South Health and Policy (Journal)
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Impact of early administration of antibiotics in patients with sepsis and its prognoses
No full textSepsis is a very complex medical condition resulting from a dysregulated inflammatory response of the host to an infectious condition, which can lead to organ dysfunction and, in the most critical cases, death. Early administration of antibiotics is crucial to improve clinical outcomes in patients with sepsis. This study aims to evaluate the impact of early administration on clinical outcomes in patients with sepsis.The objective is to evaluate the impact of early administration of antibiotics on clinical outcomes in patients with sepsis, including mortality, length of hospital stay, and complications.Materials and Methods: Data collection was performed through a search in online database such as: Pubmed, SCIELO, Google Scholar among others. The research will be composed of published and updated literatures showing the importance of early administration of antibiotics for the treatment of sepsis.Results: The review of studies suggests a strong association between delays in antibiotic administration and increased in-hospital mortality in patients with sepsis. In the first study, it was observed that even administration within six hours showed an increasing risk of mortality with each hour of delay, this risk being particularly high in cases of septic shock. The second study confirmed this trend, with a median time to antibiotic administration of 2.1 hours. Mortality increased in proportion to the length of delay, with higher mortality rates in patients with septic shock compared to those with moderate sepsis. Each additional hour was associated with a marked increase in complications, highlighting the importance of immediate interventions to improve prognosis and reduce associated mortality.Conclusion: In summary, the studies reviewed show that early administration of antibiotics is a key factor in improving clinical outcomes in sepsis, especially in severe cases. The establishment of clinical practices and guidelines that prioritize rapid intervention in patients with sepsis could contribute significantly to reducing mortality and complications associated with sepsis, that is, training health care personnel to identify probable cases of sepsis and septic shock in order to act quickly in the administration of antibiotics
Comparative evaluation between conventional and laparoscopic hernioplasty, it’s indications and complications
No full textBackground: Hernia is one of the most prevalent wall pathologies, and its resolution can be achieved through conventional or laparoscopic methods. This study provides information on inguinal hernias and their various presentations according to etiology. Additionally, it addresses different causes related to age, comorbidities, and prior surgeries. The methods of resolution through open hernioplasty and laparoscopic techniques were analyzed, and the postoperative complications of the patients involved in the study were also considered. Material and methods: This systematic review utilized search engines such as PubMed, Google Scholar, and Scielo to find clinical trials and randomized studies, identifying statistical analyses on the use of both surgical techniques. Results: This study compared the outcomes of inguinal hernia repair using laparoscopic and open techniques in 204 patients (96.6% male, 3.4% female), with an average age of 53.5 years. The duration of the procedure, postoperative complications, hospital stay, and recovery time were analyzed. Laparoscopic surgery had a longer operative time compared to the open technique, but showed benefits such as shorter recovery time (7 days versus 14.5 days, P < 0.001), less postoperative pain, and a shorter hospital stay. Complications, such as seromas and chronic pain, were more frequent in open surgery, although no infections were reported in either group. No recurrences were detected during the 6-month follow-up. Conclusion: The laparoscopic technique for inguinal hernia repair offers significant advantages in terms of less postoperative pain, faster recovery, and shorter hospital stay compared to open surgery, despite a longer operative time. These results suggest that laparoscopy is a more favorable option for patients seeking a quicker recovery and early return to daily activities
Hemophagocytic syndrome secondary to dengue: a serious complication in vulnerable patients
No full textIntroduction: Hemophagocytic syndrome (HPS) was identified as a rare immunological condition characterized by a dysregulated activation of the immune system, which caused severe systemic inflammation and multiple organ failure. It presented in primary forms, of genetic origin, and secondary forms, associated with infections, neoplasms and autoimmune diseases. In particular, the dengue virus was recognized as a relevant trigger of HS, especially in pediatric populations in endemic regions, where its early diagnosis represented a great clinical challenge.Development: The work addressed the pathophysiology of HS, in which an exaggerated activation of macrophages and cytotoxic T lymphocytes was described, together with a hypersecretion of pro-inflammatory cytokines. This uncontrolled immune reaction generated manifestations such as persistent fever, pancytopenia, hepatosplenomegaly and hyperferritinemia. The diagnosis was based on clinical and laboratory criteria established by the Histiocyte Society, with the identification of hemophagocytosis in bone marrow or other tissues being essential. Treatment strategies included intensive life support, the use of corticosteroids, intravenous immunoglobulins and, in severe cases, immunosuppressants, with special attention to the associated risks in patients with dengue.Conclusions: It was concluded that HS secondary to dengue represented a serious and little recognized complication, whose timely diagnosis was essential to improve the prognosis. The study highlighted the importance of strengthening clinical surveillance, updating management protocols and training health personnel to effectively deal with this condition in contexts of high dengue prevalence
Challenges in the Treatment of Melasma in Latin America
No full textMelasma was a chronic skin condition characterised by hyperpigmented spots, mainly on the face, and most frequently affecting women with intermediate to high phototypes in tropical and subtropical regions. Intense sun exposure contributed to its appearance and chronicity, making photoprotection an essential component in its treatment. Although depigmenting agents, peels and technologies such as laser were used, protection against ultraviolet radiation and visible light was key to preventing relapses and improving clinical results. Blue-violet light, oxidative damage and chronic inflammation were identified as aggravating factors. In Latin America, cultural and economic factors and the limited availability of suitable products made it difficult to adhere to effective photoprotection. For this reason, strategies such as the use of broad-spectrum sunscreens, oral photoprotection, patient education and improved access to products were promoted, all within an interdisciplinary approach adapted to the region
Clostridioides difficile: relationship with previous use of antibiotics, risk factors and preventive measures to reduce transmission
No full textBackground: Clostridioides difficile infection has emerged in recent years as one of the main hospital-acquired infections. This enteric pathogen is responsible for causing diarrhea related to prior antibiotic use in many healthcare settings, particularly hospitals, nursing homes, and rehabilitation clinics. This study aims to demonstrate the relationship between previous antibiotic use and Clostridioides difficile infection and determine the main risk factors and antibiotics associated with the infection, as well as the potential benefit of prevention strategies. Material and methods: A bibliographic search was carried out analyzing the database platforms of PubMed, Medline, Lilacs, Scielo and Cochrane during the period from May to September 2024. Articles were selected with a focus on risk factors, preventive measures and antibiotics related to the appearance of Clostridioides difficile infection. Results: Although any antibiotic is a potential risk factor for the development of CDI, the medications most commonly associated with the onset of the infection are Clindamycin, 2nd and 3rd generation Cephalosporins, Fluoroquinolones, Penicillins and Carbapenems. Conclusion: It is extremely important to know the risk factors and the main antibiotics associated with CDI so that when a certain type of antibiotic is indicated for relatively serious processes, extreme preventive measures are initiated, prior to the possibility that this individual that triggers it does not be the origin of an in-hospital outbreak
Walking and body balance training in people after Stroke: Case Report
No full textIntroduction: Population aging increases the risk of several acute and chronic diseases. Of these, stroke is one of the most prevalent in Portugal, resulting in neurological and motor deficits in the individual, with serious implications for their mobility, functionality and quality of life.Objective: To describe the gains in body balance, muscle movement and gait with the intervention of Rehabilitation Nursing in a person after a Stroke.Case report: Descriptive study, case report type, in which CARE recommendations were followed, of an individual with impaired body balance, muscle strength and walking with a walking aid after a stroke.An initial assessment was carried out with the development of a rehabilitation nursing care plan, and the respective health gains were demonstrated. The importance of training the individual in relation to body balance, muscle strength, walking with a walking aid and their relationship with the level of independence and functionality of the individual, in their home context, is highlighted.Conclusions: After intervention by a specialist nurse in rehabilitation nursing, there was an improvement in body balance, muscle strength and walking with a walking aid, with an increase in the level of independence and functionality of the person
Negative pressure therapy with closed incision in radical mastectomy for the prevention of complications at the surgical site
No full textThe general objective: To evaluate the efficacy of closed-incision negative pressure therapy in patients with radical mastectomy for the prevention of complications at the surgical site in the Autonomous Service of the Central Hospital of Maracay, Aragua State, Venezuela, during the 2023-2024 study period. Materials and Methods: A clinical-epidemiological study of experimental, prospective and longitudinal design was carried out. The population consisted of 40 patients undergoing radical mastectomy, from which a sample of 30 patients was selected, divided into two groups: Group A (vacuum therapy) with 15 patients and Group B (traditional treatment) with 15 patients. Variables such as age, sex, comorbidities, degree of risk of complication, side effects, and complications at the surgical site at 2, 7, and 14 days postoperatively were evaluated. Chi-square and Fisher Exacta tests were used for categorical comparisons, with an alpha significance level <0.05. Results: The mean age was 55.33 years in Group A and 60.67 years in Group B. All patients were women. There were no significant differences in comorbidities, except in the presence of cancer (60.00% in Group A vs. 93.33% in Group B, p = 0.0400) and low weight (20.00% in Group A vs. 0.00% in Group B, p = 0.0238). The degree of risk of complication was higher in Group B (100% in grade III) compared to Group A (73.33% in grade III). The incidence of wound dehiscence at 14 days was significantly lower in Group A (0.00% vs. 26.67%, p = 0.0498), as was the incidence of seroma (6.67% in Group A vs. 46.67% in Group B, p = 0.0175). Conclusion: No significant differences were observed in hematoma and infection. Closed-incision negative pressure therapy is effective in reducing postoperative complications in patients undergoing radical mastectomy, especially in decreasing wound dehiscence and seroma. These findings suggest that this therapy may be a viable and beneficial option in clinical practice to improve postoperative outcomes and patients quality of life. Its implementation, staff training and additional studies are recommended to confirm these benefits and evaluate their cost-effectiveness
Antimicrobial resistance and a versatile pathogen in the spotlight
No full textIntroduction: antimicrobial resistance is an emerging global phenomenon and is one of the most serious health problems today. The irrational use of antimicrobials has led to the early emergence of resistance mechanisms. Staphylococcus aureus is one of the pathogens classified as high priority for research and development plans for new antimicrobials due to its incidence causing infections with a high impact on health.Objective: to carry out an updated review of the problem of antimicrobial resistance of Staphylococcus aureus, at a global and national level since the discovery of antibiotics, related factors and mechanisms.Methods: a literature search was carried out in different databases such as Pubmed, SciELO, Science Direct, Google Scholar, MEDLINE and on the PAHO/WHO websites on the topics of microbial resistance and use of antimicrobials. Original and review articles published between 1998 and 2024 were consulted.Results: the information collected on the topics was analyzed and arguedreview objects carried out under an integrative approach. What is happening in Cuba was also explained.Conclusions: The reproduction power of bacteria is faster than the speed of research and development. Faced with the difficult battle against bacteria such as Staphylococcus aureus, given the development of new resistance mechanisms to eliminate the clinical effectiveness of antibiotics, the necessary measures must be adopted to stop the development of bacterial resistance
Relationship between insulin resistance and polycystic ovary syndrome: a literature review
No full textBackground: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age, and insulin resistance is a key feature of its pathophysiology. This study aims to review the relationship between insulin resistance and PCOS, as well as to analyze the efficacy of insulin-sensitizing treatments (such as metformin and myo-inositol) compared to conventional hormonal therapies. Material and methods: A systematic review of clinical studies, meta-analyses, and reviews published in scientific databases such as PubMed and Scopus was conducted, focusing on the relationship between insulin resistance and PCOS, and the effects of insulin-sensitizing treatments. Only relevant, high-quality literature from recent years was included. Results: Insulin-sensitizing treatments, especially metformin and myo-inositol, have been shown to be effective in improving insulin resistance and reducing metabolic symptoms of PCOS. However, oral contraceptives, while useful for hormonal symptoms, do not have a significant impact on insulin resistance. Conclusion: Insulin-sensitizing agents remain the most effective treatment for insulin resistance in women with PCOS. Myo-inositol offers an alternative with fewer side effects compared to metformin, but more research is needed to define optimal combinations and dosages
Level of information about lung cancer in patients at a Medical Office. Palma Soriano
No full textIntroduction: lung cancer is a common malignant neoplasm in adults, with a multifactorial etiology, characterized by the uncontrolled proliferation of cells from the lower respiratory tract, particularly the lung parenchyma.Objective: to characterize the level of information about lung cancer among patients belonging to Family Doctor\u27s Office 1 in the municipality of Palma Soriano, Santiago de Cuba province.Methods: an observational, descriptive, cross-sectional study was conducted from January to April 2025. The study population consisted of 691 patients, selected through non-probabilistic intentional sampling. Descriptive statistics were used. Absolute and relative frequencies (percentage) were employed as summary measures.Results: 51.81% of the patients were female, and 29.09% belonged to the 20-34 age group. The most frequent educational level was completed secondary education (25.33%). Smoking as a risk factor was present in 20.55% of patients, and 60.35% showed an informed level about lung cancer.Conclusions: a predominance of informed patients was identified, although exposure to multiple risk factors persists, notably the smoking habit and passive smoke exposure