Prevalencia de bullying y relación con la malnutrición en niños y adolescentes del servicio de emergencia del Hospital José Carrasco Arteaga Cuenca, Ecuador 2019

El bullying se presenta en aproximadamente 246 millones de niños y adolescentes a nivel mundial, en Ecuador 2 de cada 10 son los afectados; se asocia a factores biopsicosociales y en las últimas décadas se ha demostrado que afecta al desarrollo integral del menor. En esta investigación se determina la prevalencia de bullying y la relación con la malnutrición en niños y adolescentes. Se trata de un estudio cuantitativo, analítico y transversal, desarrollado en la emergencia pediátrica del Hospital “José Carrasco Arteaga”, la muestra estuvo conformada por 325 pacientes con edades comprendidas entre 9 y 15 años, en quienes se aplicó el test European Bullying Intervention Project Questionnaire (EBIPQ) para determinar la presencia o no de bullying; además, se recopiló los datos de peso y talla para el cálculo del Índice de Masa Corporal (IMC) con la finalidad de conocer el estado nutricional de acuerdo al percentil obtenido. Se utilizó la prueba de Chi cuadrado y Taub- Kendall, el intervalo de confianza fue de 95% y significancia positiva con (p=) menor a 0,05. De acuerdo a los resultados obtenidos se concluye que la prevalencia de bullying fue del 41,8%. Los individuos afectados presentan un peso adecuado, es decir, el estado nutricional en esta investigación NO guarda relación con la presencia de acoso escolar, de igual manera tampoco es un factor para ser víctima, agresor o víctima agresor.Bullying occurs in 246 million children and adolescents worldwide, approximately; in Ecuador 2 out of 10 children are affected by this social unrest. It is associated with biopsychosocial factors and in the last decades it has been shown that affects the integral development of the child. This research determines the prevalence of bullying and the relationship with malnutrition in children and adolescents. It is a quantitative, analytical and cross-sectional study, developed in the pediatric emergency at José Carrasco Arteaga Hospital; the sample was made up of 325 children between 9 to 15-year-old kids. The European Bullying Intervention Project Questionnaire test was applied in this group (EBIPQ) in order to determine the presence or absence of bullying. In addition, weight and height data was collected to calculate the body mass index (BMI) with the purpose of knowing the nutritional status according to the obtained percentile. The Chi Square and Taub-Kendall tests were used in this research, the reliability interval was 95% and positive significance with (p =) less than 0.05. In conclusion and according to the results, the prevalence of bullying was 41.8%; the individuals concerned are of appropriate weight, that is, the nutritional status in this research is NOT related to the presence of bullying, in the same way it is not a factor to be a victim, aggressor or aggressor victim.Especialista en PediatríaCuenc

Prevalencia de trastornos del sueño y factores asociados en adultos mayores del programa de coordinación de jubilados del seguro social, Cuenca 2014.

Objetivo: Determinar la prevalencia y factores asociados a los trastornos del sueño en el adulto mayor del Programa de Coordinación de Jubilados del Seguro Social, Cuenca 2014. Materiales y Métodos: Se realizó un estudio cuantitativo de tipo descriptivo de corte transversal. La muestra fue probabilística aleatorizada de 434 adultos mayores, la cual fue obtenida de un universo de 1042 adultos mayores. Para el cálculo se utilizó el 52,6 % de frecuencia esperada, se adicionó el 10% de posibles pérdidas (43 adultos mayores), siendo la muestra total de 434 adultos mayores. Resultados: Se ha estudiado a 434 adultos mayores, de los cuales el 65,4% son de edad entre 60 a 74 años, el 69,6% son mujeres, el 36,9% han alcanzado la educación secundaria completa, el 42,2% conviven con sus esposos/as, el 52,8% han trabajado menos de 35 años antes de jubilarse. La prevalencia de sonambulismo es de 1.6%, el 25.1% de terror nocturno, el 30.2% tienen pesadillas, el 49.3% presentan apnea del sueño, el 61.1% roncan, el 59.4% presentan paramnesias. Conclusiones: El insomnio es la patología más frecuente, afecta a los adultos mayores de 60 a 74 años con mayor prevalencia, siendo el sexo femenino el grupo más afectado, existiendo gran asociación con las variables: tiempo que trabajó, persona con quien vive, instrucción, etc. PALABRAS CLAVE: TRASTORNOS DEL SUEÑO; INSOMNIA; ADULTO MAYOR; DISOMNIAS; PAROSMIA.Objective: To determine the prevalence of the sleep upsetting and associated elements to the older people into the Retired Coordination Program of the Social Security Materials and Methods: A quantitative study of descriptive type of transversal cut will be realized. The sample will be aleatory probabilistic of 432 which one was obtained with a universe of 1042. For the calculation was used the 52.6% expected frequency, were added 10% of possible losses (43older adults), which means that the total sample was of 475 retired (n=475 older adults), belonging the Retired Coordination Program of the Social Security Results: 434 older people have been studied, among them we found 65,4% between 60 to 74 years old, the 69% of the group are women, the 36,9%of the older people has finished the high school. The people who are married and live together are 42,2%, the 52,8% of the people has worked for 35 years before their retiring, the prevalence of sleepwalking is 1,6%. The trouble of scare nocturnal on the people is 25,1%, the 30,2% of them has nightmares, the 49,3% of the people shows apneas of sleep, the 61,1% of them snores and finally the 59,4% has paramnesia. Conclusions: The sleepiness is the most frequent pathology which affects with prevalence to the 60-74 older people. The group of females is the most affected; since it is associated with the variables like: the time of the work, the group people who live with, the studies, etc. KEYWORDS: SLEEP DISORDERS; INSOMNIA; ELDERLY; DYSSOMNIAS; PAROSMIA.MédicoCuenc

Determinación anatómica del conducto mandibular en la población adulta de la Clínica de Cirugía de la Facultad de Odontología de la Universidad de Cuenca.

El presente estudio sustenta la determinación anatómica del conducto mandibular en adultos de la clínica de cirugía de la Universidad de Cuenca, considerando de gran importancia la ubicación del conducto mandibular en la realización de algunos procedimientos quirúrgicos como la colocación de implantes dentales, osteotomías, distracción osteogénica, reducción de fracturas y exodoncias complejas evitando así injurias al paquete vásculo nervioso. Además nos permitió determinar la relación del conducto mandibular con ciertas piezas dentarias mandibulares: 3.8-4.8, 3.7-4.7, 3.6-4.6, 3.5-4.5, 3.4-4.4, 3.3-4.3, con el género del paciente, con la rama mandibular y además con algunas estructuras óseas como la tabla ósea vestibular, tabla ósea lingual, cresta alveolar y el reborde basal. Para realizar el estudio la muestra fue de 50 adultos de la clínica de cirugía de la Facultad de Odontología de la Universidad de Cuenca, entre 18 a 35 años que cumplan con los criterios de inclusión. Se utilizaron tomografías y se analizaron mediante el sistema Cone Beam para obtener el ancho, altura y relación espacial de la mandíbula. Además el sistema Cone Beam nos permitió analizar la muestra mediante mediciones para determinar los resultados estadísticos y elaborar el informe final.This study supports the anatomical determination of the Mandibular Canal on adults of the Clinical Surgery, in University of Cuenca. This study has big importance considering the location of the Canal in the performance of some surgical procedures such as collocation of dental implants, osteotomies, osteogenic distraction and the reduction of fractures and complicated extractions avoiding injuries to the mandibular nerve. In addition we determined the relation of the Mandibular Canal with some mandibular teeth 3.8-4.8, 3.7-4.7, 3.6-4.6, 3.5-4.5, 3.4-4.4, 3.3-4.3, with the gender of the patient, the ramus mandibular and also with some bone structures such as the vestibular wall, the lingual wall, with the alveolar crest and the basal ridge. The study’s sample was 50 adults of the Clinical Surgery of University of Cuenca. Patients were in age of 18 to 35 years who meet the inclusion criteria. The study used the Cone Beam system to obtain the width, the height and the spatial relationship of the mandible. Once we obtained the tomography, the study continued with the digital analysis; to determine the statistical outcomes and prepare the final report.OdontólogoCuenc

Relationship between bullying and malnutrition in children and adolescents

Introducción: el bullying acontece en aproximadamente 246 millones de niños y adolescentes a nivel mundial, en Ecuador 6 de cada 10 menores son los afectados, se asocia a factores biopsicosociales, entre ellos la malnutrición. Objetivo: determinar la prevalencia de bullying y sus diferentes roles en niños y adolescentes, además de su asociación con la malnutrición.Metodología: estudio cuantitativo, analítico y transversal, realizado en la emergencia pediátrica del Hospital “José Carrasco Arteaga” durante el 2019; la muestra fue conformada por 325 pacientes con edades comprendidas entre 9 a 15 años, a quienes se aplicó el test European Bullying Intervention Project Questionnaire (EBIPQ) para determinar la presencia de bullying; además, se calculó el Índice de Masa Corporal (IMC) para determinar el estado nutricional de los participantes. Para establecer la relación con la malnutrición se utilizó la prueba de Chi cuadrado y para la correlación se empleó Taub- Kendall. Resultados: la prevalencia de bullying fue 41.8%, 50.7% para el sexo masculino y 49.3 % en el sexo femenino; el 71.3% fueron adolescentes, el 64% presentaron un adecuado estado nutricional. No se encontró asociación estadística entre bullying y malnutrición.Conclusiones: la prevalencia de bullying es similar en niños y adolescentes de ambos sexos, su estado nutricional no se encontró alterado, no constituye una condición para ejercer el rol de víctima, agresor o víctima agresor.Introduction: bullying occurs in approximately 246 million children and adolescents worldwide, in Ecuador 2 out of 10 minors are affected, it is associated with biopsychosocial factors, including malnutrition.Objective: to determine the prevalence of bullying in children and adolescents, their roles and their association with malnutrition.Methodology: it is a quantitative, analytical and cross-sectional study, carried out in the pediatric emergency room of the “José Carrasco Arteaga” Hospital during 2019; the sample consisted of 325 patients aged between 9 and 15 years, to whom the European Bullying Intervention Project Questionnaire (EBIPQ) test was applied to determine the presence of bullying. In addition, the Body Mass Index (BMI) was calculated to determine the nutritional status of the participants. To establish the relationship with malnutrition, the Chi square test was used, and the Taub-Kendall test was used for correlation.Results: the prevalence of bullying was 41.8%, 50.7% for males and 49.3% for females; the 71.3% were adolescents, and 64% had an adequate nutritional status. No statistical association was found between bullying and malnutrition.Conclusions: the prevalence of bullying is similar in children and adolescents of both sexes, highlighting that their nutritional status was not altered, in addition, it does not constitute a condition to play the role of victim, aggressor or aggressor victim

Determinación anatómica del conducto mandibular en población adulta

El presente estudio sustenta la determinación anatómica del conducto mandibular en adultos de la Clínica de Cirugía de la Facultad de Odontología de la Universidad de Cuenca, considerando de gran importancia la ubicación del conducto mandibular en la realización de algunos procedi- mientos quirúrgicos como la colocación de implantes dentales, osteotomías, distracción osteo- génica, reducción de fracturas y exodoncias complejas evitando así injurias al paquete vásculo nervioso. El objetivo del presente estudio es determinar la localización del conducto mandibular en relación con estructuras de importancia en adultos de la clínica de cirugía de la Facultad de Odontología de la Universidad de Cuenca. Para realizar el estudio la muestra fue de 50 adultos de la clínica de cirugía de la Facultad de Odontología de la Universidad de Cuenca, entre 18 a 35 años que cumplan con los criterios de inclusión. Se utilizaron tomografías y se analizaron mediante el sistema Cone Beam. En los re- sultados, en el hombre el ápice dental más cercano al conducto mandibular fue del molar 4.8, al igual que en la mujer, con respecto al borde posterior de la rama en hombres fue una distancia de 18.196 mm y en la mujer de 16.177 mm. En la literatura está bien documentado la injuria al nervio dentario inferior por la proximidad de los ápices de lo terceros molares con dicho nervio, en este estudio se coincide con esto, ya que los ápices de los terceros molares son los más próximos al nervio dentario inferior.The present study supports the anatomical determination of the mandibular canal in adults of the Surgery Clinic ofthe Faculty of Dentistry ofthe University of Cuenca, this study has big importan- ce considering the location of the Canal in the performance of some surgical procedures such as collocation of dental ¡mplants, osteotomies, osteogenic distraction and the reduction of fractures and complicated extractions avoiding injuries to the mandibular nerve. The objective of the present study is to determine the location of the mandibular canal in relation to structures of importance in adults of the surgery clinic of the Faculty of Dentistry of the Univer- sity of Cuenca. The study’s sample was 50 adults of the Clinical Surgery of University of Cuenca. Patients were ¡n age of 18 to 35 years who meet the inclusión criteria. The study used the Cone Beam system. In the results, in the man the dental apex closest to the mandibular duct was of the molar 4.8, as in the woman, with respect to the posterior edge of the branch in men was a distance of 18,196 mm and in the woman of 16,177 mm. In the literatura is well documented the injury to the inferior dental nerve by the proximity of the ápices of the third molars with this nerve, in this study is coincided with this, since the ápices of the third molars are the closest to the inferior dental nerve.0000-0002-3164-43140000-0003-2377-18980000-0002-6806-74420000-0002-7653-254

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders