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BACKGROUND: Compared with conventional cigarettes, electronic cigarettes are less harmful in some studies. However, recent research may indicate the opposite. This study aimed to determine whether e-cigarette use is related to myocardial health in adults in the U.S. METHODS: This study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional survey of adult US residents aged 18 years or older. We examined whether e-cigarette use was related to myocardial infarction byapplying a logistic regression model to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The final analytical sample included 198,530 adults in the U.S. Logistic regression indicated that U.S. adults who reported being former and some days of e-cigarette use had 23% and 52% greater odds of ever having an MI, respectively, than did those who reported never using e-cigarettes (OR = 1.23, 95% CI 1.08-1.40, p = 0.001; OR = 1.52, 95% CI 1.10-2.09, p = 0.010). CONCLUSIONS: The results suggest that former and someday users of e-cigarettes probably have increased odds of myocardial infarction in adults in the U.S. Further research is needed, including long-term follow-up studies on e-cigarettes, since it is still unknown whether they should be discouraged.
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Sistema de Vigilância de Fator de Risco Comportamental , Infarto do Miocárdio , Vaping , Humanos , Infarto do Miocárdio/epidemiologia , Masculino , Feminino , Adulto , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Estudos Transversais , Adulto Jovem , Adolescente , Vaping/epidemiologia , Vaping/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Idoso , Fatores de RiscoRESUMO
INTRODUCTION: Information and communication technologies (ICTs) improve patient-centered care and are routinely used in Allergic Rhinitis (AR), but patients' preferences and attitudes are unexplored. This study examines AR-related information preferences and ICT use by AR patients. METHODS: A survey-based cross-sectional study was carried out in Ecuador from July to September 2019 in seven centers of reference for allergic disease. Participants were 18 years or older, diagnosed with AR and had access to ICT and the Internet. Descriptive and binomial logistic regressions were performed. A value of less than 0.05 was considered statistically significant. RESULTS: 217 patients were included. 47% (n = 102) used ICTs to learn about AR, of which 38.2% (n = 83) found it useful. Most of participants (75%, n = 164) did not think that ICTs reduce their need to see a doctor. Individuals with poorer quality of life were more likely to utilize ICTs to contact their doctor (OR 1.27, 95% CI 1.04-1.55), and more likely to be interested in AR-related content (OR 1.23, 95% CI 1.00-1.52). Patients with long-term AR or other allergies were less likely to use ICTs (OR 0.92 and OR 0.40 respectively). Higher education and lower quality of life may increase AR apps adoption (OR 4.82, 95% CI 1.11-21.00). Academic preparation five-fold increased ICT use for health provider communication (OR 5.29, 95% CI 1.18-23.72). Mild-persistent AR enhanced the probabilities of using ICTs to share experiences and communicate with other patients (OR 12.59, 95% CI 1.32-120.35). CONCLUSIONS: Our study emphasizes the importance of tailoring digital resources to patient needs by considering factors such as quality of life, education, and specific subgroups within the AR patient population. Additionally, the findings suggest that while ICTs can play a valuable role in patient education and support, they should complement, rather than replace, traditional medical care for many AR patients.
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Trata-se de um relato de experiência sobre a prática de estágio curricular em psicologia realizado em um ambulatório de especialidades em um hospital geral, vinculado ao Sistema Único de Saúde. O objetivo deste artigo é apresentar reflexões sobre a prática de estágio curricular na ênfase de promoção e prevenção à saúde, a partir de um relato de experiência. Num primeiro momento, apresenta-se um delineamento histórico sobre a formação do que se conhece hoje como ambulatório em saúde mental e, posteriormente, são apresentados alguns dispositivos que podem embasar a prática do psicólogo neste contexto, fundamentados na interação entre saberes trabalhados na formação em psicologia. Os resultados apontam para a necessidade das reflexões sobre as práticas que têm sido realizadas no campo ambulatorial tendo em vista a necessidade de se atualizarem as definições técnicas sobre a atuação do psicólogo nessa área , assim como a necessidade da criação de critérios que avaliem os métodos utilizados pelos psicólogos. Dessa forma, se constata a necessidade de atualização do ensino em psicologia e da prática profissional no atendimento em saúde mental. (AU)
This paper describes a Psychology curricular internship experience at a specialty clinic managed by the Brazilian Public Health System. The goal of this paper is to discuss the practice of curricular internship required by the curricular emphasis on health promotion and prevention, based on expe-rience report. Initially, the paper explores the historical constitution of what is currently known as mental health clinic. Then, we present some tools that may support the psychologist's practice in this context, based on the interac-tion between the distinct knowledges which students must acquire to obtain a Psychology degree. The results show a need to reflect on the practices that are currently being carried out in mental health clinics given the necessity to update the technical definitions that guide psychologists' work in this field as well as a need to specify criteria for the evaluation of the methods employed by psychologists. Thus, we see that there is a need to update teaching in Psychology and professional practices in the field of mental health. (AU)
Este artículo presenta un relato de experiencia sobre la pasantía curricular realizada en un ambulatorio de especialidades vinculado al Sistema Único de Salud. Tiene el fin de presentar reflexiones sobre la pasantía con énfasis en la promoción a la salud y prevención basado en un informe de experiencia. En un primer momento, el artículo presenta un diseño histórico sobre la formación de lo que hoy se conoce como ambulatorio de salud mental y, posteriormente, se presentan algunos dispositivos que pueden apoyar la práctica del psicólogo en este contexto, a partir de la interacción entre conocimientos trabajados en la formación en psicología. Los resultados apuntan la necesidad de reflexionar sobre las prácticas que se han realizado en el ámbito ambulatorio - ante la necesidad de actualizar las definiciones técnicas sobre el desempeño del psicó-logo en esta área - así como la necesidad de generar criterios que evalúen las metodologías utilizadas por los psicólogos. Por lo tanto, queda evidente la necesidad de actualizar la docencia en psicología y la práctica profesional en el cuidado de la salud mental. (AU)
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Humanos , Psicologia/educação , Estudantes de Ciências da Saúde , Serviços de Saúde Mental , Ambulatório Hospitalar , Sistema Único de Saúde , Promoção da SaúdeRESUMO
A pandemia da Covid-19 afetou, drasticamente, o campo social. O público adolescente, por apresentar um caráter específico do desenvolvimento, também é atravessado na pandemia. O objetivo desta pesquisa foi identificar e descrever quais as demandas de atenção psicossocial que emergiram nos acolhimentos em um CAPSi de um município do interior do estado do Rio Grande do Sul na pandemia no período da adolescência. O método utilizado foi o modelo quali-quantitativo, de caráter descritivo e exploratório. Os resultados das demandas psicossociais que mais apareceram foram: comportamento suicida, ansiedade, heteroagressividade, autoagressividade, conflitos familiares e dificuldades de aprendizagem. Através do estudo pode-se perceber os atravessamentos que a pandemia da Covid-19 reverberou no público adolescente acolhido neste CAPSi, e o que essas demandas mostram sobre as questões de saúde mental no cenário pandêmico. (AU)
The Covid-19 pandemic has drastically affected the social field. Adolescents, as they present a specific character of development, are also affected by the pandemic. The objective of this research was to identify and to describe the psychosocial care demands that emerged in the receptions at a CAPSi, a Child and Youth Psychosocial Care Center, in a municipality in the interior of the state of Rio Grande do Sul, in the pandemic, during the adolescence period. The method used was the qualitative-quantitative model, with a descriptive and exploratory character. The results of the psychosocial demands that appeared the most were: suicidal behavior, anxiety, heteroaggression, self-aggression, family conflicts and learning difficulties. Through the study, it is possible to perceive the crossings that the Covid-19 pandemic reverberated in the adolescent public hosted in this CAPSi, and what these demands show about mental health issues in the pandemic scenario. (AU)
La pandemia del Covid-19 afectó, drásticamente, al campo social. El público adolescente, por presentar un carácter específico del desarrollo, también se ve afectado en la pandemia. El objetivo de esta investigación fue identificar y describir cuales las demandas de atención psicosocial que surgieron en las acogidas en un CAPSi de un municipio del interior del estado de Rio Grande do Sul en la pandemia en el periodo de la adolescencia. El método utilizado fue el modelo cuali-cuantitativo, de carácter descriptivo y exploratorio. Los resultados de las demandas psicosociales que más aparecieron fueron: comportamiento suicida, ansiedad, heteroagresividad,auto agresividad,conflictos familiares y dificuldates de aprendizaje. A través del estudio se puede percibir los atravesamientos que la pandemia del Covid-19 reverberó en el público adolescente acogido en este CAPSi, y lo que esas demandas muestran sobre las cuestiones de salud mental en el escenario pandémico. (AU)
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Humanos , Masculino , Feminino , Adolescente , COVID-19/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Ansiedade/epidemiologia , Agressão/psicologia , Conflito Familiar/psicologia , Ideação Suicida , COVID-19/epidemiologia , Deficiências da Aprendizagem/epidemiologiaRESUMO
PURPOSE: Depression is inadequately recognized and managed, and physicians' attitudes toward this condition and its treatment may play a part in this. This study aimed to assess Ecuadorian physicians' attitudes toward depression. METHODS: This was a cross-sectional study conducted using the validated Revised Depression Attitude Questionnaire (R-DAQ). The questionnaire was delivered to Ecuadorian physicians, and the response rate was 88.8%. RESULTS: 76.4% of participants had never received previous training in depression, and 52.1% of them indicated neutral or limited professional confidence when dealing with depressed patients. More than two-thirds of the participants reported an optimistic attitude toward the generalist perspective of depression. CONCLUSION: Overall, physicians in Ecuador's healthcare settings were optimistic and held positive attitudes toward patients with depression. However, a lack of confidence in the management of depression and a need for ongoing training were found, especially among medical professionals who are not in daily contact with patients with depression.
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Depressão , Médicos , Humanos , Depressão/terapia , Equador , Atitude do Pessoal de Saúde , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosRESUMO
Resumo Neste trabalho, discute-se como a noção de infância vai se constituindo nas narrativas de profissionais de saúde que atuam em Centros de Atenção Psicossociais Infantojuvenis (Capsi) e que discursos sobre as infâncias se organizam, desdobrando-se nas ações de cuidado às crianças nos serviços de saúde mental. Trata-se de uma pesquisa qualitativo-exploratória, baseada em entrevistas semiestruturadas, observações participantes e diários de campo, discutidas através da análise temática. Como resultados desse processo, observa-se uma romantização da infância que perpassa a construção do cuidado nos serviços de saúde; a dificuldade da equipe quanto à decisão sobre o que é demanda de Capsi e o que não se enquadra na população adscrita frente à complexidade dos impactos sociais que implicam o diagnóstico; e a ênfase na medicalização em detrimento da construção de ações de caráter psicossocial.
Abstract This paper discusses how the notion of childhood is built in the narrative of Psychosocial Care Centers (Capsi) and which discourses on childhood are articulated and extended to the actions for children care in mental health services. It is a qualitative-exploratory research, based on semi structured interviews, participant observations and field notes, from the theme analysis. As results of this process, it is possible to notice a romantic view of childhood which goes through the constructions of care in the health services; the team difficulty in deciding which is the Capsi demand and which does not adjust to the ascribed population in the face of the complexity of the social impact implied by the diagnosis; and the emphasis on medicalization to the detriment in the construction of psychosocial nature actions.
Resumen En este trabajo se discute como se constituye la noción de infancia en las narrativas de los profesionales de la salud que actúan con niños en los Centros de Atención Psicosocial Infantil y Juvenil (Capsi) y qué discursos sobre la infancia se organizan y extienden a las acciones de cuidado de los niños en los servicios de salud mental. Se trata de una investigación cualitativa exploratoria, basada en entrevistas semiestructuradas, observaciones participantes y diarios de campo, que luego son discutidos mediante un análisis temático. Como resultados de ese proceso, se observa una "romantización" de la infancia que permea la construcción del cuidado en los servicios de salud; la dificultad del equipo para decidir cuál es la demanda de los Capsi y que no se ajusta a la población adscrita frente a la complejidad del impacto social que implica el diagnóstico; y el énfasis en la medicalización en detrimento de la construcción de acciones de carácter psicosocial.
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Background: Despite the growing concerns related to the potential of long-term pulmonary sequelae due to COVID-19, data about intermediate and long-term changes in the respiratory function of patients who recover is relatively sparse, particularly in developing countries. Objectives: To assess the characteristics and pulmonary function at follow-up in a sample of Ecuadorian patients that recovered from the virus. Methods: We conducted a cross-sectional study that included 43 patients after symptomatic COVID infection, who were evaluated by spirometry, single breath DLCO, and 6MWT. For statistical analysis we performed point biserial correlations, and chi squared tests. Results: Overall, 30.3% of patients (n = 13) reported persistent symptoms, with fatigue being the most common (23.3%, n = 10). Around 34.9% (n = 15) of the sample had a restrictive spirometry pattern, 18.6% (n = 8) had an abnormally decreased adjusted DLCO. A restrictive spirometry pattern was associated with an abnormally low adjusted DLCO (χ2(2) = 11,979, p = 0.001). Conclusion: We found that a considerable proportion of patients presented with persistent symptoms and alterations in pulmonary function following COVID-19, mainly a restrictive respiratory pattern and abnormally low DLCO. Further studies are needed to determine which patients may benefit from the follow-up with specific pulmonary function tests.
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Despite the uncertainty about the follow up of COVID-19 survivors, there is a growing body of evidence supporting specific interventions including pulmonary rehabilitation, which may lead to a reduced hospital stay and improved overall respiratory function. The aim of this short report was to assess the attitudes toward pulmonary rehabilitation following COVID-19 among Ecuadorian physicians. A cross-sectional study was conducted, in which a 5-question survey was used to assess the level of agreement to specific statements with a 5-point Likert scale. Out of the 282 participants, 48.2% (n=136) were male, with a mean of 12.6 (SD=11.3) years of experience. More than half of physicians (63.8%, n=180; χ2(2) = 139.224, p=0.000) considered that diagnosis and treatment of patients with sub-acute and chronic COVID-19 pulmonary sequelae is not clear. Additionally, 94.3% (n=266; χ2(2) = 497.331, p=0.000) agreed that pulmonary rehabilitation must be considered as a relevant strategy in long-term care following an acute infection, with 92.6% (n=261; χ2(2) = 449.772, p=0.000) stating it will improve the likelihood of survival and return to baseline health. In conclusion, we found that considerable majority of physicians held positive attitudes to the role of pulmonary rehabilitation and considered it as a relevant strategy in long-term care following COVID-19. However, most of them also conveyed that the diagnosis and treatment of chronic pulmonary sequalae is unclear, and that guidelines for assessing pulmonary function should be established.
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Airborne pollen is a major contributor to allergic respiratory diseases. However, the literature on patterns and seasonality of specific pollen types mainly comes from northern hemisphere and developed regions, limiting our ability to extrapolate these findings to other geographical locations. With this research letter, our aim is to contribute to the current knowledge of aerobiology by analyzing the decade-long patterns of airborne tree pollen in the city of Bahia Blanca, Argentina. In general, we found late winter to early spring as the period with the highest Cupressaceae pollen counts. In 2020, the average pollen count during July through September was 78.81 (SD 79.70), the highest recorded during the last 10 years. These months had varying pollen concentrations from moderate (15-89 grains/m3 of air) to high (90-1499 grains/m3 of air). Regardless of such variation, August had consistently been the month with the highest peak concentrations from 2010 to 2020 (61.2, SD 57.3), followed by September (27.1, SD 20.3). We did not find any month with very high (Ë1500 grains/m3 of air) peak concentration. Further studies need to be done to expand our knowledge on aerobiology to characterize specific pollen sub-types and determine the exact allergenic potential of airborne pollen in different regions.
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Cupressaceae , Árvores , Alérgenos , Brasil , Monitoramento Ambiental , Humanos , Pólen , Estações do AnoRESUMO
BACKGROUND: Obstructive sleep apnea (OSA) represents an important occupational health concern in the transportation industry, affecting a substantial percentage of transportation operators. Our study aims to determine the frequency of individuals at high risk of obstructive sleep apnea, and excessive daytime sleepiness, as well as any potential association between these conditions and traffic accidents among a sample of Ecuadorian bus drivers. METHODS: We conducted a cross-sectional study involving 340 commercial bus drivers from Ecuador. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables. A Kendall's tau-b was performed to ascertain the relationship between the STOP-Bang score towards the Epworth Sleepiness Scale (ESS) score and the number of accidents and near accidents. RESULTS: In general, 18.5% (n = 63) of participants were found to be at high-risk for OSA. There was a weak positive correlation between STOP-Bang score and ESS score (τb = 0.244, p = .000). We also found a statistically significant, although negligible, correlation between the STOP-Bang score and the number of accidents (τb = 0.096, p = .039) and near accidents (τb = 0.120, p = .008). CONCLUSION: Our results suggest that a considerable proportion of Ecuadorian bus drivers were at high-risk for obstructive sleep apnea. Higher STOP-Bang scores were correlated with an increased number of accidents and near accidents. Additional studies are needed to determine whether additional interventions could increase road safety by taking care of undiagnosed and untreated OSA cases in a timely manner.
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OBJETIVE: To assess cutaneous reactions after Pfizer-BioNTech COVID-19 vaccine administration. METHODS: A cross-sectional observational study was carried out in health workers belonging to the city of Guayaquil-Ecuador, from March to May 2021. The participants were contacted through a local registry established by the Universidad Espíritu Santo. Frequencies and percentages were used to represent the proportions of nominal variables, while the mean and standard deviation were used for continuous data, given a normal sample distribution. RESULTS: Local skin reactions were the most frequent, and included redness, edema, and itching. On the other hand, delayed large local skin reactions (generalized rash and pruritus, angioedema, urticaria, eczema, petechiae) were rare and occurred in less than 1.4% of participants, (95% CI = 0.69-1.00). Finally, we did not find cases of anaphylaxis or other life-threatening reactions requiring urgent attention after vaccination. CONCLUSIONS: Our findings suggest that local skin reactions occur in a minority of recipients and are often mild and self-limited.
OBJECTIVO: Evaluar las reacciones cutáneas tras la administración de la vacuna COVID-19 de Pfizer-BioNTech. MÉTODOS: Se realizó un estudio observacional transversal en trabajadores de la salud, pertenecientes a la ciudad de Guayaquil-Ecuador, de marzo a mayo de 2021. Los participantes fueron contactados a través de un registro local establecido por la Universidad Espíritu Santo. Se utilizaron frecuencias y porcentajes para representar las proporciones de las variables nominales, mientras que la media y la desviación estándar se usaron para datos continuos, dada la distribución de muestra normal. RESULTADOS: Las reacciones cutáneas locales fueron las más frecuentes e incluyeron enrojecimiento, edema y prurito. Por otro lado, las reacciones cutáneas locales grandes retardadas (exantema y prurito generalizados, angioedema, urticaria, eccema y petequias) fueron raras y ocurrieron en menos de 1.4 % de los participantes, (IC 95 % = 0.69-1.00). Finalmente, no encontramos casos de anafilaxia u otras reacciones potencialmente mortales que requieran atención urgente después de la vacunación. CONCLUSIONES: Nuestros hallazgos sugieren que las reacciones cutáneas locales ocurren en una minoría de personas y que a menudo son leves y autolimitadas.
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COVID-19 , Vacinas , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Equador/epidemiologia , Vacina BNT162 , Estudos Transversais , PruridoRESUMO
BACKGROUND: Information/communication technologies such as mobile phone applications (apps) would enable chronic urticaria (CU) patients to self-evaluate their disease activity and control. Yet, recently Antó et al (2021) reported a global paucity of such apps for patients with CU. In this analysis, we assessed patient interest in using apps to monitor CU disease activity and control using questions from the chronic urticaria information and communication technologies (CURICT) study. METHODS: The methodology for CURICT has been reported. Briefly, a 23-item questionnaire was completed by 1841 CU patients from 17 UCAREs across 17 countries. Here, we analyzed patient responses to the CURICT questions on the use of apps for urticaria-related purposes. RESULTS: As previously published, the majority of respondents had chronic spontaneous urticaria (CSU; 63%; 18% chronic inducible urticaria (CIndU) [CIndu]; 19% with both), were female (70%) and in urban areas (75%). Over half of patients were very/extremely interested in an app to monitor disease activity (51%) and control (53%), while only â¼1/10 were not. Patients with both urticaria types versus those with CSU only (odds ratio [OR], 1.36 [1.03-1.79]) and females versus males (OR [95% CI], 1.47 [1.17-1.85]) were more likely to be very to extremely interested in an app to assess disease control. CONCLUSIONS: Overall, half of the patients with CU were very to extremely interested in using an app to assess their disease activity and control. Development of well-designed apps, specific to disease types (CSU, CIndU, CSU + CIndU, etc), validated by experts across platforms would help improve the management and possibly outcomes of CU treatment while providing important patient information to be used in future research.
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BACKGROUND: Few studies have explored the association between obstructive sleep apnea (OSA) and chronic urticaria (CU). Our study aims to fill this gap by determining the frequency of the risk categories for OSA and how they might correlate with the specific CU patient reported outcome measures urticaria activity score (UAS7), urticaria control test (UCT) and CU quality of life questionnaire (CU-Q2oL). METHODS: We conducted a cross-sectional study involving a cohort of 171 Latin American CU patients. Descriptive statistics were used to determine frequency and proportions for demographic and clinical variables, while a chi-squared test for association between STOP-Bang OSA questionnaire categories and both UAS7 and UCT categories was performed to analyze how such variables interact. To further assess the strength of the correlation a Cramer's V coefficient was reported. Finally, a Kendall-Tau b correlation coefficient was performed to measure the correlation between the STOP-Bang score and other independent continuous variables. RESULTS: The average STOP-Bang score was 2.5, with 24% and 21% of patients falling into the intermediate and high-risk category for moderate-to-severe OSA, respectively. There was a strong statistically significant association (Cramer's V = 0.263; p = .000) between UAS-7 categories and STOP-Bang risk categories. A similar pattern of strong significant association (Cramer's V = .269; p = .002) was observed between UCT categories and STOP-Bang risk categories. A weak positive correlation between the STOP-Bang score and the CU-Q2oL average score (τb = 0.188, p = .001) was identified. Overall, 72.5% patients reported limitations with respect to sleep in a varied degree according to the CU-Q2oL. CONCLUSIONS: Our results suggest that a considerable proportion of patients with CU are at intermediate to high risk for OSA. Higher disease activity, poor CU control, and worse quality of life were all found to be associated with an increased risk. Additional studies are needed to determine the exact link between these conditions, and to determine whether screening and treatment for OSA might benefit patients with CU.
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BACKGROUND: Patients with chronic urticaria (CU) are increasingly using information and communication technologies (ICTs) to manage their health. What CU patients expect from ICTs and which ICTs they prefer remains unknown. We assessed why CU patients use ICTs, which ones they prefer, and what drives their expectations and choices. METHODS: In this cross-sectional study, 1841 patients across 17 countries were recruited at UCAREs (Urticaria Centers of Reference and Excellence). Patients with CU who were >12 years old completed a 23-item questionnaire. RESULTS: Most patients were interested in receiving disease information (87.3%), asking physicians about CU (84.1%), and communicating with other patients through ICTs (65.6%). For receiving disease information, patients preferred one-to-one and one-to-many ICTs, especially web browsers. One-to-one ICTs were also the ICTs of choice for asking physicians about urticaria and for communicating with other patients, and e-mail and WhatsApp were the preferred ICTs, respectively. Many-to-many ICTs such as Facebook, Instagram, LinkedIn, and Twitter were least preferred for all 3 purposes. Living in rural areas and higher education were linked to higher odds of being interested in receiving disease information, asking physicians, and communicating with patients through ICTs. CONCLUSIONS: Most patients and especially patients with higher education who live in rural areas are interested in using ICTs for their healthcare, but prefer different ICTs for different purposes, ie, web browsers for obtaining information, e-mail for asking physicians, and WhatsApp for communicating with other patients. Our findings may help to improve ICTs for CU.
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OBJECTIVE: Allergic rhinitis (AR) represents a large burden to the healthcare system due to its high prevalence and impact on patients' lives. Despite the existence of evidence-based guidelines, some studies have found that physicians do not always follow the latest recommendations. The aim of our study was to determine how Ecuadorian otorhinolaryngologists (ENTs) perceive some epidemiological aspects related to AR, as well as their preferences for managing the disease. METHODS: We conducted an observational, survey-based cross-sectional study, among 116 Ecuadorian ENTs. The survey used was adapted from a previous publication and consisted of 30 multiple choice questions, concerning several topics of AR. Descriptive statistics (frequency, and standard deviation) were performed for clinical and demographic variables. RESULTS: A total of 116 Ecuadorian ENTs completed the survey. Of them, 62.9% were male, with an average age of 42 years (SD ± 11.58). Computed tomography (CT) scan and nasal cytology were selected as the main diagnostic tests for AR by 62/91 (68.1%) and 45/91 (49.5%) of participants, respectively. Moreover, only 12/116 (10.3%) of participants performed skin prick tests (SPT). Allergen immunotherapy (AIT) was performed by 37/107 (36.4%) of participants. CONCLUSION: In general, most participants agreed that the prevalence of AR appears to be increasing, with increased exposure to allergens, irritants, and pollutants as the main probable cause. Children and adolescents were accounted as the group most affected by AR, with sinusitis and asthma identified as the most frequent comorbidities. Finally, we found unmet needs in the diagnostic and management of AR that should be addressed among Ecuadorian ENTs, in particular the high use of CT scans as part of routine evaluations, as well as the low use of allergen immunotherapy.
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BACKGROUND: The speed and reach of the COVID-19 pandemic has created special scenarios to be considered, such as those in where patients who meet criteria for hospitalization due to moderate/severe disease cannot be hospitalized due to economic constraints and saturation of national health systems. The aim of this report is to present an unusual case of a severe COVID-19 patient managed at home in a developing country, and to discuss some of the available guidelines and potential therapeutic options for this type of cases. CASE PRESENTATION: A 60-year-old female seeking medical attention through teleconsultation presents with profound dyspnea, oppressive chest pain, fatigue, episodic hallucinations, and difficulty sleeping, for what she originally sought medical attention at an ER but could not be admitted due to saturation of the health system. A positive PCR test for COVID-19, and a CT scan of the chest showing bilateral consolidations with ground-glass opacities confirmed the diagnosis. The patient was managed at home, with corticosteroids, nitazoxanide and a single dose of 40 mg of subcutaneous enoxaparin. Colchicine was added at the third day of treatment. Standard oxygen therapy through nasal cannula was also recommended. Daily follow-ups were established to monitor for signs of clinical improvement. Two weeks later from the initial consultation the patient presents marked improvement in her symptoms, as well as in her CT scan, which prompted in discontinuation of the medications and the oxygen therapy. CONCLUSIONS: There are several limitations in this report regarding the clinical data and the management, but such limitations do also reflect the state of emergency and the chaos that resides in the health care systems of developing nations. For the ambulatory care of COVID-19 patients, several aspects of disease management may differ from current guidelines and basic requirements may represent a huge challenge to cover. Further research is needed to assist physicians in the daily clinical decision making, to optimize patient outcomes, and to reduce the probability of adverse scenarios of patients with COVID-19 managed in the ambulatory setting.
Assuntos
Assistência Ambulatorial , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Corticosteroides/uso terapêutico , Antiparasitários , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Enoxaparina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Nitrocompostos , Oxigenoterapia , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , RNA Viral/genética , RNA Viral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Índice de Gravidade de Doença , Telemedicina , Tiazóis/uso terapêutico , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The COVID-19 pandemic has affected 187 countries, representing a global public health problem. The increasing number of critically ill patients and deaths have fueled a desperate search for treatments that can halt the course of the disease. Currently, there are several experimental therapies with demonstrated in vitro activity against COVID-19 used in clinical practice, including hydroxychloroquine, remdesivir, interleukin-6 pathway inhibitors, and convalescent plasma; however, to date no agent has proven efficacy against COVID-19. In the case of convalescent plasma, this therapy consists in obtaining neutralizing antibodies from previously infected individuals by plasmapheresis and administering them to patients with severe disease. Recently, the use of convalescent plasma has shown promising results in preliminary studies, with case series reporting a decrease in temperature, and viral load, as well as improvement in clinical parameters among patients receiving this treatment. However, there are still unmet needs regarding the safety profile, tolerability, dosage, and timing this therapy should be given. Based on this, the objective of our study was to develop and propose a practical approach for the compassionate use of convalescent plasma for the treatment of patients with severe COVID-19, given the constrains and limitations of developing countries. We encourage health professionals in developing countries to use the current evidence and approaches to experimental treatments for patients with COVID-19, adapting them to their conditions, and always based on a thorough risk-benefit evaluation for each patient, and whenever possible to design and promote the much needed research in this field.
Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente , COVID-19 , Ensaios de Uso Compassivo , Infecções por Coronavirus/etiologia , Estado Terminal , Países em Desenvolvimento , Humanos , Imunização Passiva , Pandemias , Seleção de Pacientes , Plasmaferese , Pneumonia Viral/etiologia , SARS-CoV-2 , Soroterapia para COVID-19RESUMO
OBJECTIVES: In asthmatic patients, studies suggest that alexithymia leads to negative consequences and emotions that can affect physical, psychological, and social aspects of life. We designed this study to determine the frequency of alexithymia in Latin American patients with asthma, as well as to understand how this personality trait and each of its components interact with asthma severity and demographic variables, and their implications on treatment adherence and disease control under such setting. METHODS: We conducted a cross-sectional study, involving 265 Latin American patients with asthma. Patient demographics and clinical characteristics were reported. The presence of alexithymia, asthma severity, and control, as well as treatment adherence, was analyzed. To assess the presence of alexithymia, the 20-item Toronto Alexithymia Scale was used. For the statistical analyses, we performed Kendall's tau-b correlation coefficient, chi-square tests for association, and one-way analysis of variance. RESULTS: A total of 265 patients participated in the study with a gender distribution of 69.4% female and an average age of 54.7 years. In total, 30.2% of individuals presented alexithymia. There was a statistically significant correlation between educational level and 20-item Toronto Alexithymia Scale categories (p < .001), as well as a higher proportion of severe (35.1%, p = .001) and uncontrolled (50.0%, p = .185) asthma in patients with alexithymia. A higher proportion of patients with some level of non-adherence was seen on those with uncontrolled asthma (68.5%, p = .008). CONCLUSION: Our results suggest that in our sample, 3 in 10 Latin American asthma patients have alexithymia, and such mental condition is more common in those individuals with lower educational levels. Individuals with alexithymia present with severe asthma more frequently than do patients with possible or no alexithymia and are also more likely to have their disease uncontrolled.