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Background and Objectives: Medical and public recognition of "long-COVID or post-COVID syndrome", as well as its impact on the quality of life (QoL), is required to better address the disease burden. Objectives: We aimed to describe the persistence of COVID-19 symptoms and QoL among patients at three and twelve months after their discharge from the hospital. Materials and Methods: We conducted an observational, prospective, and longitudinal analytic study from September 2021 to April 2022. To measure QoL, we used a validated version of the 36-item Short-Form Health Survey (SF-36). Results: We included 68 patients in the study. A total of 54 (79.4%) patients reported at least one persistent symptom at three months vs. 52 (76.4%) at twelve months (p = 0.804). Some persistent symptoms (myalgia, alopecia, and cough) decreased significantly at twelve months (50% vs. 30.9%, 29.4% vs. 13.2%, and 23.5% vs. 7.4%; respectively, p = 0.007); in contrast, other persistent symptoms (sleep-wake and memory disorders) were more frequent (5.9% vs. 32.4% and 4.4% vs. 20.6%; respectively, p = ≤0.001). Regarding QoL, a statistically significant improvement was observed in some scores over time, p = ≤0.037. At twelve months, dyspnea, myalgia, and depression were risk factors associated with a poor physical component summary (PCS), p = ≤0.027, whereas anxiety, depression, and fatigue were associated with a poor mental component summary (MCS), p = ≤0.015. Conclusion: As the proportion of persistent symptoms at twelve months is high, we suggest that patients must continue under long-term follow up to reclassify, diagnose, and treat new onset symptoms/diseases.
Assuntos
COVID-19 , Alta do Paciente , Qualidade de Vida , Humanos , COVID-19/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Longitudinais , Idoso , SARS-CoV-2 , Síndrome de COVID-19 Pós-Aguda , Adulto , Mialgia , Fatores de Tempo , Tosse/psicologia , Alopecia/psicologiaRESUMO
OBJECTIVE: We aimed to describe the persistence of symptoms in coronavirus disease 2019 (COVID-19) and quality of life (QoL) among patients 90 days after their discharge from the hospital for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine differences in QoL domains concerning the absence or presence of persistent symptoms. METHODS: To measure QoL, we used a validated Spanish version of the 36-item Short Form Health Survey (SF-36). RESULTS: We included 141 patients. Ninety days after discharge, COVID-19 symptoms persisted in 107 patients (75.9%), with fatigue (55.3%) and joint pain (46.8%) being the most frequent. According to the SF-36, the role-physical score was the dimension with the lowest values (median score, 25; interquartile range, 0-75). Patients with joint pain, fatigue, and dyspnea had lower scores than patients without those symptoms, with 10 of the 13 evaluated SF-36 scales showing lower levels. CONCLUSION: Ninety days after hospital discharge from COVID-19 reference centers, most patients had persistent symptoms and had lower SF-36 scores than patients without symptoms. It is important to follow-up patients discharged from the hospital after SARS-CoV-2 infection, ideally through a post-COVID-19 health care clinic and rehabilitation program, to improve QoL in these patients.
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COVID-19 , Qualidade de Vida , Artralgia , Fadiga , Hospitais , Humanos , Alta do Paciente , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
Background and Objectives: An association between high red blood cell distribution width (RDW) and mortality has been found in several diseases, including infection and sepsis. Some studies have aimed at determining the association of elevated RDW with adverse prognosis in COVID-19, but its usefulness has not been well established. The objective of this study was to determine the accuracy of the RDW, measured at hospital admission and discharge, for predicting death in patients with COVID-19. Materials andMethods: An observational, retrospective, longitudinal, and analytical study was conducted in two different COVID-19 reference centers in the state of Guanajuato, Mexico. A total of 323 patients hospitalized by COVID-19 were included. Results: We found higher RDW levels at the time of hospital admission in the non-survivors group compared to levels in survivors (median = 13.6 vs. 13.0, p < 0.001). Final RDW levels were even higher in the deceased group when compared with those of survivors (median = 14.6 [IQR, 12.67−15.6] vs. 12.9 [IQR, 12.2−13.5], p < 0.001). For patients who died, an RDW > 14.5% was more common at the time of death than for patients who survived at the time of discharge (81 vs. 13 patients, p < 0.001; RR = 2.3, 95% CI 1.89−2.81). Conclusions: The RDW is an accessible and economical parameter that, together with other characteristics of the presentation and evolution of patients with COVID-19, can be helpful in determining the prognosis. An RDW that increases during hospitalization could be a more important mortality predictor than the RDW at hospital admission.
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COVID-19 , Índices de Eritrócitos , Mortalidade Hospitalar , Hospitalização , Humanos , Estudos RetrospectivosRESUMO
Identificar conocimientos que poseen los pobladores de la cuenca del río Ucayali sobre la biología, conservación y problemática, asi como avistamientos previos del manatí amazónico Trichechus inunguis. Materiales y métodos: Se encuestaron 421 personas de diferentes edades, sexos y ocupaciones, en diferentes localidades de la cuenca del río Ucayali. Resultados: El 88.8% reconoció a la especie, y el 80.1% conocen al manatí con el nombre de vaca marina. El 65.1% declaran haber consumido su carne de manera poco frecuente y oportunista. La principal razón que justifican para capturarlos fue su buen sabor (46.4%). Así mismo, 51.9% de los encuestados afirmó saber que su caza es ilegal y el 24% refirió haberlo avistado en el área de estudio. Asimismo, 96.7% manifestaron interés para que esta especie animal se conserve. Conclusiones: Los conocimientos de los pobladores encuestados son insuficientes sobre la situación poblacional, las amenazas y la legislación actual que rige la caza del manatí. Actualmente, con poca frecuencia, se siguen avistando ejemplares en vida silvestre dentro del área de estudio, pero también se sigue dando su captura. Se recomienda incluir la educación ambiental en estas comunidades como principal herramienta para la conservación del manatí amazónico...
To collect information about the knowledge of the inhabitants from the Ucayali River basin about the amazonian manateeÆs, Trichechus inunguis, biology, conservation and problematic as well as previous sightings. Materials and methods: 421 people were surveyed without bias of age, sex or occupation, in different localities of the Ucayali River basin. Results: 88.8% of the interviewed recognized species, most of them referring to it as ôsea cowõ (80.1%). The principal use attributed to this animal is the consumption of its meat (65.1%). Also 51.9% of the surveyed are aware that hunting is illegal. According to the surveyed, the consumption of this species is rare and opportunistic, being the good taste of its meat (46.4%) the main reason for its capture. There is a great interest from behalf the population in the conservation of this animal (96.7%). As for the sightings, 24.0% were within the study area. Conclusions: There is a lack of knowledge from the surveyed on the current population, threats and the laws regulating the hunting of the amazonian manatee. Currently, with low frequency, sightings are still occurring within the study area, but also their capture. Environmental education is the main tool required for the conservation of the amazonian manatee in these communities...
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Humanos , Comitês de Cuidado Animal , Educação em Saúde Ambiental , Estatísticas Ambientais , Trichechus inunguis , PeruRESUMO
Introducción. La tolerabilidad a la analgesia epidural puede comprometerse por efectos adversos derivados del opioide usado. Este estudio compara la tolerabilidad y eficacia de hidromorfona o morfina en combinación con bupivacaína, en analgesia epidural postoperatoria. Métodos. Ensayo prospectivo, aleatorizado y doble ciego en el Hospital Universitario San Vicente de Paul; 147 pacientes fueron aleatorizadosen dos grupos: 73 pacientes del grupo MB recibieron 30 mcg/ml de morfina más bupivacaína 0,1 %, y 74 pacientes del grupo HB recibieron hidromorfona 10 mcg/ml más bupivacaína 0,1 %. Resultados. El desenlace principal fue tolerabilidad, definida por la frecuencia de náusea, vómito, sedación, retención urinaria y prurito entre los grupos a las 24 horas. Se analizaron 142 pacientes: 71 en el grupo MB y 71 en el grupo HB. La frecuencia de náusea fue de 36,6 % y 31 %, (p = 0,54); vómito, 19,7 % y 25,4 % (p = 0,42); sedación 15,5 % y 14,1 % (p = 0,81); retención urinaria 11,3 % y 7 % (p = 0,38); y prurito 43,7 % y 31 % (p = 0,11) para los grupos MB y HB, respectivamente. Cinco pacientes fueron retirados del estudio debido a migración o desconexión del catéter. No se hallaron diferencias estadísticamente significativas entre los grupos. La escala verbal numérica (EVN) de dolor dinámico a las 24 horas fue de 3,42 (+/- 2,8) y 2,82 (+/- 2,5) para los grupos MB y HB, respectivamente (p = 0,16). Conclusión. La escogencia entre morfina 30 mcg/ml o hidromorfona 10 mcg/ml no influye en la tolerabilidad o eficacia de esta técnica.
Introduction. The acceptance (tolerability) of epidural analgesia can be compromised by the side effects of opioids. This study compares theside effects and efficacy of hydromorphone or morphine combined with bupivacaine in postoperativeepidural analgesia. Methods. Double-blind prospective randomizedcontrolled trial at Hospital Universitario San Vicente de Paul; 147 patients were randomized in two groups: 73 patients of the MB Group received 30 μg per ml of morphine with bupivacaine 0.1 % and 74 patients of the HB group received10 μg per ml of hydromorphone with bupivacaine 0.1 %. Results. The main outcome was the tolerability defined by the frequency of nausea and vomitingsedation urinary retention and pruritus between the groups at 24 hours. 142 patients were analyzed: 71 in group MB and 71 in group HB. The incidence of nausea was 36.6 % and 31 % (p = 0.54); vomiting 19.7 % and 25.4 % (p = 0.42); sedation 15.5 % and 14.1 % (p = 0.81); urinary retention 11.3 % and 7 % (p = 0.38); and pruritus 43.7 % and 31 % (p = 0.11) for groups MB and HB respectively. Five patients were excluded either because of catheter migration or disconnection. No statistically significant differences werefound between the groups. The verbal numerical scale (VNS) of dynamic pain at 24 hours was 3.42 (+/- 2.8) y 2.82 (+/- 2.5) for groups MB and HBrespectively (p = 0.16) Conclusions. The choice between 30 μg per ml of morphine or 10 mcg per ml of hydromorphone does not influence the incidence of side effects or the efficacy of this technique.
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Humanos , Masculino , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Analgesia , Analgésicos Opioides , Sistema Nervoso Central , Dor Pós-Operatória , Analgesia Epidural , Anestesia Epidural , Tolerância a Medicamentos , Sistema NervosoRESUMO
Introducción. Las técnicas de intubación endotraqueal sin relajación neuromuscular han crecido en popularidad, pero su impacto en unidades quirúrgicas donde existe personal en entrenamiento es desconocido. Objetivo. Evaluar el impacto de omitir la relajación neuromuscular, en términos de incidencia de disfonía y odinofagia, en pacientes sometidos a procedimientos ambulatorios cortos que requieren intubación endotraqueal en una unidad quirúrgica académica universitaria. Método. Estudio cuasi-experimental, no aleatorizado, doble ciego, en pacientes adultos programados para cirugía ambulatoria que requerían intubación endotraqueal. El grupo de no relajación recibió lidocaína (1,5 mg kg-1), propofol (1,5-2 mg kg-1) y remifentanil 4 mcg kg-1, y el grupo de relajación recibió la misma técnica, y se adicionó rocuronio a dosis de 0,3-0,6 mg kg-1. Los desenlaces primarios se evaluaron a los días 1, 3 y 14 postoperatorios. Resultados. Se incluyeron 287 pacientes. El 51,7 % recibió relajante neuromuscular. La incidencia de disfonía fue estadísticamente mayor a las 24 horas en el grupo de no relajante (26 % frente a 15 %; valor p: 0,016); así, no fue significativa a las 72 horas de seguimiento (0,6 % frente a 0 %; valor de p 0,37). No se encontraron diferencias en la incidencia de odinofagia entre los grupos. Los síntomas habían desaparecido en toda la población estudiada a la semana de seguimiento. Conclusiones. Omitir la relajación neuromuscular se asocia con un incremento transitorio de disfonía a las 24 horas del posoperatorio, pero no de odinofagia. No existen diferencias en la incidencia de síntomas laríngeos en 72 horas. La adición de relajante neuromuscular para disminuir la incidencia de disfonía temprana puede estar justificada.
Introduction. Endotracheal intubation without neuromuscular relaxation has become more common, but its impact on surgical units of teaching hospitals is unknown. Objective. To assess the impact of avoiding neuromuscularrelaxation in terms of incidence ofhoarseness and sore throat in ambulatory surgery patients requiring endotracheal intubation in surgical unit of a teaching hospital. Method. A quasi-experimental, non-randomized, double-blind study in adult patients undergoing outpatient surgery requiring endotracheal intubation. The non muscle relaxant group received lidocaine (1.5 mg kg-1), propofol (1.5 - 2 mg kg-1) and remifentanil 4 mcg * kg-1 and the muscle relaxation group received the same technique and rocuronium 0.3 to 0.6 mg * kg-1. The primary outcomes were assessed at days 1, 3 and 14.Results. We enrolled 287 patients, where 51.7 % received rocuronium. The incidence of hoarseness was significantly higher at 24 hours in the nonrelaxant group (26 % vs. 15 %, p value: 0.016) being not significant after 72 hours of follow up (0.6 % vs. 0 %; p: 0.37). We found no differences inthe incidence of sore throat between the groups. All the study patients were asymptomatic at one week. Conclusions. Avoidance of neuromuscular relaxationis associated with a transient (First 24hours) increase in hoarseness after ambulatory surgery, but no difference in sore throat. We found no differences in the incidence of laryngeal symptoms after 72 hours. The addition of musclerelaxant to reduce the incidence of hoarseness can be justified.
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Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Anestesia Geral , Intubação Intratraqueal , Complicações Pós-Operatórias , Anestesia , Anestesia Geral , Intubação Intratraqueal , MétodosRESUMO
Miscellaneous lesions of the head, skull, teeth, trunk, appendages, skin and genital tract were observed in 120 of 930 long-beaked common dolphins Delphinus capensis taken in fisheries off Peru between 1985 and 2000. Seven subsamples were defined according to the varying field sampling protocols. Forty-two dolphins showed at least 2 types of injuries or diseases affecting 1 or more organs. The majority (5 of 7) of traumas encountered were diagnosed as caused by violent, fisheries-related interactions, and the skin in 20.4 % of specimens (n = 54) showed healed scars from such interactions. Prevalences of malformations and traumas of crania (n = 103) were 2.9 and 1.9%, respectively. Lytic cranial lesions were present in 31.1% of dolphins (n = 103) and accounted for 84.2% of all bone injuries. Skull damage diagnostic for Crassicauda sp. infestation was encountered in 26.5% of dolphins (n = 98) and did not differ among sex and age classes. Crassicauda sp. and tooth infections were responsible for, respectively, 78.8 and 6.1% of the lytic lesions. Adult dolphins showed a high prevalence of worn and broken teeth (35%, n = 20) as well as damaged alveoli (20%, n = 70). Prevalence of 'paired teeth', a congenital condition, was 9.4% (n = 32). Lesions of the head, body and appendages were present in 10 dolphins and included traumas, deformations (e.g. scoliokyphosis and brachygnathia) and chronic mastitis. Ovarian cysts suggestive of follicular cysts were observed in 1 of 24 females. Chronic orchitis affected 1 of 78 males. Of 12 dolphins 2 had vesicular lesions of the penis. Prevalence of cutaneous lesions, abnormalities and scars ranged between 1.8% (n = 56) and 48.2% (n = 27).