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Objectives. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. Materials and methods. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Results. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Conclusions. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.

Introduction. After homicides, traffic accidents are the second cause of violent death in the country. The National Police of Honduras is the government entity responsible for recording the details of these events. Objective. Analyze the frequency of traffic accidents and the mortality associated with them, in the period 2013-2020. Methods. Quantitative, retrospective research. The entire population of 63,908 participants in accidents for the period 2013-2020 was considered, found in the database of the National Police of Honduras and by the Technical Unit of Institutional Coordination (UTECI). Descriptive statistics were applied with a univariate analysis. Results. The death rate decreased from 1 to 3 people per 10 participants from the year 2013-2020. The most frequent sex was male in the range of 20 to 39 years. Mortality predominated in men with 82.8% (8,929) of deaths, predominating the range of 15 to 39 years. The phenomenon of road accidents and mortality, since 2013, has contributed a growth rate of 23%, only interrupted by the global COVID19 pandemic. Regarding responsibility for accidents, 33.4% of the perpetrators (responsible) were men while 1.1% were women. Discussion. Homicides occupy a priority space on the public agenda due to their impact on society; however, traffic accidents report a constant growth rate and despite this, there are no efforts by society as a whole that aim to correct the problem.

Resumen: Antecedentes y objetivo: La endocarditis infecciosa presenta una mortalidad de 25%. La lesión renal aguda (LRA) se desarrolla en hasta 70% de los casos. El objetivo de presente estudio es determinar el impacto pronóstico de la LRA en la endocarditis y los factores asociados a la misma. Materiales y métodos: Estudio retrospectivo unicéntrico que incluyó a todos los pacientes ingresados por endocarditis entre 2015 y 2021. Basalmente se recogieron datos epidemiológicos y comorbilidades. Durante el ingreso, se recogieron datos de evolución de la función renal, variables asociadas con la propia infección y el desenlace de la misma. A través de modelos multivariables, se analizó la capacidad predictiva de la LRA en la mortalidad. Resultados: Se incluyó a 134 pacientes (63% varones, edad media 72 ± 15 años) de los que 94 (70%) presentaron una LRA (50% AKIN-1, 29% AKIN-2 y 21% AKIN-3). Los factores asociados a presentar una LRA fueron la edad, la hipertensión arterial, tener una enfermedad renal crónica, el FGe basal, padecer insuficiencia cardiaca y enfermedad vascular periférica. El único predictor independiente para presentar una LRA fue el FGe basal (OR 0,94, p = 0,001).Fallecieron 46 (34%) pacientes, de los que en 45 (98%) se desarrolló una LRA. A través de diversos modelos multivariantes ajustados, la LRA predijo independientemente la mortalidad. Asimismo, la pérdida de FGe (OR 1,054, p < 0,001) y el FGe basal (0,963, p = 0,012) se asociaron independientemente a fallecer durante la hospitalización. Conclusiones: El desarrollo de una LRA y su gravedad, es decir, la pérdida de FGe y la puntuación en la escala AKIN impactan en el pronóstico de una endocarditis infecciosa. Abstract: Introduction: Infective endocarditis presents a 25% mortality. Acute kidney injury (AKI) develops in up to 70% of the cases. The aim of this study is to evaluate the predictive value of AKI in mortality due to endocarditis and to assess its associated factors. Methods: Unicentric and retrospective study including all patients with in-hospital diagnosis of endocarditis between 2015 and 2021. Epidemiological data and comorbidities were collected at baseline. During admission, renal function parameters, infection-related variables and mortality were collected. Using adjusted multivariate models, LRA predictive value was determined. Results: One hundred and thirty-four patients (63% males, age 72±15 years) were included. Of them 94 (70%) developed AKI (50% AKIN-1, 29% AKIN-2 and 21% AKIN-3). Factors associated to AKI were age (p=0.03), hypertension (p=0.005), previous chronic kidney disease (p=0.001), heart failure (p=0.006), peripheral vascular disease (p=0.022) and glomerular filtration rate (GFR) at baseline (p

ABSTRACT Multiple myeloma is the second most common hematological cancer; it accounts for approximately 10% of all hematologic malignancies and 1%-2% of all cancer diagnoses. From 1990 to 2019, an ecological study was conducted to describe and evaluate trends in Brazil’s morbidity, mortality, and disease. The Global Burden of Disease data described age-standardized (+40 years) incidence, prevalence, mortality, disability-adjusted life years, and its components in Brazil and across its 27 federative units according to sex and Socio-demographic Index quintiles. Trends were estimated using linear regression and expressed as Average Annual Percentage Changes (AAPC) and 95% Confidence Intervals (CI). Ascending trends of the measures were found for both sexes in Brazil and its federative units. Mortality increased to a lesser extent than incidence (AAPC=1.3%; 95%CI=1.2-1.3 vs. AAPC=1.5%; 95%CI= 1.5-1.5 for men; AAPC=0.9%; 95%CI=0.9-0.9 vs. AAPC=1.1%; 95%CI=1.1-1.2 for women), resulting in higher rising trends in prevalence for both sexes. All the measures were significantly higher in high- and high-middle socio-demographic quintiles; however, higher ascending trends were found in lower socio-demographic quintiles. Aging, level of development, diagnosis, and treatment appear to explain Brazil’s ascending multiple myeloma rates and their differences among the federative units.

Abstract: Ischemic stroke is a major cause of mortality worldwide; however, few studies have been conducted to measure the impact of the distribution of healthcare services on ischemic stroke fatality. This study aimed to explore the relationship between three ischemic stroke outcomes (incidence, mortality, and fatality) and accessibility to hospitals in Spain, considering its economic development. A cross-sectional ecological study was performed using data on hospital admissions and mortality due to ischemic stroke during 2016-2018. Gross geographic product (GGP) per capita was estimated and a healthcare accessibility index was created. A Besag-York-Mollié autoregressive spatial model was used to estimate the magnitude of association between ischemic stroke outcomes and economic development and healthcare accessibility. GGP per capita showed a geographical gradient from southwest to northeast in Spain. Mortality and case-fatality rates due to ischemic stroke were higher in the south of the country in both women and men aged 60+ years. In women and men aged 20-59 years a EUR 1,000 increase in GGP per capita was associated with decreases in mortality of 5% and 4%, respectively. Fatality decreased 3-4% with each EUR 1,000 increase of GGP per capita in both sexes and in the 20-59 and 60+ age groups. Decreased healthcare accessibility was associated with higher fatality in the population aged 60+. Economic development in southwest Spain would not only improve employment opportunities but also reduce ischemic stroke mortality. New health related strategies to improve hospital accessibility should be considered in more sparsely populated regions or those with worse transport and/or healthcare infrastructure.

ABSTRACT OBJECTIVE To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil. METHODS This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals. RESULTS A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020. CONCLUSION The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.

Introduction. Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. Objective. To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. Materials and methods. A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. Results. A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). Conclusions. Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Introduction. Heart failure and type 2 diabetes mellitus are critical public health issues. Objective. To characterize the risk factors for mortality in patients with heart failure and type 2 diabetes mellitus from a large registry in Colombia and to evaluate the potential effect modifications by type 2 diabetes mellitus over other risk factors. Materials and methods. Heart failure patients with and without type 2 diabetes mellitus enrolled in the Registro Colombiano de Falla Cardíaca (RECOLFACA) were included. RECOLFACA enrolled adult patients with heart failure diagnosis from 60 medical centers in Colombia during 2017-2019. The primary outcome was all-cause mortality. Survival analysis was performed using adjusted Cox proportional hazard models. Results. A total of 2514 patients were included, and the prevalence of type 2 diabetes mellitus was 24.7% (n = 620). We found seven independent predictors of short-term mortality for the general cohort, chronic obstructive pulmonary disease, sinus rhythm, triple therapy, nitrates use, statins use, anemia, and hyperkalemia. In the type 2 diabetes mellitus group, only the left ventricle diastolic diameter was an independent mortality predictor (HR = 0.96; 95% CI: 0.93-0.98). There was no evidence of effect modification by type 2 diabetes mellitus on the relationship between any independent predictors and all-cause mortality. However, a significant effect modification by type 2 diabetes mellitus between smoking and mortality was observed. Conclusions. Patients with type 2 diabetes mellitus had higher mortality risk. Our results also suggest that type 2 diabetes mellitus diagnosis does not modify the effect of the independent risk factors for mortality in heart failure evaluated. However, type 2 diabetes mellitus significantly modify the risk relation between mortality and smoking in patients with heart failure.

Introduction. Diabetes mellitus is one of the most common diseases worldwide, with a high morbidity and mortality rate. Its prevalence has been increasing, as well as its acute complications, such as hyperglycemic crises. Hyperglycemic crises can present with combined features of diabetic ketoacidosis and hyperosmolar state. However, their implications are not fully understood. Objective. To describe the characteristics, outcomes, and complications of the diabetic population with hyperglycemic crises and to value the combined state in the Latin American population. Materials and methods. Retrospective observational study of all hyperglycemic crises treated in the intensive care unit of the Fundación Valle del Lili between January 1, 2015, and December 31, 2020. Descriptive analysis and prevalence ratio estimation for deaths were performed using the robust Poisson regression method. Results. There were 317 patients with confirmed hyperglycemic crises, 43 (13.56%) with diabetic ketoacidosis, 9 (2.83%) in hyperosmolar state, and 265 (83.59%) with combined diabetic ketoacidosis and hyperosmolar state. Infection was the most frequent triggering cause (52.52%). Fatalities due to ketoacidosis occurred in four patients (9.30%) and combined diabetic ketoacidosis/hyperosmolar state in 22 patients (8.30%); no patient had a hyperosmolar state. Mechanical ventilation was associated with death occurrence (adjusted PR = 1.15; 95 % CI 95 = 1.06 - 1.24). Conclusions. The combined state was the most prevalent presentation of the hyperglycemic crisis, with a mortality rate similar to diabetic ketoacidosis. Invasive mechanical ventilation was associated with a higher occurrence of death.

ABSTRACT Introduction and objectives: In patients with ST-segment elevation myocardial infarction (STEMI) treatment delay significantly affects outcomes. The effect of admission time in STEMI patients is unknown when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. This study aimed to determine the association between STEMI outcomes and the timing of admission in a PCI center in south-western Europe. Methods: This retrospective cohort study analyzed the local electronic data from 1222 consecutive STEMI patients treated with PCI. On-hours were defined as admission from Monday to Friday between 8:00 AM and 6:00 PM on non-national holidays. Results: A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between the 2 groups, including the percentage of patients admitted in cardiogenic shock (on-hours 5% vs off-hours 4%; P = .62). The median time from first medical contact to reperfusion did not differ between the 2 groups (on-hours 120 minutes vs off-hours 123 minutes, P = .54) and no association was observed between admission time and in-hospital mortality (on-hours 5% vs off-hours 5%, P = .90) or 1-year mortality (on-hours 10% vs off-hours 10%, P = .97). Survival analysis showed no differences in on-hours PCI vs off-hours...

Resumen: Introducción: La tasa de transferencia de moléculas pequeñas (PSTR) a través de la membrana peritoneal ha sido relacionada con un aumento en el riesgo de mortalidad en algunos estudios. Se ha observado en la literatura que aquellos pacientes con rápida difusión de solutos a través de la membrana peritoneal (transferencia alta/rápida) y probablemente aquellos con transferencia promedio alto caracterizado en la prueba de equilibrio peritoneal (PET) se asocian a una mayor mortalidad comparado con aquellos pacientes quienes tienen transferencia lenta. Sin embargo, algunos autores no han documentado este hecho. En el presente estudio queremos evaluar la relación (etiológica) entre las características de transferencia de la membrana peritoneal y mortalidad y supervivencia de la técnica en una población incidente en diálisis peritoneal en RTS Colombia durante los años 2007 a 2017 utilizando un modelo de riesgos competitivos. Materiales y métodos: Se realizó un estudio de cohortes retrospectivo en RTS Colombia en el periodo comprendido entre los años 2007 y 2017. En total fueron 8.170 pacientes incidentes mayores de 18 años, quienes tenían una prueba de equilibrio peritoneal (PET) entre los 28 y 180 días de inicio de terapia. Se evaluaron variables demográficas, clínicas y de laboratorio. Se analizó la relación (etiológica) entre el tipo de transferencia de la membrana peritoneal al inicio de la terapia y mortalidad global y la supervivencia de la técnica utilizando un modelo de riesgos competitivos (modelo de riesgo proporcional causa específico descrito por Royston-Lambert). Resultados: Los pacientes se clasificaron en cuatro categorías según el resultado de la PET: transferencia lento/bajo (16,0%), promedio bajo (35,4%), promedio alto (32,9%) y transferencia alto/rápido (15.7%). Durante el seguimiento, mediana de 730 días, fallecieron 3.025 (37,02%) pacientes, 1.079 (13,2%) fueron transferidos a hemodiálisis (HD) y 661 (8,1%) fueron trasplantados. En el análisis de riesgos competitivos, ajustado por edad, sexo, presencia de DM, HTA, IMC, función residual al inicio de la terapia, albúmina, hemoglobina, fósforo y terapia de inicio encontramos que el HR causa específico (HRce) para transferencia alto/rápido fue de 1,13 (IC 95% 0,98-1,30) p = 0,078, promedio alto 1,08 (IC 95% 0,96-1,22) p = 0,195, promedio bajo 1,09 (IC 95% 0,96-1,22) p = 0,156 comparados con el tipo de transferencia bajo. Para la supervivencia de la técnica, el HR causa-específico para transferencia alto/rápido de 1,22 (IC 95% 0,98-1,52) p = 0,66, promedio alto el HR fue de 1,10 (IC 95% 0,91-1,33) p = 0,296, promedio bajo HR de 1,03 (IC 95% 0,85-1,24) p = 0,733 comparados con el tipo de transferencia bajo/lento, ajustado por edad, sexo, DM, HTA, IMC, función renal residual, albúmina, fósforo, hemoglobina y terapia de inicio. Diferencias no significativas. Conclusiones: Al evaluar la relación etiológica entre el tipo de transferencia de membrana peritoneal y mortalidad global y supervivencia de la técnica utilizando un modelo de riesgos competitivos, no encontramos relación etiológica entre las características de transferencia de la membrana peritoneal de acuerdo con la clasificación dada por Twardowski evaluada al inicio de la terapia de diálisis peritoneal y la mortalidad global o en la supervivencia de la técnica en los modelos ajustados. Se hará posteriormente el análisis desde el modelo pronostico con el propósito de predecir el riesgo de mortalidad y sobrevida de la técnica utilizando el modelo de subdistribución de riesgos (Fine & Gray). Abstract: Introduction: In some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the peritoneal equilibrium test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007 to 2017 using a competing risk model. Materials and methods: A retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a PET between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). Results: Patients were classified into four categories based on the PET result: slow/low transfer (16.0%), low average (35.4%), high average (32.9%), and high/fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98–1.30) P = .078, high average 1.08 (95% CI 0.96–1.22) P = .195, low average 1.09 (95% CI 0.96–1.22) P = .156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98–1.52) P = .66, high average HR was 1.10 (95% CI 0.91–1.33) P = .296, low average HR of 1.03 (95% CI 0.85–1.24) P = .733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. Conclusions: When evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

ABSTRACT The effective management of disturbed forests requires adequate knowledge of forest dynamics. In this study, we assessed the changes in a managed forest using 18 permanent 1 ha plots located in a ‘terra firme’ tropical rainforest in the Eastern Amazon (Paragominas, Brazil). All individuals with a diameter at breast height (DBH) ≥ 20 cm were evaluated in two separate assessments conducted in 2006 and 2016. The results show that, ten years after logging, the managed forest exhibits an imbalance between recruitment (1.54% per year) and mortality (2.23% per year) rates, indicating that it is still in the process of recovering its structure. Nevertheless, biomass tended to increase after logging (28.49 tons per hectare). The characteristics of these changes suggest that the forest is undergoing a silvigenetic process driven by the effects of logging. Furthermore, our observations indicate that the forest remains active and has sufficient potential for new timber production at the end of the cutting cycle, considering the same species and tree sizes.

Objective: To characterize the epidemiological profile of leprosy cases and deaths in Mato Grosso - Brazil, from 2011 to 2020. Method: A population-based observational study of all leprosy cases and deaths reported between 2011 and 2020. Subsequently, the reported individuals were matched, and the trend was estimated using the Prais-Winsten regression. Results: 37,623 new cases were registered in the study years, with an average rate of 114.7/100,000 inhabitants, with higher incidence rates in multibacillary cases and males, and in the proportion of deaths (58%; 88.2%), respectively. As for the trend, it has increased over the years and among women. Conclusion: The results suggest a profile of more incident cases, possible areas with the spread of the disease, and delayed diagnosis, highlighting the need to use indicators to monitor the endemic and strengthen comprehensive care and surveillance of leprosy.

Chlorpyrifos is widely used in agricultural and building industries to control many insects including termites. However, its low aqueous solubility and tendency to decompose under sunlight results in decrease in its efficiency. In the present study, chlorpyrifos was encapsulated into nano-sized poly (styrene-co-maleic anhydrite) using a mini-emulsion in-situ polymerization method to improve the effective utilization rate. The termiticidal properties of nanocapsules at different concentrations (1 - 25 wt%) were tested against subterranean termite; Coptotermes curvignathus. Results of Choice bioassays shows that chlorpyrifos nanocapsules are strongly toxic to Coptotermes curvignathus. The filter paper feeding inhibition and repellent bioassay show a significant feeding inhibition (> 60 %) at lowest concentration of chlorpyrifos nanocapsules. The highest mortality rate of termites (90 %) after 24-h exposure was observed in the sample treated with the highest concentration of chlorpyrifos nanocapsules (25 wt%). Results obtained from this study show that chlorpyrifos nanocapsules have a strong termiticidal property against Coptotermes curvignathus. This indicates that the nanoencapsulation of biocides chlorpyrifos opens a real potential of new and advanced wood preservation technology.

Resumen: Objetivos: Se trata de determinar la enfermedad renal crónica (ERC) oculta y su relación con la aparición de los eventos cardiovasculares (ECV) y mortalidad. Además, se pretende identificar los factores de riesgo cardiovascular (FRCV) y calcular el grado de control de diabetes mellitus (DM) tipo 2 y dislipidemia (DLP) previa al ECV. Material y métodos: Consiste en un estudio de cohortes retrospectivo realizado en las zonas básicas de salud (ZBS) de San Agustín (33.321 usuarios), que consta de los centros de salud San Agustín, Illes Columbretes y los consultorios auxiliares de Borriol y Raval; y por otra parte la ZBS de Almassora (25.831 usuarios), basándose en analíticas entre enero de 2015 y diciembre de 2018. Las principales variables fueron ERC, ECV, mortalidad y los FRCV. Resultados: Muestra final de 243 pacientes de 2 cohortes de 135 sin ERC y 99 con ERC (36,4% ERC oculta). El HR de desarrollar ECV era de 4,28 y la mortalidad del 12,3 en el grupo con ERC respecto con el grupo sin ERC. En cuanto a la relación de los FRCV previos a la aparición de ECV, en la cohorte con ERC la hipertensión, la DLP y la DM tipo 2 tuvieron resultados significativos respecto a la cohorte sin ERC. Asimismo, en la cohorte con ERC el porcentaje de control de la DLP fue inferior al 50% y mayor del 66,66% en la DM tipo 2. Conclusiones: Se objetiva que un tercio de los pacientes no están diagnosticados de ERC, lo cual tienen una probabilidad elevada de desarrollar ECV o muerte. Dada la falta de diagnóstico las intervenciones en el control de la DLP y DM tipo 2 son más bajas. Abstract: Objectives: The aim is to determine hidden chronic kidney disease (CKD) and its relationship with the appearance of cardiovascular events (CVD) and mortality. Furthermore, the aim is to identify cardiovascular risk factors (CVRF) and calculate the degree of control of diabetes mellitus (DM) type 2 and dyslipidemia (DLP) prior to CVD. Material and methods: It consists of a retrospective cohort study carried out in the Basic Health Zones (BHZ) of San Agustín, (population of 33,321 users) which consists of the health centers San Agustín, Illes Columbretes, and the auxiliary clinics of Borriol and Raval; and on the other hand, the BHZ of Almassora (25,831 users), calculated in analysis between January 2015 and December 2018. The main variables were CKD, CVD, mortality and CVRFs. Results: Final sample of 243 patients from two cohorts of 135 without CKD and 99 with CKD (36.4% occult CKD). The HR of developing CVD was 4.28 and mortality was 12.3 in the group with CKD compared to the group without CKD. Regarding the relationship of CVRFs prior to the appearance of CVD, in the cohort with CKD, hypertension (HTA), DLP, and type 2 DM had significant results, compared to the cohort without CKD. Likewise, in the CKD cohort the percentage of DLP control was less than 50.0%, and greater than 66.66% in DM type 2. Conclusions: It is observed that a third of patients are not diagnosed with CKD, which has a high probability of developing CVD or death. Given the lack of diagnosis, interventions in the control of DLP and DM type 2 are lower.

Resumen: Introducción y objetivo: La pandemia por coronavirus de 2019 (COVID-19) puede causar el síndrome respiratorio agudo grave (SARS-CoV-2), causando la pandemia actual de enfermedad respiratoria aguda llamada COVID-19. La lesión hepática por COVID-19 se define como cualquier daño hepático que ocurra durante el curso de la enfermedad y el tratamiento de pacientes con COVID-19, con o sin enfermedad hepática. La incidencia de transaminasas hepáticas elevadas, alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST) va del 2.5 al 76.3%. El objetivo del estudio fue describir las anormalidades bioquímicas hepáticas posterior a la prueba reacción en cadena de la polimerasa (PCR) positiva para SARS-CoV-2 y mortalidad en el paciente crítico. Material y métodos: Es un estudio retrospectivo, se incluyeron 70 pacientes, la mediana de edad fue de 44.5 años (rango: 37-57.2), siendo del sexo masculino 43 (61.4%), de un hospital privado de la Ciudad de México, se midieron al ingreso hospitalario las pruebas de la función hepática. Período del estudio: febrero-diciembre 2021. Resultados: Encontrando elevación de gamma-glutamil transferasa (GGT) p 0.032, AST p 0.011 y ALT p 0.021, los pacientes se estratificaron en grupo de edad, 18-35, 36-50 y > 50 años. La mayor elevación fue de 18-35 años, entre más joven mayor elevación de transaminasas, debido a la baja mortalidad, un paciente que no coincide con causa hepática, el análisis multivariado explicó una asociación R2 .689 p 0.001, explicado por AST, GGT y proteína C reactiva. Conclusiones: A pesar del incremento de transaminasas durante la infección por COVID-19, en nuestra población no aumentó la mortalidad, si bien debe darse seguimiento continuo durante la evolución hospitalaria. Abstract: Introduction and aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, causing the current pandemic of acute respiratory disease known as COVID-19. Liver injury due to COVID-19 is defined as any liver injury occurring during the course of the disease and treatment of patients with COVID-19, with or without liver disease. The incidence of elevated liver transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), ranges from 2.5 to 76.3%. The aim of the present study was to describe the hepatic biochemical abnormalities, after a SARS-CoV-2-positive polymerase chain reaction (PCR) test, and the mortality rate in critically ill patients. Materials and methods: A retrospective study was conducted that included 70 patients seen at a private hospital in Mexico City, within the time frame of February-December 2021. Median patient age was 44.5 years (range: 37-57.2) and 43 (61.4%) of the patients were men. Liver function tests were performed on the patients at hospital admission. Results: Gamma glutamyl transferase (GGT) levels were elevated (P=0.032), as were those of AST (P=0.011) and ALT (P=0.021). The patients were stratified into age groups: 18-35, 36-50, and >50 years of age. The 18 to 35-year-olds had the highest liver enzyme levels and transaminase levels were higher, the younger the patient. Due to the low mortality rate (one patient whose death did not coincide with a hepatic cause), the multivariate analysis showed an R2 association of 0.689, explained by AST, GGT, and C-reactive protein levels. Conclusions: Despite the increase in transaminases in our study population during the course of COVID-19, there was no increase in mortality. Nevertheless, hospitalized patient progression should be continuously followed.

Background: Hypochloremia has been associated with increased mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease (CKD). The pathophysiological mechanisms of this finding are not clear. There are no studies describing an association between serum chloride levels (Cl−) and mortality in incident chronic hemodialysis (HD) patients. Method: Retrospective cohort study of the incident population in our chronic outpatient hemodialysis program between January 1, 2016, and January 1, 2021 (N = 374). Survival time was collected in all patients and analyzed using the Kaplan–Meyer method. A multivariate Cox regression model was performed to predict the probability of survival, applying a stepwise procedure. Results: During the median follow-up period of 20 months, 83 patients died. The 5-year overall survival rate for our patients was 45%. Both natremia and chloremia had no significant differences when compared by sex, vascular access, or etiology. There was an inverse correlation between Cl− and interdialytic weight gain (r = −0.15) (p = 0.0038). Patients belonging to the quartile with lower Cl− levels had less probability of survival than patients in the quartile with higher Cl− levels (27% and 68%, respectively, p = 0.019). On the other hand, in the multivariate Cox regression model, variables significantly associated with higher mortality were being older, having higher baseline comorbidity by modified Charlson index, not taking diuretics and having lower albumin and chloride levels. Particularly, higher Cl− levels was independently associated with both lower all-cause mortality (adjusted hazard ratio [HR] = 0.84; 95% confidence interval [CI], 0.77–0.92; p = 0.0001) and cardiovascular mortality (HR 0.9; 95% CI, 0.83–0.97; p

ABSTRACT Objective: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). Methods: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. Results: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p

ABSTRACT Backgrounds: COVID-19 pandemic led to a sharp decline in surgical volume worldwide due to the postponement of elective procedures. This study evaluated the impact of COVID-19 pandemic in surgical volumes and outcomes of abdominal surgery in high-risk patients requiring intensive care unit admission. Methods: patients admitted for postoperative care were retrospectively evaluated. Data concerning perioperative variables and outcomes were compared in two different periods: January 2017-December 2019 and January 2020-December 2022, respectively, before (period I) and after (period II) the onset of COVID-19 pandemic. Results: 1.402 patients (897 women, mean age 62+17 years) were investigated. Most of the patients underwent colorectal (n=393) and pancreato-biliary (n=240) surgery, 52% of elective procedures. Surgical volume was significantly lower in period II (n=514) when compared to period I (n= 888). No recovery was observed in the number of surgical procedures in 2022 (n=135) when compared to 2021(n=211) and 2020 (n=168). Subjects who underwent abdominal surgery in period II had higher Charlson comorbidity index (4,85+3,0 vs. 4,35+2,8, p=0,002), more emergent/urgent procedures (51% vs. 45%, p=0,03) and more clean-contaminated wounds (73,5% vs. 66,8%, p=0,02). A significant decrease in the volume of colorectal surgery was also observed (24% vs, 31%, p

ABSTRACT Objectives: to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. Methods: this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist. Results: the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality. Conclusions: discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.

ABSTRACT OBJECTIVE To evaluate the effectiveness of vaccines developed against covid-19 in reducing mortality in people hospitalized with severe acute respiratory syndrome (SARS) caused by SARS-CoV-2. METHODS This is a retrospective cohort that evaluated risk factors and the effectiveness of the two-dose vaccination schedule in reducing the mortality of people hospitalized for covid-19 in the state of Paraíba from February to November 2021. The explanatory variables were vaccination status, presence of comorbidities, socioeconomic and demographic characteristics. Descriptive analyses and bivariate and multivariable logistic regression were performed. RESULTS Most hospitalizations and deaths occurred until May 2021. The percentage of patients with a complete vaccination schedule was similar across patients admitted to public and private hospitals and higher in residents of less developed municipalities. Multivariable analysis demonstrated that women (OR = 0.896; 95%CI 0.830–0.967) and people admitted to private hospitals (OR = 0.756; 95%CI 0.679–0.842) were less likely to die. Presence of any comorbidity (OR = 1.627; 95%CI 1.500–1.765) and age ≥ 80 years (OR = 7.426; 95%CI 6.309–8.741) were risk factors for death. Patients with complete vaccination schedule at the time of admission were 41.7% less likely to die (OR = 0.583; 95% CI 0.501–0.679) from covid-19 in the adjusted analysis, as compared to unvaccinated patients. CONCLUSIONS The study reveals that immunization was effective in reducing the likelihood of death from covid-19. The results suggest that greater vaccination coverage in the first half of 2021 would prevent thousands of deaths in the country.

Objective. To analyze trends in mortality caused by cardiovascular diseases (CVD) in Chile during the period 2000–2020. Methods. Data on age-adjusted mortality rates (AAMR) from CVD per 100 000 population in Chile for 2000–2020 were extracted from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the average annual percent change (AAPC) in Chile. In addition, analyses were conducted by sex and type of CVD. Results. Between 2000 and 2020, the AAMR from CVD decreased in Chile from 159.5 to 94.6 per 100 000 population, with a statistically significant decrease in the AAPC of 2.6% (95% CI [–2.8, –2.4]). No joinpoints were identified. The AAMR from CVD decreased annually by 2.6% (95% CI [–2.8, –2.4]) and 2.8% (95% CI [–3.5, –2.6]) in men and women, respectively. The AAMR from ischemic heart disease reduced annually by 3.6% (95% CI [–4.6, –2.7]) with two joinpoints in 2011 and 2015. In the case of stroke, the mortality rate decreased annually by 3.7% (95% CI [–4.5, –3.0]), with two joinpoints in 2008 and 2011. Conclusions. Cardiovascular disease mortality rates have decreased significantly in Chile, in both sexes, especially in women. This decrease could be explained mainly by a significant reduction in the case fatality in recent decades. These results could be a reference for developing primary prevention and acute management of CVD policies focused on populations with higher mortality.

Objective. To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Methods. This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. Results. The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of –1.9% (95% CI [–3.4, –0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of –0.4% (95% CI [–1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (–3.5%; 95% CI [–5.0, –1.9]). Conclusions. During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.

Objective: To determine relationship between clinical characteristics, laboratory results and treatments with 12 month mortality in COVID-19. Materials and methods: A retrospective cohort study was conducted in three hospitals in Colombia. Odds ratios (OR) were calculated using multivariate logistic regression analysis with outcome variable mortality at 12 months. Results: A total of 1194 patients were included out of 4344 potential eligible subjects, average age was 57.7 years. The group of patients who died at 12 months showed a lymphocyte count of 922.6 (SD:572.32) compared to 1200.1 (SD:749.45) in the group of survivors (p70 years OR:7.2 (95%CI:3.9-13.3) and adjusted OR:1.05 (95%CI:1.01-1.08) (p=0.023), Charlson index >4 OR:7.8 (95%CI:4.3-14.1) and adjusted OR:1.35 (95%CI:1.1-1.67) (p=0.005), dexamethasone OR:0.3 (95%CI:0.2-0.6) and adjusted OR:0.3 (95%CI:0.14-0.65) (p=0.002) and pronation OR:0.3 (95%CI:0.1-1) and adjusted OR:0.4 (95%CI:0.08-1.87) (p=0.242). Conclusions: The increased risk of death 12 months after acute SARS-CoV-2 infection is associated with clinical variables such as age >70 years and Charlson index >4. Use of prone ventilation and dexamethasone were associated with increased survival.

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.

Resumen: Objetivos: Conocer las características, indicaciones, mortalidad, tasa de reingresos e identificar factores de riesgo. Material y método: Estudio de cohortes retrospectivo de los pacientes congénitos adultos intervenidos desde 2012 a 2020. Análisis multivariante mediante regresión logística binario. Resultados: Se intervinieron 137 pacientes. Edad media 32 (14-73) años; 39,4% mujeres. Tiempo de circulación extracorpórea de 119,28±67 minutos. Clampaje 78±46,76 minutos. Tasa de mortalidad de 5,8% y de reingreso del 9.95%, siendo las causas: fibrilación auricular, insuficiencia cardiaca e infecciosas. Las indicaciones son: defectos septales (20%), patología aórtica/TSVI (21%), patología del tracto de salida derecho (34%) y afectación de válvulas AV (12%).Según análisis multivariante se asocia a mayor mortalidad la hipertensión pulmonar severa, dos o más intervenciones previas y escala RACHS-1 de 4 (p < 0,05). Mayor probabilidad de reingresos: fibrilación auricular (p = 0,047). Conclusiones: La mortalidad de estos pacientes es baja a pesar de tiempos quirúrgicos altos, mayor complejidad y elevada tasa de reintervención. Hay un porcentaje de reingresos no previstos y complicaciones. Debería validarse una escala de riesgo específica. En general, la información de que se dispone es aún insuficiente. Abstract: Objective: To evaluate surgical results, mortality, readmission rates and identify risk factors. Methods: Retrospective study of all cases from 2012 to 2020. Risk factors were assessed fitting regression logistic models. Results: 137 patients were operated, mean age 37 (14-73), 39,4% female. Mean cardiopulmonary bypass time 119,28±67; aortic cross-clamp time 78±46,76. Mortality was 5.8% and readmission rate 9.95% mainly due to atrial fibrillation, congestive heart failure and infections. Indications were septal defects (20%), aortic and LVOT indications (21%), RVOT procedures (34%) and AV valves disease (12%). Mortality was associated to severe pulmonary hypertension, 2 or more previous cardiac surgery and RASCH-1 score 4. Readmission rate was associated to atrial fibrillation. Conclussions: Although these patients have high complexity, long cardiopulmonary bypass time and high rate of reinterventions, mortality is low. There is a number of readmissions and complications. Specific risk models should be validated. There is still a lack of information.

Context: Oral cancer is difficult to define due to several factors. It’s known as oral squamous cell carcinoma (OSCC) and is common in the head and neck. Geographic variations in the impact of OSCC highlight the need for research on risk factors and treatment trends. Aims: To identify the main research trends of studies on oral cancer risk factors in the scientific literature in the Scopus database and Web of Science. Methods: This was an exploratory study of the risk factors for oral cancer designed considering the eligibility criteria defined by the PRISMA-2020 international statement, that is, inclusion and exclusion. Results: A total of 215 documents from Scopus and Web of Science were subjected to bibliometric analysis. The years 2020 and 2021 were the most productive, with 18 and 22 articles, respectively. The leading author in productivity and impact was Johnson N, the leading journal was Oral Oncology, followed by the International Journal of Cancer, and the main contributing countries were the United States, the United Kingdom and India. The main thematic cluster was composed of concepts such as Tobacco and Alcohol as the major risk factors; concepts such as Mortality or Head and Neck were positioned as emerging within the scientific literature. Conclusions: The main risk factors, i.e., alcohol and tobacco consumption, are relevant in terms of mortality in the consumer population, which is why their role should be determined in future studies.