BMI as a Predictor for Potential Difficult Tracheal Intubation in Males

Introduction: Difficult tracheal intubation is a common source of mortality and morbidity insurgical and critical care settings. The incidence reported of difficult tracheal intubation is 0.1 to 13%and reaches 14% in the obese population. The objective of our retrospective study was to investigateand compare the utility of BMI as indicator of difficult tracheal intubation in males and females.Material and methods: We performed a retrospective chart review of patients who underwentabdominal surgeries with ASA I to V under general anesthesia requiring endotracheal intubation. Thefollowing information was obtained from medical records for analysis: gender, age, height, weight,BMI, length of patient stay in the Post Anesthesia Care Unit (PACU), past medical history of sleepapnea, Mallampati score, and the ASA classification assigned by the anesthesia care providerperforming the endotracheal intubation.Results: Of 4303 adult patients, 1970 (45.8%) men and 2333 (54.2%) women, were enrolled in thestudy. Within this group, a total of 1673 (38.9%) patients were morbidly obese. The average age of thestudy group was 51.4 ± 15.8 and the average BMI was 29.7 ± 8.2 kg/m². The overall incidence of theencountered difficult intubations was 5.23%, or 225 subjects. Thus, our results indicate that BMI is areliable predictor of difficult tracheal intubation predominantly in the male population; another strongpredictor, with a positive linear correlation, being the Mallampati score.Conclusions: In conclusion, our data shows that BMI is a reliable indicator of potential difficult trachealintubation only in male surgical patients

The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries : systematic review

Q1Artículo original1-13Aims and method This systematic review examines the effectiveness and costeffectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. Results Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. Clinical implications Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models

Characteristics and outcomes of over 300,000 patients with COVID-19 and history of cancer in the United States and Spain

Background: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza. Methods: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes. Results: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%–18% and 1%–14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin’s lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n ¼ 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events. Conclusions: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent. Impact: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.</p