El objetivo de la revisión es identificar los elementos sustanciales que son necesarios para prevenir y abordar las conductas disociales en entornos comunitarios y de esta manera facilitar la ...comprensión y abordaje relacionadas con esta temática, se realizó una revisión documental teórica que demuestra el aporte que tiene la comunidad para resolver las problemáticas derivadas de conductas disociales, los hallazgos más importantes que brinda la comunidad, van de la mano de la relaciones de convivencia, participación, sentido de comunidad y movilización, como ejes dinamizadores de la comunidad; por otro lado, entendiendo que los seres humanos, somos seres sociales, es precisamente en las comunidades en donde se gesta procesos de cambio a través del contacto con los sujetos necesitados de la acción comunitaria; la comunidad brinda espacios de cohesión social, de educación, sentido de pertenencia y participación en donde se gestan los procesos de conciencia crítica como premisa de cambio y de desarrollo endógeno.
•CLABSI and VAP are independent risk factors for ICU mortality.•Female gender is an independent risk factors for ICU mortality.•Age increase risk of ICU mortality 1% per year of age.•TLength of stay ...increases the risk of ICU mortality by 1% per day of stay.•Central lines increase the risk of ICU mortality by 2% per day.
The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients.
Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries.
Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84; P<.0001); ventilator-associated pneumonia (aOR:1.48; P<.0001); catheter-associated urinary tract infection (aOR:1.18;P<.0001); medical hospitalization (aOR:1.81; P<.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; P<.0001); female gender (aOR:1.09; P<.0001); age (aOR:1.012; P<.0001); central line-days, risk rises 2% per day (aOR:1.02; P<.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;P<.0001).
Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.
•Latin American central line-associated bloodstream infections (CLABSI) rates are higher than those of high income countries.•Our objective is to identify CLABSI rates and risk factors in Latin ...American intensive care units (ICUs).•Length of stay, duration of central line, femoral, arterial and jugular increase CLABSI risk.•Public hospital, and Medical-surgical ICU increase CLABSI risk.•PICC was not associated with risk for CLABSI.
Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America.
From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR).
About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI:
LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk.
Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this ...study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received.
An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022.
A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%;
< 0.01) with no difference in the frequency of coronary abnormalities (
= 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%;
= 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%.
Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
Purpose
Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries.
Methods
From 01/01/2014 to 02/10/2022, we conducted a ...prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period.
Results
31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01–1.02;
p
< 0.0001 female gender (aOR = 1.28; 95% CI 1.01–1.61;
p
= 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06–1.08;
p
< 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08–1.21;
p
< 0.0001, public facilities (aOR = 2.89; 95% CI 1.75–4.49;
p
< 0.0001. The periods 2014–2016 and 2017–2019 had significantly higher risks than the period 2020–2022. Suprapubic catheters showed similar risks as indwelling catheters.
Conclusion
The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
•Rates of VAP in Latin America are several times above those of high income countries.•The objective of this study is to identify risk factors for VAP in ICUs of Latin America.•Male gender, age, ...length of stay, and device utilization ratio increase the risk of VAP.•Public hospital, and surgical hospitalization increase the risk of VAP.•Adult-oncology, medical-surgical, and surgical ICUs showed the highest risk of VAP.
Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.
We implemented a multidimensional approach and an 8-component bundle in ...374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods.
174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention.
This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.
Mandibular asymmetries called the longitudinal differences of right and left sides of the jaw with respect to midline, in three spatial planes. Objective: To determine the frequency of mandibular ...asymmetries in the three planes of space by Cone Beam Volumetric Tomographic Scanner (TCCB). Methods: We analized 40 records by Cone beam scans (New Tom 3G Cone beam Volumetric Tomographic Scanner) by simple random sampling of patients between 18 and 70 years obtained since 2011 to 2013 and taken with a large window that would display the complete mandibular bone. Axial slices were obtained from the língula in cranio-caudal direction every 5 mm until the gonial angle. Results: 2.5% of the records showed moderate differences in the length of the mandibular body predominantly right. In amplitude was found the left branch predominantly. In the length of the ramus, 10% had moderate predominance of the right side. Conclusions: 1) Frequently asymmetries are at the thickness of the mandibular branches. 2) The degrees of Moderate to High differences occur more frequently at the thickness of the mandibular branches. 3) It is not possible to determinate proportionally the thickness of the mandibular branches only obtaining a 2D image.
Se denominan asimetrías mandibulares a las diferencias longitudinales de los lados derecho e izquierdo de la mandíbula con respecto a la línea media en los tres planos espaciales. Objetivo: Determinar la frecuencia de asimetrías mandibulares en los tres planos del espacio por medio de tomografía computarizada Cone Beam (TCCB) y clasificarlas según el grado de diferencia entre ambos lados. Métodos: Se analizaron 40 registros de tomografía volumétrica Cone Beam, (New Tom 3G Cone Beam Volumetric Tomographic Scanner) mediante muestreo aleatorio simple de pacientes entre los 18 y 70 años de edad, entre los años 2011 y 2013. Se obtuvieron cortes axiales a partir de la língula en sentido cráneo-caudal cada 5 mm hasta llegar al ángulo goníaco. Resultados: El 2,5% de los registros presentaron diferencias moderadas en la longitud del cuerpo mandibular con predominio del lado derecho. En la amplitud de la rama se encontró predominio del lado izquierdo. En la longitud de la rama mandibular el 10% presentó predominio moderado del lado derecho. Conclusiones: 1) las asimetrías más frecuentes se encuentran a nivel del grosor de las ramas mandibulares. 2) Los grados de diferencias moderados y altos se presentan con mayor frecuencia en el grosor de las ramas mandibulares. 3) No es posible determinar proporcionalmente el grosor de las ramas mandibulares obteniendo solo una imagen 2D.
