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OBJECTIVE: To determine the relative effectiveness of Helmet-CPAP (H_CPAP) with respect to high-flow nasal cannula oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021. DESIGN: Cohort analytical study, single center. SETTING: Units other than intensive care units. PATIENTS: Records of adults with mild to moderate hypoxemia due to coronavirus type 2. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Need for intubation or mortality. RESULTS: 159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (pâ¯=â¯0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (pâ¯<â¯0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%-98.7%; pâ¯<â¯0.01). APACHE II does not modify or confound the support and intubation relationship (pâ¯>â¯0.2, binomial regression); however, it does confound the support and mortality relationship (pâ¯=â¯0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (pâ¯=â¯0.11, binomial regression). CONCLUSIONS: The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.
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COVID-19 , Pressão Positiva Contínua nas Vias Aéreas , Hipóxia , Oxigenoterapia , Humanos , Masculino , Feminino , COVID-19/terapia , COVID-19/complicações , COVID-19/mortalidade , Pessoa de Meia-Idade , Hipóxia/terapia , Hipóxia/etiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Idoso , Oxigenoterapia/métodos , Intubação Intratraqueal , Dispositivos de Proteção da Cabeça , Resultado do Tratamento , APACHE , Índice de Gravidade de Doença , Adulto , Mortalidade Hospitalar , Estudos de Coortes , Chile/epidemiologiaRESUMO
INTRODUCTION: Postoperative chronic pain (PCP) is defined as a discomfort that lasts more than expected or beyond 3 months after surgery. The recognition and study of this clinical entity has been gaining interest in the past few years. One of the main reasons is the great impact it can have on the quality of life of patients who suffer from it. OBJECTIVE: To describe the prevalence, risk factor and impact of PCP on patients subjected to different surgical procedures. MATERIALS AND METHODS: Search on MED- LINE/Pubmed, using the following terms: "chronic postsurgical pain", "chronic post operative pain", "chronic post operative pain", "chronic post surgical pain". Publications were then sieved using their title and abstract. RESULTS: Fifty-seven articles were analyzed. Ten to fifty percent of patients were reported as suffering PCP, with up to 10% incidence of severe pain. The main risk factors identified were the use of analgesics, pre-operative pain and type of surgery. Orthopedic surgery was highly associated with moderate to severe PCP within the first year. Twenty-one percent of patients referred PCP affected their quality of life and sleep; ability to carry out physical activity and return to work. CONCLUSION: The first approach to PCP is getting to know its impact and epidemiology. Surgical treatments can cause PCP, which will affect patient recovery and increase costs. Recognizing those patients at risk and establishing preventive management protocols could improve the quality of life of postsurgical patients.
INTRODUCCIÓN: El dolor crónico posoperatorio (DCPO) es aquel que aparece tras un procedimiento quirúrgico y se mantiene por más tiempo de lo esperado o más de tres meses luego de la cirugía. Es una entidad de reciente estudio y que tiene un gran impacto en la calidad de vida de los pacientes postoperados. OBJETIVO: Describir la prevalencia, factores de riesgo y el impacto del DCPO en pacientes sometidos a diferentes procedimientos quirúrgicos. MATERIAL Y MÉTODO: Se realizó una revisión de la literatura utilizando la base de datos MEDLINE/Pubmed. Los términos libres fueron "chronic postsurgical pain", "chronic postoperative pain", "chronic post operative pain", "chronic post surgical pain". Se realizó un cribado según título y resumen. RESULTADOS: Fueron analizados 57 artículos. De 10%-50% de los pacientes presentan DCPO y hasta 10% puede ser severo. El uso de analgésicos, presencia de dolor preoperatorio y especialidad quirúrgica han sido señalados como los principales factores de riesgo. La cirugía traumatológica aparece como la más asociada a DCPO moderado y severo a un año. Hasta 21% de los pacientes refieren que afecta su calidad de vida, el sueño, actividad física y reincorporación laboral. CONCLUSIÓN: El conocimiento de la epidemiología e impacto del DCPO es un primer acercamiento a este problema. Patologías de resolución quirúrgica pueden evolucionar con DCPO, afectando su recuperación y aumentando los costos que se desea contener. El reconocimiento de la población de riesgo y la instauración de protocolos preventivos pudiera mejorar la calidad de vida de los pacientes postoperados.
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Humanos , Dor Pós-Operatória/epidemiologia , Doença Crônica , Fatores de RiscoRESUMO
Background: Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated. Aim: To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample. Material and Methods: In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA: Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression. Results: FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope β < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope β < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients. Conclusions: Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Composição Corporal , Absorciometria de Fóton , Índice de Massa Corporal , Chile , Reprodutibilidade dos Testes , Impedância ElétricaRESUMO
BACKGROUND: Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated. AIM: To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample. MATERIAL AND METHODS: In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA: Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression. RESULTS: FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope ß < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope ß < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients. CONCLUSIONS: Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.
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Composição Corporal , Absorciometria de Fóton , Adulto , Índice de Massa Corporal , Chile , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto JovemRESUMO
RESUMEN Objetivo: Relacionar la pertenencia a la etnia Mapuche y los síntomas climatéricos de indicación de Terapia Hormonal de la Menopausia (THM), en una población del sector rural de Boyeco, región de La Araucanía. Materiales y métodos: Estudio observacional realizado en mujeres rurales en control de salud en CESFAM Boyeco entre octubre de 2016 y enero de 2017. Ninguna de las participantes evaluadas recibía THM. Para el estudio, se consideró el número de apellidos mapuches. Se utilizó el instrumento validado para población chilena, "Escala MRS" (Menopause Rating Scale), el cual permite discriminar los diferentes dominios sintomáticos del climaterio. Resultados: El grupo en estudio lo componen 36 mujeres de 41 a 78 años de edad, promedio (DE) 52,8(8,6) años, un 52,8% tiene dos apellidos mapuches y 25% uno. Un 92,8% de las mujeres mapuche tiene indicación de terapia, versus todas las no mapuche. En las menores de 50 años, todas tiene indicación de terapia, frente a un 71,4% en las mayores de 50 años. Conclusiones: Las pacientes mapuches tienen mayor sintomatología en los dominios somáticos y psicológicos, especialmente aquellas bajo 50 años. Todas las mujeres estudiadas bajo 50 años requieren terapia, sin variación estadísticamente significativa x etnicidad.
SUMMARY Objective: To stablish the relationship between belonging to Mapuche ethnic group on the climacteric symptoms for indication of menopause hormone therapy (HTM), in the rural population of Boyeco, inside of Araucania's region, Chile. Materials and methods: An observational and descriptive study, in a sample in time of 36 women belonging to the sector who attended CESFAM Boyeco, between October 2016 and January 2017. None of the evaluated participants received THM. As exposure variable, it was considered the number the mapuche surnames. We used the Menopause Rating Scale (MRS), an international instrument validated for Chilean population, to discriminate the different symptomatic domains of the climacteric period. Results: 94.7% of mapuche women and all non-mapuche population had prescribed hormonal therapy. Independent of ethnicity, those under 50 years of age, 100% have an indication for therapy compared to 71.4% in those over 50 years of age. Conclusions: Mapuche patients have greater symptomatology in the somatic-psychological domains, especially in those under 50 years of age. The totality of women under 50 requires therapy, however, variation according to ethnicity.
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Humanos , Feminino , Pessoa de Meia-Idade , Climatério , Menopausa/etnologia , Indígenas Sul-Americanos , Terapia de Reposição Hormonal , Povos Indígenas , Atenção Primária à Saúde/estatística & dados numéricos , Psicometria/métodos , Chile/epidemiologiaRESUMO
Se realizó un estudio de corte transversal durante el año 2008 con una muestra 301 niños de 2 y 4 años que asisten por primera vez al servicio dental del Hospital de Calbuco, cuyo objetivo fue determinar la prevalencia de caries temprana de la infancia (CTI), severa caries temprana de la infancia (CTI-S) y sus factores asociados. El diagnóstico de caries siguió los criterios establecidos por la OMS, considerando a las caries incipientes dentro del componente caries. Además se investigó su relación con factores socio-demográficos, dietarios y hábitos de higiene oral. La información fue analizada usando test exacto de Fisher y modelos de regresión logística. La prevalencia de CTI fue de un 70 por ciento con una severidad de un 52 por ciento. Se encontró asociación estadísticamente significativa entre CTI y variables como edad, ruralidad, estado nutricional, uso de biberón, uso biberón nocturno e índice de higiene oral simplificado (p<0,05). Del estudio multivariado se determinó que a los 2 años el usar biberón nocturno es un factor protector (OR=2,6). La alta prevalencia de CTI en la población estudiada evidencia la necesidad de incorporar programas educativos y preventivos durante el primer año de vida.
A cross-sectional study was performed during 2008, with a sample of 301 two and four year-old children attending their first dental appointment in the Calbuco Hospital. The aim of the study was to determine the prevalence of early childhood caries (ECC), severe early childhood caries (S-ECC) and their associated factors. The children´s dental examination and caries diagnosis were carried out using standardized methods (World Health Organization). White spot lesion was recorded as caries. The relationship of socio-demographic factors, dietary habits and oral hygiene was also investigated. The data was analyzed using Fisher's exact test and logistic regression models. The prevalence of ECC, including white spot lesions was 70 percent with a severity of 52 percent. A significant statistical association was found between ECC and variables such as age, rurality, nutritional status, bottle-feeding, bottle-feeding at bedtime and simplified oral hygiene index (OHI-S) (p<0.05). The multivariate study determined that the presence of bottle-feeding at bed time is a protective factor in 2 year-old children (OR = 2.6). The high prevalence of ECC highlighted the need to incorporate educational and preventive programs during the first year of life.