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Abstract Introduction. Reports regarding the correlation and effect size of change of the full spectrum of quality of life and disease severity measures applied in-person to patients with atopic dermatitis are scarce. Objectives. To assess quality-of-life with 3 different instruments and to evaluate disease severity indices and to determine their correlation and effect size of change between two measurements. Materials and methods. Patient-level data were obtained through two in-person visits. Sociodemographic information and data related to disease distribution, severity (through the BSA, EASI, SCORAD, POEM, and itching scales), and the impact of atopic dermatitis on quality of life using the DLQI and Skindex-29, and EQ-5D, were assessed. The correlation between change in quality-of-life scores and disease severity scores in addition to the standardized effect size were also evaluated. Results. Only 139 out of 212 patients completed the follow-up visit. BSA highly correlated with SCORAD and EASI, and the lowest correlation was found with POEM. The best correlation of pruritus VAS was found with sleep disturbance. The SCORAD score highly correlated with EASI, and the lowest correlation was found with POEM. The magnitude of the effect at initiation of the study vs follow-up was in average moderate to important. Conclusions. Patients with atopic dermatitis experience a substantial burden on quality of life. Disease activity correlates better with quality-of-life measurements when the disease is less severe after starting therapy. POEM and Skindex-29 seem to be optimal to determine disease severity and quality of life in adults with atopic dermatitis.

Resumen Introducción. La información publicada sobre la correlación entre la magnitud del efecto de todo el espectro de la calidad de vida y la gravedad de la enfermedad en pacientes con dermatitis atópica es escasa. Objetivos. Evaluar la calidad de vida con tres instrumentos diferentes y los índices de gravedad de la enfermedad en pacientes con dermatitis atópica para determinar su correlación y el tamaño del efecto del cambio. Materiales y métodos. Los datos de los pacientes se obtuvieron a partir de dos visitas. Se evaluó la información sociodemográfica y los datos relacionados con la distribución y la gravedad de la enfermedad (mediante de las escalas BSA, EASI, SCORAD, POEM, prurito) y el impacto de la dermatitis atópica en la calidad de vida utilizando el Dermatology Life Quality Index, Skindex-29 y EQ-5D. También se evaluó la correlación entre el cambio en las puntuaciones de calidad de vida y las de gravedad de la enfermedad, además del tamaño del efecto estandarizado. Resultados. Solo 139 de los 212 pacientes completaron la visita de seguimiento. El área de superficie corporal se correlacionó fuertemente con el SCORAD y el EASI, y la correlación más débil fue con el POEM. La mejor correlación del prurito medido con la escala visual análoga se halló con la alteración del sueño. El puntaje SCORAD se correlacionó altamente con el EASI mientras que la correlación más baja se encontró con el POEM. La magnitud del efecto al inicio del estudio respecto al seguimiento fue en promedio de moderada a importante. Conclusiones. Los pacientes con dermatitis atópica experimentan una carga sustancial en la calidad de vida. La actividad de la enfermedad se correlaciona mejor con las mediciones de calidad de vida cuando esta es menos grave, después de comenzar la terapia. Los índices POEM y Skindex-29 parecen ser óptimos para determinar la gravedad de la enfermedad y la calidad de vida en adultos con dermatitis atópica.

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Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

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Background and Objectives: Since its appearance in 2019, multiple risk factors have been identified for presenting a severe form of COVID-19 and different vaccines have also been developed to prevent severe manifestations. However, despite a vaccination history, some cases progress to complications or even death. The objective of this study was to determine the strength of the association between the severity of COVID-19 and the history of vaccination in patients treated at a public reference hospital in Mexico City. Methods: This was a non-experimental, retrospective, and analytical epidemiological study of cases and controls. The study population was people treated at a concentration hospital for COVID-19 care between July 1, 2021, and June 30, 2022, in Mexico City. Results: 132 participants (44 cases and 88 controls) were included in the study. The risk factors most strongly associated with COVID-19 severity were age greater than or equal to 60 years, presenting 22 breaths per minute at the first medical evaluation, systolic blood pressure greater than or equal to 140 millimeters of mercury, and a history of at least one chronic comorbidity. However, vaccination history was associated with 94% (OR 0.06) lower odds of developing severe COVID-19 compared to those without a history of vaccination, regardless of the presence of associated risk factors. Conclusion: Lacking a history of vaccination and presenting any of the identified risk factors confer higher odds of developing severe forms of the disease.(AU)

Justificativa e Objetivos: Desde o seu aparecimento em 2019, foram identificados múltiplos fatores de risco para a apresentação de uma forma grave de COVID-19 e foram desenvolvidas diferentes vacinas para prevenir o aparecimento de manifestações graves. No entanto, apesar de um histórico de vacinação, alguns casos podem evoluir para complicações ou mesmo para a morte. O objetivo deste estudo foi determinar a força de associação entre a gravidade da COVID-19 e o histórico de vacinação em pacientes atendidos em um hospital público de referência na Cidade do México. Métodos: Estudo epidemiológico não-experimental, retrospectivo e analítico, de casos e controles. A população do estudo foram indivíduos atendidos em um hospital de concentração para atendimento à COVID-19 entre 1 de julho de 2021 e 30 de junho de 2022, na Cidade do México. Resultados: 132 participantes (44 casos e 88 controles) foram incluídos no estudo. Os fatores de risco mais fortemente associados à gravidade da COVID-19 foram idade superior ou igual a 60 anos, apresentar 22 respirações por minuto na primeira avaliação médica, pressão arterial sistólica superior ou igual a 140 milímetros de mercúrio e histórico de pelo menos uma comorbidade crônica. No entanto, histórico de vacinação foi associado a uma probabilidade 94% (OR 0,06) menor de desenvolver COVID-19 grave em comparação com aqueles sem histórico de vacinação, independentemente da presença de fatores de risco associados. Conclusão: A ausência de histórico de vacinação e a presença de algum dos fatores de risco identificados conferem maiores probabilidades de desenvolver formas graves da doença.(AU)

Justificación y Objetivos: Desde su aparición en 2019, se han identificado múltiples factores de riesgo para presentar una forma grave de COVID-19 y también se han desarrollado distintas vacunas que previenen la aparición de manifestaciones de gravedad. Sin embargo, a pesar del antecedente de vacunación, algunos casos se complican o incluso fallecen. El objetivo del este estudio fue determinar la fuerza de asociación entre la gravedad de la COVID-19 con el antecedente de vacunación en pacientes atendidos en un hospital público de referencia de la Ciudad de México. Métodos: Estudio epidemiológico no experimental, retrospectivo y analítico, de casos y controles. La población de estudio fueron personas atendidas en un hospital de concentración para la atención de COVID-19 entre el 1 de julio de 2021 y el 30 de junio de 2022 en la Ciudad de México. Resultados: 132 participantes (44 casos y 88 controles) fueron incluidos en el estudio. Los factores de riesgo más fuertemente asociados con la gravedad de la COVID-19 fueron la edad mayor o igual a 60 años, presentar 22 respiraciones por minuto en la primera valoración médica, tensión arterial sistólica mayor o igual a 140 milímetros de mercurio y el antecedente de al menos una comorbilidad crónica. No obstante, el antecedente de vacunación se asoció con 94% (RM 0.06) menos posibilidades de desarrollar COVID-19 grave con respecto a aquellos sin antecedente vacunal, independientemente de la presencia de los factores de riesgo asociados. Conclusión: carecer del antecedente de vacunación y presentar alguno de los factores de riesgo identificados confieren las mayores posibilidades de presentar formas graves de la enfermedad.(AU)

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Introducción: El cáncer de la vejiga es uno de los más frecuentes del tracto urinario y se manifiesta de dos formas: como tumor superficial de bajo grado o como neoplasia invasora de alto grado. Objetivo: Caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo, para caracterizar el cáncer vesical en adultos, según variables clínicas, epidemiológicas y de servicio de los pacientes atendidos en el servicio de Urología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» en el periodo comprendido de octubre 2019 y 2022. Población del estudio: 242 pacientes diagnosticados con cáncer vesical. Resultados: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019 (45,86 %): masculinos (75,20 %); blancos (89,25 %); mayores de 70 o más años (64,46 %) y fumadores (95,45 %). La hematuria fue el síntoma principal (91,73 %), como expresión del carcinoma urotelial papilar de bajo grado (36,77 %). Tratamiento: la resección transuretral (88,01 %), sin metástasis a distancia (88,42 %). Conclusiones: La mayoría de los pacientes diagnosticados con cáncer vesical corresponden al año 2019, masculinos, blancos, mayores de 70 o más años, fumadores y con hematuria. Más frecuente: el carcinoma urotelial papilar de bajo grado. El tiempo trascurrido antes del diagnóstico de la enfermedad fue de 36-40 días, y un mes, el tiempo trascurrido antes del tratamiento de la enfermedad.

Introduction: bladder cancer is one of the most frequent cancers of the urinary tract and manifests itself in two ways: as a superficial low-grade tumor or as a high-grade invasive neoplasm. Objective: to characterize bladder cancer in adults according to clinical, epidemiological and service variables. Methods: a descriptive and retrospective observational study was carried out to characterize bladder cancer in adults according to clinical, epidemiological and service variables of patients treated in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from October 2019 and 2022. The study population was 242 patients diagnosed with bladder cancer. Results: most of the patients diagnosed with bladder cancer correspond to the year 2019 (45.86%): male (75.20%); whites (89.25%); older than 70 or more years (64.46%) and smokers (95.45%). Hematuria was the main symptom (91.73%), as an expression of low-grade papillary urothelial carcinoma (36.77%). The treatment was transurethral resection (88.01%), without distant metastasis (88.42%). Conclusions: most of the patients diagnosed with bladder cancer correspond to the year 2019, male, whites, older than 70 years or older, smokers and with hematuria. Low-grade papillary urothelial carcinoma was the most frequent cancer. The time elapsed before the diagnosis of the disease was 36-40 days, and the time elapsed before the treatment of the disease was 1 month.

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ABSTRACT Objective: Develop and validate the content of an instrument for patient risk classification in emergency services of Primary Health Care. Method: The study included two stages: item generation and content validity. A literature review and retrospective analysis of medical records were conducted to create the instrument items. The Content Validity Ratio (CVR) was used to assess agreement among judges during content validation. Results: In the first and second rounds, 75 and 71 judges validated the risk classification instrument, respectively. The minimum adherence score for the latent variable item based on the final number of judges was 0.22 and 0.18; thus, 52 items, divided into three classification categories (red, orange, and yellow), were retained. Conclusion: The instrument was considered valid regarding clarity, relevance, pertinence, and agreement regarding the severity indicated in the item.

RESUMEN Objetivo: Desarrollar y validar contenido de un instrumento para medición de riesgo del paciente en servicios de emergencia de Atención Primaria de Salud. Método: Estudio compuesto por dos etapas: generación de ítems y validez de contenido. Realizada revision de literatura y análisis retrospectivo de prontuarios para creación de los ítems del instrumento. En la validez de contenido, fue usado el Content Validity Ratio (CVR) para averiguar la concordancia entre jueces. Resultados: El instrumento de medición de riesgo fue validado por 75 y 71 jueces en el primer y segundo ciclo, respectivamente. Utilizada calificación mínima de adherencia al ítem de la variable latente basado en el número final de jueces, adoptando 0,22 y 0,18; y mantenidos 52 ítems divididos en tres categorías de medición (rojo, naranja y amarillo). Conclusion: El instrumento fue considerado válido cuanto a claridad, relevancia, pertinencia y concordancia en relación con la gravedad indicada en el ítem.

RESUMO Objetivo: Desenvolver e validar o conteúdo de um instrumento para classificação de risco do paciente em serviços de emergência da Atenção Primária à Saúde. Método: Estudo composto por duas etapas: geração de itens e validade de conteúdo. Foi realizada revisão de literatura e análise retrospectiva dos prontuários para criação dos itens do instrumento. Na validação de conteúdo, foi usado o Content Validity Ratio (CVR) para averiguar a concordância entre os juízes. Resultados: O instrumento de classificação de risco foi validado por 75 e 71 juízes no primeiro e segundo ciclo, respectivamente. Foi utilizado escore mínimo da aderência ao item da variável latente com base no número final de juízes, adotando 0,22 e 0,18; e foram mantidos 52 itens divididos em três categorias de classificação (vermelho, laranja e amarelo). Conclusão: O instrumento foi considerado válido quanto à clareza, relevância, pertinência e concordância em relação à gravidade indicada no item.

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Resumo Objetivo Mapear as evidências disponíveis sobre as ações do óxido nítrico na fisiopatologia da sepse e sua relação com a gravidade de pacientes sépticos. Método Revisão de escopo de acordo com a metodologia do Joanna Briggs Institute. Realizou-se busca por estudos que evidenciaram as ações do óxido nítrico na sepse e se o seu aumento está associado à gravidade de pacientes sépticos. Dois revisores independentes fizeram o mapeamento das informações utilizando um instrumento de extração de dados previamente elaborado. Os dados foram analisados quanto à sua relevância, sendo posteriormente extraídos e sintetizados. Resultados De 1342 estudos, 11 foram incluídos na revisão. O primeiro foi publicado em 2017 e o último, em 2022. A maioria foi desenvolvida nos Estados Unidos, na China e na Alemanha. Os estudos apresentaram informações referentes as ações do óxido nítrico, sintetizando sua biodisponibilidade e os inibidores endógenos relacionados a sua produção, além de abordarem a relação do óxido nítrico com a gravidade da sepse. Conclusão A produção de óxido nítrico fisiológico durante a sepse atua como protetor vascular, principalmente na microcirculação, porém, em altas concentrações, contribui para a disfunção vascular, que subverte a fisiologia da regulação da pressão arterial, causando profunda vasodilatação e hipotensão refratária e aumentando a gravidade de pacientes sépticos.

Resumen Objetivo Mapear las evidencias disponibles sobre las acciones del óxido nítrico en la fisiopatología de la sepsis y su relación con la gravedad de pacientes sépticos. Métodos Revisión de alcance de acuerdo con la metodología del Joanna Briggs Institute. Se realizó una búsqueda de estudios que evidenciaron las acciones del óxido nítrico en la sepsis y si su aumento estaba asociado a la gravedad de pacientes sépticos. Dos revisores independientes hicieron el mapeo de la información utilizando un instrumento de extracción de datos previamente elaborado. Los datos se analizaron respecto a su relevancia, para luego extraerlos y sintetizarlos. Resultados De 1342 estudios, se incluyeron 11 en la revisión. El primero fue publicado en 2017 y el último en 2022. La mayoría se realizó en Estados Unidos, China y Alemania. Los estudios presentaron información referente a las acciones del óxido nítrico, sintetizando su biodisponibilidad y los inhibidores endógenos relacionados con su producción, además de abordar la relación del óxido nítrico con la gravedad de la sepsis. Conclusión La producción de óxido nítrico fisiológico durante la sepsis actúa como protector vascular, principalmente en la microcirculación. Sin embargo, en altas concentraciones, contribuye a la disfunción vascular, que subvierte la fisiología de la regulación de la presión arterial, causa una profunda vasodilatación e hipotensión refractaria y aumenta la gravedad de pacientes sépticos. Registro da revisão de escopo no Open Science Framework: https://doi.org/10.17605/OSF.IO/MXDK2

Abstract Objective Map the available evidence on the actions of nitric oxide in the pathophysiology of sepsis and its relationship with the severity of sepsis in patients. Method Scoping review following the Joanna Briggs Institute methodology. A search was carried out for studies that highlighted the actions of nitric oxide in sepsis, informing whether its increase is associated with the severity of sepsis in patients. Two independent reviewers mapped the information using a previously designed data extraction instrument. The data was analyzed for its relevance and then extracted and synthesized. Results Eleven of 1342 studies were included in the review. The first of them was published in 2017 and the last in 2022. Most of them were developed in the USA, China, and Germany. Studies have reported the actions and bioavailability of nitric oxide and endogenous inhibitors related to its production, and related nitric oxide to the severity of sepsis. Conclusion The physiological production of nitric oxide during sepsis acts as a vascular protector, mainly in the microcirculation but contributes to vascular dysfunction in high concentrations, subverting the regulation of blood pressure, causing deep vasodilation and refractory hypotension, and increasing the severity of sepsis in patients. Registration of the scoping review in the Open Science Framework: https://doi.org/10.17605/OSF.IO/MXDK2

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Resumo Objetivo Identificar a frequência de lesão renal aguda (LRA) em pacientes hospitalizados com COVID-19, as características associadas, a mortalidade e a letalidade. Métodos Revisão realizada nas bases de dados CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science e, na literatura cinzenta (Google Acadêmico) em 12 de janeiro de 2022. Foram incluídos artigos em inglês, espanhol e português, publicados a partir de novembro 2019 até janeiro de 2022, em pacientes maiores de 18 anos com COVID-19 hospitalizados e LRA conforme critério Kidney Disease Improving Global Outcomes (KDIGO). Os estudos selecionados foram lidos na íntegra para extração, interpretação, síntese e categorização conforme nível de evidência. Resultados 699 artigos encontrados e 45 incluídos. A idade avançada, sexo masculino, hipertensão, doença renal crônica, ventilação mecânica, aumento da proteína C reativa, uso de drogas vasoativas e de determinadas classes de anti-hipertensivos foram associados a LRA. A LRA está relacionada à maior frequência de mortalidade. Em 30% dos pacientes hospitalizados com COVID-19 houve LRA. A taxa de mortalidade por LRA foi de 5% e a letalidade de 18%. Conclusão Estes resultados ressaltam a relevância da LRA como uma complicação significativa da COVID-19 e sugerem que um controle mais cuidadoso e precoce dos fatores associados poderia potencialmente reduzir a mortalidade e a letalidade. É crucial intensificar a pesquisa nesse campo para esclarecer melhor os mecanismos envolvidos na lesão renal em pacientes com COVID-19, bem como identificar estratégias terapêuticas mais efetivas para sua prevenção e tratamento nesse contexto.

Resumen Objetivo Identificar la frecuencia de lesión renal aguda (LRA) en pacientes hospitalizados con COVID-19, las características relacionadas, la mortalidad y la letalidad. Métodos Revisión realizada en las bases de datos CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science y en la literatura gris (Google Académico) el 12 de enero de 2022. Se incluyeron artículos en inglés, español y portugués, publicados a partir de noviembre de 2019 hasta enero de 2022, con pacientes mayores de 18 años con COVID-19 hospitalizados y LRA de acuerdo con el criterio Kidney Disease Improving Global Outcomes (KDIGO). Los estudios seleccionados fueron leídos en su totalidad para extracción, interpretación, síntesis y categorización según el nivel de evidencia. Resultados Se encontraron 699 artículos y se incluyeron 45. Los factores relacionados con la LRA fueron: edad avanzada, sexo masculino, hipertensión, enfermedad renal crónica, ventilación mecánica, aumento de la proteína C reactiva, uso de drogas vasoactivas y de determinadas clases de antihipertensivos. La LRA está relacionada con mayor frecuencia de mortalidad. En el 30 % de los pacientes hospitalizados con COVID-19 hubo LRA. La tasa de mortalidad por LRA fue de 5 % y la letalidad de 18 %. Conclusión Estos resultados resaltan la relevancia de la LRA como una complicación significativa de COVID-19 y sugieren que un control más cuidadoso y temprano de los factores asociados podría reducir potencialmente la mortalidad y la letalidad. Es crucial intensificar la investigación en este campo para explicar mejor los mecanismos relacionados con la lesión renal en pacientes con COVID-19, así como identificar estrategias terapéuticas más efectivas para su prevención y tratamiento en este contexto.

Abstract Objective To identify the frequency of acute kidney injury (AKI) in patients hospitalized with COVID-19, associated characteristics, mortality and lethality. Methods Integrative review carried out in the databases CINAHL, Embase, LILACS, Livivo, PubMed, SCOPUS, Web of Science and in the grey literature (Google Scholar) on January 12, 2022. Articles were included in English, Spanish and Portuguese, published from November 2019 to January 2022, in hospitalized patients over 18 years old with COVID-19 and AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The selected studies were read in full for extraction, interpretation, synthesis and categorization according to the level of evidence. Results A total of 699 articles were found and 45 included. Older age, male gender, hypertension, chronic kidney disease, mechanical ventilation, increased C-reactive protein, use of vasoactive drugs and certain classes of antihypertensives were associated with AKI. AKI is related to a higher frequency of mortality. AKI occurred in 30% of patients hospitalized with COVID-19. The mortality rate from AKI was 5% and the case fatality rate was 18%. Conclusion These results highlight the relevance of AKI as a significant complication of COVID-19 and suggest that more careful and early control of associated factors could potentially reduce mortality and lethality. It is crucial to intensify research in this field to better clarify the mechanisms involved in kidney injury in COVID-19 patients, as well as to identify more effective therapeutic strategies for its prevention and treatment in this context.

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ABSTRACT Objective: To evaluate the workload and severity of patients in the Intensive Care Unit (ICU) with COVID-19. Method: Cross-sectional, analytical study carried out in the ICU of a private hospital. All patients over the age of 18 with a diagnosis of COVID-19 admitted from September 2020 to June 2021 were included. Workload assessed by the Nursing Activities Score (NAS), and severity by the Sequential Organ Failure Assessment. Descriptive and inferential analyses were performed. Results: 217 patients were included, mostly men, mean age 62.41 years, white, obese, non-smokers and sedentary. The average NAS was 84.79. Staffing was in line with legislation and NAS. NAS was not associated with severity. Severity was associated with higher age, gender, comorbidities, sedentary lifestyle, time on mechanical ventilation, hospitalization and death. Conclusion: Workload was high and not associated with severity or outcomes. Severity was associated with demographic and clinical conditions. This study shows the importance of staff sizing, with a view to promoting safety and quality of care.

RESUMEN Objetivo: Evaluar la carga de trabajo y la gravedad de los pacientes de la Unidad de Cuidados Intensivos (UCI) con COVID-19. Método: Estudio transversal y analítico realizado en la UCI de un hospital privado. Se incluyeron todos los pacientes mayores de 18 años con diagnóstico de COVID-19 ingresados entre septiembre de 2020 y junio de 2021. Carga de trabajo evaluada mediante la Nursing Activities Score (NAS), y gravedad mediante la valoración secuencial de fallo orgánico. Se realizaron análisis descriptivos e inferenciales. Resultados: Se incluyeron 217 pacientes, en su mayoría hombres, edad media 62,41 años, raza blanca, obesos, no fumadores y sedentarios. El NAS medio era de 84,79. Los niveles de personal se ajustaban a la legislación y al NAS. El NAS no se asoció con la gravedad. La gravedad se asoció a mayor edad, sexo, comorbilidades, sedentarismo, tiempo de ventilación mecánica, hospitalización y muerte. Conclusión: La carga de trabajo fue elevada y no se asoció a la gravedad ni a los resultados. La gravedad se asoció a las condiciones demográficas y clínicas. Este estudio muestra la importancia del dimensionamiento del personal, con vistas a promover la seguridad y la calidad de los cuidados.

RESUMO Objetivos: Avaliar carga de trabalho e gravidade dos pacientes na Unidade de Terapia Intensiva (UTI) com COVID-19. Método: Estudo transversal, analítico realizado na UTI em hospital privado. Incluídos todos os pacientes maiores de 18 anos, com diagnóstico de COVID-19 admitidos de setembro de 2020 a junho de 2021. Carga de trabalho avaliado pelo Nursing Activities Score (NAS), e gravidade pelo Sequential Organ Failure Assessment. Realizado análises descritiva e inferencial. Resultados: Incluídos 217 pacientes, maioria homens, média de idade 62,41 anos, brancos, obesos, não tabagistas e sedentários. A média do NAS foi 84,79. O dimensionamento de pessoal estava em concordância com legislação e NAS. O NAS não foi associado a gravidade. Houve associação da gravidade com maior idade, sexo, comorbidades, sedentarismo, tempo de ventilação mecânica, internação e óbito. Conclusão: A carga de trabalho foi alta e não associada a gravidade e desfechos. A gravidade foi associada às condições demográficas e clínicas. Este estudo mostra a importância do dimensionamento de pessoal, com vistas à promoção da segurança e qualidade assistencial.

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INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

INTRODUCTION. Obesity is recognized as a risk factor for developing severe new coronavirus disease. Bariatric surgery prior to infection could behave as a protective factor against serious infections and death. OBJECTIVE. To describe the impact of bariatric surgery on the severity and mortality of patients with obesity and new coronavirus disease; through a systematic review and meta-analysis of the specialized literature from 2020-2022. METHODOLOGY. Publications indexed in databases such as Pubmed, Tripdatabase, and Google scholar, on the impact of previous bariatric surgery on the evolution and prognosis of patients with new coronavirus disease were taken. The Newcastle-Ottawa scale was used to assess quality and risk of bias. RevMan 5.0 software was used for statistical analysis. RESULTS. Eight cohort studies were included, with a population of 137 620 adult subjects with obesity and new coronavirus disease; of these, 5638 (4.09%) had a history of bariatric surgery. In the meta-analysis, it was determined that, in subjects with obesity and new coronavirus disease, the history of bariatric surgery had a protective effect against the use of mechanical ventilation [OR: 0.68; 95% CI: 0.62-0.75] (p<0.001) and mortality [OR: 0.57; 95% CI: 0.50-0.65] (p<0.01). CONCLUSIONS. The history of bariatric surgery in subjects with obesity seems to have a protective effect against the severity defined by the use of mechanical ventilation in patients with obesity and mortality due to the new coronvirus disease; therefore, the resumption of bariatric surgical activity, at pre-pandemic levels, could represent an additional benefit for candidate subjects.

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Objetivos. Evaluar la asociación entre rinitis alérgica y el grado de compromiso pulmonar en pacientes con COVID-19 y evaluar las frecuencias de las variables principales. Materiales y métodos. Se realizó un estudio de tipo observacional, transversal y analítico mediante la revisión de historias clínicas de pacientes atendidos en el Hospital Nacional Cayetano Heredia entre el año 2020 y 2021 con diagnóstico de COVID-19. Se determinó el antecedente de rinitis alérgica, y el compromiso pulmonar se evaluó mediante una tomografía sin contraste usando el puntaje tomográfico (PT), además de, variables sociodemográficas y clínicas. Se estimaron razones de prevalencias tanto crudas (RP) como ajustadas (RPa) con sus respectivos intervalos de confianza (IC) al 95% y se empleó un modelo lineal generalizado de la familia Poisson con función de enlace logarítmica y varianzas robustas. Resultados. Se evaluaron 434 pacientes predominantemente varones, mayores de 60 años y sin antecedentes médicos relevantes. El 56,2% tenía el antecedente de rinitis alérgica y el 43,1% tuvo un compromiso pulmonar moderado a severo. En el modelo de regresión ajustado, se encontró que el antecedente de rinitis alérgica disminuyó la gravedad de COVID-19 evaluada a través del compromiso pulmonar según el PT (RPa: 0,70; IC 95%: 0,56-0,88; p=0,002). Conclusiones. El antecedente de rinitis alérgica representó una disminución en la gravedad de COVID-19 según el PT score del 30,0% en pacientes hospitalizados.

Objectives. To evaluate the association between allergic rhinitis and the degree of pulmonary involvement in patients with COVID-19 and to determine the frequencies of the main variables. Materials and methods. An observational, cross-sectional and analytical study was carried out by reviewing the medical records of patients diagnosed with COVID-19 from the Cayetano Heredia National Hospital between 2020 and 2021. We obtained information regarding the history of allergic rhinitis; pulmonary involvement was assessed by non-contrast tomography results using the chest computed tomography (CT) score. Data regarding sociodemographic and clinical variables was also obtained. Both crude (PR) and adjusted (aPR) prevalence ratios with their respective 95% confidence intervals (CI) were estimated. We also used a generalized linear Poisson family model with log link function and robust variances. Results. We evaluated 434 patients, who were mostly male, older than 60 years and had no relevant medical history. Of these, 56.2% had a history of allergic rhinitis and 43.1% had moderate to severe pulmonary involvement. The adjusted regression model showed that the history of allergic rhinitis reduced the severity of COVID-19 according to the pulmonary involvement assessed by the CT score (aPR: 0.70; 95%CI: 0.56-0.88; p=0.002). Conclusions. The history of allergic rhinitis resulted in a 30.0% decrease in COVID-19 severity according to the CT score in hospitalized patients.

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This study aimed to evaluate the relationship between frailty, sociodemographic and clinical characteristics, and disease severity of older adults with acute coronary syndrome (ACS). A total of 57 hospitalized patients ≥60 years with ACS were assessed for frailty through the Tilburg Frailty Indicator. Disease severity was assessed by the Global Registry of Acute Coronary Events, by the maximum troponin level, and by the number of severely obstructed coronary arteries. The relationship between variables was assessed by Mann Whitney's test, Pearson's chi-square test, likelihood-ratio test, Fisher's exact test, or Student's t test. Analyses were bootstrapped to 1,000 to reduce potential sample bias. About 54.4% were frail. Frailty was associated with ethnicity (p = .02), marital status (p = .05), ischemic equivalents (p = .01), self-perceived health (p = .002), arthritis/rheumatism/arthrosis (p = .002), and number of severely obstructed coronary arteries (p = .05). These relationships can support intensified surveillance planning for the elderly at greatest risk, structuring of transitional care, appropriate nurse-coordinated secondary prevention delivery in primary care, and cardiac rehabilitation following ACS.

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ABSTRACT Objectives: To evaluate the influence of the degree of severity of adolescent idiopathic scoliosis (AIS) on the distribution of plantar load on the feet during gait. Material and Methods: 40 patients with AIS were evaluated and divided into severity groups: 13 with mild AIS; 13 with moderate AIS; and 14 with severe AIS. Cobb angles (degrees) were evaluated by radiography. Gait was assessed using the pressure platform at a frequency of 100 Hz. The adolescents walked on a 20-meter track, with their feet resting on the platform, totaling an average of 12 steps. The following were evaluated: contact area, peak pressure, and maximum force on the 4 regions of the feet: hindfoot (medial and lateral), midfoot, and forefoot. Results: Adolescents with moderate and severe AIS showed an increase in peak pressure and maximum force on the medial (p=0.014; p=0.045, respectively) and lateral (p=0.035; p=0.039, respectively) hindfoot and a reduction on the midfoot (p=0.024) when compared to mild AIS. The contact area showed no differences between groups. Conclusion: The moderate and severe degree of AIS severity promoted increased plantar load on the medial and lateral hindfoot (heel) during gait compared to adolescents with a mild degree of scoliotic curvature. In this way, gait training in the milder stages of disease severity can minimize the overload and the increase in force vectors on the spine, preventing the progression of severe scoliotic curvature. Level of Evidence II; Cross-sectional study.

Resumo: Objetivos: Avaliar a influência do grau de severidade da escoliose idiopática do adolescente (EIA) sobre a distribuição da carga plantar dos pés durante a marcha. Material e Métodos: 40 pacientes com EIA foram avaliados e divididos em grupos de severidade: 13 com EIA leve; 13 com EIA moderada; e 14 com EIA grave. Os ângulos de Cobb (graus) foram avaliados pela radiografia. A marcha foi avaliada pela plataforma de pressão, a uma frequência de 100 Hz. Os adolescentes caminhavam sobre uma pista de 20 metros, com o registo do apoio dos pés sobre a plataforma, totalizando em média 12 passos. Foram avaliadas área de contato, pico de pressão e força máxima sobre as 4 regiões dos pés - retropé (medial e lateral), mediopé e antepé. Resultados: Os adolescentes com EIA moderada e grave mostraram um aumento do pico de pressão e força máxima sobre o retropé medial (p=0,014; p=0,045, respectivamente) e lateral (p=0,035; p=0,039, respectivamente) e uma redução sobre o mediopé (p=0,024) quando comparados a EIA leve. Não houve diferenças quanto a área de contato entre os grupos. Conclusão: O grau de severidade moderada e grave da EIA promoveu um aumento da carga plantar sobre retropé medial e lateral (calcanhar) durante a marcha em comparação aos adolescentes com grau leve da curvatura escoliótica. Desta forma, o treino de marcha nos estágios mais leve de severidade da doença pode minimizar a sobrecarga e o aumento dos vetores de força sobre a coluna, evitando a progressão da curvatura escoliótica grave. Nível de evidência II; Estudo transversal.

Resumen: Objetivos: Evaluar la influencia del grado de severidad de la escoliosis idiopática del adolescente (EIA) sobre la distribución de la carga plantar en los pies durante la marcha. Material y Métodos: Se evaluaron 40 pacientes con EIA y se dividieron en grupos de gravedad: 13 con EIA leve; 13 con EIA moderada; y 14 con EIA grave. Los ángulos de Cobb (grados) se evaluaron mediante radiografía. La marcha se evaluó utilizando la plataforma de presión a una frecuencia de 100 Hz. Los adolescentes caminaron sobre una pista de 20 metros, con los pies apoyados en la plataforma, totalizando un promedio de 12 pasos. Se evaluaron: área de contacto, presión pico y fuerza máxima en las 4 regiones de los pies: retropié (medial y lateral), mediopié y antepié. Resultados: Los adolescentes con EIA moderado y severo mostraron un aumento en la presión pico y la fuerza máxima en el retropié medial (p=0,014; p=0,045, respectivamente) y lateral (p=0,035; p=0,039, respectivamente) y una reducción en el mediopié (p=0,024) en comparación con EIA leve. El área de contacto no mostró diferencias entre los grupos. Conclusión: El grado moderado y severo de severidad de la EIA promovió un aumento de la carga plantar en el retropié medial y lateral (talón) durante la marcha en comparación con adolescentes con un grado leve de curvatura escoliótica. De esta manera, el entrenamiento de la marcha en las etapas más leves de la gravedad de la enfermedad puede minimizar el aumento de la sobrecarga y el aumento de los vectores de fuerza en la columna, evitando la progresión de la curvatura escoliótica severa. Nivel de Evidencia II; Estudio transversal.

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Resumo Objetivo identificar as alterações bioquímicas dos pacientes com apresentação moderada e grave da doença Covid-19 e as preditivas de gravidade nos que evoluíram do estagio moderado para o grave. Métodos Estudo de coorte prospectivo com 709 pacientes internados com diagnóstico confirmado de COVID-19 e apresentação moderada e grave da doença. Foi realizado em um hospital universitário de média e alta complexidade do estado de São Paulo, no período de abril de 2020 a dezembro de 2021. Os dados coletados dos prontuários foram exames laboratoriais e evolução clínica dos pacientes. Na análise descritiva, foi utilizado frequência absoluta, percentual, média e desvio padrão. Os Testes do Qui-Quadrado de Pearson, Exato de Fisher, Mann-Whitney ou t de Student foram utilizados para comparar as diferenças entre os grupos dos moderados e graves. O nível de significância adotado foi de 0,05. Resultados A média de idade foi significantemente maior nos pacientes graves em relação aos moderados (p<0,001). Os valores da hemoglobina e plaquetas foram estatisticamente menores na internação no grupo dos pacientes graves, proteína C-reativa e D-Dímero, maiores (p<0,001). O número de óbitos foi significantemente maior nos pacientes que foram internados em estado grave (p<0,001) e verificamos também que a hemoglobina e plaquetas estavam abaixo dos valores de referência na internação deste grupo. Dos 533 pacientes que internaram em estado moderado, 38 evoluiram para quadro grave. Conclusão Os resultados mostram a importância da avaliação clínica das variáveis bioquímicas no momento da internação como preditivas de gravidade. Os achados reportados nesta investigação corroboram com dados da literatura e podem elucidar intervenções precoces para melhor manejo dos pacientes desde o momento da internação.

Resumen Objetivo Identificar las alteraciones bioquímicas de los pacientes con cuadro moderado y grave de la enfermedad de COVID-19 y las predictivas de gravedad en los que evolucionaron de nivel moderado a grave. Métodos Estudio de cohorte prospectivo con 709 pacientes internados con diagnóstico confirmado de COVID-19 y cuadro moderado y grave de la enfermedad. Fue realizado en un hospital universitario de complejidad mediana y alta en el estado de São Paulo, durante el período de abril de 2020 a diciembre de 2021. Los datos obtenidos a partir de las historias clínicas fueron pruebas de laboratorio y evolución clínica de los pacientes. En el análisis descriptivo se utilizó frecuencia absoluta, porcentaje, promedio y desviación típica. Para comparar las diferencias entre los grupos de los moderados y graves se utilizaron las pruebas χ2 de Pearson, exacta de Fisher, Mann-Whitney o t de Student. El nivel de significación adoptado fue de 0,05. Resultados El promedio de edad fue considerablemente más alto en los pacientes graves en relación con los moderados (p<0,001). Los valores de la hemoglobina y de las plaquetas fueron estadísticamente inferiores en la internación en el grupo de los pacientes graves, proteína C reactiva y dímero D, superiores (p<0,001). El número de defunciones fue considerablemente más alto en los pacientes que ingresaron en estado grave (p<0,001) y verificamos también que la hemoglobina y las plaquetas estaban por debajo de los valores de referencia en la internación de este grupo. De los 533 pacientes que ingresaron en estado moderado, 38 evolucionaron hacia cuadros graves. Conclusión Los resultados muestran la importancia de la evaluación clínica de las variables bioquímicas en el momento de la internación como predictivas de gravedad. Los resultados informados en esta investigación confirman los datos de la literatura y pueden esclarecer intervenciones tempranas para un mejor manejo de los pacientes desde el momento de la internación.

Abstract Objective To identify the biochemical alterations of patients with moderate and severe COVID-19 and the predictors of severity in those who progressed from the moderate to the severe stage. Methods This is a prospective cohort study with 709 patients hospitalized with a confirmed diagnosis of COVID-19 and moderate and severe illness. It was carried out in a university hospital of medium and high complexity, in the state of São Paulo, from April 2020 to December 2021. Data collected from medical records were laboratory tests and clinical progression of patients. In the descriptive analysis, absolute frequency, percentage, mean and standard deviation were used. Pearson's chi-square, Fisher's exact, Mann-Whitney or Student's t tests were used to compare the differences between the moderate and severe groups. The significance level adopted was 0.05. Results The mean age was significantly higher in severe patients than in moderate ones (p<0.001). Hemoglobin and platelet values were statistically lower upon admission in the group of critically ill patients, C-reactive protein and D-dimer higher (p<0.001). The number of deaths was significantly higher in patients who were hospitalized in a serious condition (p<0.001) and we also found that hemoglobin and platelets were below the reference values at hospitalization in this group. Of the 533 patients who were hospitalized in a moderate condition, 38 progressed to a severe condition. Conclusion The results show the importance of clinical assessment of biochemical variables at the time of admission as predictors of severity. The findings reported in this investigation corroborate data from the literature and can elucidate early interventions for better management of patients from the moment of hospitalization.

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Introduction: Despite the high prevalence and impact on quality of life, there are no objective methods to estimate the severity of female pattern hair loss (FPHL). Here, we aimed to develop a dermoscopic severity score for FPHL. Methods: Cross-sectional study involving 76 women with FPHL and 12 controls. Standardized dermoscopic photos of the scalp were taken to evaluate the main findings of FPHL. The variable selection and their scores in the final model were defined by multivariate methods. Twenty participants were retested to assess the reliability, and 10 participants were tested before and after treatment for estimating its sensibility to change after 6 months. Results: Eight patients (11%) presented the Sinclair clinical scale grade I, 40 (53%) presented at grade II, 19 (25%) presented at grade III, and 9 (12%) presented at grades IV and V. In the multivariate exploration, the following variables were considered significant: total terminal hairs, total miniaturized hairs, brown peripilar sign, scalp honeycomb pigmentation, white peripilar sign, and yellow dots. The final model resulted in a high correlation (rho = 0.89) with the ranked clinical assessment. Conclusion: An objective and reliable severity score of FPHL was developed and validated, allowing its use as an additional outcome in therapeutic trials.

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ABSTRACT Introduction: Upon completion of this research, there was no evidence of studies addressing self-reported periodontal disease in Cuba, nor any antecedent of research relating it to COVID-19 in adults over 60. Objective: To determine the relationship between self-reported periodontal disease, dental loss, and COVID-19 activity. Methods: A descriptive cross-sectional investigation was carried out. The sample included 238 individuals aged over 60 who were infected with COVID-19, and survived. They gave their consent. The study was performed for over 1 year in Playa municipality of Havana, Cuba. Variables such as gender, age, COVID-19 evolutionary severity, comorbidities, and self-reported periodontal disease were used. A validated 4-question survey was applied to identify the periodontal disease and all data were processed in a database. Some variables were dichotomized to perform the odds ratio and Pearson's Chi-squared test, and determine the relationship between possible risk factors and the evolutionary severity of COVID-19. Results: As a result, the odds ratio values and confidence intervals for periodontal disease and advanced periodontal disease were 1.598 (0.261; 9.78) and 1.814 (0.296; 11.105) respectively, and the p-values were 0.609 and 0.514 respectively. Conclusion: A relationship between periodontal disease and the evolutionary severity of COVID-19 cannot be established. However, a relationship was observed targeting dental loss and respiratory diseases as determinant risk factors in the severity of COVID-19.

RESUMEN Introducción: Hasta el momento de culminada esta investigación no se encontró evidencia de estudios que aborden el autorreporte de enfermedad periodontal en Cuba, ni antecedentes de estudios que la relacionen con la COVID-19 en adultos mayores de 60 años. Objetivo: Determinar la relación entre el autorreporte de enfermedad periodontal, la pérdida dentaria y características de la COVID-19. Métodos: Se realizó una investigación descriptiva transversal. La muestra fue de 238 individuos mayores de 60 años, que contrajeron la COVID-19 y sobrevivieron. Todos dieron su consentimiento informado. El estudio fue realizado en el período de 1 año en el municipio Playa, La Habana, Cuba. Las variables estudiadas fueron, sexo, edad, gravedad evolutiva de la COVID-19, comorbilidades y autorreporte de enfermedad periodontal. Se les aplicó una encuesta validada de 4 preguntas, para identificar enfermedad periodontal y los datos fueron procesados en una base de datos. Algunas variables fueron dicotomizadas para realizar la prueba de odds ratio y ji cuadrado de Pearson, para determinar la relación entre posibles factores de riesgo y la gravedad evolutiva de la COVID-19. Resultados: Los valores de odds ratio e intervalos de confianza de la enfermedad periodontal y la enfermedad periodontal avanzada fueron de 1,598 (0,261; 9,78) y 1,814 (0,296; 11,105) y los valores de p de 0,609 y 0,514 respectivamente. Conclusiones: No se comprueba que exista relación entre la enfermedad periodontal y la gravedad evolutiva de la COVID-19. Sin embargo, existe una relación que señala a la pérdida dentaria y las enfermedades respiratorias como factores de riesgo determinante en la gravedad de la COVID-19.

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AIM: Aim of this study is to identify signs and symptoms associated with identifying critically ill patients by rapid triage assessment performed by nurses in an emergency department. BACKGROUND: In some emergency services, the immediate assessment of critically ill patients occurs before opening the hospital formal registration and it is based on the nurse's experience. Studies on the topic are essential to improve this process. DESIGN: This is a cross-sectional, quantitative study. METHODS: This study was conducted in a Brazilian emergency department in 2017. Adult patients who presented potentially life-threatening symptoms underwent rapid triage to determine the medical urgency. Those identified as being critically ill were classified as high priority and streamed to the emergency room. RESULTS: A total of 154 (84.6%) patients were classified as high priority from the total of 182 evaluations. Altered state of consciousness (35.2%) and altered skin perfusion (25.3%) were frequently identified. Signs and symptoms associated with identifying critically ill patients by rapid triage were alterations in ventilation (OR 6.09; p = 0.028), neurological dysfunction (OR 44.96; p < 0.001) and pain (OR 5.80; p = 0.004). CONCLUSION: Nurses should value neurological and ventilation alterations and pain in patients during rapid triage, since these signs and symptoms are associated with high care priority.

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RESUMEN Introducción: Los cambios de la presión intraabdominal en pacientes grandes quemados influyen en su evolución y se asocia con un mal pronóstico. Objetivo: Determinar los cambios de la presión intraabdominal en pacientes grandes quemados. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal para determinar los cambios de la presión intraabdominal en pacientes grandes quemados, ingresados en el servicio de Cirugía Plástica y Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey desde enero de 2019 hasta junio de 2021.Se estudiaron 35 pacientes, se utilizaron las variables: presión intraabdominal como variable dependiente y el índice de gravedad, la presencia de quemaduras abdominales, los volúmenes de líquidos administrado y el estado al egreso de los pacientes como variables independientes. Resultados: En los tres grupos con índice pronóstico de muy grave, crítico y crítico extremo la mayoría de los pacientes presentaron niveles de presión intraabdominal grado I. De aquellos pacientes que presentaban más de un cinco por ciento de quemaduras hipodérmicas en el abdomen, 19 presentaron presión intraabdominal grado I. De los 22 pacientes que necesitaron para su reanimación diez o más litros de cristaloides, el 60 % desarrolló algún grado de hipertensión intraabdominal.Del total de la muestra, 18 de los enfermos resultaron fallecidos. Conclusiones: El índice pronóstico, la presencia de quemaduras hipodérmicas en el abdomeny la reanimación con diez o más litro de líquido, influye en los cambios de la presión intraabdominal en estos enfermos. La hipertensión intraabdominal repercute en la mortalidad en los grandes quemados.

ABSTRACT Introduction: The changes of the intra-abdominal pressure in severely burned patients influence their evolution and it has been associated with a bad forecast. Objective: To determine the changes of the intra-abdominal pressure in severely burned patients. Methods: An observational, descriptive cross-section study was carried out to determine the changes of the intra-abdominal pressure in severely burned patients, entered in the service of Plastic Surgery and Caumatology of the University Hospital Manuel Ascunce Domenech of Camagüey province in the period understood from January, 2019 to June, 2021. 35 patients were studied and the following variables were used: intra-abdominal pressure as dependent variable and severity rate, the presence of abdominal burns, the volumes of liquids administered and the state to the expenditure of the patients as independent variables. Results: In the three groups with forecast index of very bad, critic and extreme critic most of the patients presented levels of intra-abdominal pressure degree I. Of those patients that introduced more of one and five percent of hypodermic burns in the abdomen, 19 presented intra-abdominal pressure. Of the 22 patients that needed for their revival ten or more liters of crystalloids, the 60 % developed some degree of intra-abdominal hypertension. Of the total of the sample, 18 of the patients deceased. Conclusions: The forecast index, the presence of hypodermic burns in the abdomen and the revival with ten or more liter of liquid, influence the changes of the intra-abdominal pressure in these patients. The intraabdominal hypertension has influence upon the mortality in the severely burned patients.

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ABSTRACT Objectives: to analyze the association between nursing workload and neonatal mortality risk in newborns admitted to the Neonatal Intensive Care Unit. Methods: this is an observational, cross-sectional study conducted from January 2019 to January 2020. Results: the sample consisted of 399 newborns, 55.4% male, Nursing Activities Score mean of 67.5%, and Score for Neonatal Acute Physiology Perinatal Extension mean of 17.7, revealed itself as a predictor of the risk of death, while gestational age, length of hospitalization, and the first-minute Apgar established a protective relationship. The correlation between workload and neonatal mortality was low (r= 0.23, p=0.0009). Conclusions: the workload of the nursing team is not associated with the risk of mortality in the Neonatal Intensive Care Unit, as measured by the Nursing Activities Score.

RESUMEN Objetivos: analizar la relación entre la carga de trabajo de enfermería y el riesgo de mortalidad neonatal en recién nacidos internados en Unidad de Cuidados Intensivos Neonatal. Métodos: estudio observacional, del tipo transversal, realizado en el período de enero de 2019 a enero de 2020. Resultados: la muestra se constituyó de 399 recién nacidos, siendo 55,4% del sexo masculino, Nursing Activities Score mediano de 67,5% y Score for Neonatal Acute Physiology Perinatal Extension mediano de 17,7, se mostró como pronosticador para riesgo de óbito, mientras la edad gestacional, tiempo de internación y Apgar del primero minuto establecieron una relación protectora. La correlación entre carga de trabajo y el riesgo de mortalidad neonatal fue baja (r= 0,23, p=0.0009). Conclusiones: la carga de trabajo del equipo de enfermería, mensurada por el Nursing Activities Score, no está relacionada al riesgo de mortalidad en el ámbito de la Unidad de Cuidados Intensivos Neonatal.

RESUMO Objetivos: analisar a associação entre a carga de trabalho de enfermagem e o risco de mortalidade neonatal em recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Métodos: trata-se de um estudo observacional, do tipo transversal, realizado no período de janeiro de 2019 a janeiro de 2020. Resultados: a amostra constituiu-se de 399 recém-nascidos, sendo 55,4% do sexo masculino, Nursing Activities Score médio de 67,5%, Score for Neonatal Acute Physiology Perinatal Extension médio de 17,7 e mostrou se como preditor para risco de óbito, enquanto a idade gestacional, tempo de internação e Apgar do primeiro minuto estabeleceram uma relação protetora. A correlação entre carga de trabalho e o risco de mortalidade neonatal, foi baixa (r= 0,23, p=0.0009). Conclusões: a carga de trabalho da equipe de enfermagem, mensurada pelo "Nursing Activities Score", não está associada ao risco de mortalidade no âmbito da Unidade de Terapia Intensiva Neonatal.

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RESUMO Objetivo: Analisar a associação entre ultrafiltração e gravidade de pacientes diagnosticados com lesão renal aguda com complicações clínicas decorrentes da hemodiálise. Método: Estudo transversal realizado num hospital universitário do Sul do Brasil. Foram incluídas todas as fichas diárias de sessões de hemodiálise de pacientes com lesão renal aguda submetidos à hemodiálise entre setembro e novembro de 2017. Para obtenção dos dados, elaborou-se um instrumento de coleta. Adotou-se nível de significância inferior a 5%. Resultados: Os 103 pacientes estudados fizeram um total de 519 sessões de hemodiálise. Prevaleceram pacientes do sexo masculino (66,7%) com 60 anos ou mais (51,5%). Cerca de metade dos pacientes apresentou volume médio de ultrafiltração >1501ml (51,5%). A maioria foi considerada grave (72,8%). Dentre as complicações, a mais prevalente foi a hipotensão (69,9%). A realização de um maior volume de ultrafiltração não se associou às complicações estudadas. Pacientes graves apresentaram maior chance para ocorrência de hipotensão (p<0,001 e OR: 33,73). Conclusão: Hipotensão durante a hemodiálise foi uma complicação frequente, ocorrendo em cerca de metade dos pacientes. Como não esteve associada a volumes maiores de ultrafiltração, conclui-se que, possivelmente, a maior gravidade do paciente seja um fator explicativo para o desenvolvimento dessa complicação.

RESUMEN Objetivo: analizar la asociación entre ultrafiltración y gravedad de pacientes diagnosticados con lesión renal aguda con complicaciones clínicas derivadas de la hemodiálisis. Método: estudio transversal realizado en un hospital universitario del Sur de Brasil. Se incluyeron todas las fichas diarias de sesiones de hemodiálisis de pacientes con lesión renal aguda sometidos a hemodiálisis entre septiembre y noviembre de 2017. Para obtener los datos, se elaboró un instrumento de recolección. Se adoptó un nivel de significancia inferior al 5%. Resultados: los 103 pacientes estudiados realizaron un total de 519 sesiones de hemodiálisis. Prevalecieron pacientes varones (66,7%) con 60 años o más (51,5%). Cerca de la mitad de los pacientes presentó volumen medio de ultrafiltración >1501ml (51,5%). La mayoría fue considerada grave (72,8%). Entre las complicaciones, la más prevalente fue la hipotensión (69,9%). La realización de un mayor volumen de ultrafiltración no se asoció a las complicaciones estudiadas. Pacientes graves presentaron mayor predicción de ocurrencia de hipotensión (P0,001 y OR: 33,73). Conclusión: hipotensión durante la hemodiálisis fue una complicación frecuente, ocurriendo en aproximadamente la mitad de los pacientes. Como no estuvo asociada a volúmenes mayores de ultrafiltración, se concluye que, posiblemente, la mayor gravedad del paciente sea un factor explicativo para el desarrollo de esa complicación.

ABSTRACT Objective: To analyze the association between ultrafiltration and severity of patients diagnosed with acute renal injury with clinical complications resulting from hemodialysis. Method: A cross-sectional study was conducted in a teaching hospital in southern Brazil. We included all daily records of hemodialysis sessions of patients with acute kidney injury who underwent hemodialysis between September and November 2017. For data collection, an instrument was developed. A significance level of less than 5% was adopted. Results: The 103 patients under studywent through a total of 519 hemodialysis sessions. Most were male patients (66.7%) aged 60 years or older (51.5%). About half of the patients had mean ultrafiltration volume >1501ml (51.5%). Most were considered critical (72.8%). Among the complications, hypotension (69.9%) was the most prevalent. The performance of a higher volume of ultrafiltration was not associated with the studied complications. Patients with severity showed a higher chance of hypotension (p<0.001 and OR: 33.73). Conclusion: Hypotension during hemodialysis was a frequent complication, presented by nearly half of the patients. As it was not associated with larger ultrafiltration volumes, it is concluded that, possibly, the greater severity of the patient is an explanatory factor for the onset of this complication.

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RESUMEN Fundamento: las enfermedades neurológicas son una de las principales causas de muerte e invalidez en todo el mundo. Objetivo: identificar los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves. Métodos: se realizó un estudio retrospectivo, transversal, del 1ro de enero al 31 de diciembre 2019. El universo estuvo representado por 130 pacientes y la muestra fue de 114. Se empleó el porcentaje, suma, el chi cuadrado y el Odd Radio para identificar los factores de riesgo, con un IC de 95 %. Resultados: predominó el grupo etario de 50-59 años del sexo masculino con enfermedad cerebrovascular isquémica, aunque el mayor porcentaje de fallecidos fue por enfermedad cerebrovascular hemorrágica. Los pacientes con tratamiento quirúrgico tuvieron relación con la mortalidad, con discreto predominio de la cirugía urgente. Alrededor de la mitad de los pacientes requirieron ventilación mecánica y fue un factor pronóstico de mortalidad. Predominó la desnutrición y la obesidad. Las arritmias cardíacas, necesidad de apoyo de aminas vasoactivas, estadía promedio mayor de 14 días y las complicaciones fueron factores de pronóstico de mortalidad. Igual, el índice leucoglicémico mayor de 0,75 y APACHE II inicial mayor de 15 puntos. Predominó la puntuación Glasgow por encima de ocho puntos. Conclusiones: los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves fueron la presencia de arritmias cardíacas, necesidad de ventilación mecánica y de apoyo de aminas vasoactivas tratamiento quirúrgico, índice leucoglicémico mayor de 0,75 puntos, puntuación APACHE II inicial mayor de 15 puntos y la presencia de complicaciones.

ABSTRACT Background: neurological diseases are one of the main causes of death and disability worldwide. Objective: to identify prognostic factors related to mortality from acute non-traumatic neurological diseases in seriously ill patients. Methods: a retrospective, cross-sectional study was carried out from January 1st to December 31st, 2019. Universe was constituted of 130 patients and the sample was 114. Percentage, sum, chi-square and Odd Radio were used to identify risk factors, with an IC of 95 %. Results: the age group of 50-59 years prevailed, male with ischemic cerebrovascular disease, although the highest percentage of deaths was due to hemorrhagic cerebrovascular disease. Patients with surgical treatment were related to mortality, with a slight predominance of urgent surgery. About half of the patients required mechanical ventilation and it was a prognostic factor for mortality. Malnutrition and obesity predominated. Cardiac arrhythmias, need for vasoactive amine support, average length of stay greater than 14 days and complications were prognostic factors for mortality. Likewise, the leukoglycemic index greater than 0.75 and the initial APACHE II was greater than 15 points. The Glasgow score was above 8 points. Conclusions: the prognostic factors related to mortality from acute non-traumatic neurological diseases in severe patients were the presence of cardiac arrhythmias, need for mechanical ventilation and support for vasoactive amines, surgical treatment, leukoglycemic index greater than 0.75 points, initial APACHE II score greater than 15 points and the presence of complications.