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Background Obstructive sleep apnoea (OSA) has been described as a risk factor for arterial hypertension (HT). One of the proposed mechanisms linking these conditions is non dipping (ND) pattern in nocturnal blood pressure, however evidence is variable and based on specific populations with underlying conditions. Data for OSA and ND in subjects residing at high altitude are currently unavailable. Objective Identify the prevalence and association of moderate to severe OSA with HT and ND pattern in hypertensive and non-hypertensive otherwise healthy middle-aged individuals in residing at high altitude (Bogotá:2640 mt) Methods Adult individuals with diagnosis of moderate to severe OSA underwent 24 hour- ambulatory blood pressure monitoring (ABPM) between 2015 and 2017. Univariable and multivariable logistic regression analysis were performed to identify predictors of HT and ND pattern. Results Ninety-three (93) individuals (male 62.4% and median age 55) were included in the final analysis. Overall, 30.1% showed a ND pattern in ABPM and 14.9% had diurnal and nocturnal hypertension. Severe OSA (higher apnea-hiponea index [AHI]) was associated with HT (p = 0.006), but not with ND patterns (p = 0.54) in multivariable regression. Smoking status and lowest oxygen saturation during respiratory events where independently associated with ND pattern (p = 0.04), whereas age (p = 0.001) was associated with HT. Conclusions In our sample, one in three individuals with moderate to severe OSA have non dipping patterns suggesting lack of straight association between OSA and ND. Older individuals who have higher AHI are more likely to have HT, and those who smoke have a higher risk of ND. These findings add aditional information to the multiple mechanisms involved in the relationship between OSA and ND pattern, and questions the routine use of 24-hour ABPM, particullary in our region, with limited resources and healthcare acces. However, further work with more robust methodology is needed to draw conclusions.
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The COVID-19 pandemic has prompted numerous challenges for the field of education, particularly medical education and health-related research. However, these obstacles are also an opportunity to advance this academic-medical sphere with the increased introduction of information technologies and the creation of strategies that focus on quality improvement. Previous research has highlighted the importance of adapting both clinical practice and medical education within the context of the pandemic (1). As COVID-19 continues to surge across the globe, the gaps in medical education and research grow and they must be met urgently with a creative approach toward making the available technology accessible and relevant. https://doi.org/10.29375/01237047.4019
La pandemia de COVID-19 ha generado numerosos desafíos para el campo de la educación, en particular el médico. educación e investigación relacionada con la salud. Sin embargo, estos obstáculos también son una oportunidad para avanzar en este ámbito académico-médico con la mayor introducción de tecnologías de la información y la creación de estrategias que se centran en la mejora de la calidad. Investigaciones anteriores han destacado la importancia de adaptar tanto la práctica clínica como la educación médica en el contexto de la pandemia (1). Mientras continúa COVID-19 aumenten en todo el mundo, las brechas en la educación e investigación médicas crecen y deben abordarse urgentemente con un enfoque creativo para hacer que la tecnología disponible sea accesible y relevante. https://doi.org/10.29375/01237047.4019
A pandemia COVID-19 criou inúmeros desafios para o campo da educação, especialmente o médico. educação e pesquisas relacionadas à saúde. No entanto, esses obstáculos são também uma oportunidade para avançar neste campo médico-acadêmico com a maior introdução das tecnologias de informação e a criação de estratégias que visem a melhoria da qualidade. Pesquisas anteriores destacaram a importância de adaptar a prática clínica e a educação médica no contexto da pandemia (1). À medida que o COVID-19 continua a aumentar em todo o mundo, as lacunas na educação médica e na pesquisa estão crescendo e devem ser abordadas com urgência com uma abordagem criativa para tornar a tecnologia disponível acessível e relevante. https://doi.org/10.29375/01237047.4019
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Educación Médica , Medicina Clínica , Infecciones por Coronavirus , Educación a DistanciaRESUMEN
Abstract Introduction: The obstructive sleep apnea-hypopnea syndrome (OSAHS) is usually established using polysomnography (PSG). Most patients diagnosed with this condition receive treatment with continuous positive airway pressure (CPAP). The conventional approach requires performing a full-night PSG and CPAP titration over a two-night stay in a sleep laboratory, which is costly and may present scheduling difficulties. However, the combined use of polysomnography and CPAP titration in a single night, procedure known as split-night polysomnography (SNPSG), is less-expensive and is a time saving strategy for diagnosis and treatment. Objectives: To characterize the SNPSG studies conducted in the sleep laboratory of the Hospital Universitario Santa Fe de Bogotá (HUFSFB) and assess their performance in the diagnosis and treatment of OSAHS. Materials and methods: Retrospective, observational and longitudinal study performed on a sample of 221 patients. Results: 208 (94.1%) SNPSG studies were compatible with OSAHS. Most cases (54.7%) had a hypopnea apnea index (AHI) ≥30. Adequate CPAP titration was achieved in 78% of patients who had severe AHI (p=0.00). Conclusions: OSAHS was diagnosed and an adequate CPAP titration was achieved in most of the SNPSG studies of the analyzed sample.
Resumen Introducción. El diagnóstico del síndrome de apnea/hipopnea obstructiva del sueño (SAHOS) se realiza mediante estudio de polisomnografía (PSG) y la mayoría de los pacientes con este diagnóstico recibe tratamiento con presión aérea positiva continua (CPAP). Este abordaje convencional requiere dos estudios de PSG: uno diagnóstico y otro de titulación. El uso combinado de PSG diagnóstica y de titulación en una sola noche, conocido como noche partida (PSGNP), es una alternativa diagnóstica y terapéutica válida que optimiza la utilización de tiempo y recursos. Objetivo. Caracterizar los estudios de PSGNP realizados en el laboratorio de sueño del Hospital Universitario de la Fundación Santa Fe de Bogotá (HUFSFB) y evaluar su desempeño. Materiales y métodos. Se realizó un estudio observacional analítico de tipo longitudinal retrospectivo de una muestra de 221 pacientes. Resultados. Se registraron 208 (94.1%) estudios de PSGNP compatibles con SAHOS, de los cuales la mayoría de los pacientes (54.7%) presentaron un índice de apnea hipopnea (IAH) >30. En 78% de los pacientes que presentaban IAH severo se logró una titulación adecuada del CPAP (p=0.00). Conclusiones. En la mayor parte de los estudios de PSGNP de la muestra analizada se diagnosticó SAHOS y se consiguió una titulación adecuada del CPAP.
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La celulitis periorbitaria es una patología muy frecuente en la población pediátrica. Se define como la infección que compromete los tejidos blandos adyacentes a la órbita sin atravesar el septum orbitario. Después de la introducción de la vacuna contra Haemophilus influenzae, los patógenos involucrados, generalmente, son cocos Gram-positivos. A continuación, se presenta un caso de celulitis periorbitaria asociada a conjuntivitis purulenta por Neisseria gonorrhoeae en un niño de 2 años y 10 meses. Existen pocos casos descritos en la literatura en los que este microorganismo aparece como agente causal de celulitis periorbitaria. Con este caso, se quiere resaltar la importancia de la toma de cultivo en los pacientes que concomitantemente presenten conjuntivitis bacteriana y secreción purulenta, ya que esto facilitó el diagnóstico de esta patología por un agente etiológico poco frecuente.
Periorbital cellulitis is a very common disease in pediatric population, it describes an infection involving the adjacent soft tissues anterior to the orbital septum. Pathogens involved are generally Gram-positive cocci after introduction of Haemophilus influenzae vaccine. We report a case of Neisseria gonorrhoeae periorbital cellulitis associated with bacterial conjunctivitis in a child. There are few cases reported in the literature with this microorganism as the causal agent. With this case, we would like to emphasize the importance to do a culture of the ocular secretion (if it exists) because this allowed us to determine an infrequent agent of this disease.
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Humanos , Masculino , Preescolar , Gonorrea , Celulitis Orbitaria/microbiologíaRESUMEN
Periorbital cellulitis is a very common disease in pediatric population, it describes an infection involving the adjacent soft tissues anterior to the orbital septum. Pathogens involved are generally Gram-positive cocci after introduction of Haemophilus influenzae vaccine. We report a case of Neisseria gonorrhoeae periorbital cellulitis associated with bacterial conjunctivitis in a child. There are few cases reported in the literature with this microorganism as the causal agent. With this case, we would like to emphasize the importance to do a culture of the ocular secretion (if it exists) because this allowed us to determine an infrequent agent of this disease.
La celulitis periorbitaria es una patología muy frecuente en la población pediátrica. Se define como la infección que compromete los tejidos blandos adyacentes a la órbita sin atravesar el septum orbitario. Después de la introducción de la vacuna contra Haemophilus influenzae, los patógenos involucrados, generalmente, son cocos Gram-positivos. A continuación, se presenta un caso de celulitis periorbitaria asociada a conjuntivitis purulenta por Neisseria gonorrhoeae en un niño de 2 años y 10 meses. Existen pocos casos descritos en la literatura en los que este microorganismo aparece como agente causal de celulitis periorbitaria. Con este caso, se quiere resaltar la importancia de la toma de cultivo en los pacientes que concomitantemente presenten conjuntivitis bacteriana y secreción purulenta, ya que esto facilitó el diagnóstico de esta patología por un agente etiológico poco frecuente.
Asunto(s)
Gonorrea , Celulitis Orbitaria/microbiología , Preescolar , Humanos , MasculinoRESUMEN
RESUMEN Introducción: La hospitalización domiciliaria ha surgido como una alternativa a la hospitalización tradicional, ya que brinda un mejor ambiente durante la recuperación del paciente. El objetivo del estudio fue medir la tasa de reingreso de la hospitalización domiciliaria dentro del Instituto de Ortopedia Infantil Roosevelt en Bogotá, Colombia. Materiales y método: Estudio de corte transversal. Se incluyeron 661 niños afiliados al programa de hospitalización domiciliaria entre enero y julio del 2013. Resultados: La tasa de reingreso en las primeras 72 horas fue del 2% (13 pacientes), siendo mayor en los recién nacidos (OR 4,2 - p=0,039) y patologías cráneo faciales (OR 12,1 - p=0,046). Esta tasa de reingreso fue menor que aquella evaluada en otro estudio en los que consideraron, a diferencia del presente estudio, a niños sin criterios de hospitalización; además de representar menores costos para el sistema de salud. Conclusión: Se observó una tasa de reingreso hospitalario del 2% en las primeras 72 horas lo cual permite considerar la hospitalización domiciliaria como una alternativa válida para el paciente pediátrico. MÉD.UIS. 2016;29(3):43-8.
ABSTRACT Introduction: The home care services have emerged as an alternative to traditional hospitalization, providing a better environment for patient recovery. The objective of this study was to demonstrate the readmission rate of home care services at Instituto de Ortopedia Infantil Roosevelt Bogotá, Colombia. Materials and method: Cross-sectional study. 661 patients of the home care services program were included in the study from January to July 2013. Results: We found a 72 hours - hospital readmission rate of 2% (13 patients), being higher in newborns (OR 4.2 - p=0,039) and patients with craniofacial pathologies (OR 12.1 - p=0,046). The readmission rate was lower than that assessed in another study in which they considered, unlike the present study, children without hospitalization criteria; besides representing lower costs to the health system. Conclusion: It was found a readmission rate of 2% in the first 72 hours, which allow consider home care services as a valid alternative to the pediatric patient. MÉD.UIS. 2016;29(3):43-8.