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COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate (p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.

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AIM: to describe cases of infection of Acinetobacter baumannii (A. baumannii) in critically ill patients affected by COVID-19, admitted to an intensive care unit (ICU), using dexamethasone. METHODOLOGY: cross-sectional study conducted on patients admitted to the intensive care unit COVID-19 survey among hospitalized patients from November 2020 to March 2021. SETTING: large hospital, reference for caring for patients with COVID-19 in Bahia (Brazil). PATIENTS: a convenience sample of 22 patients admitted to the COVID ICU signed the consent form agreeing to participate in the study. Three patients were excluded for having decided to participate without signing the form. RESULTS: of the 22 patients listed, 45 % (10) had blood infection or mechanical ventilation-associated pneumonia by A. baumannii in blood cultures and/or tracheal aspirate secretion. We observed that there is a moderate correlation between the length of stay and infection by A. baumannii (Spearman's ρ; 0.592; p-value<0.005) and a strong correlation between the number of days on mechanical ventilation and infection by these bacteria (Spearman's ρ; 0.740; p-value<0.001). This percentage is higher than the value of 0.62 % of infection by A. baumannii in this ICU in the same period of the year before COVID-19 (p-value<0.0001). CONCLUSIONS: hospitals that receive patients with COVID-19 may be vulnerable to outbreaks of multi-drug resistant organisms, such as A. baumannii . It is worth reflecting on the care and operational practices in handling these patients, especially in isolation and restriction measures for those from other nosocomial areas.

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BACKGROUND & AIMS: In a scenario where food is absent or restricted, as in the case of enteral nutrition (EN), eating becomes an experience filled with different meanings in the hospitalization process. This study aimed to understand the social representations of "non-eating" experienced by patients receiving EN. METHOD: This was an empirical, qualitative, cross-sectional study. Hospitalized patients using EN for at least seven days and who were over 18 years of age participated in the study. The sample size was defined using the data saturation criterion. Patients were selected after an active search was conducted through the beds of a university hospital in the state of Minas Gerais, Brazil. The instruments used were (a) a semi-structured interview script and (b) the researcher's field journal. Data analysis was based on the thematic analysis of Braun and Clark, and the theoretical foundation was supported by the theory of social representations. RESULTS: Nine patients were interviewed and four thematic categories were identified: (1) Perceptions related to the body in the experience of enteral nutrition, (2) The place of hunger and cravings in the body, (3) The price of healing, and (4) Communication with the team. The results indicate an experience largely associated with physical sensations, recognized by patients as aversive, with a tendency to a better adaptation to EN with longer use of the tube. Patients did not perceive physical hunger while the presence of "wanting" or "craving for" food, that is, the desire to taste and experience food, was reported by all, equating it to the experience of hunger. The main difficulties experienced by patients involve the absence or loss of communication with the health team and the reduction of autonomy, both in terms of mobility and the power of participation and decision-making regarding the treatment. CONCLUSIONS: The experience of patients in EN is complex and permeated by several difficulties, such as the lack of pleasure and symbolism associated with food and eating. On the other hand, even in the face of adversity, those patients undergo treatment, to seek a "cure" for their condition. It is essential to highlight the lack of communication on the part of the health team as an important difficulty listed by the patients. These results are fundamental for the health teams to review and reconstruct the management related to the care of patients to improve their well-being.

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desnutrição é uma condição frequente em pacientes críticos. Isso pode ser acentuado devido uma oferta inadequada, por meio da nutrição enteral. Objetivo: Analisar indicadores de qualidade para identificar frequência de eventos relacionados à terapia nutricional enteral. Métodos: Estudo transversal, retrospectivo, realizado em um hospital de urgência e trauma, na cidade de Goiânia (GO), com pacientes internados em Unidades de Terapia Intensiva (UTIs), no período de outubro de 2021. A coleta de dados foi realizada por meio de prontuários eletrônicos preenchidos por profissionais médicos, enfermeiros e nutricionistas da unidade. Resultados: A adequação de volume prescrito versus volume infundido foi de 86,59%. A frequência de administração de energia resultou em 3,23% de adequação de energia. A frequência de dias de administração adequada de proteína apresentou-se adequada, correspondendo a ≥ 10% da frequência de dias de administração adequada de proteína. Conclusão: O volume prescrito versus volume infundido e dias de administração adequada de proteína apresentaram-se adequados. Houve relevantes inadequações calóricas entre calorias prescritas e calorias recebidas, sugerindo que os pacientes se encontravam com déficits energéticos importantes. Esta inadequação de ingestão calórica, caso não seja revertida, é prejudicial a estes pacientes, ocasionando diversas complicações clínicas, afetando diretamente o desfecho e/ou a alta do paciente

Malnutrition is a frequent condition in critically ill patients. This can be accentuated due to inadequate supply through enteral nutrition. Objective: To analyze quality indicators to identify the frequency of events related to enteral nutritional therapy. Methods: Cross-sectional, retrospective study, carried out in an emergency and trauma hospital, in the city of Goiânia (GO), with patients admitted to Intensive Care Units (ICUs), in the period of October 2021. Data collection was carried out through electronic medical records completed by medical professionals, nurses and nutritionists at the unit. Results: The adequacy of prescribed volume versus infused volume was 86.59%. The frequency of energy delivery resulted in 3.23% energy adequacy. The frequency of days of adequate protein administration was adequate, corresponding to ≥ 10% of the frequency of days of adequate protein administration. Conclusion: The prescribed volume versus infused volume and days of adequate protein administration were adequate. There were relevant caloric inadequacies between prescribed and received calories, suggesting that patients had significant energy deficits. This inadequacy of caloric intake, if not reversed, is harmful to these patients, causing several clinical complications, directly affecting the outcome and/or discharge of the patient

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INTRODUÇÃO: O treinamento com vibração de corpo inteiro (WBV, do inglês Whole Body Vibration) foi recentemente proposto como um método de treinamento com potencial para melhorar a composição corporal e prevenir osteoporose e perda de massa óssea.18 Nos últimos anos, alguns estudos mostraram que o WBV pode ser um modo de treinamento benéfico na força, resistência física, atividades relacionadas à mobilidade (transferência, equilíbrio e caminhada) em pacientes com esclerose múltipla19, diabetes tipo 220, doença pulmonar obstrutiva crônica21 e receptores de transplante cardíaco.22 Torna-se relevante em razão ao alto impacto na funcionalidade e consequentemente qualidade de vida dos pacientes hospitalizados. OBJETIVO: Verificar o efeito da vibração de corpo inteiro no paciente hospitalizado. MÉTODOS: Revisão de ensaios clínicos controlados randomizados (ECR) e estudo piloto nas bases de dados PubMed, Cochrane Library, Medline e PEDro. As pesquisas nas bases de dados foram realizadas através de combinações (utilizando os conectores "AND" e "OR") através das estratégias de pesquisa PICOS pacientes hospitalizados, vibração de corpo inteiro, fisioterapia, e seus respectivos correlatos em inglês: "hospitalized patients", "whole body vibration", "physiotherapy". Utilizou-se a escala PEDro com o ponto de corte ≥5 para análise da qualidade metodológica. Os critérios de elegibilidade; incluiu pacientes adultos (com idade ≥18 anos); um desenho de ensaio clínico controlado randomizado e estudo piloto; pacientes que utilizaram a vibração de corpo inteiro no âmbito hospitalar. RESULTADOS: Foram incluídos 6 artigos, publicados entre os anos 2014 e 2018, a terapia mostrou-se eficaz em pacientes hospitalizados, havendo significância em alguns desfechos TC6- 167,9 ± 117,46m para 263,45±22124,13m; p<0,001 e VEF1- 32,71 ±13,18% pred. para 3,71± 13,89%, entretanto não houve diferença estatística na PA e FC. CONCLUSÃO: O uso da vibração de corpo inteiro mostrou-se segura e viável em pacientes hospitalizados. O TC6 e o VEF1 apresentado em todos os artigos demonstraram significantes, entretanto não houve diferença estatística na PA e FC. Portanto, é necessário ensaios clínicos randomizados para investigar a eficácia e os efeitos adversos dessa terapia. Embora efeitos positivos tenham sido relatados, sugerimos outras investigações em maior escala com parâmetros controlados e protocolos bem elaborados.

INTRODUCTION: Whole Body Vibration (WBV) training was recently proposed as a training method with the potential to improve body composition and prevent osteoporosis and bone loss.18 In recent years, some studies have shown that WBV can be a beneficial training mode in strength, physical endurance, mobilityrelated activities (transfer, balance, and walking) in patients with multiple sclerosis19, type 2 diabetes20, chronic obstructive pulmonary disease21, and recipients of heart transplantation.22 It becomes relevant due to the high impact on the functionality and consequently the quality of life of hospitalized patients. OBJECTIVE: To verify the effect of whole-body vibration in hospitalized patients. METHODS: Review randomized controlled clinical trials (RCT) and a pilot study in PubMed, Cochrane Library, Medline, and PEDro databases. The searches in the databases were carried out through combinations (using the "AND" and "OR" connectors) through the search strategies PICOS hospitalized patients, whole-body vibration, physiotherapy, and their respective counterparts in English: "hospitalized patients" "whole-body vibration," "physiotherapy. The PEDro scale with a cutoff point ≥5 was used to analyze the methodological quality. Eligibility criteria; included adult patients (aged ≥18 years); a randomized controlled clinical trial and pilot study design; patients who used whole-body vibration in the hospital setting. RESULTS: Six articles published between 2014 and 2018 were included. The therapy proved to be effective in hospitalized patients, with significance in some outcomes 6MWT- 167.9 ± 117.46m to 263.45 ±22124.13m; p<0.001 and FEV1-32.71 ±13.18% pred. for 3.71 ± 13.89%, however, there was no statistical difference in BP and HR. CONCLUSION: The use of whole-body vibration proved safe and viable in hospitalized patients. The 6MWT and FEV1 presented in all articles were significant. However, there was no statistical difference in BP and HR. Therefore, randomized clinical trials are needed to investigate this therapy's efficacy and adverse effects. Although positive effects have been reported, we suggest further investigations with controlled parameters and well-designed protocols on a larger scale.

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Hyperglycemia in hospitalized patients, either with or without diabetes, is a common, serious, and costly healthcare problem. Evidence accumulated over 20 years has associated hyperglycemia with a significant increase in morbidity and mortality, both in surgical and medical patients. Based on this documented link between hyperglycemia and poor outcomes, clinical guidelines from professional organizations recommend the treatment of hospital hyperglycemia with a therapeutic goal of maintaining blood glucose (BG) levels less than 180 mg/dL. Insulin therapy remains a mainstay of glycemic management in the inpatient setting. The use of non-insulin antidiabetic drugs in the hospital setting is limited because little data are available regarding their safety and efficacy. However, information about the use of incretin-based therapy in inpatients has increased in the past 15 years. This review aims to summarize the different treatment strategies for hyperglycemia in hospitalized noncritical patients that are supported by observational studies or clinical trials with insulin and non-insulin drugs. In addition, we propose a protocol to help with the management of this important clinical problem.

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INTRODUCTION AND OBJECTIVES: Identification of asymptomatic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriers is fundamental to reach the World Health Organization objective to eradicate viral hepatitis. The aim of this study was to evaluate the HBV and HCV prevalence among patients hospitalized for a non-liver-related disease but showing increased liver enzyme values. PATIENTS AND METHODS: All consecutive patients without history of hepatic disease but showing increased amino-transferase and/or gamma-glutamil-transpeptidase levels at admission to the Internal Medicine and Surgery divisions of the Messina University Hospital from 1st January to 31st December 2019 ("study group") were tested for HBV surface antigen (HBsAg) and anti-HCV antibody. Analogously, HBsAg and anti-HCV were tested for in all the individuals with normal liver enzyme values consecutively admitted from October 1st to December 31st, 2019 ("control group"). RESULTS: Of the 332 "study group" patients, 13 (3.9%) were anti-HCV positive versus 5/306 (1.6%) patients of the "control group" (p=0.008). HCV RNA was detected in 11/13 and in 0/5 anti-HCV patients of the "study group" and "control group", respectively (p=0.001). HBsAg was detected in 5 (1.5%) "study group" patients and in none of the "control group" (p=0.03). Prevalence of diabetes, arterial hypertension, and dyslipidaemia was comparable between the two groups, whereas 75/332 (22.3%) patients of the "study group" and 34/306 (11.1%) patients of the "control group" drank > 2 alcohol units/day (p < 0.001). CONCLUSION: Testing HBsAg and anti-HCV in subjects showing increased liver enzyme values may represent an efficacious tool to identify asymptomatic carriers of hepatitis virus infections.

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RESUMEN Introducción: La alta transmisión de la COVID-19 propicia que el personal de salud contraiga la infección durante la atención a los pacientes con la probabilidad de propagarla a otros pacientes hospitalizados y compañeros de trabajo. Objetivo: Describir un brote intrahospitalario de COVID-19. Métodos: Estudio descriptivo, transversal realizado en el Hospital Universiario Clínico Quirúrgico " General Calixto García" , La Habana en marzo de 2020. Se estudiaron 545 personas entre pacientes y trabajadores. Los datos se recolectaron mediante fichas clínico-epidemiológicas e historias clínicas. Los casos se describieron según: tipo de personal de salud, servicios que atienden, sexo, síntomas, signos y comorbilidades. Se realizó una matriz de contactos y para evaluar la intensidad del brote se calculó el número reproductivo y el valor de dispersion. Resultados: De los 545 estudiados, 30 % fueron pacientes y 70 % trabajadores de siete servicios, 30 tuvieron el diagnóstico confirmado de SARS-CoV-2. Las acciones de control de foco se dirigieron a la identificacion, notificacion y aislamiento de los enfermos. La edad promedio fue de 45 años, el cuadro clínico caracterizado por tos, disnea y astenia. Las comorbilidades más frecuentes (60 %) fueron hipertensión arterial, cardiopatia isquémica y diabetes mellitus, asintomaticos 53,3 % y tres fallecidos. La tasa de ataque fue de 5,5 %. Conclusiones: Los trabajadores más afectados son los médicos y las enfermeras. La oportunidad en las acciones del control de foco y la calidad en la investigacion epidemiológica son esenciales para lograr un control efectivo.

ABSTRACT Introduction: The high transmission of COVID-19 has resulted in healthcare workers becoming infected while caring for patients and spreading the disease to other hospital patients or coworkers. Objective: To describe an in-hospital COVID-19 outbreak. Methods: A cross-sectional descriptive study conducted in March 2020 at the "General Calixto García Íñiguez" Clinical-Surgical University Hospital, Havana. The study included 545 individuals among patients and healthcare workers. The data was collected from the clinical-epidemiological profiles and the medical records. Each case was described using the following criteria: type of health worker, service provided, sex, signs, symptoms, and comorbidities. To determine the outbreak intensity, a contact matrix was created and the reproductive number and the dispersion value were calculated. Results: Of the 545 studied individuals, 30% were patients and 70% workers of seven services, 30 tested positive for SARS-CoV-2. Outbreak control actions were aimed at identifying, reporting and isolating sick individuals. The average age was 45 years. The clinical pictures was characterized by cough, dyspnea and asthenia. The most common comorbidities (60%) were hypertension, ischemic cardiopathology, and diabetes mellitus; 53.3% were asymptomatic and three people died. The attack rate was 5.5%. Conclusions: During the outbreak, medical doctors and nurses were the most affected. The timeliness of outbreak control actions and the quality of the epidemiological investigation are essential to ensure effective control.

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BACKGROUND: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

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Abstract Introduction It is now evident that the loss of smell and/or taste may be consistent accompanying symptoms of the SARS-CoV-2 infection. Objective To estimate the social behavior of recent anosmic non-hospitalized patients in the COVID-19 pandemic and to try to obtain the natural pattern in society in a cross-sectional study. Methods A cross-sectional study conducted on 4,860 patients with anosmia complaints during the COVID-19 pandemic. Patients who needed a consultation for an anosmia complaint confirmed that they had completed the survey regarding age, gender, history of general diseases, history of nasal disease, associated COVID-19 symptoms, smoking, blood group, and risk factors. Results A total of 4,860 patients with a mean age of 34.26 ± 11.91 years completed the study. There was a predominance of female patients: 3,150 (58.9%). Most patients (4,083 patients; 83%) developed sudden anosmia. In 85% (4131 patients) of the patients, a previous history of contact with anosmic patients was present. The most prevalent blood group was O (39%). In total, 67.4% of the patients underwent medical treatment. A history of unusual influenza attacks in December 2020 was reported by by 27% (1312 patients) of the patients. Conclusion Despite large diversity of behaviors among anosmic patients in the COVID-19 pandemic, we can observe a great similarity in the pattern of anosmia in non-hospitalized patients, especially in the way it spreads, the predisposing factors, and the individual recovery.

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O presente estudo tem como objetivo conhecer as principais experiências com a biblioterapia voltadas para pessoas acometidas por doenças variadas, sejam físicas e/ou mentais, ou sociais no Brasil e no exterior. Justifica-se por apresentar a função terapêutica da leitura. Sua base são os conceitos teóricos e históricos da biblioterapia, o conhecimento das principais experiências com a biblioterapia no Brasil e um comparativo entre a realidade nacional e internacional da sua utilização. Para tanto, foi feita uma pesquisa exploratória, qualitativa e bibliográfica em bases de dados nacionais e internacional (LISA) com material publicado sobre experiências que utilizassem a biblioterapia para o bem-estar do indivíduo. Desse modo, observa-se que o Brasil caminha para ampliação da utilização da terapia, enquanto outros países a utilizam nos âmbitos hospitalar, escolar, prisional, entre outros. Isso permite concluir que a biblioterapia proporciona saúde e bem-estar aos que dela fazem uso.

This study aims to find out the main experiences with bibliotherapy aimed at people affected by various diseases, whether physical and/or mental, or social in Brazil and abroad. It is justified by presenting the therapeutic function of reading. This study is based on the theoretical and historical concepts of bibliotherapy, the knowledge of the main experiences with bibliotherapy in Brazil and comparing it with the national and international reality regarding its use. To this end, it is an exploratory, qualitative and bibliographic research, which searched for published material on national and international databases (LISA) on experiences that used bibliotherapy for the well-being of the individual. Thus, it is observed that Brazil is moving towards expanding the use of therapy, while other countries use it in hospitals, schools, prisons, among others. This allows us to conclude that bibliotherapy provides health and well-being to those who use it.

Este estudio tiene como objetivo conocer las principales experiencias con biblioterapia dirigidas a personas afectadas por diversas enfermedades, físicas y/o mentales, o sociales en Brasil y en el exterior. Se justifica presentando la función terapéutica de la lectura. Este estudio se basa en los conceptos teóricos e históricos de la biblioterapia, el conocimiento de las principales experiencias con biblioterapia en Brasil y su comparación con la realidad nacional e internacional en cuanto al uso de esta terapia. Para ello, se trata de una investigación exploratoria, cualitativa y bibliográfica, que buscó material publicado en bases de datos nacionales e internacionales (LISA) sobre experiencias que utilizaron la biblioterapia para el bienestar del individuo. Así, se observa que Brasil avanza hacia la expansión del uso de la terapia, mientras que otros países la utilizan en diversos nichos, como hospital, escuela, prisión, entre otros. Esto nos permite concluir que la biblioterapia brinda salud y bienestar a quienes la utilizan.

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Introduction It is now evident that the loss of smell and/or taste may be consistent accompanying symptoms of the SARS-CoV-2 infection. Objective To estimate the social behavior of recent anosmic non-hospitalized patients in the COVID-19 pandemic and to try to obtain the natural pattern in society in a cross-sectional study. Methods A cross-sectional study conducted on 4,860 patients with anosmia complaints during the COVID-19 pandemic. Patients who needed a consultation for an anosmia complaint confirmed that they had completed the survey regarding age, gender, history of general diseases, history of nasal disease, associated COVID-19 symptoms, smoking, blood group, and risk factors. Results A total of 4,860 patients with a mean age of 34.26 ± 11.91 years completed the study. There was a predominance of female patients: 3,150 (58.9%). Most patients (4,083 patients; 83%) developed sudden anosmia. In 85% (4131 patients) of the patients, a previous history of contact with anosmic patients was present. The most prevalent blood group was O (39%). In total, 67.4% of the patients underwent medical treatment. A history of unusual influenza attacks in December 2020 was reported by by 27% (1312 patients) of the patients. Conclusion Despite large diversity of behaviors among anosmic patients in the COVID-19 pandemic, we can observe a great similarity in the pattern of anosmia in non-hospitalized patients, especially in the way it spreads, the predisposing factors, and the individual recovery.

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INTRODUCTION: For the pharmacotherapy of delirium in elderly adults who are hospitalized, atypical antipsychotics are used. Currently, there is insufficient evidence on the effectiveness of this treatment in low complexity units. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE/PubMed, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 13 systematic reviews that included three randomized trials. We concluded that the use of atypical antipsychotics in hospitalized patients likely increases the risk of mortality compared to placebo and could decrease the response rate associated with reducing the risk of adverse effects. Furthermore, using atypical antipsychotics probably results in low or no difference in the severity of delirium.

INTRODUCCIÓN: Para el tratamiento farmacológico de delirium en pacientes adultos mayores hospitalizados se plantea el uso de antipsicóticos atípicos. Actualmente, existe poca evidencia sobre la efectividad y los resultados de estos fármacos en pacientes adultos hospitalizados en unidades de baja complejidad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE y Cochrane. Extrajimos los datos desde las revisiones sistemáticas identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 13 revisiones sistemáticas que en conjunto incluyeron tres estudios primarios, de los cuales todos corresponden a ensayos aleatorizados. Concluimos que el uso de antipsicóticos atípicos en pacientes hospitalizados probablemente aumenta el riesgo de mortalidad en comparación con el placebo, y podría disminuir la tasa de respuesta asociado a disminuir el riesgo de efectos adversos. Además, probablemente resulta en poca o nula diferencia en la severidad del delirium.

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Cada año, unas 800 mil personas mueren por suicidio. Dada la importancia del estudio de la conducta suicida para la salud pública en general, y para la salud mental en particular, y habida cuenta de su alta frecuencia, se consideró oportuno realizar esta investigación con el objetivo de caracterizar a los pacientes con conducta suicida, que recibieron atención médica en un hospital universitario. Este fue un estudio descriptivo, con muestreo no probabilístico, de casos consecutivos. Se incluyó a 127 pacientes que estuvieron hospitalizados en el Servicio de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción, Paraguay, entre 2014 y 2018. El 78% de la muestra era del sexo femenino, con una media de edad de 29±13 años. El 28,16% de los pacientes presentó conducta suicida. En cuanto a los diagnósticos psiquiátricos que poseían estos pacientes, la mayor frecuencia fue para el trastorno límite de la personalidad (43,3%), seguido por trastorno depresivo mayor (18,9%). El 53,5% de los pacientes tenía antecedentes de algún intento previo de suicidio. Los métodos más utilizados fueron ingesta de medicación (42,5%), ahorcamiento (16,5%) y cortes en el antebrazo (11,8%). Los resultados encontrados coinciden con la literatura médica e investigaciones al respecto y sirven para caracterizar a esta población, sin embargo, se deben tener en cuenta las limitaciones propias del diseño del presente estudio. Conocer las características principales de aquellas personas con conducta suicida permite a profesionales de la salud estimar el riesgo vital y establecer planes de atención

Each year about 800 thousand people die from suicide. Given the importance of the study of suicidal behavior for public health in general, and for mental health in particular, and given its high frequency, it was considered appropriate to conduct this research in order to characterize patients with suicidal behavior, who received medical attention at a university hospital. This was a descriptive study, with non-probabilistic sampling, of consecutive cases. One hundred twenty-seven patients who were hospitalized, between 2014 and 2018, in the Psychiatry Service of the Hospital de Clínicas of the National University of Asunción, Paraguay, were included. Seventy eight percent of the sample was female, with a mean age of 29±13 years while 28.16% of the patients presented suicidal behavior. As for the psychiatric diagnoses that these patients possessed, the highest frequency was for borderline personality disorder (43.3%), followed by major depressive disorder (18.9%). Fifty-three-point five percent of the patients had a history of some previous suicide attempt. The most used methods were medication intake (42.5%), hanging (16.5%) and cuts in the forearm (11.8%). The results coincide with the medical literature and research in this regard and serve to characterize this population, however, the limitations of the design of the present study must be considered. Knowing the main characteristics of those with suicidal behavior allows health professionals to estimate life risk and establish care plans

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BACKGROUND & AIMS: Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. METHODS: The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24-48 h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. RESULTS: Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy-a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. CONCLUSIONS: Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.

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Objetivo: Verificar a prevalência de infecções bucais em ambiente hospitalar no período de 13 meses. Materiais e métodos: Estudo transversal, realizado no Centro de Terapia Intensiva (CTI) e na Clínica Neurológica da Santa Casa de Caridade de Diamantina, Minas Gerais, Brasil. Foram analisados todos os dados referentes às infecções bucais e hospitalares, ocorridas no período de março de 2017 a março de 2018, obtidos pela Comissão de Controle de Infecção Hospitalar da instituição. A população estudada compreendeu todos os pacientes desses setores, com idade acima de 16 anos, de ambos os sexos e que tiveram infecção bucal após 48 horas de internação. Resultados: Dentro do total de 2.703 pacientes a prevalência de infecção bucal foi de 1,15% (n=31) dentro do período de 13 meses, sendo a candidíase de maior ocorrência. A prevalência de infecção hospitalar foi de 2,85%. Conclusão: A prevalência das infecções bucais foi maior no CTI, em comparação à Clínica Neurológica, sendo a infecção mais prevalente a candidíase oral. Sugere-se maior atenção à saúde bucal dos pacientes hospitalizados, diante da maior vulnerabilidade dosmesmos às infecções bucais

Aim: To verify the oral infections prevalence in a hospital environment within a period of 13 months. Materials and methods: A cross-sectional study was carried out at the Intensive Care Center and Neurological Clinic of Santa Casa de Caridade, in Diamantina,Minas Gerais, Brasil. All data referring to oral and hospital infections occurred in the period from March 2017 to March 2018 were obtained. The research source was the Hospital Infection Control Committee of the institution. The sample comprised all the patients of these sectors, aged over 16 years, of both genders and who had oral infection after 48 hours of hospitalization. Results: Within 2703 patients, the oral infection prevalence was 1.15% (n=31) within 13 months, being candidiasis the most frequent. The prevalence of nosocomial infection was 2.85%. Conclusion:The prevalence of oral infections was higher in the Intensive Care Center compared to Neurological Clinic, being candidiasis the most common oral infection. More attention should be given tothe hospitalized patients's oral health, considering their greater vulnerability to oral infections

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Frailty syndrome encompasses several physical hallmarks such as loss of muscle strength, power output and mass, which leads to poor gait ability, fatigue, falls and overall difficulty to perform activities of daily living. On the other hand, physical exercise interventions induce marked improvements in frailty physical hallmarks (e.g., gait ability, muscle strength, balance and falls). In addition, because cognitive impairment is closely related to frailty syndrome, exercise is an effective intervention to counteract the physical consequences of mild cognitive impairment and dementia. Moreover, exercise and early rehabilitation programs are among the interventions through which functional decline is prevented in older patients during acute hospitalization. This narrative review provides a summary of the effectiveness of different exercise interventions in the hallmarks of frailty. Furthermore, this review addresses special considerations on exercise in frail older with cognitive impairment. Also, we review the role of exercise interventions in acute hospitalized older patients. There is strong evidence that exercise training is an effective intervention for improving muscle strength, muscle mass, incidence of falls, and gait ability in frail older adults. In addition, it seems that multicomponent exercise intervention programs including resistance, gait and balance training is the best strategy for improving the frailty hallmarks, as well as for reducing the rate of falls in frail individuals, and so maintaining their functional capacity during aging. This training modality also proved to be safe and effective to revert the functional decline and cognitive impairment in acutely hospitalized older adults of advanced age. Based on the association between muscle power output and physical function, explosive resistance training should be included in the exercise intervention in order to optimize the functional outcomes in frail older adults.

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BACKGROUND: Influenza A H1N1 infections carry a significant mortality risk. This study describes inpatients with suspected and confirmed Influenza A H1N1 infection who were prescribed oseltamivir, the risk factors associated with infection, the association between infection and mortality, and the factors associated with in-hospital mortality in infected patients. METHODS: This study was a matched case-control study of hospitalized patients who underwent real-time polymerase chain reaction testing for Influenza A H1N1 and were treated with oseltamivir from 2009 to 2015 in a tertiary care hospital. Cases (patients with positive Influenza A H1N1 testing) were matched 1:1 to controls (patients with negative test results). RESULTS: A total of 1405 inpatients who underwent PCR testing and received treatment with oseltamivir were identified in our study and 157 patients confirmed Influenza A H1N1. Almost one third of patients with Influenza A H1N1 were diagnosed in the pandemic period. There was no difference in mortality between cases and controls. Immunocompromised status, requirement of vasoactive drugs, mechanical ventilation, acute hemodialysis, albumin administration, surgical procedures and thoracic procedures and length of stay were associated with increased risk of death in Influenza A H1N1 infected patients. CONCLUSIONS: We found no increased risk of mortality for patients with proven Influenza A H1N1 when compared to similar patients without confirmed Influenza.

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The aim of this study was to evaluate the frequency of Candida species between a non-hospitalized and a hospitalized population. For this purpose, samples of saliva were sampled through sterile swabs, moistened in peptone water and rubbed in the oral cavity of 140 individuals, from which, 70 were hospitalized patients from the Medical Clinic of a Teaching Hospital and the other 70 were non-hospitalized subjects. All saliva samples were plated in Sabouraud Dextrose agar added with Chloramphenicol and incubated at 36 °C for 48 hours. The morphology identification was performed through macroscopic and microscopic characterization, the CHROMagar Candida medium and the VITEK® system Yeast Biochemical Card (bio Mérieux SA, France). The results showed a colonization of Candida spp. in 85.7% the hospitalized individuals, where the species found were C. albicans (60%), C. tropicalis (23.4%), C. krusei (3.3%) and Candida spp. (13.3%). In the non-hospitalized individuals the colonization by Candida spp was 47.1%, and the species found were: C. albicans (45.5%), C.krusei (9.1%), C. guilliermondii (9.1% %), C. tropicalis (3.0%), C. famata (3.0%) and Candida spp. (30.3%). In spite of their presence in oral cavity in both groups, Candida spp. was more frequently isolated in hospitalized individuals, who were 6.73 times more likely to have this fungus in the oral cavity and were 3.88 times more likely to have Candida albicans.(AU)

O objetivo deste estudo foi avaliar a frequência de espécies de Candida entre uma população de indivíduos não-hospitalizados e hospitalizados. Para isto, amostras de saliva foram coletadas através de swabs estéreis, umedecidas em água de peptona e friccionadas na cavidade bucal de 140 indivíduos, dos quais 70 eram pacientes internados em uma Clínica Médica de um Hospital Escola e os outros 70 eram indivíduos não hospitalizados sem contato com ambiente hospitalar. Todas as amostras de saliva foram plaqueadas em ágar Sabouraud dextrose adicionadas de cloranfenicol e incubadas a 36 °C durante 48 horas. A identificação morfológica foi realizada através da caracterização macroscópica e microscópica, com o meio CHROMagar Candida e do sistema VITEK® Biochemical Card (bio Mérieux SA, França). Os resultados mostraram uma colonização de Candida spp. em 85,7% dos indivíduos hospitalizados, onde as espécies encontradas foram: C.albicans (60%), C. tropicalis (23,4%), C. krusei (3,3%) e Candida spp. (13,3%). Nos indivíduos não-hospitalizados a colonização por Candida spp foi de 47,1%, e as espécies encontradas foram: C. albicans (45,5%), C. krusei (9,1%), C. guilliermondii (9,1%), C. tropicalis (3,0%), C. famata (3,0%) e Candida spp. (30,3%). Apesar de sua presença na cavidade oral em ambos os grupos, Candida spp. foi mais freqüentemente isolada em indivíduos hospitalizados, que foram 6,73 vezes mais propensos a ter este fungo na cavidade oral e foram 3,88 vezes mais propensos a ter Candida albicans.(AU)

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