Salud Integral y Comunitaria (Journal)
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From Catabolism to Recovery: Optimizing Nutrition in Critically Ill Adults
Full text linkIntroduction: Nutrition is a critical component of care for critically ill adult patients, influencing morbidity, mortality, and recovery in intensive care units (ICUs).Objective: To summarize current evidence on nutritional requirements, interventions, and clinical outcomes in adult ICU patients, highlighting strategies to optimize recovery and reduce complications.Methods: A comprehensive narrative review with a systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science (2010–2025) was conducted. Included studies comprised randomized controlled trials, observational cohorts, meta-analyses, and guidelines reporting nutritional interventions and outcomes in adult ICU populations. Studies on pediatric patients, non-ICU settings, or non-peer-reviewed sources were excluded. Data on type and timing of nutritional support, caloric and protein targets, micronutrient supplementation, and clinical outcomes (mortality, ICU length of stay, infections, mechanical ventilation duration) were extracted.Results: Seventy-two studies met inclusion criteria. Early enteral nutrition (within 24–48 hours) and protein intake of 1.2–2.0 g/kg/day improved nitrogen balance, reduced muscle wasting, shortened mechanical ventilation duration, and decreased ICU-acquired infections. Micronutrient supplementation (vitamins D, C, thiamine; selenium, zinc) and immunonutrition (arginine, omega-3 fatty acids, nucleotides) showed promising but variable effects, particularly in surgical and trauma patients. Overfeeding was associated with hyperglycemia and hepatic steatosis, while underfeeding correlated with catabolism and poor functional recovery. Nutritional risk assessment using APACHE II, NUTRIC, or mNUTRIC scores enabled individualized interventions.Conclusions: Early, individualized nutrition is central to ICU care. Multidisciplinary coordination improves outcomes. Future research should address precision nutrition, long-term recovery, and metabolic monitoring
Atypical rash, a diagnostic challenge in clinical practice: A Case Report from Bolivia
Full text linkHand-foot-and-mouth disease, commonly caused by Coxsackievirus A16, can manifest in atypical and severe forms associated with the CVA6 serotype, termed "eczema coxsackium," which may mimic serious pathologies. This report describes the case of a 10-year-old boy with a diffuse maculopapular rash, targetoid and bullous lesions, and systemic compromise, initially diagnosed as erythema multiforme major. The discussion focuses on the differential diagnostic challenge with eczema herpeticum, highlighting that despite the alarming clinical presentation, etiological confirmation via PCR for CVA6 was crucial to rule out other infections, discontinue unnecessary acyclovir, and focus treatment on supportive care, leading to a favorable outcome. In conclusion, eczema coxsackium due to CVA6 should be considered in severe vesiculobullous rashes, with PCR being essential for an accurate diagnosis and proper management, as its prognosis is generally benign
Epidemiological, clinical, and therapeutic profile of tuberculosis in a high-burden Latin American capital: Tegucigalpa, Honduras
Full text linkIntroduction: Tuberculosis (TB) remains a major public health problem in Honduras, particularly in urban areas such as Tegucigalpa. Identifying clinical and epidemiological patterns helps guide control strategies. Objective: To describe the sociodemographic, clinical, and treatment outcome characteristics of patients diagnosed with TB in Tegucigalpa between 2022 and 2024. Methods: A descriptive, retrospective study was conducted with 165 patients diagnosed with TB. Data on sociodemographics, medical history, diagnostic methods, type of TB, treatment regimen, and discharge condition were collected. Analysis was performed using frequencies and percentages. Results: Males accounted for 61.2% of patients. Unemployed individuals represented 15.8%, prisoners 14.5%, and housewives 8.5%. A total of 14.5% had completed preschool education, and another 14.5% had no formal education. The most common comorbidity was diabetes mellitus (11.5%), followed by diabetes mellitus/hypertension (8.5%). The most frequent diagnostic method was smear microscopy (80.6%). Pulmonary TB accounted for 97.6% of cases. Basic treatment was administered to 96.4% of patients. Cure rate was 84.8%, with 3.6% relapses and 1.8% deaths. Conclusion: Most TB cases in Tegucigalpa occurred in adult men with low education levels and chronic comorbidities such as diabetes. Diagnosis was mainly through smear microscopy, with a high cure rate, though challenges remain in relapse monitoring and prevention in vulnerable populations
Nursing assessment of people with bone metastases
Full text linkIntroduction:Bone metastasis is one of the most frequent complications in patients with advanced cancer, causing severe pain, functional limitation, and emotional distress. Nursing assessment is essential to identify needs and design individualized care that promotes patient well-being and quality of life.Objective:To present a nursing clinical case focused on the comprehensive assessment of a person with bone metastasis, applying the nursing process based on functional health patterns.Methods:A clinical case study was conducted on an adult female patient diagnosed with bone metastasis secondary to breast cancer. Data were collected through interviews, direct observation, and review of the clinical record. The assessment was carried out using Virginia Henderson’s model of the 14 fundamental needs, considering physical, psychological, and social dimensions.Results:The assessment identified priority problems related to cancer pain, reduced mobility, sleep disturbance, and ineffective coping. Nursing diagnoses and interventions were formulated focusing on pain control, emotional support, and self-care promotion. The implemented care plan improved comfort and patient participation in her treatment.Conclusions:This case demonstrates that comprehensive and systematic nursing assessment guides clinical decision-making and strengthens the autonomous role of nurses in managing patients with bone metastasis
Care for pregnant women with anxiety: implications for nursing practice
Full text linkIntroduction: During the perinatal period, anxiety affects one in five women. These symptoms may worsen in the postpartum stage, increasing the risk of future episodes. It is the responsibility of nursing to address this issue by supporting and collaborating with the new mother to help her overcome anxiety. Specialist nurses in obstetrics and gynecology play a key role in the care of low-risk pregnancy, childbirth, and postpartum.
Objective: To characterize nursing care directed at pregnant women with anxiety.
Methods: A literature review was conducted using databases such as PubMed, Google Scholar, and ResearchGate with keywords including: pregnancy, anxiety, mental health, nursing, and nursing care. A total of 18 articles were selected, more than 70% of which were published in the last 5 years.
Discussion: The most commonly used interventions are counseling, prenatal education, and preparation for childbirth with a companion. Educational interventions have been shown to increase knowledge and promote self-care, which significantly helps reduce anxiety. Humanized nursing care focuses on providing comprehensive support that goes beyond technical and medical aspects, also encompassing the emotional well-being of patients.
Conclusions: Anxiety during pregnancy is a frequent and underestimated condition that requires specific attention from the nursing field. In this process, nursing care plays a key role by offering continuous and sensitive support, which directly contributes to maternal-fetal well-being
Complex intestinal ascariasis with secondary peritoneal obstruction and irritation. Report of a case
Full text linkRoundworm (Ascaris lumbricoides) is a nematode known in Latin America as the roundworm. It belongs to the group of parasites transmitted through contact with contaminated soil and is the most common helminthiasis worldwide, especially in children aged 2 to 10 years. In Paraguay, the prevalence of intestinal parasitosis in school-aged children is high, mainly due to poor sanitary conditions and adverse socioeconomic factors. In this context, we present the case of a 3-year-old female patient, a resident of a rural area, who presented with severe abdominal pain, vomiting, fever, and abdominal distension. The physical examination revealed signs of peritoneal irritation, and stool examination confirmed the presence of Ascaris lumbricoides eggs. Imaging studies showed intestinal obstruction and abundant worms in the small intestine. Due to the severity of the condition, emergency surgery was performed, removing the parasites and performing peritoneal lavage. The patient made a favorable outcome after treatment. This case highlights the importance of timely diagnosis and comprehensive management of ascariasis complications, as well as the need to strengthen prevention strategies, health education, and access to treatment in vulnerable communities to reduce the incidence and complications associated with this parasitic infection
Nursing assessment in an elderly adult with Diabetes Mellitus
Full text linkIntroduction: Diabetes mellitus in older adults represents a challenge for nursing due to comorbidities, functional decline, and social vulnerability. Nursing care focused on basic human needs allows for the identification of risks, the promotion of self-care, and the improvement of quality of life.Objective: To apply the Nursing Care Process in an older adult with diabetes mellitus, using NANDA, NOC, and NIC taxonomies, in order to establish individualized, safe, and evidence-based care.Methods: A descriptive study based on the Nursing Care Process using Virginia Henderson’s assessment model. Altered needs were identified through interviews, observation, and physical examination. Nursing diagnoses were established according to NANDA, expected outcomes according to NOC, and interventions based on NIC.Results: Priority diagnoses included ineffective management of the therapeutic regimen and risk for unstable blood glucose level. Interventions included health education, glucose monitoring, and self-care promotion. Improvement was observed in treatment adherence, glycemic control, and family participation.Conclusions: Comprehensive nursing assessment in older adults with diabetes mellitus enables holistic, person-centered care that promotes autonomy, reduces complications, and optimizes quality of life
Nurse’s Characteristics as a Leader in Emergency Settings: a Bibliographic Review
Full text linkIntroduction: The nurse\u27s leadership in emergency settings plays a crucial role in the efficiency and safety of care provision, where swift and critical decisions in unstable environments are required. The nurse\u27s ability to lead teams, coordinate resources, and ensure the quality of care can be decisive in guaranteeing favorable outcomes for both team and patients.Objective: To identify and synthesize evidence on the nurse’s characteristics as a leader in emergency settings.Methods: A rapid review following the Cochrane methodology. A search was conducted in two databases: CINAHL Complete and MEDLINE Complete. The methodological quality assessment and risk of bias for the selected studies were conducted using the Joanna Briggs Institute\u27s critical appraisal tools. The results from the studies were summarized narratively.Results: Three articles were selected. The nurse’s characteristics as a leader in emergency settings were synthesized into three key domains: intellectual, encompassing knowledge and cognitive skills; technical, related to clinical and procedural expertise; and relational, with a strong emphasis on effective communication, the most frequently cited attribute.Conclusions: This review’s findings provide a foundational reference for future research, underscoring the need for further primary studies to expand and deepen the understanding of nursing leadership in emergency settings
Sociodemographic and clinical factors associated with fractures in older adults treated in a public hospital in Paraguay in 2024
Full text linkIntroduction: Fractures in the elderly constitute a significant public health problem due to their high incidence and impact on morbidity and mortality. Globally, an estimated 178 million fractures occurred in 2019, a number that is increasing due to the aging population. Older adults, especially women, are most susceptible, and most of their fractures are caused by low-energy trauma (falls from standing height). Objective: To identify the factors associated with fractures in older adults treated at a public hospital in Paraguay in 2024. Methodology: A descriptive, cross-sectional observational study. One hundred patients aged ≥60 years with a history of bone fracture, treated at the Trauma Service of a surgical specialty hospital between January and July 2024, were included. Sociodemographic data, comorbidities (hypertension, diabetes), and fracture characteristics (anatomical location, mechanism, type, and treatment) were collected from medical records. Results: The mean age was 76.3±7.9 years (median 77); 78% were female. The average body mass index was ~25 kg/m². Sixty-nine percent had hypertension and 34% had diabetes mellitus. The predominant mechanism was a fall from standing height (84%). The most frequently affected bone was the proximal femur (61%), followed by the distal radius (17%) and the proximal humerus (10%). Ninety-eight percent of the fractures were closed (non-compound), and all received surgical treatment. Discussion: Fragility fractures primarily affected older women with common comorbidities, typically occurring due to low-energy falls and affecting osteoporotic bones (hip, wrist, humerus). These findings are consistent with international literature and highlight the need to prevent falls and implement proactive management of bone health (e.g., treatment of osteoporosis) to reduce the incidence of fractures and their consequences in the elderly population
Analysis of Study Strategies and Their Effect on the Academic Performance of Medical Students at a Private University in Paraguay in 2025
Full text linkIntroduction: The methods and resources used to understand information are considered learning techniques. They constitute the basis of all knowledge and are strongly correlated with the academic performance of students. Those who know and master the techniques are more likely to achieve their educational goals than those who do not. Objective: To evaluate the influence of study strategies on the academic performance of medical students at a private university in Paraguay in 2024. Methodology: The methodological design was observational, analytical, and prospective with a cross-sectional approach. The sample consisted of 82 students enrolled in the basic cycle of the Medicine program at a private university in Paraguay. Results: The greatest predominance among the ages of the students who participated in the study was found between 17 to 25 years representing 67%, the students of the medical career used various learning techniques, among those used by more than 50% of the population studied were reading and summarizing texts and the use of educational videos and digital platforms, although the practice techniques with simulators and oral explanation are those that present a stronger positive correlation. Conclusion: The techniques used by the majority of the student population prove to be not very effective if used alone and according to the participants themselves, they do not generate good academic performance, It is suggested to improve the combination of techniques used to improve academic performance.