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Resumen: Introducción: La vasculitis primaria del sistema nervioso central (VPSNC) representa una enfermedad rara que afecta a los vasos sanguíneos de mediano y pequeño calibre del sistema nervioso central. Objetivo: Realizar una descripción de los hallazgos clínicos y aspectos diagnósticos, con especial atención a los hallazgos histopatológicos, así como a los tratamientos utilizados y la respuesta a los mismos en pacientes diagnosticados de VPSNC en nuestro centro. Pacientes y métodos: Presentamos un análisis descriptivo retrospectivo.Se ha analizado el registro de altas hospitalarias del Hospital General Universitario de Castellón entre enero de 2000 y mayo de 2020, escogiéndose aquellos con diagnóstico al alta de VPSNC que reunían los criterios de Calabrese en 1988, una vez revisada la historia clínica. Resultados: Se analizan una serie de 7 pacientes que ingresaron con cuadros de alteraciones focales transitorias y otros más inespecíficos, como cefalea o mareo, alcanzándose el diagnóstico mediante histología en 5 de ellos y mediante angiografía sugestiva en los 2 restantes.La neuroimagen fue patológica en todos los casos y el estudio del LCR resultó alterado en 3 de los 5 casos practicados.Todos ellos recibieron tratamiento inicial con megadosis de corticoides seguido de tratamiento inmunosupresor.La evolución fue desfavorable en 6 casos, resultando exitus 4 de ellos. Conclusiones: A pesar del reto diagnóstico que representa la VPSNC es fundamental tratar de aproximarse al máximo al diagnóstico definitivo, valiéndonos de herramientas como la histopatología y/o angiografía para establecer un tratamiento adecuado de manera precoz y reducir así la morbimortalidad de esta entidad. Abstract: Introduction: Primary central nervous system vasculitis (PCNSV) is a rare disease affecting medium- and small-calibre blood vessels of the central nervous system. Objective: The aim of this study was to analyse clinical findings and diagnostic aspects, with special attention to histopathological findings, as well as the treatments used and treatment response in patients diagnosed with PCNSV at our hospital. Patients and methods: We conducted a retrospective descriptive analysis of patients with a diagnosis of PCNSV at discharge from our centre and meeting the 1988 Calabrese criteria. To this end, we analysed the hospital discharge records of Hospital General Universitario de Castellón between January 2000 and May 2020. Results: We analysed a series of 7 patients who were admitted with transient focal alterations and other less specific symptoms such as headache or dizziness; diagnosis was based on histological findings in 5 cases and on suggestive arteriographic findings in the remaining 2.Neuroimaging results were pathological in all cases, and CSF analysis detected alterations in 3 of the 5 patients who underwent lumbar puncture.All patients received initial treatment with megadoses of corticosteroids followed by immunosuppressive treatment.Progression was unfavorable in 6 cases, with fatal outcomes in 4. Conclusions: Despite the diagnostic challenge of PCNSV, it is essential to attempt to reach a definitive diagnosis using such tools as histopathology and/or arteriography studies, in order to promptly establish appropriate treatment and thus reduce the morbidity and mortality of this condition.

Introduction: Chronic non-communicable diseases (NCDs) are a significant global health challenge due to their prolonged duration and varied progression rates, leading to increased noncompliance, especially in developing nations. Pharmacological adherence, defined by WHO, is crucial for maintaining patients' quality of life and reducing morbidity, yet it remains inadequate, with about 50% non-adherence in developed countries, 30% of which is unintentional. Understanding disease burden is vital, but research on medication adherence, burden, and morbidity in the Dominican Republic and Latin American countries is lacking, necessitating comprehensive studies. Objectives: Ascertaining the degree of pharmaceutical adherence, disease burden, and morbidity amongst individuals with chronic illnesses were the study’s primary endpoints. Methodology: The project was a cross-sectional, prospective study that examined the sociodemographic data, past medical history, and medication regimens of a sample of 284 patients attending an outpatient clinic. Patients were selected using convenience sampling, to be later screened and interviewed after consultation for any of the diseases present on the MAR-Scale or the DBMA questionnaires. The screening sought only those individuals who met inclusion criteria (> 18 years old, diagnosed with a disease present on either scale) and did not meet exclusion criteria (not being able to fill the questionnaire due to language barrier). Data collected was stored using the KoboToolBox program and later summarized with mean and standard deviation for further processing using STATA BE. Statistical tests were programmed with an alpha of 5%, 95% CI, and p < 0.05 for statistical significance. Results: The sample, comprising 133 individuals, had a mean age of approximately 58.4 years, with a majority of female participants. Most participants were married, Dominican, and of Hispanic Latino ethnicity, with Christianity being the predominant religion. Regarding past medical history, while a substantial portion had no prior respiratory or cardiovascular ailments, diabetes mellitus was prevalent, indicating potential implications for current health status and treatment adherence. Adherence, measured by daily and weeklyscores, ranged from 1.0 to 3.8, with the burden score per patient averaging 50.1 and per disease averaging 2.6. The analysis revealed that 16.9% of participants were monomorbid, while 83.1% were multimorbid, showcasing the complexity of health conditions within the cohort. Conclusion: The study's key results reveal a significant portion of patients without a history of respiratory or cardiovascular diseases, suggesting a relatively healthy baseline. However, a notable proportion had diabetes, potentially impacting their current health status and treatment adherence. Furthermore, the study delves into factors influencing adherence, burden levels, and reasons for nonadherence. Findings indicate unmarried patients and those with lower education levels tend to exhibit higher burden levels and lower adherence scores. Mental health conditions like depression or anxiety, osteoporosis, and heart failure are associated with elevated burden levels. The study also assesses the reliability of adherence and burden measurement tools, emphasizing the importance of considering population variability in interpreting results. Limitations include challenges in patient selection and data collection, particularly regarding patients with multimorbidity. Overall, the study highlights the need for comprehensive exploration of adherence, burden, and morbidity to predict disease control, progression, and patient quality of life effectively in future research endeavors.

Background: The health challenges faced by the homeless are widely unaccounted for in the global south. In India, the lack of a primary healthcare sector in urban areas has led informal healthcare providers, such as Street Medicine, to step in. Methods: By compiling data collected by the Centre for Equity Studies’ Street Medicine teams from June 2016 to October 2018 (n =16,635), this study provides the first empirical assessment of the homeless disease burden in a global south country, while limited to only the people experiencing homelessness that the teams treat, hence being a burden of treatment. Our analysis quantifies this burden among those who seek care from Street Medicine teams and identifies variations in this burden’s distribution across demography and time. Results: The majority (n = 13,557; 81.5%) of Street Medicine cases can be attributed to 19 diagnoses or symptoms, which are mostly therapeutically-simple conditions. The distribution of disease seems to be affected by different configurations of three characteristics: demographics (age and sex), urban geography (where homeless reside), and season. Conclusion: The Street Medicine teams must reflect on the balance they wish to achieve by addressing the relatively common and mild conditions documented in the dataset, and more severe and established diseases within homeless communities. Rapid diagnostic tests for resource-constrained settings could be integrated into Street Medicine practice in order to strengthen the data on which resource allocation decisions are made and improve assessments of homeless disease burden.

Introduction: Major amputation is a significant intervention in advanced stages of peripheral arterial disease (PAD) and has important morbidity and mortality rates. Despite being a frequently performed procedure in Colombia, local statistics on its frequency and outcomes are not available. Objectives: To analyze the morbidity and mortality in patients with lower limb PAD during the 30 days following major amputation or during the index hospitalization. To identify factors related to the outcome and characterize the population. Methods: A retrospective study of patients with lower limb PAD who underwent major amputation for acute ischemia (AI) or chronic limb-threatening ischemia (CLTI) between March 2011 and December 2019 at Hospital Universitario San Vicente Fundación in Medellín, Colombia (HUSVF). Variables related to the underlying disease and perioperative morbidity were calculated in a general analysis and by groups, according to the level of amputation. Results: A total of 558 major amputations were performed, 83.5% for CLTI. The overall mortality rate was 14.7%, with 32.6% in AI and 11.2% in CLTI. The most frequent complication was delirium (28.8%). After multivariate analysis, no influential factors were identified for fatal outcomes, except for cardiovascular complications in AI. Conclusions: In this study, the only variable related to early mortality was cardiovascular complications in patients with AI. The percentages of heart disease are lower compared to those reported in studies from other countries. The most common complication was delirium.

Objective. To estimate the early impact of coronavirus disease 2019 (COVID-19) vaccination on cases in older populations in four countries (Chile, Colombia, Guatemala, and the United States of America), and on deaths in Chile and Guatemala. Methods. Data were obtained from national databases of confirmed COVID-19 cases and deaths and vaccinations between 1 July 2020 and 31 August 2021. In each country, pre- and post-vaccination incidence ratios were calculated for COVID-19 cases and deaths in prioritized groups (50–59, 60–69, and ≥70 years) compared with those in the reference group (

ABSTRACT Introduction: the ability of the care team to reliably predict postoperative risk is essential for improvements in surgical decision-making, patient and family counseling, and resource allocation in hospitals. The Artificial Intelligence (AI)-powered POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator represents a user-friendly interface and has since been downloaded in its iPhone and Android format by thousands of surgeons worldwide. It was originally developed to be used in non-traumatic emergency surgery patients. However, Potter has not been validated outside the US yet. In this study, we aimed to validate the POTTER calculator in a Brazilian academic hospital. Methods: mortality and morbidity were analyzed using the POTTER calculator in both trauma and non-trauma emergency surgery patients submitted to surgical treatment between November 2020 and July 2021. A total of 194 patients were prospectively included in this analysis. Results: regarding the presence of comorbidities, about 20% of the population were diabetics and 30% were smokers. A total of 47.4% of the patients had hypertensive prednisone. After the analysis of the results, we identified an adequate capability to predict 30-day mortality and morbidity for this group of patients. Conclusion: the POTTER calculator presented excellent performance in predicting both morbidity and mortality in the studied population, representing an important tool for surgical teams to define risks, benefits, and outcomes for the emergency surgery population.

ABSTRACT Objective: To evaluate the impact of COVID-19 social distancing recommendations on nutritional status, pulmonary function, and morbidity in patients with cystic fibrosis (CF). Methods: A retrospective cohort study including patients older than six years with a diagnosis of CF was performed. Demographic and clinical data, anthropometric measurements, pulmonary function, days of antibiotic use, and length of hospital stay were recorded. Variables were recorded at three time points relative to the baseline for implementation of social distancing measures: T-1 (14 months before implementation), T0 (baseline), and T1 (14 months after implementation). Delta (Δ) was calculated for each period: Δ1 (pre-pandemic T0-T-1) and Δ2 (pandemic T1-T0). Results: The study included 25 patients, with a mean age of 11.7±4.3 years. The mean forced expiratory volume in the first second (FEV1) was 85.6±23.6%, and body mass index (BMI) was 17.5±3.0 kg/m2. When comparing the two periods (Δ1 and Δ2), there was a significant increase in the FEV1/forced vital capacity (FVC) ratio (p=0.013) and in the forced expiratory flow between 25 and 75% of vital capacity (FEF25–75%) (p=0.037) in the pandemic period. There was also a significant reduction (p=0.005) in the use of antibiotics in the pandemic period compared with the pre-pandemic period. The Δ1 and Δ2 values did not differ significantly for BMI, FEV1, or length of hospital stay. Conclusions: COVID-19 social distancing recommendations had a positive impact (decrease) on morbidity (use of antibiotics) and small airway obstruction (FEF25–75%) in patients with CF.

Objective: To describe the epidemiological profile of hospitalizations for Land Transport Accidents, involving motorbikes, between the years 2011 to 2020, in the state of Rio Grande do Sul. Method: This is a descriptive epidemiological study with data from the Hospital Information System. Descriptive methods of analysis were used, with rates expressed in absolute numbers, relative frequency and weighted by population. Results: The results indicate that young white males concentrate the highest rates of hospitalizations in the state. They also suggest an increase of cases between the months of October and March, besides presenting the highest hospital mortality rates in the southern macro-region of the state. Conclusion: The knowledge of the profile of hospitalizations involved in these accidents can help in the structuring of strategies appropriate to local realities, with the aim of reducing accidents, damage to health, suffering and treatment costs.

The aim of this population-based study is to analyze the association of loneliness and physical health, pain, health-related quality of life, mental health, cognitive performance, morbidity, and use of health services. Based on the census, a stratified random sampling was chosen. A telephone interview was conducted with 2,060 people over 65 years old, using the GHQ-12 and the COOP-Wonca. An association of loneliness with General Mental Health (GHQ-12) was found, OR = 1.43 (1.34, 1.52) and depression, OR = 2.34 (1.54, 3.53). In cognitive performance the highest effect variable was “memory problems disturb your daily life”, OR = 3.11 (1.25, 7.72); illnesses-related variables: the highest effect variables were perception of health status, OR = 1.37 (1.13, 1. 67) and quality of life (COOP-Wonca), OR = 3.03 (2.32, 3.94); pain-related variables: the highest effect variables were non-localized pain, OR = 2.67 (1.87, 3.83) and arthritis/arthrosis, OR = 1.94 (1.38, 2.72); impaired vision, OR = 2. 62 (1.84, 3.73) and hearing, OR = 1.81 (1.21, 2.72). It is concluded that loneliness is a complex phenomenon associated with variables of different nature. This fact should be taken into account at the time of planning possible solutions.

Abstract Objective: To translate and culturally adapt the scales Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) to the Brazilian population. Methods: Two English language proficient professionals independently translated the original version of the scales into Brazilian Portuguese. After consensus, it was generated a translated version of each scale. These were back translated into English by two native English translators. A new consensus process resulted in an English version of each scale, which were compared with the originals and approved by the author. A committee of experts with clinical and academic experience in intensive care checked the validity of the content and produced the pre-final versions of the scales, which were tested by 25 professionals from a Pediatric Intensive Care Unit. An audit was conducted to verify the consistency of the methodological process. Results: The pre-final versions were approved by 96% of the Brazilian professionals. No significant changes were made to the content of the instrument; however, it was identified the need of a guide with instructions on how to use the scales. Conclusions: The process of translation and cross-cultural adaptation of the scales was completed and resulted in PCPC-BR and POPC-BR scales.

Resumen: Introducción: Las fracturas de cadera (FC) constituyen un problema de salud pública capital asociado al envejecimiento y la fragilidad por su impacto en la calidad de vida y la morbimortalidad de las personas mayores. Se ha propuesto el uso de servicios de enlace de fracturas (FLS) para minimizar este problema emergente. Material y métodos: Estudio observacional prospectivo con 101 pacientes con FC tratados en el FLS de un hospital regional entre octubre de 2019 y junio de 2021 (20 meses). Se recogieron variables epidemiológicas, clínicas y quirúrgicas durante el ingreso y hasta 30 días después del alta. Resultados: La edad media de los pacientes fue de 87,6 ± 6,1 años, 77,2% eran mujeres y 71,3% tenían deterioro cognitivo al ingreso según el cuestionario de Pfeiffer; 13,9% estaban institucionalizados y 76,24% podían caminar de forma independiente antes de la fractura. Las fracturas fueron más frecuentemente pertrocantéricas (45,5%). Los pacientes recibían tratamiento antiosteoporótico en 10,9% de los casos. La mediana de la demora quirúrgica desde el ingreso fue de 26 horas (RIC 15-46 horas), la mediana de la estancia fue de seis días (RIC tres a nueve días) y la mortalidad intrahospitalaria fue de 10,9%, y de 19,8% a los 30 días, con una tasa de reingreso de 5%. Discusión: Los pacientes tratados en nuestro FLS al inicio de su actividad eran similares a la imagen general de nuestro país en cuanto a edad, sexo, tipo de fractura y proporción de pacientes tratados quirúrgicamente. Se observó una alta tasa de mortalidad y se siguieron bajas tasas de osteoprotección al alta. Los resultados clínicos de la implantación del FLS en los hospitales regionales deben ser evaluados de forma prospectiva para decidir su idoneidad. Abstract: Introduction: Hip fractures constitute a capital public health issue associated with aging and frailty because of its impact on both quality of life and morbidity and mortality in older people. Fracture liaison services (FLS) have been proposed as tools to minimize this emergent problem. Material and methods: A prospective observational study was conducted with 101 patients treated for hip fracture by the FLS of a regional hospital between October 2019 and June 2021 (20 months). Epidemiological, clinical, surgical, and management variables were collected during admission and up to 30 days after discharge. Results: Mean age of patients was 87.6 ± 6.1 years and 77.2% were female. Some degree of cognitive impairment was detected at admission in 71.3% of patients using the Pfeiffer questionnaire, and 13.9% were nursing home residents, and 76.24% could walk independently before the fracture. Fractures were more commonly pertrochanteric (45.5%). Patients were receiving antiosteoporotic therapy in 10.9% of cases. The median surgical delay from admission was 26 h (RIC 15–46 h), the median length of stay was 6 days (RIC 3–9 days) and in-hospital mortality was 10.9%, and 19.8% at 30 days, with a readmission rate of 5%. Discussion: Patients treated in our FLS at the beginning of its activity were similar to the general picture in our country in terms of age, sex, type of fracture, and proportion of patients treated surgically. A high mortality rate was observed, and low rates of pharmacological secondary prevention were followed at discharge. Clinical results of FLS implementation in regional hospitals should be assessed prospectively in order to decide their suitability.

Introduction: The Covid-19 pandemic changed medi-cal education, with strategies supported by virtual platforms and non-conventional scenarios. An example of this is the morbidity and mortality meetings (M&M). The objective of this study is to find the characteristics of virtual M&M meetings in different institutions focused on general surgery resident ́s students in Colombia, and how medical residents and professors feel about them compared to the traditional face-to-face meetings. Methodology: This is an observational, and descriptive study in 21 hospital practice institutions of 17 General Surgery programs in Colombia, where virtual M&M operate. Information was obtained on their objectives, operational characteristics and scope. Additionally, in self-completion surveys, the participants’ perception about the usefulness and operation was investigated, this, because of the shift to virtuality. There was participation of 82 residents and 65 professors from different postgraduate programs in General Surgery in the country. Results: Virtual M&Ms continue in 53% of the practice sites, with a predominance in private institutions. There are differences in their organization, although the traditional M&M model persists: objectives, structure, and scope. There is a longer duration of meetings, uncon-ventional schedules and the perception of a reduced academic level. There is an improvement in the hostile environment, within the virtuality. Conclusion: M&Ms have a place in a virtual scenario. Its operation is like face-to-face meetings, and its execution offers opportunities for improvement in terms of form and content.

Resumen: Introducción y objetivos: La cirugía es el tratamiento principal para el cáncer gástrico. La gastrectomía radical D2 está asociada a morbilidad y mortalidad postoperatoria variable a nivel mundial. El objetivo del estudio fue identificar los factores de riesgo asociados con morbilidad y mortalidad postoperatoria de la gastrectomía radical D2 con intención curativa por cáncer gástrico. Material y métodos: En este estudio de serie de casos retrospectivo, se revisó las historias clínicas de los pacientes con cáncer gástrico operados de gastrectomía radical D2 desde enero del 2014 a diciembre del 2018. Se realizó un análisis univariado y multivariado para identificar los factores de riesgo relacionados con la morbilidad y mortalidad postoperatoria a los 90 días. Resultados: En 691 pacientes, el porcentaje de morbilidad y mortalidad postoperatoria fue del 23.3% y del 3.3%, respectivamente. En el análisis multivariado, la edad ≥ 70 años (OR = 1.85, IC 95%: 1.25-2.76), ASA III-IV (OR = 2.06, IC 95%: 1.28-3.34), la realización de gastrectomía total (OR = 1.96, IC 95%:1.19-3.23) y pancreatoesplenectomía (OR = 5.41, IC 95%:1.42-20.61) se asociaron con mayor morbilidad postoperatoria. Por otro lado, la edad ≥70 años (OR = 4.92, IC 95%:1.78-13.65), un menor IMC (OR = 0.81, IC 95%:0.71-0.92) e hipoalbuminemia (OR = 0.91, IC 95%:0.85-0.98) se asociaron a una mayor mortalidad en la gastrectomía radical D2 distal y total. Conclusiones: La gastrectomía radical D2 por cáncer gástrico es un tratamiento seguro con una baja morbilidad y mortalidad postoperatoria. La edad ≥ 70 años, ASA III-IV, la gastrectomía total y la realización de pancreatoesplenectomía fueron factores asociados con una mayor tasa de complicaciones. La edad ≥ 70 años, un menor IMC e hipoalbuminemia son predictores de mortalidad en la gastrectomía radical distal y total. Abstract: Introduction and aims: Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. Materials and methods: A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. Results: The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥ 70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. Conclusions: D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥ 70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥ 70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.

Resumen: Antecedentes y objetivos: Comparar la morbimortalidad, el tiempo de estancia hospitalaria y el gasto económico de la fractura por fragilidad de cadera en 2 años no consecutivos gracias a la atención ortogeriátrica integrada. Material y método: Estudio observacional retrospectivo de cohorte con 633 pacientes con fractura por fragilidad de cadera, con una media de edad de 85,5 años, tratados en un mismo servicio de cirugía ortopédica y traumatología en 2 años diferentes (2012 y 2017). Se midieron la estancia media, la demora quirúrgica, la mortalidad perioperatoria, al mes y al año, y las complicaciones perioperatorias como la retención aguda de orina, las úlceras por presión y la necesidad de transfusión. Resultados: La mortalidad durante el ingreso disminuyó del 10% en 2012 al 3,6% en 2017 (p = 0,004), a la vez que la mortalidad a los 30 días (10,5% frente a 7%) (p = 0,123) y al año (28,9% frente a 24,9%) (p = 0,277). También disminuyeron los tiempos de estancia hospitalaria, la demora quirúrgica y el tiempo de ingreso postoperatorio. El ahorro económico total anual estimado gracias a la atención ortogeriátrica integrada supuso 1.017.084,94 €. Conclusiones: La atención ortogeriátrica integrada del paciente con fractura por fragilidad de la cadera resulta en un modelo de atención más efectivo y eficiente. Se mejora tanto la calidad asistencial como la situación clínica de los pacientes en el periodo perioperatorio, se disminuyen significativamente tanto la estancia hospitalaria como la mortalidad durante el ingreso, y todo ello con un importante ahorro económico asociado. Abstract: Background and objectives: Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. Material and method: Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. Results: Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P = .004 *), while mortality at thirty days (10.5% vs 7%) (P = .123) and one year (28.9% versus 24.9%) (P = .277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to € 1,017,084.94. Conclusions: Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.

Resumen: Introducción: la prevalencia de determinadas enfermedades entre los estudiantes de Medicina (EM) parece aumentar respecto a la población en general. Sin embargo, se trata de investigaciones puntuales sin un enfoque global para un análisis de posibles causas en profundidad. Realizamos un análisis de la literatura existente que aborda las enfermedades prevalentes en los EM y su relación con posibles factores intrínsecos. Método: se ha realizado una revisión narrativa de la literatura disponible en Medline sobre el EM, incluyendo revisiones sistemáticas, metaanálisis y estudios primarios, tanto en inglés como en español de trabajos publicados entre marzo de 2016 y marzo de 2022. Las palabras clave utilizadas han sido: «ill», «sick», «morbidity», «suffering» y «students, medical», «medical student», «medical student health». Resultados: de los 567 identificados, se seleccionaron 152 (115 de psicopatología y 37 de enfermedad física). De ellos, 38 artículos cumplieron con los criterios de inclusión. Se aprecia una elevada prevalencia de síntomas depresivos (27%) y ansiosos (28-33,8%) en los EM, mayor que en la población en general de referencia. El consumo de alcohol y tabaco presenta una alta prevalencia y predominan las enfermedades físicas relacionadas con la exposición a niveles altos de estrés, como los problemas digestivos, cardiovasculares, osteomusculares y de sequedad ocular. Conclusión: la psicopatología se encuentra ampliamente estudiada, mostrando diferencias respecto a la población en general. Las enfermedades del ámbito físico más prevalentes son propias de grupos de poblaciones con altos niveles de estrés y sedentarismo. Es necesario realizar estudios contrastados con los estudiantes del ámbito universitario con niveles similares de carga lectiva y estrés. Abstract: Introduction: The prevalence of certain medical conditions appears to be increasing in medical students (MS) in relation to the general population according to studies conducted without a global focus. In-depth analysis of the existing literature is required in order to ascertain the predisposing factors in medical students for those highly prevalent medical conditions. Method: A narrative review of the literature available on Medline on MS, including systematic reviews, meta-analyses and primary studies, both in English and Spanish of papers published between March 2016 and March 2022, was conducted. The keywords used were: ''ill'', ''Sick'', ''morbidity'', ''suffering'' and ''Students, medical'', ''medical student'', ''medical student health''. Results: Of the 567 articles identified, 152 were selected (115 psychopathology and 37 physical pathology). Of these, 38 articles met the inclusion criteria. A high prevalence of depressive symptoms (27%) and anxiety (28-33.8%) was found in MS, higher than in the general reference population. Alcohol and tobacco consumption is highly prevalent and physical pathologies related to high levels of stress exposure predominate, such as digestive, cardiovascular, musculoskeletal and dry eyes. Conclusion: Psychopathology has been extensively studied, showing differences with respect to the general population. The most prevalent physical pathologies are typical of population groups with high levels of stress and sedentary lifestyles. The need is raised for studies contrasting medical students with university students in general who have similar academic loads and stress levels.

The ankle-brachial index (ABI) is the relationship between the systolic blood pressure taken at the ankle level and the brachial artery. A pathological ABI (1.40) indicates the presence of peripheral artery disease (PAD). Many studies indicate the great utility of this test in the diagnosis of PAD due to its ease of use, reproducibility, low cost, and high cost-effectiveness. This evaluation can be directly correlated with cardiovascular morbidity and mortality; however, it has recently been confirmed that a low ABI can be a predictor of major cardiovascular events, as it is related to diabetes mellitus, chronic coronary disease, stroke, and more. The objective of this work was to review the current evidence on the importance of ABI in the diagnosis of PAD and its main role as a predictor of cardiovascular morbidity and mortality.

Objective: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI)., Materials and Methods: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications., Results: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR., Conclusions: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification., (Copyright © 2024 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Surgical complications are preventable in up to 50% of cases, actually are various tools to avoid them, one of these are morbidity and mortality conferences. However, there are no guides that define their structure for them to be effective. Objective; Analyze the impact of a new modality of surgical conferences in a sector of benign biliary pathology, called quality evaluation conferences. Methodology: Descriptive observational study where the overall improvement of the sector, the decrease in complications and the quality of patient care are compared. For 6 months, a weekly quality evaluation conference was carried out. It had 5 stages; 1. Analysis of all discharged patients. 2. Review of adverse events. 3. Review of the list and order of patients in the surgical plan. 4. Reproduction of recorded surgeries and review of scientific articles. 5. Review of own scientific works in development., Results: after implementing the conferences, there was a decrease in the number and severity of complications, as well as an improvement in the correct and timely surgical indication. Conclusion; Quality evaluation workshops as an evolution of morbidity and mortality workshops are a novel tool that, when well implemented, can help improve quality standards and in turn be used as a learning option in training centers., (Universidad Nacional de Córdoba)

Objective. To describe the life expectancy, healthy life expectancy, disease burden, and leading causes of mortality and disability in adults aged 65 years and older in the Region of the Americas from 1990 to 2019. Methods. We used estimates from the Global Burden of Disease Study 2019 to examine the level and trends of life expectancy, healthy life expectancy, years of life lost, years lived with disability, and disability-adjusted life years (DALYs). Results. Across the Region, life expectancy at 65 years increased from 17.1 years (95% uncertainty intervals (UI): 17.0–17.1) in 1990 to 19.2 years (95% UI: 18.9–19.4) in 2019 while healthy life expectancy increased from 12.2 years (95% UI: 10.9–12.4) to 13.6 years (95% UI: 12.2–14.9). All-cause DALY rates decreased in each older persons’ age group; however, absolute proportional DALYs increased from 22% to 32%. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease were the leading causes of premature mortality. Diabetes mellitus, age-related and other hearing loss, and lower back pain were the leading causes of disability. Conclusion. The increase in life expectancy and decrease of DALYs indicate the positive effect of improvements in social conditions and health policies. However, the smaller increase in healthy life expectancy suggests that, despite living longer, people spend a substantial amount of time in their old age with disability and illness. Preventable and controllable diseases account for most of the disease burden in older adults in the Americas. Society-wide and life-course approaches, and adequate health services are needed to respond to the health needs of older people in the Region.

Introduction: Microorganisms able to produce carbapenemases are spreading worldwide and have become a concerning global public-health problem. In Colombia, the Gram-negative resistance to carbapenems at intensive care units is currently increasing and its impact on clinical outcomes is not well known. Objectives: To determine the demographic, clinical characteristics and outcomes of critically ill adult patients with infection by carbapenemase producing bacteria in a polyvalent intensive care unit of a highly complex institution. Methods: Single-center retrospective, descriptive observational study including critically ill adult patients infected by carbapenemase-producing bacteria and transferred to a polyvalent intensive care unit from January 1th 2014 to January 1th 2018. Known colonized patients were excluded. Clinical complications, ICU and in-hospital days of stay were evaluated, as ICU and in-hospital mortality. Results: A total of 58 patients were included. Overall mortality was 67.2%, of which 55.17% died during their stay in the intensive care unit and 12.06% in hospitalization. The median stay in the intensive care unit was 18 days (IQR 4-28). The most frequent cause of death was septic shock in 51% and the most common complications were acute renal injury and delirium in 55.2% and 43.1%, respectively. The median stay in the ICU was 18 days (RIQ 4-28). Conclusions: Infections caused by carbapenem-resistant bacteria in critically ill patients are associated with high mortality rates, complications and long stay in ICU.

ABSTRACT Objective: To describe the maternal and obstetric characteristics associated with severe maternal morbidity, and the factors of the assistance process involved in the severe outcomes according to nurses and doctors. Method: Sequential mixed study at the tertiary maternity in the city of Rio de Janeiro, based on care records and interviews with these professionals, from February to July 2019. Chi-square test, prevalence ratio and thematic content analysis were applied. Results: In 66 (100%) women with SMM, severe preeclampsia (77.3%) was more prevalent and there were 12 (18.2%) cases of near miss and one maternal death. Postpartum hemorrhage (PR = 3.21; 95% CI 1.22-8.41) and blood transfusions (PR = 3.60; 95% CI 1.81-7.16) contributed to severe outcomes. There are deficiencies in the health system, access to reproductive health and quality of care. Conclusion: Improvements in access to health and quality of the care process are imperative to reduce severe maternal outcomes.

Resumen: Objetivo: Determinar el grado de asociación entre el estado de salud percibido y el obtenido a partir de información sobre morbilidad atendida. Método: Se estudió la población de cuatro áreas básicas de salud de la comarca del Baix Empordà (N = 91.067), en el año 2016, con una muestra de 1202 personas a las que se realizó una encuesta de salud. Paralelamente, las personas encuestadas se clasificaron en estados de salud mediante el agrupador Clinical Risk Groups. El grado de asociación se analizó mediante regresión logística. Resultados: Un 27% de las personas con más de dos enfermedades crónicas mayores o con condiciones de salud complejas afirmaron tener buena salud. Se detectó asociación entre percepción de salud y carga de enfermedad. El sexo, la situación laboral, la clase social y especialmente la edad también mostraron asociación con la percepción de salud. Conclusiones: La inferencia del estado de salud a partir de registros clínicos sobre morbilidad atendida aproxima la percepción subjetiva de la salud, y viceversa. No obstante, determinados factores sociodemográficos modulan la percepción individual. Los resultados obtenidos son esperanzadores en relación con el desarrollo de nuevas metodologías de cálculo de indicadores de calidad de vida. Abstract: Objective: To determine the degree of association between perceived health status and that obtained from information on attended morbidity. Method: The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N = 91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. Results: 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. Conclusions: The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators.

Influenza is an infectious respiratory disease that is caused by influenza A and B viruses in humans. Pandemic outbreaks mainly involve type A virus of zoonotic origin. The severity of the pandemic flu depends on many factors, including the virulence of the pandemic virus strain and the level of pre-existing immunity. Symptoms associated with influenza virus infection differ from mild respiratory disease limited to the upper respiratory tract and are characterized by fever, sore throat, runny nose, cough, headache, muscle pain and fatigue, as well as severe and in some cases fatal pneumonia due to influenza virus or secondary bacterial infection of the lower respiratory tract. The influenza virus is quite often subject to modifications, which makes it necessary to formulate an influenza vaccine every year to match the circulating strains. These vaccines are not mandatory and, despite the broadly understood promotion among the public, they are not widely purchased. In addition, the vaccine's effectiveness is quite low in the case of an antigenic mismatch between the vaccine and the circulating strain of the virus, which causes a still high level of illness during the year. In the 2019/2020 season, a significant decrease in the number of influenza cases was observed in Poland and in the world. In this work, we will take a closer look at the numerical values of people with influenza and discuss the possible causes of this decline. Did the Covid-19 pandemic favorably affect the incidence of another virus, such as the influenza virus, and cause its decline, or did it just overshadow the real numbers, put society to sleep, and diverted their attention?

Morbidity and mortality (M&M) meetings or conferences, a common practice worldwide, seek to assess adverse events and complications related to medical care, from an academic perspective and considering an improvement in the quality of hospital care. However, in our country, its execution is a methodological challenge due to the difficulty for its conceptualiza-tion, implementation, evaluation of its effectiveness and usefulness as an educational tool, since it lacks a formalized structure that considers these issues. The aim of this work is to evaluate its role from an individual and institutional academic perspective, considering the different theories and models that could support M&M (theory of experimental learning, activity theory in sociocultural learning, just culture, security theory model and theory of the second victim), in order to answer the question: are M&M meetings a learning strategy?

Introduction The use of local references or standard for neonatal studies still requires their validation through indicators of morbidity and mortality. Objective: evaluate the performance of the INTERGROWTH-21st Project (IG-21) standard and a commonly used Argentinian reference (Urquia) by examining the differences in the frequency of growth phenotypes, and the associated neonatal morbidity and mortality. Methods: Retrospective cohort study of all singleton live-births from Sarda Maternity Hospital (Buenos Aires, Argentina) between 33 and 42 gestational age, using information obtained from a Perinatal Surveillance System (Agustina) dataset between 1996-2001 (n = 25948). Phenotypes small- and large-for-gestational age, stunting and waisting and a composite of neonatal morbidity/mortality (CNMM) were contrasted between the IG-21 standard and Urquia reference. Results: the Urquia 3rd centile value was lower than IG-21 before 37 weeks, but then it surpassed IG-21 until term. Among Sarda , 2.3%, 5.9% and 8.9 were 97th centile, respectively, under the IG-21 standard, while 3.7%, 10.1% and 8.4% were 97th centile, respectively, under the Urquia reference. Stunting and waisting were 16.1% and 0.9%, respectively under IG-21. The IG-21 detection rates of CNMM showed that 28.5%, 19.6% and 8.5% occurred among weight97th centile, respectively, while 21.8%, 14.2% and 8.0% occurred among 97th centile under the Urquia criteria. Newborn weight 97th centile under IG-21 showed higher neonatal CNMM risk compared with Urquia reference. Conclusions: The IG-21 standard identified a higher risk of neonatal morbidity and mortality than the Urquia reference.

ABSTRACT Deficits in health after being released are common, even with a higher risk of death. In these cases, the main cause of death is the use of heroin and other opioids, but there are more causes of death and most are potentially preventable. The most vulnerable groups to the increase of post-release morbidity and mortality are the drug users, the mentally ill and the foreign inmates from countries with few economic resources. It is urgent to implement interventions that optimize access to health devices after the prison release, avoid interruptions in the continuity of care and treatment prescribed in prison and reduce morbidity and mortality. To achieve this, it is necessary to coordinate the effective form of care inside and outside the prison and apply support measures. We present the project implemented in the prisons of Catalonia, which the “nurse of liaison” has used as a key figure in the process. We also present the internal and external procedure used to facilitate the transfer of sanitary and therapeutic information, to link released patients to health devices and to ensure that they are received in a timely and appropriate manner.

Present day tularemia prevalence in the world and in Ukraine is described as well as the current epidemic and epizootic situation in various regions. The mechanisms of transmission of the pathogen are discussed. The causative agent of tularemia Francisella subsp. tularensis is one of the most virulent microorganisms of the highest priority (category "A"). This can be used as a biological weapon, and so poses a real threat to the humanity’s security. Human infection occurs as a result of bites by infected blood-sucking arthropods (mosquitoes, thrips, ticks), consumption of rodent-contaminated food and water, inhalation of air-dust aerosol from diseased rodents contaminated with the pathogen, and also after direct contact with infected animals (hunting, caring for pets, carcass processing). Isolates of the most virulent for humans and animals subspecies F. tularensis subsp. tularensis circulate only in North America. The less virulent subspecies F. tularensis subsp. Holarctica circulates in North America, Europe, Asia (Japan), Australia (including Tasmania). The wide distribution of this subspecies in the world is due to its ability to exist in the aquatic environment. In most European countries, the terrestrial cycle of existence of the tularemia microbe is dominant, in the body of small mammals and carriers of the pathogen - mosquitoes, ticks, and whiteflies. The main clinical form of tularemia is ulcerative-bubonic, it is quite easily diagnosed, infection occurs as a result of bites by infected blood-sucking arthropods. Anginal-bubonic and gastrointestinal forms are diagnosed in hot countries, they are associated with the consumption of food and water contaminated by rodents. In the nearest future the worsening of tularemia epidemic situation in various regions of the world is predicted due to the activation of enzootic centers and lack of vaccination of risk groups persons and the population of endemic areas.

Resumen: Objetivo: Presentar, a los 22 meses de que la Organización Mundial de la Salud declarara como pandemia la infección global por SARS-CoV-2 el 11 de marzo de 2020, el impacto hasta el momento de la pandemia en términos de salud física y mental. Método: Se han revisado resultados procedentes de metaanálisis y revisiones sistemáticas, citándose para algún aspecto específico de interés artículos individuales. La información nacional procede de la Red Nacional de Vigilancia Epidemiológica (RENAVE). Resultados: Hasta finales de octubre se habían producido más de 250 millones de infecciones y 5 millones de muertes. En España se han notificado 4,7 millones de infecciones, aunque la cifra real es superior a los 7 millones. Se ha reducido la esperanza de vida, con efectos especialmente dramáticos en grupos de población con comorbilidad y de edad avanzada. Se constata un empeoramiento de la salud mental general. Es previsible que algunos colectivos, como los/las profesionales sanitarios/as, en su mayoría mujeres, y trabajadores/as de primera línea, tengan un mayor riesgo de desarrollar patologías de salud mental en el futuro. La pandemia y las medidas de control han tenido otras consecuencias indeseables, como la disminución de la actividad asistencial, el aumento del sedentarismo y el aumento de la violencia de género. Conclusiones: Son necesarios estudios longitudinales para determinar la magnitud de las consecuencias de la propia infección y de las medidas de control y las actuaciones necesarias. Abstract: Objective: The World Health Organization declared the global SARS-CoV-2 infection a pandemic on March 11, 2020. The objective of this paper is to present its impact in terms of physical and mental health 22 months later. Method: We have reviewed results from published meta-analysis and systematic reviews, and some individual articles on specific aspects of special interest. National information on infection comes for the Red Nacional de Vigilancia Epidemiológica (RENAVE). Results: Up to the end of October, more than 250 million infections and 5 million deaths had been reported globally. In Spain, 4.7 million infections have been documented although the real figure might be above 7 million. The pandemic has reduced life expectancy, and its effects have been especially dramatic in people with comorbidities and the elderly. There is a worsening of mental health in the general population. It is foreseeable that some groups, such as health professionals, mostly women, and front-line workers, may have a greater risk of developing mental health pathologies. The pandemic and the control measures have had other undesirable consequences such as a decrease in healthcare utilization, an increase in sedentary lifestyle or an increase in gender violence. In addition to its immediate effect on morbidity and mortality, the control measures have damaged the overall health status of the global population. Conclusions: Longitudinal studies are necessary to determine the mid and long consequences of the pandemic and the control measures, and to identify and evaluate effective health interventions.

Objective. To provide an overview of morbidity and mor­tality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016. Materials and methods. We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortal­ity due to diarrheal diseases. Results. Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the gen­eral population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico. Conclusions. Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diar­rhea, which could have been avoided with health promotion.

Abstract Background Health expectancy indicators aim at capturing the quality dimension of total life expectancy.; however, the underlying approach, definition of health, and information source differ considerably among the indicators available. Objective (1) Review the main concepts and approaches used to estimate health expectancy focusing on two widely used European health indicators: Health-Adjusted Life Expectancy (HALE) and Healthy Life Years (HLY); (2) identify underlying differences between the results yielded by these two indicators. Method Statistical differences between the HALE and HLY indicators by sex at ages 50, 60, and 70 were tested using pairwise and global Student´s t-tests and z-scores based on standard deviation. Data for 29 European countries were collected from the European Health Expectancy Monitoring Unit (EHEMU) information system and the World Health Organization (WHO) Global Burden of Disease Study 2016 (GBD 2016). Results The HALE indicator estimates were smoother across European countries compared with those of the HLY indicator, present a narrower sex gap in morbidity, higher z-scores compared with the average distribution across Europe, and results less sensitive to cross-national variations. Conclusion The HALE estimates indicate that morbidity is more compressed for both sexes, whereas the HLY estimates suggest that morbidity is more compressed for males but more expanded for females. These contrasting results demonstrate that health expectancy indicators should be interpreted with caution.

ABSTRACT To describe the prevalence of risk factors for retinopathy of prematurity and respective stages. Retrospective data were extracted from original articles addressing risk factors for retinopathy of prematurity retrieved from Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL) and National Library of Medicine - NLM (PubMed) databases. In the initial search, 186 articles were found. Following title and abstract reading and application of inclusion and exclusion criteria, 25 articles were selected for this analysis. Variables of interest varied widely between studies. Gestational age and birth weight were listed as risk factors in all studies. Gender analysis revealed small gender-related differences, since approximately 52.9% of affected neonates were males and 47.1% females. As to race/color, approximately 72.7% were white, 12% were brown and 2.7% were black. However, there is a lack of consensus over the significance of these factors. The study revealed that retinopathy of prematurity is a multifactorial disease primarily associated with prematurity, low birth weight and oxygen therapy. Albeit potentially avoidable and reversible, the incidence of the condition is high. Therefore, further studies along the same lines are needed for deeper understanding of risk factors for or retinopathy of prematurity and mitigation of long-term consequences.

Introduction: Placenta previa can cause bleeding during the second half of pregnancy and may compromise the health of both the mother and the fetus. Knowing the associated risk factors allows for the early identification of pregnant women at high risk of placenta previa. Objective: To describe the risk factors for placenta previa in a sample of pregnant women treated in Bogotá D.C., Colombia, as well as their maternal and perinatal morbidity and mortality. Materials and methods: Retrospective descriptive study. 17 pregnant women diagnosed with placenta previa and admitted to the High Obstetric Risk Unit of a tertiary care hospital between 2013 and 2017 were included. Medical records were reviewed to collect data on risk factors for placenta previa and clinical and sociodemographic characteristics. In the descriptive analysis, means and standard deviations and absolute and relative frequencies were calculated for quantitative and qualitative variables, respectively. Results: The most frequent risk factors were ≥4 pregnancies (64.70%), maternal age >35 years (29.41%), and history of miscarriage (29.41%). Maternal morbidity was higher than fetal morbidity: three patients required transfusion of blood products, and another underwent a subtotal hysterectomy, while no perinatal complications were reported, with the exception of one stillbirth. Conclusions: A history of miscarriage, ≥4 pregnancies, and maternal age >35 years were the most frequent risk factors. Furthermore, the degree of maternal-perinatal complications did not depend on the type of placenta previa. Knowing which pregnant women are at higher risk of placenta previa as a result of the early identification of these risk factors allows for a better clinical approach, reducing morbidity and mortality rates in both the mother and the child.

Resumen: Introducción: La enfermedad meningocócica invasiva (EMI) supone una causa importante de morbimortalidad en niños y adultos. Objetivo principal: describir las características clínicas y epidemiológicas de los pacientes con EMI. Objetivos secundarios: describir las diferencias entre niños y adultos, factores pronósticos y cambios epidemiológicos en los últimos 14 años. Métodos: Estudio retrospectivo realizado en un hospital terciario. Se incluyeron los pacientes diagnosticados de EMI entre 2004 y 2017, recogiéndose datos epidemiológicos, clínicos y microbiológicos. Resultados: Fueron diagnosticados 84 pacientes con EMI, 50 (59,5%) niños. Edad mediana en niños 2 años (RIC: 0,7-7,5) y adultos 41,2 años (RIC: 26,4-69,3). Bacteriemia en 47 casos (56%), meningitis en 24 (28,6%) y ambas en 13 (15,5%). Predominio del serogrupo B (MenB), en el 40,5%, seguido del serogrupo C (MenC), en el 15,5%, con mayor proporción de MenC en adultos (26,5 vs. 8%; p = 0,022). Disminución en la incidencia de 2004-2010 a 2011-2017, pasando de 3,14 a 1,33 casos/100.000 urgencias en el centro de estudio (p

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p

Visual and ocular pathologies are among the main causes of vision loss worldwide. Objective: to describe visual and ocular morbidity in the central region of Colombia according to reports from the database of Individual Records for Health Care Delivery, or RIPS reports 2013-2015. Methodology: Quantitative, retrospective, descriptive cross-sectional study of the most frequent visual and ocular pathologies registered among the population of the central region of the country. For the analysis, we used the codes found in chapter VII of the International Classification of Diseases, 10th Version (ICD-10), in 18 groups, according to the classification defined by the Ibero-American Epidemiological Network in Visual and Ocular Health. (REISVO). Results: The pathologies with the highest morbidity in the central region population were disorders of: conjunctiva (15.22%); extra ocular muscles (13.37%); accommodation and refractive disorders (13.06%). Disorders of the cornea showed the lowest rates (0.7% and 1.03%). Conclusions: Conjunctival disorders had the highest rate among ocular conditions in the central region, in population ages 15-44. Female patients exhibited the highest rate of visual affections. The contributory health care system had the highest number of visual health appointments.

This reflection on the influence of Napoleon and the consequences of the wars on the major British poets of the Romantic era is meant to illustrate how the reactions of both nobility and commoners are recorded in literature and media. The dual perception of Napoleon as both hero and tyrant and the atrocious suffering of those at home and bloody battles are manifest in the works of the major poets, William Wordsworth, Samuel Taylor Coleridge, Percy Bysshe Shelly, and especially George Gordon, Lord Byron. Even today, Napoleon transcends precise definition and he has inspired some of the greatest poets in British literature

Objectives. To describe patterns of multimorbidity in six diverse Latin American and Caribbean countries, examine its effects on primary care experiences, and assess its influence on reported overall health care assessments. Methods. Cross-sectional data are from the Inter-American Development Bank's international primary care survey, conducted in 2013/2014, and represent the adult populations of Brazil, Colombia, El Salvador, Jamaica, Mexico and Panama. Robust Poisson regression models were used to estimate the extent to which those with multimorbidity receive adequate and appropriate primary care, have confidence in managing their health condition, and are able to afford needed medical care. Results. The prevalence of multimorbidity ranged from 17.5% in Colombia to 37.3% in Jamaica. Most of the examined conditions occur along with others, with diabetes and heart disease being the two problems most associated with other conditions. The proportions of adults with high out-of-pocket payments, problems paying their medical bills, seeing multiple doctors, and being in only fair/poor health were higher among those with greater levels of multimorbidity and poorer primary care experiences. Multimorbidity and difficulties with primary care were positively associated with trouble paying for medical care and managing one's conditions. Nonetheless, adults with multimorbidity were more likely to have received lifestyle advice and to be up to date with preventive exams. Conclusions. Multimorbidity is reported frequently. Providing adequate care for the growing number of such patients is a major challenge facing most health systems, which will require considerable strengthening of primary care along with financial protection for those most in need.

ABSTRACT Purpose: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients’ quality of life (QoL). Aims: to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. Methods: we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). Results: the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. Conclusion: the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

Background: This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients., Methods: A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality., Results: Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients)., Conclusions: No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Noncardiovascular events represent a significant proportion of the morbidity and mortality burden in patients with heart failure (HF). However, the risk of these events appears to differ by left ventricular ejection fraction (LVEF) status. In this study, we sought to evaluate the risk of noncardiovascular death and recurrent noncardiovascular readmission by LVEF status following an admission for acute HF., Methods: We retrospectively assessed a cohort of 4595 patients discharged after acute HF in a multicenter registry. We evaluated LVEF as a continuum, stratified in 4 categories (LVEF ≤ 40%, 41%-49%, 50%-59%, and ≥ 60%). Study endpoints were the risks of noncardiovascular mortality and recurrent noncardiovascular admissions during follow-up., Results: At a median follow-up of 2.2 [interquartile range, 0.76-4.8] years, we registered 646 noncardiovascular deaths and 4014 noncardiovascular readmissions. After multivariable adjustment including cardiovascular events as a competing event, LVEF status was associated with the risk of noncardiovascular mortality and recurrent noncardiovascular admissions. When compared with patients with LVEF ≤ 40%, those with LVEF 51%-59%, and especially those with LVEF ≥ 60%, were at higher risk of noncardiovascular mortality (HR, 1.31; 95%CI, 1.02-1,68; P=.032; and HR, 1.47; 95%CI, 1.15-1.86; P=.002; respectively), and at higher risk of recurrent noncardiovascular admissions (IRR, 1.17; 95%CI, 1.02-1.35; P=.024; and IRR, 1.26; 95%CI, 1.11-1.45; P=.001; respectively)., Conclusions: Following an admission for HF, LVEF status was directly associated with the risk of noncardiovascular morbidity and mortality. Patients with HFpEF were at higher risk of noncardiovascular death and total noncardiovascular readmissions, especially those with LVEF ≥ 60%., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

ABSTRACT Objective: To analyze near miss cases among newborns hospitalized in the Intensive Care Unit. Methods: An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher’s exact tests. Results: A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight

ABSTRACT Objective: to assess scientific evidence on SARS-CoV-2 Acute Kidney Injury in patients with COVID-19. Methods: an integrative review, with adoption of PICO strategy and classification of the level of evidence, carried out on April 10, 2020 in the PubMed database, of articles available between December 2019 and April 2020. Results: the sample consisted of six original, five observational and one experimental articles. Observational studies addressed the clinical findings of patients with COVID-19 and association between kidney damage, infection, and morbidity-mortality. Conclusion: the studies addressed the mechanism of intracellular infection of SARS-CoV-2, its cytopathic effects on kidney cells and incidence of acute kidney injury in patients infected with SARS-CoV-2. Acute kidney injury is associated with increased mortality and morbidity in these patients. This review realizes the need for new research that can mention kidney care to patients with COVID-19.