Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease : A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered "exposed". The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2-2.0), urgent surgery (OR: 1.6; 95% CI: 1.2-2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1-1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3-2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97-1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03-2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Impact of Biological Agents on Postsurgical Complications in Inflammatory Bowel Disease: A Multicentre Study of Geteccu

Background: The impact of biologics on the risk of postoperative complications (PC) in inflammatory bowel disease (IBD) is still an ongoing debate. This lack of evidence is more relevant for ustekinumab and vedolizumab. Aims: To evaluate the impact of biologics on the risk of PC. Methods: A retrospective study was performed in 37 centres. Patients treated with biologics within 12 weeks before surgery were considered “exposed”. The impact of the exposure on the risk of 30-day PC and the risk of infections was assessed by logistic regression and propensity score-matched analysis. Results: A total of 1535 surgeries were performed on 1370 patients. Of them, 711 surgeries were conducted in the exposed cohort (584 anti-TNF, 58 vedolizumab and 69 ustekinumab). In the multivariate analysis, male gender (OR: 1.5; 95% CI: 1.2–2.0), urgent surgery (OR: 1.6; 95% CI: 1.2–2.2), laparotomy approach (OR: 1.5; 95% CI: 1.1–1.9) and severe anaemia (OR: 1.8; 95% CI: 1.3–2.6) had higher risk of PC, while academic hospitals had significantly lower risk. Exposure to biologics (either anti-TNF, vedolizumab or ustekinumab) did not increase the risk of PC (OR: 1.2; 95% CI: 0.97–1.58), although it could be a risk factor for postoperative infections (OR 1.5; 95% CI: 1.03–2.27). Conclusions: Preoperative administration of biologics does not seem to be a risk factor for overall PC, although it may be so for postoperative infections

Calidad de la atención dispensarial a la cardiopatía isquémica

Se realizó un estudio transversal sobre la calidad de la atención dispensarial en una muestra de 129 cardiópatas isquémicos, atendidos en los consultorios urbanos del Policlínico "Centro" del municipio de Camagüey durante 1998, a través de una encuesta confeccionada al efecto que contenía las variables a estudiar, aplicada por los autores y procesada por métodos automatizados. En la serie estudiada predominaron: el sexo femenino (55 %); el grupo de 45 años y más (92,24 %); el sedentarismo (83,72 %), el antecedente patológico familiar de cardiopatía isquémica (82,17 %), y la hipertensión arterial (72,87 %) entre los factores de riesgo coronario, y la angina de pecho (52,71 %) entre las formas clínicas. Desde el punto de vista de la atención dispensarial, todos (100 %) estaban registrados, pero más de las 2/3 partes no recibieron los controles periódicos en consultas programadas y casi la mitad no mantuvo la adherencia al tratamiento. A pesar del alto porcentaje de controlados, no se consideró eficiente la atención dispensarialA crosswise study of the quality of classified care in a sample of 129 patients with ischemic heart disease, who were seen at the urban physician’s office of "Centro" polyclinics in Camagüey municipality during 1998, was performed by using an specially designed that included variables to be studied, was applied by the authors themselves and automatically processed. The following prevailed in the studied sample: females (55%), the 45 y and over age group (92.24%), the sedentary lifestyle (83.72%), the pathological family history of ischemic heart diseases (82.17%); and blood hypertension (72.87%) among the coronary risk factors and the angina pectoris (52.71%) among the clinical forms. From the classified medical care viewpoint, all the patients were registered, but two thirds were not systematically controlled in scheduled visits whereas almost half of them did not adhere to the medical treatment. In spite of the high percent of patients under control, the classified care was not considered to be efficien

Comportamiento del proceso de adaptación en un círculo infantil

Se realizó un estudio descriptivo de eficacia en el Círculo Infantil "XX Aniversario", del Policlínico "Ignacio Agramonte" del municipio Camagüey, entre septiembre y diciembre de 1993, en 23 niños que comenzaron el proceso de adaptación para conocer su comportamiento. Se incluuyeron variables sobre las incidencias de la planificación, realización, control y atención y orientación a los padres, causas de las dificultades y medidas tomadas. Entre los niños estudiados predominaron los del 2do. año de vida (56,5 %), del sexo masculino (65,2 %), de padres con buen nivel económico (100 %) y de escolaridad (93 %), procedentes de familias integradas (60,8 %). El uso del chupete (30,4 %) y la alteración de los hábitos alimentarios (21,7 %) predominaron entre los hábitos negativos; mientras que las enfermedades respiratorias crónicas (47,7 %) y las alteraciones del lenguaje (43,4 %) entre los antecedentes patológicos personales. Finalmente las dificultades encontradas fueron: inadecuada planificación y realización del proceso, repercusión negativa de las infecciones respiratorias agudas y el manejo inadecuado por la familia, y presentación frecuente de adaptaciones difíciles<br>A descriptive efficacy study was conducted at the " XX Aniversario" Day Care Center of the " Ignacio Agramonte" Polyclinic, in the municipality of Camagüey, from September to December, 1993. 23 children that started the process of adaptation were studied to know their behaviour. Variables on the incidences of planning, making, control and attention and guidance of parents, as well as the causes of the dificulties and the measures taken were included. 2-year-old children ( 56. 5 %) predominated among the studied children. 65. 2 % were males, 100 % had parents with a good economic level, 93 % had parents with an adequate educational level and 60. 8 % were from families integrates into society. The use of pacifier (30.4 %) and the alteration of the nutritional habits ( 21. 7 %) prevailed among the negative habits, whereas the chronic respiratory diseases ( 47.7 %) and the speech disorders ( 43.4 %) predominated among the personal pathological histories. Finally, the difficulties found were: inadequate planning an making of the process, negative repercussion of acute respiratory infections and the inappropiate management by the family, and the frequent difficulties presented by children to adapt themselves to the day care cente

Enfermedades diarreicas agudas en el niño: comportamiento de algunos factores de riesgo

Se realizó un estudio de casos y controles, pareado 1:1, con el objetivo de conocer el comportamiento de algunos factores de riesgo de las enfermedades diarreicas agudas en el niño, en el Policlínico Comunitario Centro de Camagüey, durante 18 meses de trabajo. El grupo de casos estuvo representado por 89 niños de dicha área de salud egresados con ese diagnóstico, y el grupo control, por la misma cantidad de niños no egresados por ninguna enfermedad y de la misma área de salud. A ambos grupos se les aplicó una encuesta cuyos datos obtenidos se procesaron automatizadamente. Se encontraron como resultados más importantes un 97,67 % de niños menores de 1 año, la higiene doméstica no fue buena en el 80,9 % y la personal mala en el 73,03 %. Hubo destete precoz en el 65,17 % y hacinamiento en el 62,92 %, presentándose en el 45,9 % algún grado de desnutrición y el 37,08 % fueron bajo peso al nacer. El 32,58 % eran madres menores de 20 años y sólo el 15,73 % uso la lactancia materna pura. Se concluyó que todos los factores evaluados se comportaron como factores de riesgo, infiriéndose la importancia de la Educación para la Salud.A case-control study, matched 1:1, was conducted aimed at knowing the behaviour of some risk factors of acute diarrheal diseases in children at the Central Community Polyclinic of Camagüey, during 18 months. The case group was composed of 89 children from that health area that were discharged with that diagnosis, whereas the control group had the same number of children who were sound and lived in the same area. Both groups were surveyed and the data obtained were automatically processed. 97.6 % of the children were under 1, domestic hygiene was not good in 80.9 % and personal hygiene was also bad in 73.03 %. It was observed early weaning in 65.1 % and heaping in 62.92 %. Some degree of malnutrition was found in 15.9 % and 37.08 % were considered as low birth weight. 32.58 % were mothers under 20. Only 15.73 % used breast feeding

La participación de la comunidad en salud

Se realizó una revisión bibliográfica sobre el tema actualizando los conceptos de comunidad, salud, participación social y participación comunitaria, así como analizando los requisitos indispensables para alcanzar esta última. Abordamos sus grados, tipos, etapas o fases, principales mecanismos para lograrla en los programas de salud, elementos con que se interrelaciona, factores desfavorables y la estrategia de promoción de salud a través del movimiento de Municipios Saludables. Finalmente se expone brevemente la experiencia en nuestro país sobre este movimiento y su articulación en los Consejos Populares, haciendo énfasis en las orientaciones metodológicas para el trabajo en la atención primaria de salud de nuestro Ministerio de Salud Pública, con el objetivo de facilitar un material de estudio para el personal de salud de este nivel, especialmente Médicos y Enfermeras de la Familia<br>A bibliographic review on the topic was made in order to bring up to date the concepts of community, health, social participation and community participation and to analyze the requirements necessary to attain comunity participation. We approached its degrees, types, stages or phases, main mechansism to achieve it in 2 health programs, elements with which it is interrelated, unfavorable factors and the strategy of health promotion through the Movement of Healthy Municipalities. Finally, the experience accumulated in our country in relation to this movement and its implementation in the People's Councils is briefly explained, making emphasis on the methodological instructions given by our Ministry of Public Health to work at the primary health care level, so that the health personnel working at this level, specially family physicians and nurses, have study materials

Muerte súbita cardiovascular

Morir súbitamente del corazón, ha pasado a convertirse desde la segunda mitad del siglo XX, en el principal problema de salud para todos aquellos países en los que las enfermedades infectocontagiosas no ocupan un lugar preponderante. La muerte súbita atribuible a causas cardíacas es una importante situación sanitaria a nivel mundial. Se revisaron importantes bases de datos, con el objetivo de realizar una búsqueda de las principales causas de muerte súbita cardiovascular. Se ha demostrado que hay un conjunto de enfermedades hereditarias con alteraciones estructurales o sin aparente causa orgánica que explican muchos de los casos de muerte súbita en la juventud, relacionados o no con el esfuerzo. Hay ciertos grupos de la población donde se concentra el riesgo más alto de padecer esta enfermedad, que son relativamente fáciles de identificar y donde se pueden implementar medidas de prevención primaria