Hospital Regional De Research Articles

AVALIAÇÃO DA QUALIDADE DE VIDA E APOIO FAMILIAR NO PACIENTE DIAGNOSTICADO COM CÂNCER DE MAMA

Breast cancer is the main cause of death in the female population in almost all regions of Brazil, in addition to being an important global public health problem, due to high incidence and morbidity rates. The aim of the work is to evaluate the quality of life and psychosocial support of patients diagnosed with breast cancer. It refers to an observational study, in which interviews were carried out with women diagnosed with breast cancer treated at the Hospital Regional de Presidente Prudente. It was observed that the more negative the patients' self-perception was in relation to the support they received, their ability to carry out daily activities and their post-surgical mood, the worse their self-perception of quality of life was. This study highlights the importance of adopting multidisciplinary, patient-centered approaches and promoting a support network, which are essential for women to have a better quality of life.

Longitudinal assessment of SNPs rs72552763 and rs622342 in SLC22A1 over HbA1c control among Mexican-Mestizo diabetic type 2 patients.

Background: In Mexico, 75% of diabetes mellitus type 2 (DMT2) patients are not in glycaemic control criteria (HbA1c<7%); this entails a significantly variable drug response. Amongst the factors influencing such variability, are genetics, more specifically, single nucleotide polymorphisms (SNPs). Three genes implied in metformin pharmacokinetics are SLC22A1, SLC22A2, and SLC22A3, which are polymorphic. While there have been cross-sectional studies on their SNPs impact over drug response, a longitudinal study would contribute valuable information on their effect over time. Methods: SNPs of SLC22A1 (rs72552763, rs622342, rs12208357, rs2282143, rs594709, rs628031, and rs683369), SLC22A2 (rs316019), and SLC22A3 (rs2076828), were determined through PCR-TR. The clinical records of 69 patients undergoing metformin monotherapy were retrospectively assessed. Metformin is the first line treatment against DMT2. A level of HbA1c <7% (time 0) was considered as an inescapable inclusion criterion. The study's cases were those patients who reported HbA1c ≥ 7% (time1) after time 0 (t0). Kaplan-Meier curves including a Log-Rank test and a Cox multivariate analysis of proportional risks were performed. Aim: Determining clinical, biochemical, and genetic variables which may affect non-control (HbA1c ≥ 7%) survival time spans amongst DMT2 Mexican-Mestizo patients undergoing metformin monotherapy at Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) between October 2013 and December 2023. Results: All 69 patients were monitored over a median period of 642 days (273-1,134). A comparison between time 0 and time 1 (t1) revealed differences in weight (p = 0.036), metformin dose mg/kg/day (p = 0.003), plasmatic glucose mg/dL (p = 0.048), and HbA1c (p < 0.001). The median non-control survival rate was different across the 3 genotypes of rs62552763 in SLC22A1 (p = 0.0034) and the dominant genotypic model GAT/GAT vs. GAT/del + del/del (p = 0.009). There were differences between rs622342 genotypes as well (p = 0.041). In GAT/GAT the Cox model found HR = 0.407 (IC95%: 0.202-0.818, p = 0.011) in the univariate analysis and HR = 0.418 (IC95%: 0.204-0.856, p = 0.034) in the multivariate analysis, adjusted by initial metformin dose (mg/kg/day), initial weight (kg), and final metformin dose (mg/kg/day). Genotype A/A of rs622342 in SLC22A1, reported HR = 0.392 (IC95%: 0.169-0.910, p = 0.029) in the multivariate analysis as well. Conclusion: Among DMT2 Mexican-Mestizo patients undergoing metformin monotherapy the minor allele del in rs72552763 and the minor allele C in rs622342 reported a significantly shorter survival median respect to the wild type variant. Patients carrying del in rs72552763 or C in rs622342, both in SLC22A1, will reach non-control in less time with respect to other patients. Therefore these genotypes may constitute a therapeutic response biomarker for this population.

Caracterización de los pacientes atendidos con accidente ofídico en el Hospital Regional de la Orinoquía

Introduction: an ophidian accident is an intoxication due to snakebite venom inoculation. In Colombia, venomous snakes belong to the Viperidae, Elpidae and Colubridae genus. The bite causes tissue damage and characteristic clinical manifestations, including variable local and systemic pathophysiological alterations. Objective: to characterize patients with ophidian accidents treated at Hospital Regional de la Orinoquia (HORO) of Yopal, Colombia. Materials and methods: an observational, descriptive, cross-sectional, retrospective study, was conducted. All patients with snakebites who attended HORO between January 1, 2014, and May 30, 2020, were included. Results: 571 patients affected by an ophidian accident were identified; 70.1% were males; the minimum age at occurrence was 2 years and the maximum age, 89 years; most cases occurred in 2018 (19.5%). These accidents happened more often when walking along trails (31.2%) and in agricultural activities (29.6%). Bites predominantly involve the lower limbs (70.2%). Conclusions: ophidian accidents are a major public health problem, due to their frequency and outcomes. They are featured by tissue lesions and pathophysiological alterations, which can lead to critical illness and death.

Temporary clamping of the uterine arteries versus coventional technique for the prevention of postpartum hemorrage during cesarean section: a randomized controlled trial study

BackgroundCesarean sections are the most common abdominal surgical interventions worldwide, with increasing rates in both developed and developing countries. Postpartum (hemorrhage PPH) during cesarean sections can lead to maternal morbidity, prolonged hospital stays, and increased mortality rates. Although various non-surgical measures have been recommended for PPH prevention, surgical techniques such as uterine artery ligation and embolization have been used to manage PPH effectively.ObjectiveThis study aimed to evaluate the effectiveness of a surgical technique based on the temporary bilateral clamping of uterine arteries to reduce blood loss during cesarean sections.MethodsA longitudinal prospective, randomized, controlled study was conducted with a preliminary population group of 180 patients at the University Hospital Regional de Málaga from November 2023 to January 2024. The study protocol was approved by the Ethics Committee of the Regional University Hospital of Malaga (protocol 1729-N-23 and registred with ISRCTN15307819|| http://www.isrctn.org/, Date submitted 12 June 2023 ISRCTN 15307819). The patients were divided into two groups based on whether the clamping technique was applied during their cesarean sections. The study assessed hemoglobin levels before and after surgery, hospitalization durations, and the prevalence of anemia at discharge as the primary outcomes.ResultsThe patients who underwent the clamping technique demonstrated significant reductions in hemoglobin differences (0.80 g/dL) compared to the control group (1.42 g/dL). The technique also resulted in shorter hospital stays (3.02 days vs. 3.90 days) and a lower prevalence of anemia at discharge (76.2% vs. 60%).ConclusionTemporary clamping of uterine arteries during cesarean sections appears to be an effective measure for preventing postpartum hemorrhaging, reducing hospital stays, and decreasing the prevalence of anemia at discharge. Further research with larger sample sizes and standardized indications is warranted to confirm the benefits and potential broader applications of this technique.Trial registrationISRCTN 15,307,819.

Multiple sclerosis: A descriptive series

IntroductionMultiple sclerosis (MS) is a chronic multifocal inflammatory demyelinating disease that progresses with neurodegeneration and is associated with a high risk of disability. ObjectivesWe describe a series of patients diagnosed with MS in the past 10 years at a secondary hospital in Colombia. MethodsWe conducted a descriptive, retrospective study of a series of patients attended at the outpatient clinic of the neurology department of Hospital Regional de la Orinoquía, in Colombia, between 2013 and 2022, and who were diagnosed with MS according to the McDonald criteria. ResultsWe included 15 patients with a confirmed diagnosis of MS; 66.7% were women, with a mean age of 42 years (range, 16–71). Mean time from symptom onset to inclusion in the study was 87.4 months; 20% of patients presented disability. The distribution by type of MS was as follows: 20% patients had primary progressive MS, 20% had secondary progressive MS, 40% had clinically isolated syndrome, and 20% had relapsing–remitting MS. The mortality rate was 20%, with a median survival time of 89.83 months. ConclusionsAlthough treatment achieves significant improvements in symptoms and quality of life at every stage of the disease, early diagnosis is essential to prevent progression to disability.

Comparison of Two Therapeutic Approaches (Pediatric vs. Adult) for Treating Acute Lymphoblastic Leukemia. Experience of Two Centers in Mexico City

Background: Chemotherapy is the most frequently used strategy in treating adult acute lymphoblastic leukemia (ALL) in conjunction with monoclonal antibodies and tyrosine kinase inhibitors. One of the primary considerations is the type of treatment based on pediatric inspiration regimens (CALGB10403, BFM, St Jude XIII) or regimens for adult patients (HyperCVAD), with pediatric regimens being those that have improved the prognosis in the young adult population. Along with this scheme, strict monitoring through measurable residual disease (MRD) is the main dynamic prognostic factor since its positivity is associated with a greater risk of relapse. We aimed to compare the effect on the clinical prognosis of two treatment regimens based on a pediatric regimen versus an adult regimen in patients with ALL. Material and methods: A retrospective, observational, descriptive study of 5 years of follow-up was carried out in patients with ALL at the Hospital General de México and the Hospital Regional de Alta Especialidad de Ixtapaluca, classifying the treatment into two types of regimens (adult regimen vs. pediatric inspiration) evaluating the impact on survival as well as the association of different factors both to diagnosis and measurable residual disease (MRD). Results: A total of 450 patients were studied, 50.4% (n=227) were male, and 49.6% (n=223) were female. 21.1% (n=95) received a pediatric-inspired protocol (CALGB-10403), and 78.9% (n=355) received an adult protocol (Hyper-CVAD). 71.8% (n=323) were considered high risk, and 8.4% (n=38) were identified with Philadelphia positive ALL. 94.4% had a B-cell precursor phenotype ALL, and 8.7% had a nervous system infiltration at diagnosis. Overall, 60.4% integrated complete remission (n=272), with 31.3% (n=141) post-induction MRD negative. The percentage of negative MRD was higher in the pediatric protocol (38.5% vs 29.6%, p=0.000). Relapses occurred in 34% (n=153), and 21.3% (n=96) had a relapse to the central nervous system. Survival at 1000 days of follow-up was 32%, with significant differences in favor of the pediatric protocol (Log Rank 0.000) with 42% at 1000 days (Figure 1), the use of MRD as an impact tool with the prognosis (0.000) (Figure 2), the presence of a post-induction MRD+ (0.000) and high risk (Log-Rank 0.004) were the significant variables. Conclusions: The prognosis of a patient with ALL depends on the type of treatment. The prognosis is favorable when treated with a pediatric protocol. The detection of MRD by flow cytometry is the best follow-up tool, and its positivity decreases survival in adults with ALL.

Systemic lupus erythematosus in pediatric patients: Pulmonary manifestations

The pulmonary manifestations of Systemic Lupus Erythematosus (SLE) in pediatric patients are poorly understood and the pulmonary manifestations reported from the adult population are generally extrapolated to the pediatric population. In the present work, the review of 228 files was carried out, in which the pulmonary manifestations, symptoms and antibody levels of the patients treated at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), State of Mexico, Mexico, were identified. Statistical significance between groups was estimated using the Chi-square and Mann-Whitney U test. The main pulmonary manifestations identified were pleurisy (14 %), pulmonary hemorrhage (3.9 %), pulmonary thromboembolism (0.9 %), acute lupus pneumonitis (0.4 %), pulmonary arterial hypertension (0.4 %), and small lung syndrome (0.4 %). While the initial symptomatology was dyspnea with an incidence of 9.6 %, the mean oxygen saturation in the population was 96.87 %. Pleural effusion was identified as the most frequent pulmonary manifestation in radiographic changes. No statistically significant difference was found in antibody levels when comparing the groups. The most common pulmonary manifestation associated with SLE is pleurisy, however, the range of pulmonary manifestations in this type of patient can be very varied, as well as the presentation of each of them.

Association between phenotypic characteristics of Escherichia coli and UTI recurrence in immunocompromised patients: A case-control study

Urinary tract infection (UTI) recurrence is important in immunocompromised patients. There is a trend to study genotypically and phenotypically the role of certain virulence factors of Escherichia coli in the diagnosis of recurrent UTI. The main objective of this study was to determine if there is an association between phenotypic characteristics of E coli and UTI recurrence in immunocompromised patients. A case-control study was performed on immunocompromised patients from Hospital Regional de Alta Especialidad del Bajío, Mexico. E coli strains isolated from these patients were identificated and antimicrobial susceptibility test were performed. Strains with filamented cell morphology, mucoid colonial phenotype, or biofilm production were considered cases. Strains without the characteristics were considered controls. UTI recurrence was identified based on clinical records. The odds ratio (OR) was calculated to quantify the magnitude of the association. An association between filamented cell morphology and UTI recurrence was found (OR=2.19 95% CI 1.06-4.51; P=.031). No association was found between mucoid colony morphology (P>.05) or biofilm production (P>.05) and UTI recurrence. An association between mucoid colony morphology and extended-spectrum β-lactamase production was found (OR=3.09 95% 1.59-5.99; P<.001). Filamented cell morphology and mucoid colonial phenotype may have a possible diagnostic value for the detection of UTI recurrence and antimicrobial resistance. Further diagnostic test studies are needed to fully assess their clinical utility.

FNA versus CNB in thyroid nodules, the experience at the Hospital Regional de Antofagasta

FNA versus CNB in thyroid nodules, the experience at the Hospital Regional de Antofagasta

Biomarkers of Acute Appendicitis Severity: Diagnostic Test Study

Appendicitis (AA) is one of the most frequent abdominal surgical pathologies in the world, with appendectomy being the most frequently performed emergency surgery worldwide. This study was conducted to determine the possible biomarkers to detect the severity in AA for diagnostic purposes, and for the timely management of appendicitis and, thereby avoiding possible complications. This research was conducted based on a randomized sampling, where a total of 239 patients diagnosed with AA at the Hospital Regional de Orinoquia, Colombia was recruited for this study. Blood count, C–reactive protein (CRP), and neutrophil/lymphocyte ratio (NLR) records were analyzed, further their relationship with the surgical findings of AA described by Guzman–Valdivia was established. The study showed that, in the emergency department, these reactants are capable of making an approximate diagnosis and as biomarkers of the severity of AA, with CRP&gt;15mg/dL (diagnostic accuracy 76.15%), and the percentage of neutrophils&gt;85% (diagnostic accuracy 61.09%) being the best initial operative performance. For complications, such as intestinal perforation, CRP&gt;15mg/dL and neutrophil percentage&gt;85% were found statistically to be the biomarkers with the highest predictive performance, with OR 14.46, and OR 2.17, respectively, which is consistent with the findings described by Guzman–Valdivia. In conclusion, elevated level of CRP and neutrophil percentage&gt;85 is the acute phase reactants with the best diagnostic characteristics and predictors of possible complications of AA.

Análisis poblacional de donantes para subgrupos del antígeno "A" en la ciudad de Yopal, Casanare

Objective: The study seeks to analyze in a population, the subgroups of the “A” antigen in donors in Yopal-Casanare in 2020. Materials and methods: It is a cross-sectional descriptive study, information was gathered through the blood bank database of the Hospital Regional de la Orinoquía (HORO) in donors from January to December 2020, accessing to immunohematological records. Results: A total of 3341 donors’ records were obtained, 600 of them were initially classified as A, and from these, 465 were subclassified as A1 equivalent to 77.88% and 135 as A2, that is, 22.61%. Conclusion: It was possible to identify the importance of determining the subgroup of blood group A donors, since sensitization may occur in patients that trigger adverse events in the future.

Triagem positiva para transtorno depressivo maior em gestantes de alto risco

ABSTRACT Objective: To estimate the frequency of positive screening for major depressive disorder and associated factors in high-risk pregnant women at a reference hospital of the Brazilian Public Health System. Methods: Cross-sectional study with 184 high-risk pregnant women at the Maternity at the Hospital Regional de São José , SC, Brazil. Positive screening for major depressive disorder using the Edinburgh Postpartum Depression Scale was selected as the dependent variable. Socio-demographic and pregnancy-related variables were also collected. Data were analyzed using Poisson regression with a robust estimator, including all variables that presented a p-value &lt; 0.20 in the bivariate analysis. Statistically significant differences were considered when p ≤ 0.05. Results: The frequency of positive screening for major depressive disorder was 37.5%. Non-white skin color, income of less than USD 572,56 per month and maternal age of less than 18 years or greater than or equal to 35 years were statistically and independently associated with positive screening for major depressive disorder in high-risk pregnant women. Conclusion: The frequency of positive screening for major depressive disorder in the high-risk pregnant women studied was 37.5%. The frequency was statistically associated with skin color, family income and extremes in the maternal age.

Dual activation profile of monocytes is associated with protection in Mexican patients during SARS-CoV-2 disease.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been one of the most catastrophic diseases observed in recent years. It has reported nearly 550 million cases worldwide, with more than 6.35 million deaths. In Mexico, an increased incidence and mortality of this disease were observed, where the immune response has been involved in the magnitude and severity. A critical version of the disease is accompanied by hyperinflammatory responses, with cytokine and defective cellular responses. A detailed understanding of the role of molecules and cells in the immune response during COVID-19 disease may help to generate effective protection mechanisms, improving those we already have. Here we analyzed blood samples obtained from patients at the Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI), Mexico, which were classified according to living guidance for clinical management of COVID-19 by the World Health Organization: asymptomatic, mild, severe, and critical disease. We observed increased interleukin (IL)-6 levels and a T-CD8+ and T-CD4+ cell reduction correlated with the critical disease version. Importantly, here, we described a significant reduction of CD11b+CD45highCD14low monocytes during severe disease, which displayed a non-classical profile, expressing IL-10, transforming growth factor (TGF)-β, and indoleamine 2,3-dioxygenase (IDO)1 molecule. Moreover, CD11b+CD45highCD14low monocytes obtained from infected one-dose vaccinated patients (Pfizer® vaccine) who suffered minimal symptoms showed simultaneously a dual classical and no-classical profile expressing pro- and anti-inflammatory cytokines. These results suggest that blood monocytes expressing a dual pro- and anti-inflammatory profile might be a predictive marker for protection in the Mexican population during COVID-19 disease. KEY POINTS : • Exacerbated immune response is associated with COVID-19 severe disease. • Dual monocyte activation profile is crucial for predicting protection during COVID-19. • Vaccination is crucial to induce the dual activation profile in monocytes.

Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina

Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Relationship between lipid accumulation product and oxidative biomarkers by gender in adults from Yucatan, Mexico

Excessive adipose tissue can lead to metabolic abnormalities resulting in lipid alteration and oxidative stress (OS) status. The lipid accumulation product (LAP) index is a biomarker that indicates central lipid accumulation and has been proposed as an accurate and independent indicator of risk for several cardiometabolic related conditions. There is a lack of information about the possible association of LAP and OS biomarkers. Therefore, this work aimed to investigate the relationship between LAP and OS biomarkers in adults. A cross-sectional study was performed in 250 subjects attending the Hospital Regional de Alta Especialidad de la Península de Yucatán. Anthropometrical and clinical parameters were measured. The serum oxidative biomarkers such as malondialdehyde (MDA) and total antioxidant capacity (TAC) were evaluated by spectrophotometry and by the oxygen radical absorbance capacity (ORAC), respectively. A positive and significant correlation between serum levels of MDA and LAP (r = 0.162, p = 0.010) was observed. This relationship was stronger in women (r = 0.189, p = 0.013) than in men. The association between them remained significant after adjusting for confounders (r = 0.23, p < 0.001). A cutoff of LAP of 73.73 predicts high levels of MDA in women aged between 40 and 59. LAP index was associated with OS biomarkers in women and men from Yucatan, Mexico. Therefore, the elevation of the LAP index could identify an imbalance in the redox status.

Infección del tracto urinario en el servicio de Pediatría del Hospital Regional de Moquegua

Objective: To determine the clinical and epidemiological characteristics of urinary tract infections (UTIs) supported by the diagnosis, therapy and antimicrobial susceptibility of inpatients of the Pediatric Unit of the Hospital Regional de Moquegua from 2014 to 2020. Materials and methods: An observational, descriptive and retrospective study. The research included a population of 248 patients aged between 1 month and 14 years 11 months 30 days with a diagnosis of UTI who underwent a urine culture. A data collection sheet was used and the results were processed using the IBM SPSS Statistics statistical software 23.0. Results: The infection occurred more often in female patients (82.26 %), with fever being the most prevalent clinical manifestation (83.87 %). The most widely used medical treatment was amikacin (49.19 %). E. coli was the most frequently isolated germ (70.57 %). The isolated germs showed sensitivity to antibiotics such as nitrofurantoin (70.16 %), ceftazidime (51.20 %), gentamicin (43.14 %) and amikacin (28.62 %). In contrast, they were resistant to sulfamethoxazole–trimethoprim (74.59 %). One of the most common findings in the imaging tests was unilateral pyelectasis (43.14 %). Conclusions: UTIs occur more frequently in women. The anamnesis and clinical examination, together with a complete urinalysis and imaging tests, are essential for the diagnosis and treatment of these patients. The definitive diagnosis must be established by a urine culture. The choice of an empirical therapy will depend on the patient’s history of sensitivity and resistance to antibiotics based on the urine cultures performed.

Prognosis in Traumatic Brain Injury

Abstract Objective To characterize the profile of TBI victims who required neurosurgical approach in two reference hospitals in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil, and to identify the prognostic increase in the Pupil Reactivity Score when subtracted from the Glasgow Coma Score, found in the Glasgow-P. Additionally, to present demographic, etiological, clinical, and tomographic data, and associate them with the outcome of death. Methods Medical record data and computed tomography (CT) scans of patients with TBI undergoing neurosurgical procedures from January 2014 to April 2019, at 2 reference hospitals in the metropolitan area of Florianópolis, state of Santa Catarina, Brazil – Hospital Regional de São José Dr. Homero de Miranda Gomes (HRSJ-HMG, in the Portuguese acronym) and Hospital Governador Celso Ramos (HGCR, in the Portuguese acronym). Results The results of the 318 cases studied indicated that the male gender predominated (87.7%). The most affected age group was between 35 and 65 years old (47.5%). The main cause was motorcycle accidents (26.1%), followed by a fall from a height (16.4%). Most patients required admission to the intensive care unit (ICU) (85.8%), with an average duration of 13 days. The average total hospital stay was 28 days. Most cases needed external ventricular drain (EVD) (64.8%). The predominant tomographic classification was Marshall II (43.4%), followed by Marshall IV (26.1%). Most patients presented with extra-axial hematoma (64.2%), with subdural hematoma (SDH) being the most frequent (45%). Most patients presented with sequelae at hospital discharge (43.4%). Conclusion There was no clinically relevant increase between the Glasgow and Glasgow-P scores for the tested outcomes (need for decompressive craniectomy, midline shift, presence of basal cisterns obliteration, need for ICU admission, and death).

Visual prostate symptom score (VPSS). Is it an effective alternative for the assessment of lower urinary tract symptoms? Experience in a reference center in southeastern Mexico

The International Prostate Symptom Score (IPSS) assesses lower urinary tract symptoms (LUTS). In our Department, we receive Mayan-speaking patients with low educational levels, which makes it difficult for them to understand the questionnaire. The visual prostate symptom score (VPSS) overcomes these barriers.&#x0D; Objectives: To correlate the VPSS score with the IPSS one, in patients with LUTS who attend the Urology Department of the Hospital Regional de Alta Especialidad, to determine the prevalence of patients requiring assistance in answering both instruments. The correlation between the IPSS and VPSS and the Qmax of these patients will be evaluated.&#x0D; Material and methods: A comparative cross-sectional study was performed in men of 40 years of age or older with LUTS, between January 2019 to January 2020. Uroflowmetry was performed and the VPSS and IPSS were applied to them, identifying those who required help to answer the questions. Pearson or Spearman correlation tests were performed according to the distribution of the data, evaluated using the Kolmogorov-Smirnov test. Categorical variables were compared using X2 or Fischer's test.&#x0D; Results: Eighty-one men with LUTS were included. The mean age was 62.89+9.52. A significant correlation was found between total VPSS and total IPSS (r=0.708, p&lt;0.001). 83.8% (n=67) of patients were able to answer the IPSS, and 98.8% (n=79) were able to answer the VPSS. The percentage of patients who required help to solve the IPSS was 43.5% (n=34) and the VPSS was 25% (n=20). No significant correlations were found between VPSS and Qmax (r=-.123, p=0.277), and IPSS and Qmax (r=-0.085, p=0.456).&#x0D; Conclusions: The VPSS is a useful instrument in the assessment of LUTS, as it correlates with the IPSS. It also overcomes the barriers of language and educational level. However, it overestimates the severity of the symptoms referred by the patient. Then, studies are needed to improve this instrument.

Video simulation to learn pediatric resuscitation skills tailored to a low resource setting: A pilot program in Iquitos, Peru.

Introduction:The Hospital Regional de Loreto in Peru partners with the University of California Los Angeles Global Health Program to enhance educational experiences for US and Peruvian trainees. University of California Los Angeles Pediatric faculty led intermittent in-person code simulation sessions for Peruvian residents, and there is a need for regular education on this topic.Methods:University of California Los Angeles residents created a video simulation of a patient in respiratory distress. The video was presented to Hospital Regional de Loreto trainees in pediatrics. Stakeholder interviews and reuse of the video after initial presentation assessed acceptability of this mode of education by the site. Pre- and post-surveys using numerical rating scales evaluated the educational utility of this specific simulation video. Paired t-tests compared the pre- and post-surveys in the effectiveness of increasing the trainees’ comfort of specific resuscitation skills.Results:Stakeholder interviews revealed the video simulation was integrated into formal intern orientation trainings as well as used for resident and physician trainings multiple times in the year after the introduction. Twenty trainees completed the pre-intervention survey and 19 completed the post-intervention survey. Trainee comfort with code team leadership (2.6 ± 0.9, 3.5 ± 0.09, p = 0.03) and arrhythmia recognition/automated external defibrillator (AED) management (2.4 ± 0.9, 3.1 ± 0.9, p = 0.03) increased significantly with the video intervention. There was no significant difference in comfort with other skills. Overall, trainees rated the helpfulness of the video as an average of 4.2 (±1.1) out of 5. The most common positive feedback included the utility of reviewing medication dosing and the skill of performing chest compressions. The most common suggestions for improvement were to review more pathophysiology and simulate available resources at Hospital Regional de Loreto more realistically.Conclusion:E-learning is an acceptable mode of education in a resource-limited setting when tailored to the local context. This pilot project demonstrated short-term improvement in reported confidence and skills with some aspects of pediatric resuscitation.

EPIDEMIOLOGICAL PROFILE OF PROXIMAL FEMORAL FRACTURES IN OLDER ADULTS AT THE REGIONAL HOSPITAL IN COTIA - SP, BRAZIL.

ABSTRACTObjective: To identify the epidemiological profile of older patients with proximal femoral fractures treated at the Hospital Regional de Cotia, SP - Brazil, and describe the nutritional status of these patients.Methods: Data were obtained from the electronic patient medical records from August 2020 to April 2021. The variables studied were age, gender, ethnicity, weight and height (for BMI calculation), and presence of comorbidities. Fracture circumstances were also assessed, including trauma mechanism, anatomical location, and treatment. Moreover, the nutritional profile of patients was assessed using the Mini Nutritional Assessment (MAN).Results: Most patients were white women, with a mean age of 80 years and an average BMI of 23.55 kg/m2. Almost all patients suffered the fracture at home and the most common comorbidities were systemic arterial hypertension, diabetes mellitus, and Alzheimer’s disease. Most patients were considered to be malnourished or at risk of malnutrition.Conclusion: The nutritional status of older adults seems to be directly related to the risk of proximal fractures of the femur. Level of Evidence II, Retrospective Study.