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Many authors have been working on approaches that can be applied to social robots to allow a more realistic/comfortable relationship between humans and robots in the same space. This paper proposes a new navigation strategy for social environments by recognizing and considering the social conventions of people and groups. To achieve that, we proposed the application of Delaunay triangulation for connecting people as vertices of a triangle network. Then, we defined a complete asymmetric Gaussian function (for individuals and groups) to decide zones where the robot must avoid passing. Furthermore, a feature generalization scheme called socialization feature was proposed to incorporate perception information that can be used to change the variance of the Gaussian function. Simulation results have been presented to demonstrate that the proposed approach can modify the path according to the perception of the robot compared to a standard A* algorithm.
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Robótica , Algoritmos , Simulação por Computador , Humanos , Distribuição Normal , Robótica/métodos , Interação SocialRESUMO
Social robotics is an emerging area that is becoming present in social spaces, by introducing autonomous social robots. Social robots offer services, perform tasks, and interact with people in such social environments, demanding more efficient and complex Human-Robot Interaction (HRI) designs. A strategy to improve HRI is to provide robots with the capacity of detecting the emotions of the people around them to plan a trajectory, modify their behaviour, and generate an appropriate interaction with people based on the analysed information. However, in social environments in which it is common to find a group of persons, new approaches are needed in order to make robots able to recognise groups of people and the emotion of the groups, which can be also associated with a scene in which the group is participating. Some existing studies are focused on detecting group cohesion and the recognition of group emotions; nevertheless, these works do not focus on performing the recognition tasks from a robocentric perspective, considering the sensory capacity of robots. In this context, a system to recognise scenes in terms of groups of people, to then detect global (prevailing) emotions in a scene, is presented. The approach proposed to visualise and recognise emotions in typical HRI is based on the face size of people recognised by the robot during its navigation (face sizes decrease when the robot moves away from a group of people). On each frame of the video stream of the visual sensor, individual emotions are recognised based on the Visual Geometry Group (VGG) neural network pre-trained to recognise faces (VGGFace); then, to detect the emotion of the frame, individual emotions are aggregated with a fusion method, and consequently, to detect global (prevalent) emotion in the scene (group of people), the emotions of its constituent frames are also aggregated. Additionally, this work proposes a strategy to create datasets with images/videos in order to validate the estimation of emotions in scenes and personal emotions. Both datasets are generated in a simulated environment based on the Robot Operating System (ROS) from videos captured by robots through their sensory capabilities. Tests are performed in two simulated environments in ROS/Gazebo: a museum and a cafeteria. Results show that the accuracy in the detection of individual emotions is 99.79% and the detection of group emotion (scene emotion) in each frame is 90.84% and 89.78% in the cafeteria and the museum scenarios, respectively.
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Robótica , Emoções , Humanos , Espécies Reativas de Oxigênio , Robótica/métodos , Interação Social , Percepção SocialRESUMO
Se tuvo como objetivo identificar la estructura intelectual de la producción científica sobre la COVID-19 en el área de Salud Pública, Ambiental y Ocupacional. Se usó el análisis de acoplamiento bibliográfico y de cocitación de autores a partir de la producción científica en Web of Science Core Collection en el periodo diciembre 2019 a agosto 2020. Las unidades de análisis fueron los autores citantes y los autores citados. Un total de 1 065 registros fueron recuperados bajo los criterios de búsqueda establecidos. El análisis de acoplamiento bibliográfico de autores identificó 12 clústeres, que representaron a los 106 autores activos más importantes que investigaron la pandemia desde distintas perspectivas y formaron diversos frentes de investigación. Mediante el análisis de cocitación se obtuvieron 96 autores citados más influyentes representados en cinco clústeres. Se identificó a la Organización Mundial de la Salud y al Centro para el Control y la Prevención de Enfermedades de los Estados Unidos de América como referencias muy influyentes, así como a autores de la República Popular China. En conclusión, se logró identificar la estructura intelectual de la producción científica sobre COVID-19 en el área de Salud Pública, Ambiental y Ocupacional con el uso de los métodos bibliométricos de análisis de acoplamiento bibliográfico y de cocitación de autores(AU)
The aim was to identify the intellectual structure of the scientific production on COVID-19 in the area of Public, Environmental and Occupational Health. Author bibliographic-coupling analysis and author cocitation analysis were used from the scientific production in Web of Science Core Collection in the period December 2019 to August 2020. The units of analysis were the citing authors and cited authors. A total of 1065 records were retrieved under the established search criteria. The Author bibliographic-coupling analysis identified 12 clusters representing 106 major active authors who investigated the pandemic from different perspectives forming diverse research fronts. The author cocitation analysis obtained 96 most influential cited authors represented in five clusters. The WHO and CDC-USA were identified as very influential references, as well as authors from the People's Republic of China. In conclusion, it was possible to identify the intellectual structure of scientific production on COVID-19 in the area of Public, Environmental and Occupational Health with the use of bibliometric methods of author bibliographic-coupling and author cocitation analysis(AU)
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Humanos , Indicadores de Produção Científica , Prevenção de Doenças , COVID-19/epidemiologia , BibliometriaRESUMO
INTRODUCTION: There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality. OBJECTIVE: To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality. MATERIAL AND METHODS: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for studies published between December 2019 and December 2020. Effect statistics were pooled using random effects models. The quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Targeted outcomes: mortality and severity proportions in COVID-19 patients with 25(OH)D deficiency, defined as serum 25(OH)D < 50 nmol/L. RESULTS: In the 23 studies included (n = 2692), the mean age was 60.8 (SD ± 15.9) years and 53.8% were men. Results suggested that vitamin 25(OH)D deficiency was associated with increased risk of severe SARS-CoV-2 disease (RR 2.00; 95% CI 1.47-2.71, 17 studies) and mortality (RR 2.45; 95% CI 1.24-4.84, 13 studies). Only 7/23 studies reported C-reactive protein values, all of which were > 10 mg/L. Conclusions 25(OH)D deficiency seems associated with increased SARS-CoV-2 infection severity and mortality. However, findings do not imply causality, and randomized controlled trials are required, and new studies should be designed to determine if decreased 25(OH)D is an epiphenomenon or consequence of the inflammatory process associated with severe forms of SARS-CoV-2. Meanwhile, the concentration of 25(OH)D could be considered as a negative acute phase reactant and a poor prognosis in COVID-19 infection.
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COVID-19/mortalidade , Índice de Gravidade de Doença , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Fatores Etários , COVID-19/sangue , Feminino , Humanos , Masculino , Vitamina D/sangue , Deficiência de Vitamina D/sangueRESUMO
For social robots, knowledge regarding human emotional states is an essential part of adapting their behavior or associating emotions to other entities. Robots gather the information from which emotion detection is processed via different media, such as text, speech, images, or videos. The multimedia content is then properly processed to recognize emotions/sentiments, for example, by analyzing faces and postures in images/videos based on machine learning techniques or by converting speech into text to perform emotion detection with natural language processing (NLP) techniques. Keeping this information in semantic repositories offers a wide range of possibilities for implementing smart applications. We propose a framework to allow social robots to detect emotions and to store this information in a semantic repository, based on EMONTO (an EMotion ONTOlogy), and in the first figure or table caption. Please define if appropriate. an ontology to represent emotions. As a proof-of-concept, we develop a first version of this framework focused on emotion detection in text, which can be obtained directly as text or by converting speech to text. We tested the implementation with a case study of tour-guide robots for museums that rely on a speech-to-text converter based on the Google Application Programming Interface (API) and a Python library, a neural network to label the emotions in texts based on NLP transformers, and EMONTO integrated with an ontology for museums; thus, it is possible to register the emotions that artworks produce in visitors. We evaluate the classification model, obtaining equivalent results compared with a state-of-the-art transformer-based model and with a clear roadmap for improvement.
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Processamento de Linguagem Natural , Robótica , Emoções , Humanos , Semântica , FalaRESUMO
Nowadays, mobile robots are playing an important role in different areas of science, industry, academia and even in everyday life. In this sense, their abilities and behaviours become increasingly complex. In particular, in indoor environments, such as hospitals, schools, banks and museums, where the robot coincides with people and other robots, its movement and navigation must be programmed and adapted to robot-robot and human-robot interactions. However, existing approaches are focused either on multi-robot navigation (robot-robot interaction) or social navigation with human presence (human-robot interaction), neglecting the integration of both approaches. Proxemic interaction is recently being used in this domain of research, to improve Human-Robot Interaction (HRI). In this context, we propose an autonomous navigation approach for mobile robots in indoor environments, based on the principles of proxemic theory, integrated with classical navigation algorithms, such as ORCA, Social Momentum, and A*. With this novel approach, the mobile robot adapts its behaviour, by analysing the proximity of people to each other, with respect to it, and with respect to other robots to decide and plan its respective navigation, while showing acceptable social behaviours in presence of humans. We describe our proposed approach and show how proxemics and the classical navigation algorithms are combined to provide an effective navigation, while respecting social human distances. To show the suitability of our approach, we simulate several situations of coexistence of robots and humans, demonstrating an effective social navigation.
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BACKGROUND: Anti-hypertensive medications may reduce the incidence of cognitive disorders. This may be due to reasons beyond their pure hypotensive effect. This study aimed to systematically review the association between the use of Angiotensin-Receptor Blockers (ARBs) and the incidence of Alzheimer's disease (AD). METHODS: We systematically searched studies reporting the association between ARB use and the incidence of AD. RESULTS: Ten studies (1 RCT, 2 case-control and 7 cohort studies) met the inclusion criteria. When all observational studies (9) were analyzed, ARB use was associated with a reduced risk of incident AD (HR 0.72, 95% CI: 0.58-0.88, p<0.001). In the only RCT, decrease in the incidence of AD was also significant (HR= 0.31, 95% CI: 0.14-0.68). CONCLUSION: ARB use may reduce the risk of incident AD. This association does not imply causation and further research is required to clarify potential mechanisms.
Assuntos
Doença de Alzheimer , Antagonistas de Receptores de Angiotensina , Anti-Hipertensivos , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/prevenção & controle , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Angiotensinas/uso terapêutico , Anti-Hipertensivos/uso terapêutico , HumanosRESUMO
INTRODUCTION: In the emergency department, there is a need to provide palliative care; however, they are not usually administered. The present study evaluates the evolution of the intensity of the symptoms when applying palliative care, in adult patients with advanced chronic disease admitted to the emergency room, and compares survival between those who receive this care and those who do not. MATERIALS AND METHODS: A clinical intervention study was conducted including patients older than 18 years with advanced chronic disease admitted to the emergency room with an indication of palliative support according to the Supportive and Palliative Care Indicators Tool 2015. Three hundred and seven patients were studied (74 in the intervention group and 233 in the group not intervened). In the intervention group, the intensity of pre- and postintervention symptoms was compared (Wilcoxon test). The survival of both the groups were then compared (logrank test). RESULTS: There was a significant decrease in pain and dyspnea at 24 and 48 h postintervention (P < 0.01), respectively, while drowsiness increased significantly at 24 h (P < 0.01) but did not change at 48 h (P = 0.38). Excluding patients with better functional status, there was less survival at 3 months in the intervention group (P = 0.01). CONCLUSIONS: Dyspnea and pain decreased with the application of palliative care but not drowsiness. Survival in the intervention group was lower than in the nonintervention group. However, the reason for providing palliative care is to relieve suffering at the end of life.
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In order to determine the characteristics of drug-induced liver injury (DILI), adult patients diagnosed with tuberculosis and with an anti-tuberculosis treatment scheme including pyrazinamide were studied. The re-exposure process was used for the cause-effect analysis of the DILI. A total of 10 patients were found with pyrazinamide-associated DILI; the median age and hospital stay were 40.5 years (from 22 to 76 years) and 41 days (from 11 to 130 days), respectively. The median time in which the events appeared was 14 days (from 3 to 46 days); jaundice was observed in 4 patients and radiological patterns such as hepatocellular, mixed and cholestatic were found in 5, 3 and 2 patients, respectively. Mild presentation of DILI was observed in 6 cases (60%) and moderate in 3 (30%). In conclusion, pyrazinamide-associated DILI required prolonged hospital stay, presented jaundice in little more than a third of the cases, and radiologically, the hepatocellular pattern predominated.
Con el objetivo de determinar las características de la enfermedad hepática inducida por el medicamento (DILI) se realizó un estudio de pacientes adultos con diagnóstico de tuberculosis y esquema de tratamiento antituberculoso con pirazinamida. El análisis de causa efecto de la DILI fue mediante el proceso de reexposición. Se encontraron 10 pacientes con DILI asociada a pirazinamida, la mediana de edad y de estancia hospitalaria fue de 40,5 años (rango 22-76) y 41 días (rango 11-130), respectivamente. La mediana de presentación del evento fue de 14 días (rango 3-46), 4 pacientes presentaron ictericia, 5 tuvieron patrón hepatocelular, 3 mixtas y 2 colestásicos. La presentación de la DILI fue leve en 6 casos (60%) y moderados en 3 (30%). En conclusión, la DILI asociada a la pirazinamida requiere estancia hospitalaria prolongada, se presenta con ictericia en un poco más de un tercio de los casos siendo el patrón predominante el hepatocelular.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Pirazinamida , Tuberculose , Adulto , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Hospitais , Humanos , Peru , Pirazinamida/efeitos adversos , Tuberculose/tratamento farmacológicoRESUMO
In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.
Con el objetivo de describir las manifestaciones de pacientes con enfermedad por coronavirus 2019 (COVID-19), se evaluaron variables sociodemográficas, antecedentes, manifestaciones clínicas y radiológicas, tratamientos y evolución en pacientes que ingresaron por emergencia, del 6 al 25 de marzo de 2020, al Hospital Nacional Edgardo Rebagliati Martins en Lima. Se registraron 17 pacientes: el 76% eran varones, edad promedio de 53,5 años (rango de 25 a 94); el 23,5% había regresado del extranjero; 41,2% referido de otros establecimientos de salud; 41,2% ingresó a ventilación mecánica; falleció el 29,4% (5 pacientes). Los factores de riesgo detectados fueron adulto mayor, tener hipertensión arterial y obesidad; los principales síntomas, tos, fiebre y disnea; los hallazgos de laboratorio frecuentes, proteína C reactiva elevada y linfopenia; la presentación radiológica predominante, el infiltrado pulmonar intersticial bilateral. Se reporta una primera experiencia en el manejo de pacientes con diagnóstico de la COVID-19 grave en el Perú.
Assuntos
Infecções por Coronavirus/fisiopatologia , Hospitalização , Pneumonia Viral/fisiopatologia , Respiração Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Peru , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
La enfermedad por coronavirus originada en el año 2019 (COVID-19), se ha diseminado rápidamente en todo el mundo produciendo estragos en el sistema de salud y la sociedad. Se reporta el caso de un varón de 26 años de edad con antecedentes de asma y obesidad, que retornó de EE.UU y acudió a emergencia con síntomas respiratorios, hipoxemia e infiltrado intersticial en la radiografía de tórax, se decide internamiento en sala de aislamiento, la prueba molecular RT-PCR de hisopado nasofaríngeo resultó negativa, por lo que fue traslado a una sala de emergencia común. El manejo inicial fue conservador, sin embargo el paciente evolucionó desfavorablemente requiriendo soporte ventilatorio, pero fallece al quinto día de internamiento. Se recibió un segundo resultado positivo para SARS-CoV-2 al día siguiente de fallecido el paciente, siendo una de las primeras víctimas jóvenes en el Perú.
The coronavirus disease originated in the year 2019 (COVID-19), has spread rapidly throughout the world, wreaking havoc on the health system and society. We report the case of a 26-year-old man with a history of asthma and obesity, who returned from the US and went to the emergency room with respiratory symptoms, hypoxemia and interstitial infiltrate on chest radiography, he was admitted to the isolation room The nasopharyngeal swab RT-PCR molecular test was negative, so he was transferred to a common emergency room. Initial management was conservative, however the patient evolved unfavorably requiring ventilatory support, but died on the fifth day of hospitalization. A second positive result for SARS-CoV-2 was received the day after the patient died, being one of the first young victims in Peru.
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RESUMEN Los cambios demográficos mundiales han producido nuevos retos en el sistema de salud. La atención de pacientes de mayor edad y con problemas de salud más complejos se ha incrementado de manera importante y sobrepasan nuestra capacidad de respuesta; el Perú no escapa a esta realidad. Estos pacientes necesitan cada vez mayores cuidados y la enfermedad crónica en fase avanzada requiere un cambio de enfoque; de los tratamientos agresivos con fines curativos hacia un enfoque paliativo, de mejora de la calidad de vida, asociado a un importante contenido social. La enfermedad en fase terminal se sitúa en la etapa final de la vida, en la que existe daño irreversible y múltiples síntomas somáticos, psicológicos y espirituales, con gran impacto en el paciente y su familia. Se ha estudiado con relativa frecuencia la enfermedad oncológica en fase terminal, sin embargo, las no oncológicas tienen mayor frecuencia y sobrevida. El objetivo de la presente revisión es hacer un compendio de las definiciones operacionales de esta condición, describir criterios diagnósticos específicos de terminalidad, resumir instrumentos para identificar necesidad de cuidados paliativos y escalas de pronóstico publicadas en la literatura científica.
ABSTRACT Global demographic changes have generated new challenges in the health system. Treating increasingly older patients with more complex health problems has significantly raised and exceeded our response capacity, and Peru is not indifferent to this situation. These patients need more and more care, and late-stage chronic diseases require an approach change: from aggressive healing treatments to palliative ones which improve quality of life and are associated with an important social content. Late-stage diseases occur in the final stage of life, where irreversible damage; multiple somatic, psychological and spiritual symptoms; as well as great impact in the patients and their families take place. Late-stage cancer diseases have been studied on a relatively frequent basis; however, non-cancer diseases occur more often and result in better survival rates. This review article aims at gathering the operational definitions of this condition, describing the specific diagnostic criteria of terminality, and summarizing the instruments to identify the need of palliative care and the prognostic scales published in the scientific literature.
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RESUMEN Con el objetivo de determinar las características de la enfermedad hepática inducida por el medicamento (DILI) se realizó un estudio de pacientes adultos con diagnóstico de tuberculosis y esquema de tratamiento antituberculoso con pirazinamida. El análisis de causa efecto de la DILI fue mediante el proceso de reexposición. Se encontraron 10 pacientes con DILI asociada a pirazinamida, la mediana de edad y de estancia hospitalaria fue de 40,5 años (rango 22-76) y 41 días (rango 11-130), respectivamente. La mediana de presentación del evento fue de 14 días (rango 3-46), 4 pacientes presentaron ictericia, 5 tuvieron patrón hepatocelular, 3 mixtas y 2 colestásicos. La presentación de la DILI fue leve en 6 casos (60%) y moderados en 3 (30%). En conclusión, la DILI asociada a la pirazinamida requiere estancia hospitalaria prolongada, se presenta con ictericia en un poco más de un tercio de los casos siendo el patrón predominante el hepatocelular.
ABSTRACT In order to determine the characteristics of drug-induced liver injury (DILI), adult patients diagnosed with tuberculosis and with an anti-tuberculosis treatment scheme including pyrazinamide were studied. The re-exposure process was used for the cause-effect analysis of the DILI. A total of 10 patients were found with pyrazinamide-associated DILI; the median age and hospital stay were 40.5 years (from 22 to 76 years) and 41 days (from 11 to 130 days), respectively. The median time in which the events appeared was 14 days (from 3 to 46 days); jaundice was observed in 4 patients and radiological patterns such as hepatocellular, mixed and cholestatic were found in 5, 3 and 2 patients, respectively. Mild presentation of DILI was observed in 6 cases (60%) and moderate in 3 (30%). In conclusion, pyrazinamide-associated DILI required prolonged hospital stay, presented jaundice in little more than a third of the cases, and radiologically, the hepatocellular pattern predominated.
Assuntos
Humanos , Masculino , Feminino , Pirazinamida , Tuberculose , Antituberculosos , Preparações Farmacêuticas , HipersensibilidadeRESUMO
RESUMEN Con el objetivo de describir las manifestaciones de pacientes con enfermedad por coronavirus 2019 (COVID-19), se evaluaron variables sociodemográficas, antecedentes, manifestaciones clínicas y radiológicas, tratamientos y evolución en pacientes que ingresaron por emergencia, del 6 al 25 de marzo de 2020, al Hospital Nacional Edgardo Rebagliati Martins en Lima. Se registraron 17 pacientes: el 76% eran varones, edad promedio de 53,5 años (rango de 25 a 94); el 23,5% había regresado del extranjero; 41,2% referido de otros establecimientos de salud; 41,2% ingresó a ventilación mecánica; falleció el 29,4% (5 pacientes). Los factores de riesgo detectados fueron adulto mayor, tener hipertensión arterial y obesidad; los principales síntomas, tos, fiebre y disnea; los hallazgos de laboratorio frecuentes, proteína C reactiva elevada y linfopenia; la presentación radiológica predominante, el infiltrado pulmonar intersticial bilateral. Se reporta una primera experiencia en el manejo de pacientes con diagnóstico de la COVID-19 grave en el Perú.
ABSTRACT In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.
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Humanos , Masculino , Feminino , Pacientes , Peru , Pneumonia Viral/fisiopatologia , Respiração Artificial , Infecções por Coronavirus/fisiopatologia , COVID-19 , Hospitalização , Pneumonia Viral , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Estudos Retrospectivos , Fatores de Risco , Infecções por Coronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Tosse/etiologia , Tosse/epidemiologia , Síndrome Respiratória Aguda Grave , Dispneia/etiologia , Dispneia/epidemiologia , Serviços Médicos de Emergência , Pandemias , Febre/etiologia , Febre/epidemiologiaRESUMO
RESUMEN La enfermedad por nuevo coronavirus se detectó en Perú en marzo de 2020, diseminándose rápidamente, produciendo afecciones respiratorias graves y alta mortalidad. En el servicio de emergencia se debe implementar medidas de aislamiento de pacientes con ambientes específicos para casos sospechosos y confirmados (según gravedad) y definir flujogramas de atención basados en datos objetivos y fácilmente evaluables. Asimismo, se deben establecer pautas para realizar exámenes auxiliares y adoptar tratamiento según la mejor evidencia disponible. Las medidas de higiene y equipos de protección personal deben estar asegurados para evitar el contagio, así como suspender visitas y acompañamiento de familiares; pero a la vez se debe asegurar adecuado flujo de información (de preferencia virtual) para familiares y el propio personal. Es necesaria la rápida adecuación de los planes y recursos (materiales y humanos) para responder a la creciente demanda de pacientes, siendo indispensable la participación interdisciplinaria.
ABSTRACT New coronavirus disease was detected in Peru in March 2020, spreading rapidly, producing serious respiratory conditions and high mortality. In the emergency service, isolation measures must be implemented for patients with specific environments for suspected and confirmed cases (depending on severity). Define care flow charts based on objective and easily evaluable data. Guidelines should be established for conducting ancillary examinations and adopting treatment based on the best available evidence. Hygiene measures and personal protective equipment must be ensured to avoid contagion, as well as suspending visits and accompaniment of family members; but at the same time, an adequate flow of information (preferably virtual) must be ensured for family members and the staff themselves. Rapid adaptation of plans and resources (material and human) is necessary to respond to the growing demand for patients; Interdisciplinary participation is essential.
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Introducción: La pandemia debida a enfermedad por coronavirus 2019 (COVID-19) ha producido más de 70 mil muertes en el mundo. Objetivo: Describir las características de pacientes fallecidos por COVID-19 en un hospital terciario. Métodos: Estudio descriptivo realizado en el servicio de emergencia del hospital Rebagliati Lima-Perú, que incluye los pacientes fallecidos con resultado positivo a infección por SARS-CoV-2 mediante PCR-TR hasta el 4 de abril de 2020. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, radiológicas, tratamiento y evolución. Resultados: Se identificaron 14 casos, 78,6% de sexo masculino, edad promedio 73,4 años (rango 26 a 97). Adquirieron la infección en el exterior del país el 21,4% de casos. Se encontró factores de riesgo en 92,9% de pacientes (más frecuentes adulto mayor, hipertensión arterial y obesidad). Los síntomas más frecuentes fueron disnea, fiebre y tos, con tiempo de enfermedad 8 días (+/- 3,0); los signos polipnea y estertores respiratorios. Los hallazgos de laboratorio más frecuentes fueron proteína C reactiva elevada (promedio 22 mg/dL) e hipoxemia. La presentación radiológica predominante fue infiltrado pulmonar intersticial bilateral en vidrio esmerilado. Ingresaron a ventilación mecánica 78,6% (11 de 14 casos); recibió azitromicina 71,4%, hidroxicloroquina 64,3% y antibióticos de amplio espectro 57,1% de los casos; con estancia hospitalaria de 4,7 días (+/-2,4). Conclusión: Los fallecidos por COVID-19 presentaron neumonía grave bilateral, más frecuentes en varones, con factores de riesgo (adulto mayor, hipertensión arterial y obesidad), con alta necesidad de asistencia ventilatoria.
Introduction: The COVID-19 pandemic has caused more than 70 thousand deaths worldwide. Objective: To describe the characteristics of COVID-19 patients who died in a tertiary hospital. Methods: A descriptive study was carried out in the emergency service of the Hospital Rebagliati in Lima, Peru, which includes deceased patients with a positive result for SARS-CoV-2 infection diagnosed by PCR-TR until April 4, 2020. The medical history was reviewed. and hospital records looking for sociodemographic variables, clinical characteristics, radiological manifestations, treatment and evolution. Results: 14 cases were identified, 78.6% were male, average age 73.4 years (range 26 to 97). 21.4% of cases acquired the infection out of Peru. Risk factors were found in 92.9% of patients (more frequent elderly, hypertension and obesity). The most frequent symptoms were dyspnea, fever and cough, with illness time 8 days (+/- 3); signs of polypnea and respiratory rales. The most frequent laboratory findings were elevated C-reactive protein (average 22 mg / dL) and hypoxemia. The predominant radiological presentation was bilateral interstitial pulmonary infiltration in ground glass. 78.6% (11 of 14 cases) entered mechanical ventilation; 71.4% of the cases received azithromycin, 64.3% hydroxychloroquine and 57.1% broad-spectrum antibiotics; with a 4.7 day hospital stay (+/- 2.4). Conclusion: Those who died from COVID-19 presented bilateral severe pneumonia, more frequent in men, with risk factors (elderly, hypertension and obesity), with a high need for ventilatory assistance.
RESUMO
Introducción: La saturación y hacinamiento de pacientes son un problema en el servicio de emergencia. Objetivo: Describir las características de la demanda de atención médica al servicio de emergencia de un hospital terciario de la seguridad social y evaluar su hacinamiento. Métodos: Estudio observacional realizado en el hospital Rebagliati, primer trimestre 2019. Se evaluaron variables sociodemográficas, de tiempo e indicadores de emergencia del sistema estadístico institucional. Se realizó estadística descriptiva con IBM SPSS 24.00. Resultados: 51294 atenciones en pacientes entre 14 y 102 años (mediana 60), 56,7% de sexo femenino. 18% registró más de una atención en el trimestre. El día de mayor demanda fue el lunes y el horario entre 08 y 13 horas. Las atenciones de prioridad III y IV fueron el 83,5% del total. En los tópicos de medicina y de alivio se realizaron el 63% de atenciones. En unidad de trauma-shock se realizaron el 3% de las atenciones. Se admitieron en las salas de observación el 13% de las atenciones de emergencia. Los diagnósticos más frecuentes fueron insuficiencia respiratoria, infecciones y accidentes cerebrovasculares. El 88% de las admisiones se realizaron en salas comunes con una estancia entre 4,4 y 7,0 días. Falleció el 0,8% de los atendidos, se realizó intervención quirúrgica en el 0,7% y se transfirió a otro establecimiento al 0,1% respectivamente. Conclusión: La demanda al servicio de emergencia es principalmente por problemas médicos (de prioridad 3 y 4), predominando pacientes adultos mayores y de sexo femenino. Se admitió al 13% de los atendidos con estancia prolongada, baja mortalidad, muy pocas transferencias y alta tasa de retorno
Introduction: The saturation and overcrowding of patients are problem in the emergency service. Objective: To describe the characteristics of the demand for medical attention to the emergency service of an urban hospital and to assess its overcrowding. Methods: Observational study carried out at the Rebagliati hospital, first quarter 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated. Descriptive statistics were performed with IBM SPSS 24. Results: Of 5,1244 attentions in patients between 14 and 102 years (median 60), 56.7% were female. 18% recorded more than one service in the quarter. The day of greatest demand was Monday and the hours between 08 and 13 hours. Priority care III and IV were 83.5% of the total. In the topics of medicine and relief, 63% of care was performed. In the trauma-shock unit, 3% of the care was performed. 13% of emergency care were admitted to observation rooms. The most frequent diagnoses were respiratory failure, infections and strokes. 88% of admissions were made in common rooms with a stay between 4.4 and 7.0 days. 0.8% of those seen died, surgery was performed in 0.7%, and 0.1% was transferred to another facility, respectively. Conclusion: The demand to the emergency service is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of those attended were admitted with a long stay, low mortality, very few transfers and a high rate of return
RESUMO
Objetivo. Los recursos hospitalarios resultan insuficientes ante la demanda de pacientes graves con COVID-19. La adecuada gestión de recursos es esencial para brindar la mejor atención posible. Se revisaron criterios que ayuden a tomar decisiones adecuadas y oportunas, siguiendo principios éticos. La priorización del soporte ventilatorio invasivo debe hacerse de manera transparente y objetiva, evaluando integralmente al paciente y basado en criterios objetivos como escalas de pronóstico, ciclo de vida o compromiso clínico. El tratamiento sintomático (incluyendo cuidados paliativos) es indispensable en esta pandemia y la comunicación con el aciente o la familia permiten humanizar la atención del personal de salud.
Objetive. Hospital resources are insufficient given the demand for seriously ill patients with COVID-19. Proper resource management is essential to provide the best possible care. Criteria to help make appropriate and timely decisions were reviewed, following ethical principles. The prioritization of invasive ventilatory support must be done in a transparent and objective manner, comprehensively evaluating the patient and based on objective criteria such as prognostic scales, life cycle or clinical commitment. Symptomatic treatment (including palliative care) is essential in this pandemic and communication with the patient or family makes it possible to humanize the care of health personnel.