RESUMO
BACKGROUND: In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized. METHODS: We conducted a retrospective municipal and individual-level study using 1â069â174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively. RESULTS: We identified a 51% higher mortality rate (276.11 deaths per 100â000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths. CONCLUSION: Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.
Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Humanos , Pandemias , Atestado de Óbito , Causas de Morte , Estudos Retrospectivos , México/epidemiologia , MortalidadeRESUMO
BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City. METHODS: We analyzed suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, from the Mexico City Epidemiological Surveillance System from 24 February 2020 to 31 March 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the general civil registry. RESULTS: We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater risk for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic. CONCLUSIONS: Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City.
Assuntos
COVID-19 , COVID-19/epidemiologia , Cidades/epidemiologia , Humanos , México/epidemiologia , Pandemias , SARS-CoV-2RESUMO
BACKGROUND: COVID-19 has had a disproportionate impact on older adults. Mexico's population is younger, yet COVID-19's impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging. METHODS: We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction. RESULTS: We analyzed 20 804 confirmed SARS-CoV-2 cases in adults aged 60 and older. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization, and intensive care unit (ICU) admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas. CONCLUSIONS: Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.
Assuntos
COVID-19/mortalidade , COVID-19/fisiopatologia , Disparidades nos Níveis de Saúde , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , COVID-19/epidemiologia , Comorbidade , Suscetibilidade a Doenças , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS: We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS: Among the 177â 133 subjects at the time of writing this report (May 18, 2020), we observed 51â 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included ageâ ≥â 65 years, diabetes, early-onset diabetes, obesity, ageâ <â 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statisticâ =â 0.823). CONCLUSIONS: Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.
Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/mortalidade , Obesidade/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , COVID-19 , Comorbidade , Infecções por Coronavirus/imunologia , Bases de Dados Factuais , Suscetibilidade a Doenças , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Prognóstico , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/mortalidade , Insuficiência Renal Crônica/mortalidade , Medição de Risco/métodos , Fatores de Risco , SARS-CoV-2 , Fatores SexuaisRESUMO
INTRODUCTION: In Latin America, the number of children and adolescents who are overweight or obese has significantly increased in recent decades, and this situation has become a major public health concern. To address this problem, several intervention programmes, based on factors such as physical activity and nutrition, have been implemented, and body mass index (BMI) has been widely used as a means of measuring the impact of such interventions. Although some Latin America-based systematic reviews have been performed, there have been no previous meta-analyses of findings regarding the effect of physical activity interventions on BMI. Thus, the objective of the systematic review and meta-analysis will be to provide an up-to-date synthesis of the effects of physical activity interventions on BMI of Latin American children and adolescents aged 4-18 years. METHODS AND ANALYSIS: This systematic review and meta-analysis protocol is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. The literature search will involve MEDLINE, EMBASE, Cochrane Library, Web of Science and Scielo for articles published up to July 2019. This search will include randomised controlled trials (RCTs), non-randomised experimental studies and single-arm pre-post studies. Further, the Cochrane Collaboration's tool for RCT studies and the Quality Assessment Tool for Quantitative Studies for non-randomised experimental and single-arm pre-post studies will be used to assess the risk of bias among the studies included in the systematic review. For the meta-analysis, the statistical program STATA V.14 will be used, and standardised mean differences are calculated as the primary outcomes. Subgroup analyses will then be performed based on the characteristics of the interventions and populations included in the studies examined. ETHICS AND DISSEMINATION: This systematic review protocol is designed to provide updated evidence regarding the effects of physical activity interventions on the Latin American population; such evidence may be useful for institutions responsible for the development of public health policies and for those tasked with implementing such interventions among children and adolescents in Latin America. The results should be disseminated through publication in a peer-reviewed journal. Since the data used in systematic reviews of this type will be extracted exclusively from published studies, approval from an ethics committee will not be required. PROSPERO REGISTRATION NUMBER: CRD42019077702.
Assuntos
Exercício Físico , Obesidade Infantil , Adolescente , Criança , Humanos , Índice de Massa Corporal , Protocolos Clínicos , América Latina , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
Se realizó un estudio descriptivo y transversal de 139 estudiantes de segundo año de la carrera Licenciatura en Enfermería, pertenecientes a la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, desde septiembre de 2017 hasta enero de 2018, a fin de evaluar la utilidad de un material didáctico sobre Investigación Cualitativa como herramienta de apoyo a la asignatura Elementos de Investigación Cualitativa en Salud. Se obtuvo un elevado nivel de aceptación en los estudiantes, quienes confirmaron la claridad con que se exponen los contenidos, el nivel de profundidad y la importancia de contar con un texto que ejemplifique y vincule el contenido de metodología de la investigación con situaciones de su práctica diaria. Este material favoreció la calidad del proceso de enseñanza - aprendizaje, dada en la promoción alcanzada, que resultó cualitativamente superior a la de cursos anteriores.
A descriptive and cross-sectional study of 139 students of 2nd year of Licentiate in Nursing, belonging to the Health Nursing-Technology Faculty in Santiago de Cuba was carried out from September, 2017 to January, 2018, in order to evaluate the usefulness of a didactic material on Qualitative Investigation as a support tool to the subject Elements of Qualitative Investigation in Health. A high level of acceptance was obtained in the students who confirmed the clarity with which the contents and their quality are exposed and the importance of having a text that exemplifies and links the content of the investigation methodology with situations of the daily practice. This material favored the quality of the teaching - learning process, given the high marks, which were qualitatively higher to those of previous courses.
Assuntos
Humanos , Masculino , Feminino , Adulto , Materiais de Ensino , Pesquisa em Enfermagem/métodos , Pesquisa Científica e Desenvolvimento Tecnológico , Atividades Científicas e Tecnológicas , Pesquisa , Estudantes de Enfermagem , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Objetivo Establecer la prevalencia de la patología maligna en pacientes con masa sólida palpable, sin diagnóstico previo de cáncer de seno en dos hospitales de Bogotá, Colombia. Materiales y métodos Estudio descriptivo retrospectivo entre marzo de 2010 y febrero de 2013 en los hospitales de San José e Infantil Universitario de San José, Bogotá D. C., Colombia. Se incluyeron mujeres mayores de 14 años que consultaron por masa sólida palpable sin diagnóstico previo de cáncer de seno, corroborada por examen físico; no se consideró ningún criterio de exclusión. Los datos se recolectaron de las historias clínicas y se llevaron a un formato creado por los investigadores. El programa estadístico utilizado fue Stata 13. Resultados Se confirmó la masa en 342 pacientes por examen clínico, en 307 pacientes con resultado de biopsia. La prevalencia de la patología maligna fue 12,2% y benigna 71,66%. Discusión La prevalencia de patología maligna por masa palpable fue menor que los datos reportados a nivel mundial, siendo el tumor más frecuente el carcinoma ductal infiltrante en un 87%, carcinoma lobulillar infiltrante en 6,4%), con estadio clínico IIA y BI-RADS 4 A (ecografía) y BI-RADS 4B (mamografía).
Objective To determine the prevalence rate of malignancy in patients with no prior breast cancer diagnosis who consulted for a solid palpable mass in two hospitals in Bogotá, Colombia. Materials and methods A descriptive retrospective study conducted between March 2010 and February 2013 at San José and Infantil Universitario de San José hospitals in Bogotá D. C., Colombia. Women 14 years or older with no prior breast cancer diagnosis who consulted for a palpable solid mass, confirmed by physical exam, were included. No exclusion criteria were considered. Data was collected from the clinical records and included in a format created by the researchers. Stata 13 was used for data analysis. Results The mass was confirmed by physical exam in 342 patients and by a biopsy in 307 patients. The prevalence rate for malignancy was 12.2% and for benign masses 71.66%. Discussion Our prevalence of breast cancer associated with a palpable mass was less than worldwide reported prevalence. The most frequent malignancy was invasive ductal carcinoma in 87% and invasive lobular carcinoma in 6.4% in stage IIA and BI-RADS 4A ultrasound category and BI-RADS 4B mammogram category.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Neoplasias da Mama , Prevalência , Mamografia , Carcinoma Ductal de Mama , MastodiniaRESUMO
Se realizó una revisión del tema Absceso Dentoalveolar Agudo donde se abordaron temas como su concepto, sinónimos en su nomenclatura, diagnóstico, síntomas cardinales, evolución del proceso infeccioso, sus fases de desarrollo, examen clínico, medios auxiliares de diagnóstico, tratamientos, complicaciones del proceso, abscesos en el maxilar superior y en la mandíbula, el tratamiento quirúrgico de los abscesos en general así como las medidas de promoción y prevención para evitarlo.
A revision of the topic: Acute Dentoalveolar Abscess was carried out where subjects such as the concept, synonyms in the cardinal nomenclature, diagnosis, symptoms, evolution of the infectious process, the phases of development, clinical examination, auxiliary means of diagnosis, treatments, complications of the process, abscesses in upper maxillary and the jaw, the surgical treatment of the abscesses as well as the measures of promotion and prevention to avoid it were approached.
Assuntos
Humanos , Infecções , Abscesso Periapical , Literatura de Revisão como AssuntoRESUMO
Se realizó una revisión bibliográfica para enriquecer nuestros conocimientos acerca de la inflamación aguda. Esto se debe a la frecuencia con que se presenta la misma en las patologías que vemos a diario en nuestras consultas. Se comprobó como existen diferentes mecanismos ya sean exógenos como endógenos que son los que producen la lesión celular. También analizamos que son múltiples los agentes lesivos que la pueden provocar así como los diferentes signos y síntomas que la acompañan que hace que no exista ningún tipo de confusión cuando ésta se presenta. Así como las manifestaciones pulpares según las características que se puede acompañar de inflamación aguda o crónica.
A bibliographical revision was carried out to increase our knowledge about acute inflammation due to the frequency it presents in the pathologies most frequently treated in our surgeries nowadays. The existence of different exogenous and endogenous mechanism was checked, which lead to the cell lesion. It was also noticed that it can be caused by several injurious agents as well as the several signs and symptoms it brings about, therefore there is no confusion when it occurs, there are also mass signs according to the characteristics that can be accompanied by acute or chronic inflammation.
Assuntos
Humanos , Inflamação/patologiaRESUMO
Se realizó un trabajo de revisión sobre el tema de municipios por la salud donde se abordaron aspectos relacionados con su definición, objetivos del movimiento, tareas, fortalezas, características del movimiento, principales logros de la red, deficiencias y evaluación de la estrategia.
There has been done a revision about the topic of municipality for health where there were tackled aspects related to its defenition, movement´s objectives, tasks, strenghts, movement´s characteristics,main achievements of the net, defficiencies and strategy´s evaluation.
Assuntos
Humanos , Atenção à Saúde , Sistemas de Saúde , Cidade SaudávelRESUMO
BACKGROUND: Gallstones and extrahepatic biliary obstruction is a difficult management problem during pregnancy. Choledocholithiasis may cause cholangitis or pancreatitis, potentially life-threatening conditions. As surgery may result in significant fetal mortality when performed on these patients. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are preferred and could be performed safely in pregnant women provided suitable precautions are taken to minimize exposure to radiation. OBJECTIVE: To show our experience in ERCP and ES for symptomatic choledocholithiasis during pregnancy. MATERIAL AND PATIENTS: We described our experience in seven young women (mean age, 27.4 years) who presented with symptoms caused by choledocholithiasis, one in first trimester of pregnancy, four in second trimester, and two in third month. All had obstructive jaundice corroborated by abnormal liver function test and dilation of biliary tree on abdominal ultrasound. RESULTS: All had ERCP, ES, and stone extraction without complication and went on to deliver healthy babies at term. A lead apron was positioned over the abdomen of the mother to shield the fetus during roentgenographic fluoroscopy. Mean fluoroscopy time was 26 (range, 5-60 sec). CONCLUSIONS: Endoscopic management should be considered in women presenting with choledocholithiasis during pregnancy.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/terapia , Complicações na Gravidez/terapia , Adulto , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Icterícia/etiologia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/cirurgiaRESUMO
Biliovascular fistulas are abnormal communications with two types of clinical manifestations depending on type of flow in fistulous tract: 1) hemorrhage into biliary tract known as hemobilia, or 2) bile into bloodstream, known as bilhemia. Historically, this complication has been treated with surgery; however, technological progress at present allows treatment with intervention techniques without surgery being mandatory. In 1975, Clemens and Wittrin introduced the term bilhemia, a rare complication of hepatic damage producing excessively high levels of serum bilirubin and moderate rise of hepatic enzymes secondary to post-traumatic intrahepatic biliovenous fistula. Although this pathology is rare, it is considered dangerous; of 50 patients reported in the literature, 25 died due to this problem. The main purpose of treatment is to release tract obstruction by endoscopic sphincterotomy of Vater's papilla or, if the process is localized in proximal areas of biliary tract, through percutaneous biliary drainage or preferably nasobiliary drainage with continuous suction. This procedure can at least produce temporary relief and occasionally fistula closure. A longer effect can be achieved with biliary stent placement. We describe what is, to our knowledge, the first case of diagnosis and successful treatment of non-traumatic bilhemia with endoscopic sphincterotomy and nasobiliary catheter placement.
Assuntos
Bile , Fístula Biliar/sangue , Fístula Biliar/complicações , Fístula Vascular/sangue , Fístula Vascular/complicações , Idoso , Cateterismo , Feminino , Humanos , Esfinterotomia EndoscópicaRESUMO
Entre octubre de 1990 y diciembre de 1994, se valoraron 200 pacientes en quienes se colocó endoprótesis en la vía biliar. La distribución por sexo fue de 102 mujeres y 98 hombres, con rangos de edad entre los 18 y los 94 años. Las indicaciones para el procedimiento fueron: obstrucción biliar maligna en 96 casos, coledocolitiasis de difícil manejo en 47, estenosis iatrogénica de la vía biliar en 27, fístula biliar en 12, compresión de colédoco por pancreatitis crónica en nueve, por pancreatitis aguda en seis, colangitis supurativa en dos y un paciente con estenosis de la papila de Vater. Inmediatamente después de la colocación de las prótesis se observó drenaje adecuado de bilis al duoneno. Como complicaciones, se presentaron cinco migraciones, 14 cuadros de obstrucción de las prótesis con colangitis subsecuente, una hemorragia secundaria a esfinterotomía y una prancreatitis grave con defunción. Se concluye que la colocación de endoprótesis es de gran utilidad para mantener permeable la vía biliar. Las pocas complicaciones en manos esperimentadas, su bajo costo y mínima morbimortalidad, la hacen el método de primera elección en los procesos obstructivos de la vía biliar.
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Procedimentos Cirúrgicos Operatórios , Ductos Biliares/fisiopatologia , Cálculos Biliares/terapia , Colestase/terapia , EndoscopiaRESUMO
Se realizó un estudio retrospectivo, clínico y transversal, en el Hospital Central Militar de México, de septiembre de 1990 a mayo de 1994. Encaminado a recopilar los partos complicados con varicela, embarazos complicados con varicela, partos totales y encamados por varicela en este nosocomio. Se encontró que la incidencia de partos complicados con varicela es del 0.033 por ciento, con un promedio de edad de 18.7 años; el cuadro clínico de varicela fue típico y sin complicaciones, no provocó alteraciones durante el trabajo de parto, no requirieron tratamiento especial, excepto aislamiento; todos los productos fueron de término, el 25 por ciento de los productos padecieron varicela con un cuadro clínico común, aún con tratamiento profiláctico (aciclovir) por ser considerados potencialmente infectados. La distribución de la varicela durante el embarazo fue del 22 por ciento en el primer trimestre, del 40 por ciento en el segundo, del 16 por ciento en el tercero y del 22 por ciento durante el parto
Assuntos
Gravidez , Adulto , Humanos , Feminino , Complicações na Gravidez/etiologia , Complicações Infecciosas na Gravidez/etiologia , Aciclovir/uso terapêutico , Varicela/epidemiologia , Herpesvirus Humano 3/patogenicidade , Exantema/terapia , Doenças Fetais/etiologia , Forceps ObstétricoRESUMO
Las infecciones respiratorias bajas (IRAB) son una de las principales causas de consulta a nivel primario, de mortalidad del lactante y también de hospitalizaciones. Con el fin de determinar la capacidad resolutiva cualitativa (CRC) de un Consultorio en el manejo de las IRAB en menores de 2 años, de establecer el destino de los consultantes referidos y la forma de ingreso al Hospital por IRAB de todos los internados correspondientes a la población del mismo Consultorio, se realizó un análisis retrospectivo de los casos. Se definió como IRAB: bronconeumonías, neumonía, bronquiolitis y neumonitis, diagnosticadas clínicamente en el Consultorio Quinta Bella y por clínica más radiología en el Hospital. Se analizaron 359 fichas de pacientes por primeras consultas por IRAB y 144 de hospitalizados por esa causa, menores de 2 años, detectados en el período 1 julio, 1988 a 30 junio, 1989. El 19,5% de las primeras consultas a nivel primario fueron derivadas al Hospital Roberto del Río, hospitalizándose el 82,2% de los casos; de éstos el 88% correspondió a menores de 1 año de edad, la GRC resultó algo mayor en lactantes de 12 a 24 meses que en menores de 1 año (91,5% vs 75%). Del total de hospitalizados, 40,3% ingresaron por interconsulta desde el Consultorio, 23,6% consultaron previamente pero no fueron derivados y 36% ingresaron directamente sin consulta previa. Sólo 1 de cada 4 pacientes menores de 1 año con IRAB son derivados al centro de referencia. Los casos verdaderamente resueltos por la atención primaria corresponderían a la diferencia entre el número de consultas ambulatorias catalogadas como resueltas menos el número de hospitalizados que consultaron previamente en el Policlínico sin ser referidos. Hecha esta corrección, la proporción de resueltos disminuye de un 80% a un 71%
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Lactente , Humanos , Masculino , Feminino , Infecções Respiratórias/terapia , Infecções Respiratórias/epidemiologiaRESUMO
Con el objeto de comparar el rendimiento del aislamiento en cultivo celular y de la inmunofluorescencia indirecta (IFI) para la detección de adenovirus y VRS, se analizaron 390 muestras de aspirado nasofaríngeo provenientes de 256 lactantes menores de dos años ingresados al Hospital Roberto del Río, Santiago. Se inocularon células HEp-2 y se hizo IFI para VRS y adenovirus con anticuerpos monoclonales. Los efectos citopáticos observados se confirmaron con IFI. Se detectaron 100/390 (25,6%) cultivos positivos: 40 VRS, 43 adenovirus y 17 ambos virus. Con IFI hubo 145/390 (37,2%) muestras positivas: 116 VRS, 9 adenovirus y 20 ambos virus. En total se detectaron 136 muestras positivas para VRS: 96 por IFI, 13 por cultivo y 27 por ambas técnicas. Del total de 57 adenovirus diagnosticados, 14 lo fueron por IFI, 39 por aislamiento y 4 por ambos métodos. El análisis de los casos dio cifras semejantes a la relatada para las muestras. Se concluye que en nuestro medio la IFI es más sensible que el cultivo celular para detección de VRS. Por el contrario, el aislamiento viral en HEp-2 tiene mejor rendimiento que la IFI para detectar adenovirus
Assuntos
Humanos , Masculino , Feminino , Lactente , Infecções por Adenovirus Humanos/diagnóstico , Adenovírus Humanos/isolamento & purificação , Vírus Sinciciais Respiratórios/isolamento & purificação , Infecções por Respirovirus/diagnóstico , Imunofluorescência , Nasofaringe/microbiologiaRESUMO
Un problema clínico que diariamente deben enfrentar los médicos que atienden niños, ya sea en el hospital, en el policlínico y en su consultorio, es aquél del niño que llega febril, polipneico y con tos, cuadro que los debería llevar al planteamiento de cuatro interrogantes: ¿Cuáles de estos pacientes tienen una neumonía, y cuáles una enfermedad menos importante, como una infección respiratoria alta o una bronquitis? ¿Es la enfermedad de etiología bacteriana? Cuando el médico ha contestado estas preguntas, contestar las otras se hace más fácil. ¿Se debe administrar antibióticos? ¿Debe ser hospitalizado? En lo que sigue, se tratará de dar una respuesta a estas interrogantes
Assuntos
Humanos , Broncopneumonia/etiologia , Broncopneumonia/classificação , Pneumopatias/etiologiaRESUMO
Con el objetivo de analizar la utilidad en nuestro medio de la detección del Virus Respiratorio Sincicial (VRS), mediante la técnica de Inmunoflorescencia (IF), se estudiaron 48 lactantes en el Hospital Roberto del Río. Sólo se incluyó en el estudio niños de 1 a 12 meses de edad ingresados entre julio a octubre de 1985, con diagnóstico de Infección Respiratoria Baja y de no más de 5 días de evolución. Se descartaron niños con cualquier otra patología previa o concomitante. En estos pacientes se tomó muestra de aspirado nasofaríngeo y se preparó de inmediato los frotis para IF. Se demostró presencia de VRS (IF positiva) en 34 niños. El análisis de las características clínicas y radiológicas, demostró que los niños con IF positiva presentaron: promedio de edad menor y mayor incidencia de hipoxemia. Tres niños del grupo con IF positiva requirieron ventilación mecánica. En el resto de las características clínicas analizadas no se observó diferencias significativas