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RESUMEN Introducción: la dexametasona es un medicamento que demostró una disminución de la mortalidad en la neumonía por SARS-CoV-2. Se desconoce la utilidad de otros corticoides, dosis y su duración para mejorar este resultado clínico. Objetivo: comparar la mortalidad de los pacientes adultos con neumonía por SARS-CoV-2 tratados con dexametasona versus metilprednisolona en el Hospital Nacional, Itauguá, Paraguay. Materiales y métodos: estudio ambispectivo. Se incluyeron 97 pacientes, 52 recibieron dexametasona y 45 metilprednisolona. Se utilizó un muestreo no probabilístico de casos consecutivos. Las variables fueron sometidas a estadística descriptiva y analítica. El protocolo fue aprobado por el Comité de Ética del Hospital Nacional. Los autores no presentan conflictos de interés. Resultados: todos los pacientes ingresaron con neumonía con valoración de 4 (OMS). No se encontraron diferencias significativas en la mortalidad entre ambos grupos. Al aplicar un análisis estratificado por edad, en los pacientes <65 años la mortalidad en los que recibieron dexametasona fue 15,8% mientras que los que recibieron metilprednisolona no fallecieron (p 0,03). En el grupo de ≥65 años la mortalidad n los recibieron dexametasona fue 29,4% vs. 21,4% en los que recibieron metilprednisolona (p 0,7). Conclusiones: en los pacientes <65 años tratados con dexametasona la mortalidad fue mucho más alta que en los que recibieron metilprednisolona, ya que en este último grupo no se registraron fallecimientos.
ABSTRACT Introduction: Dexamethasone is a medication that demonstrated a decrease in mortality in SARS-CoV-2 pneumonia. The usefulness of other corticosteroids, dose and their duration to improve this clinical result is unknown. Objective: To compare the mortality of adult patients with SARS-CoV-2 pneumonia treated with dexamethasone versus methylprednisolone at the Hospital Nacional of Itauguá, Paraguay. Materials and Methods: Ambispective study. Ninety seven patients were included, 52 received dexamethasone and 45 methylprednisolone. A non-probabilistic sampling of consecutive cases was used. The variables were subjected to descriptive and analytical statistics. The protocol was approved by the Ethics Committee of the Hospital Nacional. The authors do not present conflicts of interest. Results: All patients entered with 4 (WHO) vaulting pneumonia. No significant differences were found in mortality between both groups. When applying an age stratified analysis, in patients <65 years who received dexamethasone the mortality was 15.8% while those who received methylprednisolone did not die (p 0.03). In the ≥65 years group, mortality in those who received dexamethasone was 29.4% vs. 21.4% in those who received methylprednisolone (p 0.7). Conclusions: In patients <65 years treated with dexamethasone, mortality was much higher than in those who received methylprednisolone, since in the latter group no deaths were recorded.
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RESUMEN Algunos estudios han encontrado que la severidad de la COVID-19 se asocia con una alta carga viral determinada por los números de ciclos (Ct) de amplificación de ADN de SARS-CoV-2. El objetivo fue determinar la relación entre el umbral de ciclos de PCR de SARS-CoV-2 y la severidad de la infección por el virus SARS-COV-2 en pacientes internados y ambulatorios en un hospital de referencia entre marzo a junio del 2021. Estudio retrospectivo observacional analítico de corte trasverso de pacientes adultos con COVID-19, ambulatorios e internados en el Hospital Nacional. Se incluyeron los pacientes cuya infección fue confirmada por RT-PCR para SARS-CoV-2, se consideró un punto de corte para Ct60 años (36,6%), estuvieron hospitalizados (69,8%), internados en sala (57,1%), y admitidos en cuidados intensivos (12,8%), tiempo medio de enfermedad 8,48 ± 4,2 días. La mortalidad fue de 22,2%. Se encontró mayor riesgo de fallecer para los pacientes con Ct 60 años (OR: 3,69; IC95%: 2,39-5,68). Estos dos factores permanecieron asociados con el óbito en el análisis multivariado. Hubo mayor riesgo de hospitalizarse y fallecer en los pacientes con Ct<25. El valor Ct podría ser útil para la predicción del curso clínico y el pronóstico de los pacientes con COVID-19.
ABSTRACT Some studies have found that severity of COVID-19 is associated with a high viral load determined by the number of cycles (Ct) of SARS-CoV-2 DNA amplification. The objective was to determine the relationship between the Ct value and the severity of the SARS-COV-2 virus infection in inpatients and outpatients at a reference hospital in Paraguay between March and June 2021. Cross-sectional retrospective study of adult patients with COVID-19, ambulatory and hospitalized admitted to the National Hospital. Patients whose infection was confirmed by RT-PCR for SARS-CoV-2 were included, a cut off point of Ct 60 years (36.6%), hospitalized (69.8%), admitted to ward (57.1%), and admitted to intensive care (12.8%), mean time of illness 8.48 ± 4.2 days and mortality was 22.2%. A higher risk of death was found for patients with Ct 60 years (OR: 3.69; 95% CI: 2.39-5.68). These two factors remained associated with death in the multivariate analysis. There was a higher risk of hospitalization and death in patients with TC <25. Ct value could be useful for predicting clinical course and prognosis of COVID-19 patients.
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Hígado Graso no Alcohólico (HGNA) es una enfermedad prevalente en la consulta diaria. La mayoría de médicos generales no conocen adecuadamente el diagnóstico, tratamiento y pronóstico de esta patología. Además, no existieron estudios, ni un instrumento que midiera el nivel de conocimiento sobre HGNA, por lo que hemos considerado necesario realizar esta investigación. OBJETIVO: Diseñar y validar un cuestionario y así determinar, luego, el nivel de conocimientos sobre Hígado Graso no Alcohólica (HGNA) en médicos generales de los distritos de Chiclayo y La Victoria durante Enero a Agosto del 2011. MÉTODOS: Se diseñó un cuestionario de 13 preguntas, se analizó la validez de contenido mediante la valoración por expertos y la validez de constructo mediante análisis factorial. Se evaluó la fiabilidad del cuestionario analizando la consistencia interna por el método del alfa de Cronbach y la fiabilidad test-retest mediante el coeficiente de correlación intraclase(CCI). Se realizó la prueba piloto, entrevistando a 15 médicos generales. RESULTADOS: El alfa de Cronbach del cuestionario fue de 0,77. El valor de Káiser - Meyer-Olkin fue de 0,091 y el test de esfericidad de Bartlett fue de 0.003, por lo que no se realizó el análisis factorial, la correlación intraclase tuvo un valor de 77%. La puntuación aprobatoria en la parte de diagnóstico fue mayor a 4.6 puntos y para tratamiento y pronóstico mayor a 4 puntos. CONCLUSIONES: Este estudio proporcionó un instrumento con una fiabilidad alta para medir el nivel de conocimiento de hígado graso no alcohólico en Médicos generales.
Nonalcoholic fatty liver disease (NAFLD) is a prevalent disease in daily practice. Most General medical do not know how to make a proper diagnosis, treatment and prognosis of this disease. In addition, there were no studies, nor an instrument that measures the level of knowledge about NAFLD, so we found it necessary to conduct this research. OBJECTIVE: To design and validate a questionnaire to determine the level of knowledge of nonalcoholic fatty liver disease (NAFLD) in general practitioners in the districts of Chicago and La Victoria since January to August 2011. METHODS: We designed a questionnaire of 13 questions; we analyzed the content validity through expert assessment and construct validity using factor analysis. We assessed there liability of the questionnaire examining the internal consistency by CronbachÆs alpha method and test-retest reliability by intraclass correlation coefficient (ICC). The pilot test was conducted, interviewing 15 general medical. RESULTS: CronbachÆs alpha of the questionnaire was 0.77. The value of Kaiser - Meyer-Olkin was 0.091 and BartlettÆs sphericity test was 0.003, so we did not perform factor analysis, the intraclass correlation had a value of 77%. Also passing score for diagnosis was greater than 4.6 points and for treatment and prognosis than 4 points. CONCLUSIONS: This study provided an instrument with high reliability to measure the level of awareness of NAFLD in General Medical.
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Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Fígado Gorduroso , Clínicos Gerais , Estudos Transversais , Pesquisa Qualitativa , Estudos Observacionais como AssuntoRESUMO
OBJECTIVE: Diabetes mellitus (DM) has been proposed as a risk factor for both chronic liver disease (CLD) and for hepatocellular carcinoma (HCC); however, studies among Hispanics are limited. Puerto Rico (PR) has a high prevalence of DM (13%), supporting the need for a better understanding of the public health implications associated with DM in this population. We assessed the association of DM with CLD and with HCC in a population of Puerto Rican adults with health insurance. METHODS: The study sample consisted of 1,040,025 individuals, aged > or = 18 years, all covered by the government-run healthcare program in PR, in 2002. The ICD-9 codes for DM, CLD, and HCC were obtained in order to determine the prevalence of these conditions. Logistic regression models were used to determine the association of DM with CLD and with HCC, after adjusting for covariates. RESULTS: The prevalence of DM was higher in patients with CLD (17%) and those with HCC (18%) than it was in patients without either of these conditions (8% and 7%, respectively). Among women, those with DM were significantly more likely to have CLD than were those without DM (POR: 35-49 yrs: 3.26, 95% CI = 2.12, 5.00; POR: 50-64 yrs: 2.10, 95% CI = 1.63, 2.71; POR: > or = 65 yrs: 2.33, 95% CI = 1.67, 3.25). Among men, those with DM were more likely to have CLD than were those without DM; this association was significant among males aged 50-64 (POR: 1.30, 95% CI = 1.03-1.63) and those aged > or = 65 yrs (POR: 1.94, 95% CI = 1.35-2.80). CONCLUSION: Consistent with other studies, we observed a strong association of DM with CLD and HCC. In order to reduce the burden of these conditions in PR, research and public health efforts should be concentrated on gaining a better understanding of these associations.
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Complicações do Diabetes/complicações , Hepatopatias/complicações , Neoplasias Hepáticas/complicações , Adulto , Idoso , Doença Crônica , Estudos Transversais , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hepatopatias/epidemiologia , Neoplasias Hepáticas/epidemiologia , Masculino , Pessoa de Meia-Idade , Porto RicoRESUMO
UNLABELLED: Nonalcoholic fatty liver disease (NAFLD) is a prevalent disease in daily practice. Most General medical do not know how to make a proper diagnosis, treatment and prognosis of this disease. In addition, there were no studies, nor an instrument that measures the level of knowledge about NAFLD, so we found it necessary to conduct this research. OBJECTIVE: To design and validate a questionnaire to determine the level of knowledge of nonalcoholic fatty liver disease (NAFLD) in general practitioners in the districts of Chicago and La Victoria since January to August 2011. METHODS: We designed a questionnaire of 13 questions; we analyzed the content validity through expert assessment and construct validity using factor analysis. We assessed the reliability of the questionnaire examining the internal consistency by Cronbach's alpha method and test-retest reliability by intraclass correlation coefficient (ICC). The pilot test was conducted, interviewing 15 general medical. RESULTS: Cronbach's alpha of the questionnaire was 0.77. The value of Kaiser - Meyer-Olkin was 0.091 and Bartlett's sphericity test was 0.003, so we did not perform factor analysis, the intraclass correlation had a value of 77%. Also passing score for diagnosis was greater than 4.6 points and for treatment and prognosis than 4 points. CONCLUSIONS: This study provided an instrument with high reliability to measure the level of awareness of NAFLD in General Medical.