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OBJECTIVE: Autoimmune diseases generate an impact on the morbidity and mortality of patients and are a burden for the health system through hospital admissions and readmissions. The prevalence of readmission of patients with these diseases has not yet been described as a group, but rather as sub-phenotype. The objective of this study is to determine the prevalence of hospital readmissions in a Colombian population with autoimmunity and the factors related to readmission. METHODS: All patients with autoimmune diseases who were evaluated by the rheumatology service and hospitalized between August 2018 and December 2019 at the Fundación Hospital Infantil Universitario De San José de Bogotá were described. A bivariate analysis was done, and three multivariate logistic regression models were built with the dependent variable being readmission. RESULTS: Of the total 199 admissions, 131 patients were evaluated and 32% were readmitted. The most frequent sub-phenotype in both groups (readmission and no readmission) was SLE (51% and 59%). The most frequent cause of hospitalization and readmission was disease activity (68.7% and 64.3%). History of hypertension was associated with readmission (adjusted OR: 2.98-95% CI: 1.15-7.72). In a second model adjusted for confounding variables, no factor was associated. In a third model analyzing the history of kidney disease and previous use of immunosuppressants (adjusted for confounding variables), the previous use of immunosuppressants was related to readmission (OR: 2.78-95% CI 1.12-6.89). CONCLUSION: Up to a third of patients with autoimmunity were readmitted and arterial hypertension was an associated factor. This suggested a greater systemic compromise and accumulated damage in patients who have these two conditions that may favor readmission. A history of immunosuppressant use may play a role in readmission, possibly by increasing the risk of developing infections.

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Objetivo: alertar os profissionais da Implantologia sobre a alta incidência de hipertensão arterial (HTA) nos pacientes da terceira idade que se submeterão ao procedimento cirúrgico, considerando-se também os protocolos de carga imediata. Material e métodos: foram realizados 113 procedimentos com anestesia parenteral com a finalidade de reabilitação oral por meio de protocolos de carga imediata entre os anos de 2010 e 2014. A idade dos pacientes variou entre 65 e 75 anos, salientando que todos eles eram portadores de hipertensão arterial de grau leve, moderado e grave. Destes pacientes, 90 eram hipertensos sintomáticos que usavam medicamentos hipotensores, e 23 eram hipertensos assintomáticos. No caso dos pacientes que optaram pelas cargas imediatas de dupla arcada, por escolha própria, os procedimentos foram efetuados em hospitais, já que poderiam ser realizados em clínicas odontológicas, desde que gozassem de boa saúde. Os pacientes com avaliação física A.S.A. III somente podem passar por procedimentos realizados em hospitais. Todos os procedimentos foram catalogados em fichas de anestesia, que consistem em um documento de responsabilidade do anestesiologista e que contém os dados clínicos do paciente, orientando os procedimentos da futura anestesia. Resultados: nos pacientes de carga imediata, foram identificados 90 portadores de HTA de grau leve, moderado e grave. Ainda, dois casos demonstraram níveis críticos de pressão arterial elevada (180 e 200 mmHg) logo no começo da infiltração, e providências imediatas foram realizadas, como o uso de um hipotensor de ação rápida via sublingual de Adalat de 10 mg. Conclusão: é importante aferir a pressão arterial, em curtos intervalos de tempo, em procedimentos odontológicos nos pacientes da terceira idade, com história pregressa de HTA. A prevenção da HTA na fase pré-cirúrgica consiste em diminuir a ansiedade com o uso de medicamento com finalidade ansiolítica...

Objective: to alert implant dental practitioners on the high incidence of arterial hypertension (AHT) on third age patients undergoing surgical procedures, also considering the immediate loading protocols. Material and methods: between the years of 2010 to 2014, 113 procedures were performed with parenteral anesthesia for oral rehabilitation treatment. The patient´s age ranged from 65 to 75 years, all demonstrating mild, moderate, and severe AHT. From these, 90 were hypertensive under appropriate medication, while 23 were asymptomatic. For patients preferring immediate loading in both jaws, all procedures were performed in a hospital setting. Patients under A.S.A. III category cannot be operated at dental clinics. All procedures were recording in appropriate anesthesiology files with all clinical data for further anesthetic administration. Results: 90 patients were considered with mild, moderate, and severe AHT levels. Also, two cases demonstrated critical levels of arterial pressure (180 and 200 mmHg) at the beginning of infi ltration, and immediate maneuvers were provided with a fast hypotensive sublingual agent (Adalat 10 mg). Conclusion: it is important to check arterial pressure at short periods of time during dental procedures for third age patients with a reported history of AHT. Prevention of ATH at the pre-surgical moment can reduce the anxiety by use of appropriate medication. ATH levels can be diminished with an hypotensive agent and a boosting dose also reducing epinephrine doses relative to ATH classification.

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OBJECTIVE: To determine the rate of retinal hemorrhages in children evaluated for physical abuse without traumatic brain injury (TBI) by diagnostic imaging. STUDY DESIGN: This study was a prospectively planned, secondary analysis of the Examining Siblings to Recognize Abuse (ExSTRA) research network, and included only index children who presented with concerns for abuse. Subjects were eligible for the parent study if they were less than 10 years old and evaluated by a Child Abuse Physician for concerns of physical abuse. Child Abuse Physicians recorded results of all screening testing and determination of the likelihood of abuse in each case. For this analysis, we examined the results of dedicated retinal examinations for children with neuroimaging that showed no TBI. Isolated skull fractures were not considered to be TBI. RESULTS: The original ExSTRA sample included 2890 index children evaluated for physical abuse. Of this group, 1692 underwent neuroimaging and 1122 had no TBI. Of these 1122 children, 352 had a dedicated retinal examination. Retinal hemorrhages were identified in 2 (0.6%) children. In both cases, there were few (defined as 3-10) hemorrhages isolated to the posterior poles; neither was diagnosed with physical abuse. The presence of facial bruising, altered mental status, or complex skull fractures was neither sensitive nor specific for retinal hemorrhage identification. CONCLUSIONS: Forensically significant retinal hemorrhages are unlikely to be found in children evaluated for physical abuse without TBI on neuroimaging, and such children may not require routine dedicated retinal examination.

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