other units. Materials and Methods. We performed a cross-sectional study of patients admitted in the ICU of adults-HECAM from 2014-2016. Quantitative variables were presented with central tendency and dispersion. Qualitative variables with percentages. Results. During of study were admitted in the ICU 4549 patients. 60,4% were male, crude mortality was of 23.4% and 21,16% for those hospitalizations superior to 48 hours. The median age was 59 years (IQR 41 - 72 years) and the group > 65 years of age was 38.7%. The median length of stay was 3,16 days (IQR 1,35 7,16 days) but mode was <48 hours. The mean APACHE II was 17.07±9.71. The most frequent pathologies were respiratory failure 48,10%, metabolic disorders 42,9% and septic shock 30,4%. The pathologies that increase the risk of mortality are: late VAP (OR: 13,02), delirium (OR 6,88), polineuropathy (OR 6,06). Conclusions. The Intensive Care Unit is mainly occupied by elderly patients. Mortality rates were similar to local and international studies ICU rates. The most frequent organ dysfunction was respiratory failure. Late VAP, delirium and polyneuropathy have an increased risk of mortality in the multivariate analysis.
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Humanos , Perfil de Saúde , Cuidados Críticos , Monitoramento Epidemiológico , Pesquisa sobre Serviços de Saúde , Unidades de Terapia Intensiva , Morbidade , MortalidadeRESUMO
Se realizó un estudio descriptivo y transversal de 58 recién nacidos antes del término, con muy bajo peso, atendidos en el Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río en el período 2012-2013, con el objetivo de determinar la morbilidad y la mortalidad por esta causa. El análisis de historias clínicas aportó la información que dio salida a las variables estudiadas. En la serie predominaron el sexo femenino, con una media de 30,3 ± 2,7 semanas al momento del nacimiento y de 1 229 ± 183 g de peso. La morbilidad estuvo relacionada mayoritariamente con la enfermedad de la membrana hialina y la hemorragia intraventricular, cuyos antecedentes fueron las madres toxémicas y la rotura prematura de membrana mayor de 18 horas; en tanto, la supervivencia fue de 72,4 por ciento y la hemorragia intraventricular constituyó la principal causa de muerte. La información obtenida permite trazar nuevas líneas de trabajo con vistas a lograr una atención eficaz a estos pacientes y disminuir tanto la morbilidad, como la mortalidad en edades tempranas de la vida.
A descriptive and cross sectional study of 58 before term newborns, with very low weight, assisted in Abel Santamaría Cuadrado Teaching General Hospital in Pinar del Río was carried out in the period 2012-2013, with the objective of determining the morbility and mortality due to this cause. The analysis of medical records provided the information from which the studied variables emerged. The female sex, with a mean of 30.3 ± 2.7 weeks at the moment of birth and of 1 229 ± 183 g of weight prevailed in the series. The morbility was mostly related to the hyaline membrane disease and the intraventricular hemorrhage which antecedents were toxemic mothers and the premature rupture of membrane of more than 18 hours; while, the survival was of 72.4 percent and the intraventricular hemorrhage constituted the main cause of death. The obtained information allows to trace new work lines with the objective of achieving an effective care to these patients and to decrease either morbility, as the mortality in early ages of life.
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Humanos , Masculino , Feminino , Recém-Nascido , Morbidade , Mortalidade , Recém-Nascido de muito Baixo Peso , Atenção Secundária à Saúde , Recém-Nascido , Recém-Nascido Prematuro , SobrevivênciaRESUMO
Introducción: Cuba está en alerta dada la incidencia creciente del cáncer de piel. La histopatología es la regla de oro para la confirmación de toda neoplasia cutánea. Objetivo: identificar la morbilidad por tumores malignos en esta localización según informes de biopsias. Materiales y métodos: se realizó un estudio observacional descriptivo y retrospectivo de todos los diagnósticos de cancer de piel registrados en el Libro de biopsias desde enero de 2010 a diciembre de 2015 en el departamento de anatomía patológica del Hospital Dr. "Mario Muñoz Monroy" de Colón y se estudiaron las variables: año de diagnóstico, edad y sexo de los pacientes, el tipo histológico del tumor, la presencia de márgenes libres, el subtipo histológico del carcinoma basocelular, el grado de diferenciación y la presencia de infiltración del epidermoide. Resultados: se analizaron 1096 informes de biopsia con diagnóstico de carcinomas cutáneos. Se halló un predominio del sexo masculino, de las edades por encima de los 61 años, del basocelular como tumor más frecuente y de las lesiones bien resecadas dadas por los márgenes libres quirúrgicos. El subtipo sólido constituyó más de la mitad de todos los basales examinados. Del epidermoide se analizó la presencia en el resultado del aspecto diferenciación citado en la tercera parte de las muestras. Conclusiones: el cáncer de piel continúa en ascenso y el informe de anatomía patológica aporta datos esenciales para la decisión terapéutica, el pronóstico y el reporte del mismo lo que se reafirma la importancia de su completa descripción (AU).
Introduction: Cuba is given in alert the growing incidence of the skin cancer. The histopathology is the rule of gold for the confirmation of all cutaneous neoplasia. To identify the morbility for wicked tumors in this localization according to studies of biopsies was the objective that motivated to make this investigation. Materials and methods: Its was carried out a descriptive and retrospective observational study of all the diagnoses of skin cancer registered in the Book of Biopsies from January from 2010 to December of 2015 in the department of pathological anatomy of the Hospital Dr. "Mario Muñoz Monroy" of Colon. The variables were studied: year of the diagnosis, age and sex of the patients, the type histological of the tumor, the presence of free margins, the subtype histological of the basal cell carcinoma, the differentiation grade and the presence of infiltration of the squamous carcinoma. Results: The 1096 biopsy reports were analyzed with diagnostic of cutaneous carcinomas. It was a prevalence of the masculine sex, of the ages above the 61 years, of the basal cell carcinoma like more frequent tumor and of the well dried up lesions given by the surgical free margins. The solid subtype constituted more than half of all the basal cell examined. Of the squamous carcinoma the presence was analyzed in the result of the aspect differentiation mentioned in the third part of the samples. Conclusions: The skin cancer continues in ascent and the report of pathological anatomy contributes essential data for the therapeutic decision, the prognosis and the report of the same one what the importance of its complete description is reaffirmed (AU).
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Humanos , Masculino , Feminino , Neoplasias Cutâneas/diagnóstico , Biópsia , Neoplasias Cutâneas/epidemiologia , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnósticoRESUMO
Se realizó un estudio observacional, prospectivo y longitudinal de las 202 gestantes y puérperas ingresadas en la Unidad de Cuidados Intensivos del Hospital Dr Agostinho Neto de Guantánamo, durante el período 2015-2016, con vistas a caracterizar la mortalidad y la morbilidad maternas según variables sociodemográficas y biológicas de interés para la investigación. La edad media fue de 26,3 ± 6,4 años. En la serie, 14,8 por ciento tenía antecedente de asma bronquial y 10,9 por ciento recibió ventilación artificial; asimismo, 37,1 por ciento ingresó por alguna enfermedad obstétrica y 62,9 por ciento por afección no obstétrica, con predominio de la eclampsia-preclampsia grave (10,8 por ciento) y la neumonía bacterina (15,3 por ciento ), respectivamente. Por otra parte, a 24,8 por ciento de la muestra se le realizó histerectomía y 58,4 por ciento presentó complicaciones. Fallecieron 3 pacientes (1,5 por ciento), de modo que en dicha Unidad, la morbilidad materna fue notable y la letalidad baja
An observational, prospective and longitudinal study of the 202 pregnant and postpartum women who were admitted at the Intensive Care Unit of Dr Agostinho Neto Hospital in Guantánamo was carried out during the period 2015-2016, with the aim of characterizing the maternal morbility and mortality according to social demographic and biological variables of interest for the investigation. The mean age was of 26,3 ± 6,4 years. In the series, 14,8 percent had a history of bronchial asthma and 10,9 percent received artificial ventilation; also, 37,1 percent were admitted due to some obstetric disease and 62,9 percent due to non obstetric disorder, with a prevalence of the severe eclampsia-preclampsia (10,8 percent) and the pneumonia bacterina (15,3 percent), respectively. On the other hand, in 24,8 percent of the sample hysterectomy was carried out and 58,4 percent of it presented complications. Three patients died (1,5 percent), so in this Unit the maternal morbility was remarkable and letality was low