RESUMO
BACKGROUND: Environmental pollution is a risk factor for cardiorespiratory diseases. Energy generated by thermoelectric power plants (TEPP) represents a relevant source of pollution. The aim of this study was to evaluate the relationship between living near a coal-fired TEPP and the consultation rates for bronchial obstructive crises (BOC) in the province of Concepción, Chile. METHODS: Population-based study. The epidemiological weeks from 2012 to 2014 were analyzed. The dependent variable was the emergency consultation rate for BOC in two health centers within 5 km of a TEPP (Coronel) and two that were more than 40 Km away from a TEPP (Talcahuano). The independent variables were the commune, climatological variables (air temperature and relative atmospheric humidity), environmental pollutants (PM10, PM2.5 and nitrogen oxide), weeks with the highest consultation rate and the years. Rates, Pearson's correlation and gross risk measures were calculated and adjusted for environmental and climatological variables. RESULTS: BOC rates were significantly higher in Coronel (RR = 4.9 95% CI 4.0-5.8; p < 0.05). The PM2.5 it showed the strongest correlation with BOC rates (r = 0.3; p < 0.01) in Coronel, but not Talcahuano. Linear regression modelling indicated that proximity to a TEPP (health center location) and temperature explained 26 and 18% of the variance in BOC rates, respectively. CONCLUSIONS: Rates of emergency consultation for BOC were significantly higher among a population living within 5 km of a coal-fired TEPP than those living 40 km away.
Assuntos
Poluição do Ar/efeitos adversos , Broncopatias/epidemiologia , Exposição Ambiental/efeitos adversos , Centrais Elétricas , Adolescente , Adulto , Poluição do Ar/análise , Broncopatias/etiologia , Chile/epidemiologia , Exposição Ambiental/análise , Feminino , Geografia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Temperatura , Adulto JovemRESUMO
Introducción: El Síndrome Obstructivo Bronquial (SOBA) es una de las patologías más prevalentes de la práctica pediátrica habitual y es responsable de consultas frecuentes a las emergencias, ya que afecta al 5 a 10 por ciento de todos los niños menores de 3 años de edad existiendo un incremento de la morbilidad y mortalidad a pesar de los recursos terapéuticos disponibles hoy en día; es generalmente secundario a infecciones virales y su presentación clínica y evolución intra y extra hospitalaria se cree dependen de numerosos factores tanto ambientales, epidemiológicos, y clínicos Objetivos: Determinar la asociación de riesgo entre características Clínicas y Epidemiológicas presentes al ingreso de los pacientes pediátricos menores de 3 años hospitalizados con diagnóstico de Síndrome Obstructivo Bronquial Agudo; y estancia hospitalaria prolongada, en el Hospital Nacional Madre Niño San Bartolomé, durante el año 2013. Material y métodos: Estudio analítico de casos y controles; el grupo Caso (constituidos por pacientes con estancias hospitalarias prolongadas) y el grupo Control (constituidos por pacientes con estancias hospitalarias no prolongadas), donde se evaluó múltiples variables tanto clínicas, epidemiológicas y de manejo terapéutico mediante pruebas de contraste de hipótesis (Chi-Cuadrado). Resultados: Durante el año 2013 se registraron en el libro de ingresos hospitalarios 276 casos ingresados con el diagnóstico de Síndrome Obstructivo Bronquial; de los cuales 198 cumplían los criterios de inclusión, se repartieron en dos grupos, el Grupo Caso de 80 pacientes (los cuales tenían un tiempo de hospitalización mayor a cinco días, y el grupo control de 118 pacientes (los cuales tenían un tiempo de hospitalización menor a cinco días), de las variables estudiadas solo se encontró asociación de riesgo para la variable grupo etario con un Chi cuadrado menor de 0,05 y Odds ratio de 2,1 (IC 95 por ciento: 1,179-3,752); y para la variable Estado Nutricional, con...
Introduction: Bronchial Obstructive Syndrome (SOBA) is one of the most prevalent diseases in the usual pediatric practice and is responsible for frequent emergency consultations, affecting 5-10 per cent of all children under 3 years of age. There are a increased morbidity and mortality despite treatment resources available today; this is usually secondary to viral infections and their clinical presentation and intra- and extra-hospital outcome depend of numerous environmental, epidemiological and c1inical factors. Objectives: To determine the association of risk between Clinical and Epidemiological factors present on admission in pediatric patients under 3 years of age hospitalized with diagnosis of Acute Bronchial Obstructive Syndrome; and prolonged hospital stay in the National Hospital Mother Child St. Bartholome, in 2013. Methods: Analytical case control-case study. Where the case group (consisting of patients with prolonged hospital stays) and the control group (consisting of patients without prolonged hospital stays), multiple variables was evaluating by the testing hypothesis (Chi-Square). Results: During the year 2013 were registered in the book of hospital admissions 276 patients with the diagnosis of Obstructive Bronchial Syndrome; of which 198 was including in the study, they were divided into two groups: the case group with 80 patients (who had a longer than five days hospitalization), and the control group with 118 patients (who had a hospital stay less than five days) of the variables studied only the age had risk association (Chi square less than 0.05) and odds ratio of 2.1 (95 per cent CI: 1.179 to 3.752) and for the Nutritional state, with a Chi-square less than 0.05 and an odds ratio of 2.4 (95 per cent CI 1.190 to 4.76). The most common diagnosis associated with the syndrome Obstructive bronchial acute was pneumonia Viral and bronchiolitis (50 per cent). Conclusions: Obstructive bronchial syndrome occurs mostly in males, under the 12 months...
Assuntos
Masculino , Feminino , Humanos , Recém-Nascido , Lactente , Pré-Escolar , Broncopatias/diagnóstico , Broncopatias/epidemiologia , Hospitalização , Obstrução das Vias Respiratórias , Estudos de Casos e ControlesRESUMO
OBJECTIVES: The objective was to apply quality indicators in respiratory disease triage during a set time period. METHODS: This was a retrospective, descriptive, and comparative study of all patients attending the emergency department of Acosta Ñu Children's Hospital with breathing difficulty, between January 1 and July 31, 2011. RESULTS: Two thousand five hundred eighty-two patients were included in the study. The delay in medical care according to severity of breathing difficulty was as follows: for critical patients, 1 minute (100% compliance); for emergencies, 6.4 minutes (93.4% compared with 95% standard); for urgencies, 15.8 minutes (90% compared with the standard 90%); and for semiurgencies, 35 minutes (92.4% vs. 85% standard). Regarding to the admission-triage time indicator: mean time was 6.1 minutes; 2220 patients (86%) were classified in less than 10 minutes from the time of hospital admission, and 2453 (95%) were evaluated before 15 minutes. Respiratory rate was recorded in 2368 patients (91.7%), and pulse oximetry in 2443 (94.6%). Both parameters were recorded in 2271 children (88%). Errors in classification were detected, mainly tendency to underestimate the risk or exacerbate the clinical situation; 441 patients underwent subtriage (20.5%), and 44 overtriage (1.7%). There were drawbacks to classify emergencies error rate 45.8% (P < 0.00001). Relationship between pathophysiologic diagnosis and triage level was significant (P < 0.00001). CONCLUSIONS: Indicators of triage quality were acceptably met in respiratory disease. Breathing difficulty was identified and classified as urgent, although problems arouse at differentiation between moderate and severe dyspnea.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Transtornos Respiratórios/diagnóstico , Triagem/normas , Broncopatias/diagnóstico , Broncopatias/epidemiologia , Criança , Pré-Escolar , Erros de Diagnóstico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Dispneia/etiologia , Emergências , Feminino , Humanos , Lactente , Laringite/diagnóstico , Laringite/epidemiologia , Masculino , Oximetria/estatística & dados numéricos , Paraguai/epidemiologia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Transtornos Respiratórios/classificação , Transtornos Respiratórios/epidemiologia , Taxa Respiratória , Estudos Retrospectivos , Estado Asmático/diagnóstico , Estado Asmático/epidemiologia , Fatores de Tempo , Triagem/estatística & dados numéricosRESUMO
INTRODUCTION: Bronchial complications owing to the airway anastomosis in lung transplantation are important causes of morbidity and mortality. They occur in up to 27% of cases as defined by stenosis, necrosis, and dehiscence. Treatment depends on the type of complication. OBJECTIVE: To report our experience to treat this complication. METHODS: Between 2000 and 2007, we performed 71 lung transplants of which 36 were bilateral. The total number of anastomoses was 107:52 to the right and 55 to the left. The telescoping technique was initially used (14 initial unilateral transplants), and after October, 2003 it was changed to an end-to-end anastomosis (57 transplants and 93 anastomoses). RESULTS: Eight patients developed bronchial complications including two that were bilateral. There were 4 stenosis, 3 dehiscences, and 3 necrosis complications (9.4%). The complication rate for telescoping anastomosis was 21.4%, and for the end-to-end technique, 7.5%. The treatment of the stenosis used metallic or plastic self-expandable stents. Two bronchial dehiscences resulted in case of bronchopleural fistulae, empyema, and death; the other patient experienced spontaneous resolution. Concerning bronchial necrosis, 1 patient developed fistulization to the pulmonary artery and massive hemoptysis, and the other with bilateral necrosis, a spontaneous resolution. CONCLUSION: Our bronchial anastomosis complication rate was comparable with that in other reports. The rate for the telescoping technique was greater compared with the end-to-end technique. The treatment of bronchial stenosis with a self-expandable prosthesis showed good results.
Assuntos
Broncopatias/epidemiologia , Transplante de Pulmão/efeitos adversos , Adulto , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Lateralidade Funcional , Humanos , Soluções Hipertônicas , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos , Soluções para Preservação de Órgãos , Polipropilenos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Fibrose Pulmonar/cirurgia , Estudos Retrospectivos , Suturas , Resultado do TratamentoRESUMO
OBJECTIVE: The diagnosis of tuberculosis in patients with negative acid-fast bacillus smears poses a challenge to both clinicians and public health authorities. In an attempt to aid diagnosis in such cases, an expert committee was established in Ciudad de La Habana, Cuba in 1995. The aim of this study was to describe the progress of the committee's work and the corresponding results for the period 1996 through 2003. PATIENTS AND METHODS: For each patient studied by the commission, we analyzed the following data: patient's residence and referring center, tentative diagnosis proposed by the attending physician, history of antibiotic treatment, and final diagnosis made by the commission. RESULTS: Of the 1703 patients studied, 84.8% were from La Habana, 48.4% were 55 years or older, and 63.8% were men. Between 2001 and 2003, 11.3% of patients were already on antituberculosis treatment when their case was studied by the commission. The corresponding percentage for 1996 through 2000 was 16.9% (P=.001). Active tuberculosis was confirmed in 43.1% of a total of 918 patients with full test results during the period 1996 through 2000 and in 52.2% of a total of 619 patients (52.2%) during the period 2001 through 2003 (P< .001). Of 344 patients with suspected pulmonary tuberculosis and negative acid-fast bacillus smears between 2001 and 2003, 128 (37.2%) were diagnosed with active tuberculosis. CONCLUSIONS: These findings indicate that the work of the commission is viable, sustainable, and useful for preventing overdiagnosis and inappropriate treatment, and that it also serves an educational purpose.
Assuntos
Técnicas Bacteriológicas , Programas Governamentais/organização & administração , Controle de Infecções/organização & administração , Tuberculose/diagnóstico , Adolescente , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Broncopatias/diagnóstico , Broncopatias/epidemiologia , Criança , Pré-Escolar , Corantes , Cuba/epidemiologia , Feminino , Programas Governamentais/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Lactente , Controle de Infecções/estatística & dados numéricos , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/crescimento & desenvolvimento , Mycobacterium tuberculosis/isolamento & purificação , Avaliação de Programas e Projetos de Saúde , Escarro/microbiologia , Tuberculose/epidemiologia , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
Introducción: El medio ambiente es uno de los elementos que interviene en la determinación de las causas de enfermedad y salud en los sistemas humanos; la pertubación de la calidad del aire por las industrias que operan en el perímetro urbano, incrementa el riesgo de daño a la salud. Objetivo: Determinar si los aerocontaminantes específicos constituyen factores de riesgo en la prevalencia de afecciones respiratorias, en población escolar adyacente a fábrica de agregados calcáreos. Sujetos y métodos: Estudio de corte seccional, de diseño epidemiológico analítico que mide la fuerza de asociación estadística, entre la afección respiratoria y la exposición respiratorias y la exposición a los aerocontaminantes mediante el Odds Ratio. La muestra se constituyó mediante afijación proporcional con 185 expuestos y 481 controles, con escolares de cuatro colegios seleccionados previo informe de DIGESA sobre calidad del aire de la zona. El instrumento se validó por el Comité de Asma de SPN y se basó en el GINA de la OMS/NHBLI. Resultados: Hay mayor porcentaje de alumnos con antecedente de bronquitis (41.2 vs 30.8), neumonía (6.2 vs 3.8), asma (10 vs. 8.1), alergias (34.7 vs 23.8) entre grupos de expuestos y control. Sobre síntomas presentes, comparando expuestos con controles tenemos: congestión nasal (59.7 vs 53.2), tos con flema o enfermedad de los bronquios 57.1 vs 42.7), ardor de garganta (46.2 vs 31.4), disfonía (30.5 vs 20.6), falta de aire (34.7 vs 25.9), sensación torácica (40.1 vs 29.8), tos seca estornudos (53.7 vs 37.8). Al efectuar el análisis inferencial del indicador vs la exposición hay alta significancia estadística para antecedentes de bronquitis OR = 1.571, IC95 por ciento (1.095 - 2.254), (p 0 0.008), presencia de alergias OR 0 1.704, IC95 por ciento (1.57 -2.51), (p 0 0.004), diagnóstico de asma OR = 2.63, IC95 por ciento (1.81- 3.83), (p = 0.000)...
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Masculino , Feminino , Criança , Adolescente , Humanos , Broncopatias/epidemiologia , Doenças Respiratórias/epidemiologia , Fatores de Risco , Poluentes Industriais , Estudos Epidemiológicos , Estudos TransversaisRESUMO
Se estudiaron 108 pacientes con diagnóstico preestablecido de asma bronquial. Se encontró que el antecedente de asma bronquial en la familia, la exposición a agentes alergénicos de diferente tipo (animales, lana, cambios de clima), la infección respiratoria aguda y la ablactación temprana constituyeron los factores de riesgo mas importantes desde el punto de vista epidemiológico
Assuntos
Humanos , Asma/epidemiologia , Broncopatias/epidemiologiaRESUMO
To test the hypothesis that decreased mortality from severe HMD will result in increased morbidity from BPD, chest films of 30-day survivors of severe HMD were reviewed for evidence of Northway's Stage IV BPD. During July, 1970 to June, 1971, 20 survivors of severe HMD were identified; one case of Stage IV BPD was found in this group. During July 1974-June 1975, 80 survivors of severe HMD were identified; five infants had BPD. In spite of more survivors of severe HMD, no increase in the incidence of BPD could be demonstrated.