Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.01
Gabriela Urman, Adriana Pistochini, María Laura Ferri, Ivianna Sarmiento, Arnoldo Grosman
Objective: To analyze child oral health training background, habits and knowledge in a group of pediatric graduate students and recently graduated pediatricians. Materials and methods: A descriptive study using an anonymous self-administered 18-item survey sent via Google Forms to students and graduates of a master’s program in Pediatrics from Universidad Maimonides in the Autonomous City of Buenos Aires, Argentina. Results: Sixty participants completed the survey: 80 % were women, most of them with no children, who were pursuingone of the three years of a master’s program or had less than two years of clinical experience. Out of the respondents, 78.9 % did not usually record information on oral health in the patients’ medical records, and 72 % failed to establish the prevalence of cavities in relation to other childhood illnesses. Misconceptions were also found regarding cavities etiology. A total of 67.2 % have had no prior oral health training, and those who had had such training stated that it had been insufficient. The self-perception to carry out preventive actions was uneven, and difficulties were identified for the early detection of dental disease. Sixty percent were unable to establish the right amount of toothpaste recommended for a child and felt unprepared to offer advice on the right brushing technique. Likewise, in the sample there were no correctand uniform criteria for the first visit of healthy children to pediatric dentists. Conclusions: As stated by other authors, deficiencies were found in pediatric graduate students’ and recently graduated pediatricians’ training and, therefore, self-perception of topics related to oral health. Despite the difficulties participants identified, they agreed on the key role pediatricians play in oral health prevention and its impact on children’s quality of life.
{"title":"Conocimientos y conductas de estudiantes de posgrado de Pediatría y pediatras sobre la salud bucodental infantil","authors":"Gabriela Urman, Adriana Pistochini, María Laura Ferri, Ivianna Sarmiento, Arnoldo Grosman","doi":"10.24265/horizmed.2023.v23n3.01","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.01","url":null,"abstract":"Objective: To analyze child oral health training background, habits and knowledge in a group of pediatric graduate students and recently graduated pediatricians. Materials and methods: A descriptive study using an anonymous self-administered 18-item survey sent via Google Forms to students and graduates of a master’s program in Pediatrics from Universidad Maimonides in the Autonomous City of Buenos Aires, Argentina. Results: Sixty participants completed the survey: 80 % were women, most of them with no children, who were pursuingone of the three years of a master’s program or had less than two years of clinical experience. Out of the respondents, 78.9 % did not usually record information on oral health in the patients’ medical records, and 72 % failed to establish the prevalence of cavities in relation to other childhood illnesses. Misconceptions were also found regarding cavities etiology. A total of 67.2 % have had no prior oral health training, and those who had had such training stated that it had been insufficient. The self-perception to carry out preventive actions was uneven, and difficulties were identified for the early detection of dental disease. Sixty percent were unable to establish the right amount of toothpaste recommended for a child and felt unprepared to offer advice on the right brushing technique. Likewise, in the sample there were no correctand uniform criteria for the first visit of healthy children to pediatric dentists. Conclusions: As stated by other authors, deficiencies were found in pediatric graduate students’ and recently graduated pediatricians’ training and, therefore, self-perception of topics related to oral health. Despite the difficulties participants identified, they agreed on the key role pediatricians play in oral health prevention and its impact on children’s quality of life.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135958516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.00
Arturo Pareja Cruz
Durante siglos, los humanos hemos buscado formas de protegernos contra enfermedades mortales. Desde experimentos y oportunidades hasta el lanzamiento mundial de vacunas en medio de una pandemia, la inmunización posee una largahistoria. Las vacunas se han convertido en los mejores “salvavidas” para la humanidad frente a cualquier otro invento en medicina durante la historia del hombre (1).Desde el punto de vista histórico, desde el siglo XV, el hombre ha intentado prevenir diversas enfermedades contagiosas,por ejemplo, cuando se expuso intencionalmente la viruela a personas sanas, una práctica conocida como variolización. Algunas fuentes históricas sugieren que estas prácticas ya se ensayaban en el año 200 a. C. en China. En 1796, el médico inglés Edward Jenner inoculó el material recogido de una lesión de viruela bovina al niño James Phipps, de 8 años. A pesar de que le provocó una reacción local y se sintió mal durante varios días, el niño se recuperó por completo (1,2).
{"title":"Vacunas y pandemia, ¿qué aprendimos?","authors":"Arturo Pareja Cruz","doi":"10.24265/horizmed.2023.v23n3.00","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.00","url":null,"abstract":"Durante siglos, los humanos hemos buscado formas de protegernos contra enfermedades mortales. Desde experimentos y oportunidades hasta el lanzamiento mundial de vacunas en medio de una pandemia, la inmunización posee una largahistoria. Las vacunas se han convertido en los mejores “salvavidas” para la humanidad frente a cualquier otro invento en medicina durante la historia del hombre (1).Desde el punto de vista histórico, desde el siglo XV, el hombre ha intentado prevenir diversas enfermedades contagiosas,por ejemplo, cuando se expuso intencionalmente la viruela a personas sanas, una práctica conocida como variolización. Algunas fuentes históricas sugieren que estas prácticas ya se ensayaban en el año 200 a. C. en China. En 1796, el médico inglés Edward Jenner inoculó el material recogido de una lesión de viruela bovina al niño James Phipps, de 8 años. A pesar de que le provocó una reacción local y se sintió mal durante varios días, el niño se recuperó por completo (1,2).","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.03
Alberto Guevara Tirado
Objective: To determine the risk of death from underlying congestive heart failure among Peruvian patients with anemia. Materials and methods: An observational, descriptive, case-control and retrospective study based on data from theSistema Informático Nacional de Defunciones (SINADEF - National Death Computer System) of the Ministry of Health of Peru (MINSA) and conducted between January 2021 and August 2022. A non-probability purposive convenience sampling wasused considering the inclusion and exclusion criteria. All patients with and without anemia who died from congestive heart failure or other comorbidities were included in the research, totaling 35,724 people. The variables were anemia, defined as a condition related to the amount or number of red blood cells and hemoglobin, as well as to iron absorption and availability, and congestive heart failure, defined as the inability of the myocardium to pump blood efficiently. Chi-square test and phi and Cramer’s V coefficients were used to determine the presence and degree of association of the variables and the odds ratio for risk estimation. A significant p value less than 0.05 with a 95 % confidence interval was considered. Results: Anemia was moderately associated with congestive heart failure: 62.80 % of people with anemia died from this disease.The variables were statistically related and, according to phi and Cramer’s V coefficients, there was a moderate relationship. People with anemia had 11.14 times higher risk of dying from congestive heart failure than people with other comorbidities.
{"title":"Riesgo de muerte por insuficiencia cardiaca congestiva en pacientes anémicos de la población peruana","authors":"Alberto Guevara Tirado","doi":"10.24265/horizmed.2023.v23n3.03","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.03","url":null,"abstract":"Objective: To determine the risk of death from underlying congestive heart failure among Peruvian patients with anemia. Materials and methods: An observational, descriptive, case-control and retrospective study based on data from theSistema Informático Nacional de Defunciones (SINADEF - National Death Computer System) of the Ministry of Health of Peru (MINSA) and conducted between January 2021 and August 2022. A non-probability purposive convenience sampling wasused considering the inclusion and exclusion criteria. All patients with and without anemia who died from congestive heart failure or other comorbidities were included in the research, totaling 35,724 people. The variables were anemia, defined as a condition related to the amount or number of red blood cells and hemoglobin, as well as to iron absorption and availability, and congestive heart failure, defined as the inability of the myocardium to pump blood efficiently. Chi-square test and phi and Cramer’s V coefficients were used to determine the presence and degree of association of the variables and the odds ratio for risk estimation. A significant p value less than 0.05 with a 95 % confidence interval was considered. Results: Anemia was moderately associated with congestive heart failure: 62.80 % of people with anemia died from this disease.The variables were statistically related and, according to phi and Cramer’s V coefficients, there was a moderate relationship. People with anemia had 11.14 times higher risk of dying from congestive heart failure than people with other comorbidities.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.10
Jorge Luis Wong-Armas, César-Justo Obregón-Manzur, Bruce-Jorge Wong-Ramírez, Tian-Hanayka-Del Carmen Wong-Ramírez, Carlos-Alberto Ortiz-Castillo
This report describes the case of two male HIV-positive patients who were not receiving treatment and whose diagnosis was confirmed by serology testing. Both patients developed midbrain stroke syndrome and the structural injury, whichwas caused by a central nervous system infection due to cerebral toxoplasmosis, was verified by brain magnetic resonance imaging. This condition was confirmed by cerebrospinal fluid serology testing.Weber’s syndrome is a very rare type of midbrain stroke syndrome with little information available on its symptoms and evolution. It was first described by Sir Herman David Weber in 1863 and is characterized by ipsilateral injury of the third cranial nerve fascicle with contralateral hemiparesis due to injury of the corticospinal and corticobulbar tracts of the cerebral peduncle. Its causes range from ischemic or hemorrhagic processes, which damage the third cranial nerve fascicle and cerebral peduncle, to brain tumors, aneurysms, extradural hematomas and infectious diseases that behave like spreading processes.The assessed patients showed clinical signs and symptoms such as ptosis; vertical double vision; difficulty standing up; hemiparesis; hyporeflexia; decreased superficial and deep sensation; poor balance and coordination; third cranial nervepalsy; slurred speech; intermittent disorientation in time, place and person; and facial asymmetry. Oral trimethoprim-
{"title":"Síndrome alterno mesencefálico: síndrome de Weber en dos pacientes varones VIH positivos con toxoplasmosis cerebral","authors":"Jorge Luis Wong-Armas, César-Justo Obregón-Manzur, Bruce-Jorge Wong-Ramírez, Tian-Hanayka-Del Carmen Wong-Ramírez, Carlos-Alberto Ortiz-Castillo","doi":"10.24265/horizmed.2023.v23n3.10","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.10","url":null,"abstract":"This report describes the case of two male HIV-positive patients who were not receiving treatment and whose diagnosis was confirmed by serology testing. Both patients developed midbrain stroke syndrome and the structural injury, whichwas caused by a central nervous system infection due to cerebral toxoplasmosis, was verified by brain magnetic resonance imaging. This condition was confirmed by cerebrospinal fluid serology testing.Weber’s syndrome is a very rare type of midbrain stroke syndrome with little information available on its symptoms and evolution. It was first described by Sir Herman David Weber in 1863 and is characterized by ipsilateral injury of the third cranial nerve fascicle with contralateral hemiparesis due to injury of the corticospinal and corticobulbar tracts of the cerebral peduncle. Its causes range from ischemic or hemorrhagic processes, which damage the third cranial nerve fascicle and cerebral peduncle, to brain tumors, aneurysms, extradural hematomas and infectious diseases that behave like spreading processes.The assessed patients showed clinical signs and symptoms such as ptosis; vertical double vision; difficulty standing up; hemiparesis; hyporeflexia; decreased superficial and deep sensation; poor balance and coordination; third cranial nervepalsy; slurred speech; intermittent disorientation in time, place and person; and facial asymmetry. Oral trimethoprim-","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.09
Luis Lopez Chau, Michael Kabar
Transcranial magnetic stimulation (TMS) is a noninvasive technique that uses magnetic fields to stimulate neurons in the cerebral cortex.While electricity has previously been intended to be used in the medical field, the history of TMS dates back to the discovery of electromagnetic induction by Faraday in the 19th century. However, it was not until the 1980s when Anthony Barker developed the first TMS device at the University of Sheffield.TMS works by means of a coil placed against the scalp, thereby producing a magnetic field. This magnetic field can pass through the skull and stimulate cortical neurons. The intensity and frequency of the magnetic field can be adjusted to target specific areas of the brain and produce excitatory and inhibitory effects.The principles of TMS are based on the concept of neuroplasticity, which refers to the brain’s ability to change and adapt in response to new experiences and stimuli. By stimulating neurons in the brain with TMS, it is possible to cause changes in neuronal activity and connectivity, which in turn can lead to cognitive and mood changes.
{"title":"Historia y principios básicos de la estimulación magnética transcraneal","authors":"Luis Lopez Chau, Michael Kabar","doi":"10.24265/horizmed.2023.v23n3.09","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.09","url":null,"abstract":"Transcranial magnetic stimulation (TMS) is a noninvasive technique that uses magnetic fields to stimulate neurons in the cerebral cortex.While electricity has previously been intended to be used in the medical field, the history of TMS dates back to the discovery of electromagnetic induction by Faraday in the 19th century. However, it was not until the 1980s when Anthony Barker developed the first TMS device at the University of Sheffield.TMS works by means of a coil placed against the scalp, thereby producing a magnetic field. This magnetic field can pass through the skull and stimulate cortical neurons. The intensity and frequency of the magnetic field can be adjusted to target specific areas of the brain and produce excitatory and inhibitory effects.The principles of TMS are based on the concept of neuroplasticity, which refers to the brain’s ability to change and adapt in response to new experiences and stimuli. By stimulating neurons in the brain with TMS, it is possible to cause changes in neuronal activity and connectivity, which in turn can lead to cognitive and mood changes.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.11
Roberth Nixon Moreno Muñoz, Richard Adrián Vergara Trujillo, German Andrés Guevara Lizarazo, Patrick Junior Brett Cano, Dalila Andrea León Cuervo, Adriana Marcela Puerta Lidueñas, Mariana Sarmiento Figueroa, Michael Ortega Sierra
Cerebrovascular disorders remain the leading cause of neurological morbidity and mortality in the world, representing one of the pathological entities responsible for the greatest burden of disease worldwide. Carotid atherosclerosis or stenosis is a potential risk factor for ischemic stroke. The identification and strict follow-up of this condition are essential in the secondary prevention of complications through primary care and the specialized treatment of cardiometabolicrisk. However, depending on this risk and/or presence of symptoms, definitive treatment is necessary. Currently, there is controversy as to whether asymptomatic carotid stenosis is better to be treated medically or surgically. Consideringthe significance of such entity, this review aims to analyze recent evidence on the risk of ischemic stroke in the case of asymptomatic carotid atherosclerosis among adults, as well as the potential benefit of the surgical vs. pharmacologicaltreatment for this condition. For this purpose, a literature search for publications up to 2023 was carried out in PubMed, ScienceDirect, Web of Science and MEDLINE databases. It was shown that there is a significant risk of stroke associated with asymptomatic carotid stenosis (> 10 % approximately), even in patients with active antiplatelet and lipid-lowering therapy. Out of all those who receive medical treatment, around 80 % had a five-year survival rate. However, stenosisprogression occurs on average in more than 60 % of the cases and is significant. On the other hand, carotid stenting and endarterectomy are curative interventions. Nevertheless, these procedures involve a higher risk compared to the medicaltherapy during the peri- and postoperative period, as well as 30 days afterwards, due to the occurrence or recurrence of stroke, acute myocardial infarction or death from any cause. Despite this, the use of endarterectomy has shown superiorlong-term benefits concerning these same outcomes. Thus, evidence regarding the superiority of surgical treatment compared to pharmacological treatment for asymptomatic carotid atherosclerosis or stenosis is heterogeneous. However, it seems that surgical treatment, specifically endarterectomy, could have a significant impact on the occurrence orrecurrence of ipsilateral stroke and death in the long term but with controversial peri- and postoperative outcomes.
脑血管疾病仍然是世界上神经系统发病和死亡的主要原因，是造成世界上最大疾病负担的病理实体之一。颈动脉粥样硬化或狭窄是缺血性中风的潜在危险因素。这种情况的识别和严格随访对于通过初级保健和心脏代谢风险的专门治疗进行并发症的二级预防至关重要。然而，根据这种风险和/或症状的存在，明确的治疗是必要的。目前，对于无症状性颈动脉狭窄是采用药物治疗还是手术治疗存在争议。考虑到这种实体的重要性，本综述旨在分析成人无症状颈动脉粥样硬化病例缺血性卒中风险的最新证据，以及手术治疗与药物治疗的潜在益处。为此，在PubMed、ScienceDirect、Web of Science和MEDLINE数据库中检索了截至2023年的出版物。研究表明，无症状颈动脉狭窄与卒中的风险显著相关(>(约10%)，即使在积极抗血小板和降脂治疗的患者中也是如此。在所有接受治疗的患者中，约80%的患者有5年生存率。然而，平均超过60%的病例发生狭窄进展，并且是显著的。另一方面，颈动脉支架置入术和动脉内膜切除术是治疗性干预措施。然而，由于中风、急性心肌梗死或任何原因导致的死亡的发生或复发，与药物治疗相比，这些手术在围手术期和术后以及术后30天内的风险更高。尽管如此，在这些相同的结果中，使用动脉内膜切除术显示出优越的长期益处。因此，关于无症状颈动脉粥样硬化或狭窄的手术治疗优于药物治疗的证据是不一致的。然而，手术治疗，特别是动脉内膜切除术，可能对同侧卒中的发生或复发以及长期死亡产生重大影响，但其围手术期和术后预后存在争议。
{"title":"Riesgo de accidente cerebrovascular en pacientes con aterosclerosis carotídea asintomática: ¿se debe tratar médicamente o quirúrgicamente?","authors":"Roberth Nixon Moreno Muñoz, Richard Adrián Vergara Trujillo, German Andrés Guevara Lizarazo, Patrick Junior Brett Cano, Dalila Andrea León Cuervo, Adriana Marcela Puerta Lidueñas, Mariana Sarmiento Figueroa, Michael Ortega Sierra","doi":"10.24265/horizmed.2023.v23n3.11","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.11","url":null,"abstract":"Cerebrovascular disorders remain the leading cause of neurological morbidity and mortality in the world, representing one of the pathological entities responsible for the greatest burden of disease worldwide. Carotid atherosclerosis or stenosis is a potential risk factor for ischemic stroke. The identification and strict follow-up of this condition are essential in the secondary prevention of complications through primary care and the specialized treatment of cardiometabolicrisk. However, depending on this risk and/or presence of symptoms, definitive treatment is necessary. Currently, there is controversy as to whether asymptomatic carotid stenosis is better to be treated medically or surgically. Consideringthe significance of such entity, this review aims to analyze recent evidence on the risk of ischemic stroke in the case of asymptomatic carotid atherosclerosis among adults, as well as the potential benefit of the surgical vs. pharmacologicaltreatment for this condition. For this purpose, a literature search for publications up to 2023 was carried out in PubMed, ScienceDirect, Web of Science and MEDLINE databases. It was shown that there is a significant risk of stroke associated with asymptomatic carotid stenosis (> 10 % approximately), even in patients with active antiplatelet and lipid-lowering therapy. Out of all those who receive medical treatment, around 80 % had a five-year survival rate. However, stenosisprogression occurs on average in more than 60 % of the cases and is significant. On the other hand, carotid stenting and endarterectomy are curative interventions. Nevertheless, these procedures involve a higher risk compared to the medicaltherapy during the peri- and postoperative period, as well as 30 days afterwards, due to the occurrence or recurrence of stroke, acute myocardial infarction or death from any cause. Despite this, the use of endarterectomy has shown superiorlong-term benefits concerning these same outcomes. Thus, evidence regarding the superiority of surgical treatment compared to pharmacological treatment for asymptomatic carotid atherosclerosis or stenosis is heterogeneous. However, it seems that surgical treatment, specifically endarterectomy, could have a significant impact on the occurrence orrecurrence of ipsilateral stroke and death in the long term but with controversial peri- and postoperative outcomes.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.06
Aurora Ruiz, Silvia Makhoul, M. Teresa Carnuccio, Simón Salzberg, Alejandro Pellegrini, Enrique Gayet, Brenda Mangariello, Francisco Paulin
Objective: To evaluate the prevalence and characteristics of “de novo” cardiovascular findings (DNCFs) among post-COVID patients based on a basic cardiovascular diagnostic procedure. Moreover, to describe the patients’ results obtained by means of different diagnostic methods, to determine the clinical variables associated with DNCFs during the examination and, finally, to find out the diagnostic value of different data from the medical records (MRs). Materials and methods: Patients aged > 18 years who had COVID-19 either at the hospital or at home were evaluated by clinical interviews, physical examination, electrocardiogram (EKG), echocardiogram, routine lab tests and cardiac biomarkers between 30 and 120 days after discharge. A total of 246 patients (age: 52 ± 13 years; women: 48 %; mild, moderate and severe COVID-19: 37 %, 39 % and 24 %, respectively) were included in the study. Twenty-four percent of the population were asymptomatic at the time of the evaluation. In those patients who developed symptoms, dyspnea was the most frequent one (28 %). Interviews were the method with the highest index of suspicion (45 %). Physical examination, EKG, echocardiogram and biomarkers showed normal values among 61 %, 60 %, 75 % and 96 % of the patients, respectively. Results: DNCFs were found in 62 patients (25.2 %): heart rhythm disorders in 42 (17 %) and ventricular dysfunction in 20 (8 %). Five patients had coronary artery disease, six had myocarditis and two had valvular heart disease. In addition, post-COVID pulmonary embolism (PE) was detected in 10 patients, six of whom (2.4 %) had to be rehospitalized. Furthermore, in a multivariate analysis, the independent predictive variables of DNCFs were prior history of chronic obstructive pulmonary disease (COPD), QTc > 440 msec, leukocytosis and intra-COVID cardiovascular complication. MRs showed both low sensitivity and positive predictive value for DNCFs. Conclusions: Although DNCFs were observed in 25 % of the population, only 2 % were significant. According to the data collected from this diagnostic procedure and in this time frame, special attention should be paid to patients with prior history of COPD and/or cardiovascular complications during the acute stage and/or prolonged QTc interval. Post-COVID symptoms were of limited value for the diagnosis of arrhythmias or ventricular dysfunction.
{"title":"Observaciones a partir del registro de evaluación cardiológica pos-COVID-19","authors":"Aurora Ruiz, Silvia Makhoul, M. Teresa Carnuccio, Simón Salzberg, Alejandro Pellegrini, Enrique Gayet, Brenda Mangariello, Francisco Paulin","doi":"10.24265/horizmed.2023.v23n3.06","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.06","url":null,"abstract":"Objective: To evaluate the prevalence and characteristics of “de novo” cardiovascular findings (DNCFs) among post-COVID patients based on a basic cardiovascular diagnostic procedure. Moreover, to describe the patients’ results obtained by means of different diagnostic methods, to determine the clinical variables associated with DNCFs during the examination and, finally, to find out the diagnostic value of different data from the medical records (MRs). Materials and methods: Patients aged > 18 years who had COVID-19 either at the hospital or at home were evaluated by clinical interviews, physical examination, electrocardiogram (EKG), echocardiogram, routine lab tests and cardiac biomarkers between 30 and 120 days after discharge. A total of 246 patients (age: 52 ± 13 years; women: 48 %; mild, moderate and severe COVID-19: 37 %, 39 % and 24 %, respectively) were included in the study. Twenty-four percent of the population were asymptomatic at the time of the evaluation. In those patients who developed symptoms, dyspnea was the most frequent one (28 %). Interviews were the method with the highest index of suspicion (45 %). Physical examination, EKG, echocardiogram and biomarkers showed normal values among 61 %, 60 %, 75 % and 96 % of the patients, respectively. Results: DNCFs were found in 62 patients (25.2 %): heart rhythm disorders in 42 (17 %) and ventricular dysfunction in 20 (8 %). Five patients had coronary artery disease, six had myocarditis and two had valvular heart disease. In addition, post-COVID pulmonary embolism (PE) was detected in 10 patients, six of whom (2.4 %) had to be rehospitalized. Furthermore, in a multivariate analysis, the independent predictive variables of DNCFs were prior history of chronic obstructive pulmonary disease (COPD), QTc > 440 msec, leukocytosis and intra-COVID cardiovascular complication. MRs showed both low sensitivity and positive predictive value for DNCFs. Conclusions: Although DNCFs were observed in 25 % of the population, only 2 % were significant. According to the data collected from this diagnostic procedure and in this time frame, special attention should be paid to patients with prior history of COPD and/or cardiovascular complications during the acute stage and/or prolonged QTc interval. Post-COVID symptoms were of limited value for the diagnosis of arrhythmias or ventricular dysfunction.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.05
Juan Carlos Torres Mantilla, José Diego Torres Mantilla
Objective: To determine the prevalence and factors associated with depressive disorder among Peruvian older adults over 60 years of age.Materials and methods: An observational, analytical and cross-sectional study was conducted based on a secondary analysis of the 2019 Encuesta Demográfica y de Salud Familiar (ENDES - National Demographic and Family Health Survey),administered at national level by Instituto Nacional de Estadística e Informática del Perú (INEI - National Institute of Statistics and Informatics of Peru). The sample consisted of 4,174 older adults. The main variable was suffering from a depressive disorder (depressed/not depressed) and the independent variables were age, sex, educational level, wealthquintile (classified into five levels of wealth), area of residence (classified as urban/rural), geographic domain (classified as Lima Metropolitan Area, the rest of the coast, the highlands and the jungle), health coverage (classified as insured/uninsured), alcohol consumption (yes/no), smoking (yes/no) and presence of a disability (yes/no). Analyses of absoluteand relative frequencies, differences in proportions and a multivariate analysis using generalized linear models (GLM) were performed.Results: The prevalence of depressive disorder and disability accounted for 13.18 % and 7.86 %, respectively. Older males were less likely to suffer from a depressive disorder (PRa = 0.602; 95 % CI: 0.513-0.706) than females, and the group over85 years of age showed a higher risk than those from 60 to 74 years (PRa = 1.664; 95 % CI: 1.304-2.124). Besides, not presenting a disability behaved as a preventive factor (PRa = 0.542; 95 % CI: 0.440-0.668), while a higher educational level and wealth quintile, starting from the “Middle” quintile, were protective factors when taking the categories "No education" and "The poorest" as reference, respectively (p < 0.005). Conclusions: Belonging to the group over 85 years of age, being a female, being in lower wealth quintiles, suffering from a disability and having a lower educational level were risk factors for depressive disorder among Peruvians older adults.
目的:了解秘鲁60岁以上老年人抑郁症的患病率及相关因素。材料和方法:根据对2019年Encuesta Demográfica y de Salud Familiar (ENDES -国家人口和家庭健康调查)的二次分析，进行了一项观察性、分析性和横断面研究，该调查由秘鲁国家统计和信息学研究所Estadística e Informática del Perú (INEI -秘鲁国家统计和信息学研究所)在国家一级进行。样本包括4174名老年人。主要变量是患有抑郁症(抑郁/不抑郁)，自变量是年龄、性别、教育水平、财富五分位数(分为五个财富水平)、居住地区(分为城市/农村)、地理领域(分为利马大都市区、其他沿海地区、高地和丛林)、医疗保险(分为有保险/没有保险)、饮酒(是/否)、吸烟(是/否)和是否残疾(是/否)。使用广义线性模型(GLM)进行绝对频率和相对频率、比例差异和多变量分析。结果:抑郁症患病率为13.18%，残疾患病率为7.86%。老年男性患抑郁症的可能性较小(PRa = 0.602;95% CI: 0.513-0.706)高于女性，且85岁以上人群的风险高于60 ~ 74岁人群(PRa = 1.664;95% ci: 1.304-2.124)。此外，未表现出残疾是预防因素(PRa = 0.542;95% CI: 0.440-0.668)，而以“未受教育”和“最贫穷”类别为参照，从“中等”五分位数开始，较高的教育水平和财富五分位数是保护因素(p <0.005)。结论:属于85岁以上群体、女性、处于较低财富五分位数、患有残疾和受教育程度较低是秘鲁老年人患抑郁症的危险因素。
{"title":"Factores asociados al trastorno depresivo en adultos mayores peruanos","authors":"Juan Carlos Torres Mantilla, José Diego Torres Mantilla","doi":"10.24265/horizmed.2023.v23n3.05","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.05","url":null,"abstract":"Objective: To determine the prevalence and factors associated with depressive disorder among Peruvian older adults over 60 years of age.Materials and methods: An observational, analytical and cross-sectional study was conducted based on a secondary analysis of the 2019 Encuesta Demográfica y de Salud Familiar (ENDES - National Demographic and Family Health Survey),administered at national level by Instituto Nacional de Estadística e Informática del Perú (INEI - National Institute of Statistics and Informatics of Peru). The sample consisted of 4,174 older adults. The main variable was suffering from a depressive disorder (depressed/not depressed) and the independent variables were age, sex, educational level, wealthquintile (classified into five levels of wealth), area of residence (classified as urban/rural), geographic domain (classified as Lima Metropolitan Area, the rest of the coast, the highlands and the jungle), health coverage (classified as insured/uninsured), alcohol consumption (yes/no), smoking (yes/no) and presence of a disability (yes/no). Analyses of absoluteand relative frequencies, differences in proportions and a multivariate analysis using generalized linear models (GLM) were performed.Results: The prevalence of depressive disorder and disability accounted for 13.18 % and 7.86 %, respectively. Older males were less likely to suffer from a depressive disorder (PRa = 0.602; 95 % CI: 0.513-0.706) than females, and the group over85 years of age showed a higher risk than those from 60 to 74 years (PRa = 1.664; 95 % CI: 1.304-2.124). Besides, not presenting a disability behaved as a preventive factor (PRa = 0.542; 95 % CI: 0.440-0.668), while a higher educational level and wealth quintile, starting from the “Middle” quintile, were protective factors when taking the categories \"No education\" and \"The poorest\" as reference, respectively (p < 0.005). Conclusions: Belonging to the group over 85 years of age, being a female, being in lower wealth quintiles, suffering from a disability and having a lower educational level were risk factors for depressive disorder among Peruvians older adults.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.12
Dania Nilbeth Castillo Muñoz, Roberto Carlos Fernández Bula, Ginna Johana Guerra Díaz, Maximiliano Ortega Lasso, Luis Alfonso Valderrama Matallana, María Carolina Mercado Ortega, Elías Moisés Torres Osorio, Yelson Alejandro Picón Jaimes
The elderly, often frail, are patients susceptible to numerous complications, both immediate and in the short, medium and long term, following surgical interventions. Depending on their comorbidities, a comprehensive approach should be taken to achieve the best condition of the organs prior to surgery and attempt to maintain it during and after the intervention. Considering the statistical strength of negative outcomes, specifically mortality in elderly patients undergoing major surgery, is truly a challenge. This even extends to other fields such as bioethics, raising a dilemma about dysthanasia when resorting to certain risky interventions in those with a fearful life prognosis. Recently, interesting evidence estimating the incidence, mortality risk and factors associated with negative outcomes in elderly patients undergoing major surgery has been published, suggesting possible modifications in decision-making algorithms for future clinical practice guidelines insurgery. The objective of this review is to analyze updated evidence on which risk factors would have the greatest impact on negative outcomes and mortality in elderly patients undergoing major surgery. A literature search was conducted usingthe search terms “Major Surgery” and “Elderly,” in addition to synonyms, in the PubMed, ScienceDirect, Web of Science and MEDLINE databases. In general surgery and subspecialties, it is very complex to determine precise risk factors that canbe extrapolated to all surgical scenarios due to the complexity and specificity of certain organs and procedures. Evidence has found that frail adults undergoing surgery for colorectal cancer, liver metastasis, lung cancer, pancreatic disease andesophageal cancer have the longest hospital stays, and overall mortality is higher in those undergoing oncologic surgery.However, both physical and mental integrity are associated with worse outcomes, and surgical prehabilitation could positively impact this situation by improving functional reserve and post-surgical recovery time.
老年人往往体弱多病，在手术干预后容易出现许多即刻和短期、中期和长期并发症。根据其合并症，应采取综合方法，在手术前达到器官的最佳状态，并试图在干预期间和之后保持它。考虑到负面结果的统计强度，特别是接受大手术的老年患者的死亡率，确实是一个挑战。这甚至延伸到其他领域，如生物伦理学，当对那些生命预后堪忧的人采取某些危险的干预措施时，引发了关于dysthanasia的两难境地。最近，发表了一些有趣的证据，估计了接受大手术的老年患者的发病率、死亡率风险和与负面结果相关的因素，这表明可能会修改决策算法，以供未来临床实践指导手术。本综述的目的是分析哪些危险因素对接受大手术的老年患者的负面结果和死亡率影响最大的最新证据。在PubMed、ScienceDirect、Web of Science和MEDLINE数据库中，除了同义词外，还使用搜索词“Major Surgery”和“Elderly”进行了文献检索。在普通外科和专科手术中，由于某些器官和手术的复杂性和特殊性，确定精确的危险因素是非常复杂的，这些危险因素可以推断出所有的手术场景。有证据表明，接受结直肠癌、肝转移癌、肺癌、胰腺疾病和食道癌手术的体弱多病的成年人住院时间最长，接受肿瘤手术的人总体死亡率更高。然而，身体和精神完整性都与较差的结果相关，手术前康复可以通过改善功能储备和术后恢复时间来积极影响这种情况。
{"title":"Desenlaces negativos y mortalidad en el anciano frágil sometido a cirugía mayor: ¿qué factores de riesgo impactan más?","authors":"Dania Nilbeth Castillo Muñoz, Roberto Carlos Fernández Bula, Ginna Johana Guerra Díaz, Maximiliano Ortega Lasso, Luis Alfonso Valderrama Matallana, María Carolina Mercado Ortega, Elías Moisés Torres Osorio, Yelson Alejandro Picón Jaimes","doi":"10.24265/horizmed.2023.v23n3.12","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.12","url":null,"abstract":"The elderly, often frail, are patients susceptible to numerous complications, both immediate and in the short, medium and long term, following surgical interventions. Depending on their comorbidities, a comprehensive approach should be taken to achieve the best condition of the organs prior to surgery and attempt to maintain it during and after the intervention. Considering the statistical strength of negative outcomes, specifically mortality in elderly patients undergoing major surgery, is truly a challenge. This even extends to other fields such as bioethics, raising a dilemma about dysthanasia when resorting to certain risky interventions in those with a fearful life prognosis. Recently, interesting evidence estimating the incidence, mortality risk and factors associated with negative outcomes in elderly patients undergoing major surgery has been published, suggesting possible modifications in decision-making algorithms for future clinical practice guidelines insurgery. The objective of this review is to analyze updated evidence on which risk factors would have the greatest impact on negative outcomes and mortality in elderly patients undergoing major surgery. A literature search was conducted usingthe search terms “Major Surgery” and “Elderly,” in addition to synonyms, in the PubMed, ScienceDirect, Web of Science and MEDLINE databases. In general surgery and subspecialties, it is very complex to determine precise risk factors that canbe extrapolated to all surgical scenarios due to the complexity and specificity of certain organs and procedures. Evidence has found that frail adults undergoing surgery for colorectal cancer, liver metastasis, lung cancer, pancreatic disease andesophageal cancer have the longest hospital stays, and overall mortality is higher in those undergoing oncologic surgery.However, both physical and mental integrity are associated with worse outcomes, and surgical prehabilitation could positively impact this situation by improving functional reserve and post-surgical recovery time.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-23DOI: 10.24265/horizmed.2023.v23n3.02
Shirley Alejandra Núñez Alcocer, Alicia Fernández-Giusti, María Elena López Vera, Marco Antonio Benites Ramos
Objective: To determine the effectiveness of the implementation of the Immediate Care Office as a quality management strategy at the Emergency Service of a public hospital in Lima, Peru. Materials and methods: An analytical, quasi-experimental, before-and-after study conducted with 338 outpatients from different groups treated at the Emergency Service of Hospital María Auxiliadora. Before and after the implementation of the Immediate Care Office, waiting time, satisfaction—assessed through the modified SERVQUAL questionnaire, which was validated and recommended by the Ministry of Health and administered to the postimplementation group—as well as the relationship between satisfaction and waiting time were evaluated. The analysis was performed using IBM SPSS statistics V25.0, frequencies and percentages, the mean difference of both groups obtained through the Levene’s test, and the nonparametric measurement of the Spearman’s correlation coefficient with a significance level of p < 0.05. Results: The results showed a predominance of the female sex (60.95 %), the 14-to-29-year age range (24.56 %) and the Emergency Severity Index level IV (67.16 %). The average waiting time accounted for 17.70 and 4.27 before and after the office implementation, respectively. Therefore, there was a significant difference after the management strategy (p < 0.00). Out of all outpatients, 56.21 % were satisfied with the implementation of the Immediate Care Office, mainly with the empathy (76.33 %) and responsiveness (69.23 %) dimensions, while reliability was the dimension with the lowest satisfaction score (48.52 %). Additionally, there was a significant inverse correlation between waiting time and satisfaction (p < 0.01 and rho: -0.39). Conclusions: The implementation of the Immediate Care Office at the Emergency Service was effective since it reduced the waiting time, which in turn brought satisfaction to the outpatients.
{"title":"Consultorio de Atención Inmediata como estrategia de gestión de calidad en el Servicio de Emergencia de un hospital de Lima, Perú","authors":"Shirley Alejandra Núñez Alcocer, Alicia Fernández-Giusti, María Elena López Vera, Marco Antonio Benites Ramos","doi":"10.24265/horizmed.2023.v23n3.02","DOIUrl":"https://doi.org/10.24265/horizmed.2023.v23n3.02","url":null,"abstract":"Objective: To determine the effectiveness of the implementation of the Immediate Care Office as a quality management strategy at the Emergency Service of a public hospital in Lima, Peru. Materials and methods: An analytical, quasi-experimental, before-and-after study conducted with 338 outpatients from different groups treated at the Emergency Service of Hospital María Auxiliadora. Before and after the implementation of the Immediate Care Office, waiting time, satisfaction—assessed through the modified SERVQUAL questionnaire, which was validated and recommended by the Ministry of Health and administered to the postimplementation group—as well as the relationship between satisfaction and waiting time were evaluated. The analysis was performed using IBM SPSS statistics V25.0, frequencies and percentages, the mean difference of both groups obtained through the Levene’s test, and the nonparametric measurement of the Spearman’s correlation coefficient with a significance level of p < 0.05. Results: The results showed a predominance of the female sex (60.95 %), the 14-to-29-year age range (24.56 %) and the Emergency Severity Index level IV (67.16 %). The average waiting time accounted for 17.70 and 4.27 before and after the office implementation, respectively. Therefore, there was a significant difference after the management strategy (p < 0.00). Out of all outpatients, 56.21 % were satisfied with the implementation of the Immediate Care Office, mainly with the empathy (76.33 %) and responsiveness (69.23 %) dimensions, while reliability was the dimension with the lowest satisfaction score (48.52 %). Additionally, there was a significant inverse correlation between waiting time and satisfaction (p < 0.01 and rho: -0.39). Conclusions: The implementation of the Immediate Care Office at the Emergency Service was effective since it reduced the waiting time, which in turn brought satisfaction to the outpatients.","PeriodicalId":245951,"journal":{"name":"Horizonte Médico","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135959088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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